#StepUpForBreastfeeding: We are the Building Blocks #WBW2022

It takes a village to raise a child – we all have a role to play to support breastfeeding mothers and babies.

We all are the building blocks responsible for supporting new families: partners and family members, health workers, neighbours and community members, religious leaders, employers, academics, governments and policy makers. We can all make a difference. We need to step up to our responsibilities. Everyone needs to understand the importance of breastfeeding – for maternal and infant physical and mental health and wellbeing, for public health, for our economy, and for our planet.

For WBW this year, WABA has produced an extensive suite of materials looking at all these roles and responsibilities. They have outlined the challenges that breastfeeding families face at every stage from conception, through birth, getting breastfeeding off to a good start, and maintaining breastfeeding all the way through starting solids and going back to work, and the solutions we need in each situation – all backed up by links to the latest evidence.

The #WBW2022 Action Folder pulls all this together: it is a useful resource for anyone using evidence to build policies and best practice. You can download it as a PDF and all the links to research and references will be live.

The UK WBTi team will be highlighting just a few of the concepts this week:

Health workers: the importance of relevant, evidence-based. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding. training for all those who work with women, infants and young children

UNICEF UK Baby Friendly Initiative and the BFHI worldwide sets out ways in which healthcare staff can receive sound, evidence-based, basic training in supporting breastfeeding.

ALSO join a special webinar from the Global Breastfeeding Collective on BFHI, with some added specialist topics on supporting small and underweight breastfeeding infants, and on infant feeding in emergencies. (7-9 AM BST and again at 4-6 PM BST). Register HERE

Community support: Access to skilled, integrated support for all, with a special focus in the GBC webinar on how to support breastfeeding infants who are not gaining well (NICE NG 75,2017). All parents should have easy access to trained healthcare staff- midwives, paediatricians, health visitors and GPs- breastfeeding peer supporters and specialist support (IBCLC, BFCs). Supporting breastfeeding in complex circumstances: Specialist support from IBCLCS, BFCs, or infant feeding leads, integrated with specialist healthcare teams

Protecting infants and young children in emergencies. National policies should guide Local Resilience Forums but these do not exist at present.

The impact of misleading marketing: The International Code. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding.

Governments with national and local policy makers need to protect all families and support them to make informed feeding decisions free of commercial influence.

What can YOU do?

It is time for a reassessment of the UK’s national infant feeding policies and programmes. YOU could help! Volunteers are welcome with knowledge in any of the ten policy areas (Indicators 1-10), or with skills such as research, writing, graphics, social media and more – feel free to contact us for a chat!

WBTi Key Indicators:

Indicator 1: National policy, programme and coordination
Indicator 2: Baby Friendly Initiative
Indicator 3: International Code of Marketing of Breastmilk Substitutes

Indicator 4: Maternity protection
Indicator 5: Health professional training
Indicator 6: Community-based support
Indicator 7: Information support
Indicator 8: Infant feeding and HIV

Indicator 9: Infant and young child feeding during emergencies

Indicator 10: Monitoring and evaluation

Which one will YOU choose?

Contact us: wbti@ukbreastfeeding.org

Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.

Shocking gaps in emergency preparedness for Europe’s babies

The Covid-19 pandemic has shown how important it is for countries to protect their citizens from illness.

Yet a new WBTi regional report shows gaps in support for families across Europe, with the poorest overall scores in national leadership and, shockingly, emergency preparedness, where the UK scored 0/10. This pandemic is an emergency for infants and young children and only North Macedonia was found to have an adequate strategy.

Babies who are breastfed have better health and resistance to infection, and most mothers want to breastfeed. Yet many European mothers stop or reduce breastfeeding in the early weeks and months, and bottle feeding is prevalent, due to inadequate support from health systems and society.

Launched today, the first European report on infant and young child feeding policies and practices, Are our babies off to a healthy start?, compares 18 countries and identifies the considerable improvements they need to make in supporting mothers who want to breastfeed. A summary report has been published today in the International Breastfeeding Journal .

The full report can be downloaded from the World Breastfeeding Trends Initiative global website.

The new report, Are our babies off to a healthy start?, compares the implementation of WHO’s Global Strategy for Infant and Young Child Feeding across 18 European countries. The comparisons show clearly that inadequate support and protection for breastfeeding mothers is a Europe-wide problem. The health of babies, mothers and whole populations lose out as a result. However, countries do differ considerably. Turkey rates highest overall; the five countries with the lowest scores belong to the European Union.

‘Nutrition is key to achieving the Sustainable Development Goals related to health, education, sustainable development, reduction of inequalities and more.’
Joao Breda, Head, WHO European Office for Prevention and Control of Noncommunicable Diseases

The scope of the assessment is wide-ranging, with ten policy and programme indicators, including national leadership, Baby Friendly hospital and community practices, marketing controls on breastmilk substitutes, health professional training, emergency preparedness and monitoring. There are also five feeding practices indicators, such as exclusive breastfeeding for 6 months, a WHO recommendation.

The original assessments were all carried out using the World Breastfeeding Trends Initiative (WBTi), a tool first developed in 2004 by the International Baby Food Action Network (IBFAN) but only launched in Europe in 2015. It requires collaboration with relevant organisations within a country on assessment scores, gaps identified and recommendations for improvements. The Report highlights good practice, enabling countries to learn from one another.

˝Success …rests first and foremost on achieving political commitment at the highest level and assembling the indispensable human and financial resources.’
WHO Global Strategy 2003

If governments, other policymakers, hospitals and community services, public health departments, institutions that train health professionals, and others, adopt the report recommendations, it will enable more mothers to initiate and continue breastfeeding, strengthening the health of the population for the future.

The WBTi European Working Group, led by Dr. Irena Zakarija-Grkovic of Croatia, produced the Report and comprises coordinators from European countries which have carried out a WBTi assessment. The production of the report was supported by the Croatian Ministry of Health and UNICEF Croatia.

UK media contact: wbti@ukbreastfeeding.org

We want the new government to invest in the health of women and children by supporting and protecting breastfeeding.

The WBTi UK team are proud to be part of producing this joint statement calling for our next government to make breastfeeding a priority in setting the agenda to prioritise the early years of life.

Download the PDF HERE

The new government needs to prioritise the first 1001 days of a child’s life, from conception to age two, to enable children to survive and thrive. How an infant is fed and nurtured strongly influences a child’s future life chances and emotional health. Importantly, if a woman breastfeeds there are substantial health benefits for her – having impacts onher future long after breastfeeding has stopped.

Independent, practical, evidence-based information and support is essential for every family. Supporting women with breastfeeding can go a long way to protecting children and mothers from a wide range of preventable ill health, including obesity and mental health problems.

This window of opportunity cannot be missed for the future health outcomes of mothers and the next generation. In addition to well documented health outcomes, supporting breastfeeding will also contribute to a stronger economy – potential annual savings to the NHS are estimated at about £40 million per year from just a moderate increase in breastfeeding rates.

Support for breastfeeding is also an environmental imperative and recognition of the contribution breastfeeding can make to avoiding environmental degradation should be a matter of increasing global and political attention.

In the UK, the majority of women start to breastfeed but breastfeeding rates drop rapidly – our continuation rates are some of the lowest in the world and are even lower amongst women living in deprived areas, where increasing rates could make a real difference to health inequalities. Support for all women, parents and families with breastfeeding falls short of what is wanted and needed.

Women tell us they encounter difficulties with the public perceptions of breastfeeding out of the home. Families tell us they are still regularly exposed to conflicting messaging and marketing for formula milks that drowns out advice from healthcare professionals.

Women tell us they receive little to no help with infant feeding and that their health visitors, midwives and doctors often have little training or knowledge about breastfeeding and limited time to support them.

Recent cuts in health visitor numbers and breastfeeding peer support services mean many women may be left without the support they need however they choose to feed their infants.

Despite robust evidence showing that investment in breastfeeding support and protection makes sense, politically breastfeeding has been viewed by governments as a lifestyle choice and so left to parents to work out for themselves. For too many women, trying to breastfeed without support, or stopping before they want to, is deeply upsetting and the situation is made worse by fragmented care, and poor and often conflicting advice from those they are seeking to support them. To ensure an increase in breastfeeding rates, to help reverse obesity rates and to reduce widening health inequalities will require significant investment in breastfeeding.

It is essential that our new government prioritises breastfeeding and invests in its support and protection.

We call on all political parties to commit to the following actions, if elected:

To appoint a permanent, multi-sectoral infant and young child feeding strategy group and develop, fund and implement a national strategy to improve infant and young child feeding practices.
To include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
To implement the Unicef UK Baby Friendly Initiative across community and paediatric services, building on the recommendation for maternity services in the NHS Long Term Plan.
To protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
To commission, and sustainably fund, universal breastfeeding support programmes delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists, such as IBCLC lactation consultants and breastfeeding counsellors, alongside trained peer supporters with accredited qualifications.
To maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline and sustaining the Drugs in Breastmilk Service.
To deliver universal health visiting services and the Healthy Child Programme by linking in with local specialist and support services.
To establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.
To make it a statutory right of working mothers and those in education to work flexibly as required and to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
To commit to resourcing for charitable organisations who play a key role within the health agenda working at a national and local level to support families and communities with infant feeding.
To support the commitment to undertake an Infant Feeding Survey which builds on the data previously collected in the Infant Feeding Survey 2010 (now discontinued).
To implement the recommendations of the Becoming Breastfeeding Friendly (BBF) study.

CASE FOR ACTION

Breastfeeding benefits all babies, and studies have shown that just a small increase in breastfeeding rates could cut NHS expenditure considerably. It is vital to invest in breastfeeding support in the early months and this will reap rewards in the future that are likely to exceed the initial cash flows associated with putting proper support in place.
A UNICEF reportstates that “no other health behaviour has such a broad-spectrum and long-lasting impact on public health. The good foundations and strong emotional bonds provided in the early postnatal period and through breastfeeding can affect a child’s subsequent life chances”.
Evidence has also demonstrated that a child from a low-income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula-fed. Breastfeeding provides one solution to the long-standing problem of health inequality.
Research into the extent of the burden of disease associated with low breastfeeding rates is hampered by data collection methods. This can be addressed by investment in good quality research.

References

1. Laurence M. Grummer‐Strawn Nigel Rollins, (2015), Impact of Breastfeeding on Maternal and Child Health. https://onlinelibrary.wiley.com/toc/16512227/2015/104/S467

2. Borra C, Iacovou M, Sevilla A (2015) Maternal Child Health Journal (4): 897-907. New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions.

3. Brown, A, Rance J, Bennett, P (2015) Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing 72 (2): 273-282

4. https://www.brunel.ac.uk/research/News-and-events/news/Breastfeeding-for-longer-could-save-the-NHS-40-million-a-year

5. Li R, Fein SB, Chen J, Grummer-Strawn LM, (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 122: S60-S76

6. Support for breastfeeding is an environmental imperative. (2019) BMJ 2019;367:l5646 https://www.bmj.com/content/367/bmj.l5646

7. McAndrew F et al (2012) Infant Feeding Survey 2010

8. NHS (2019) NHS Long term Plan https://www.longtermplan.nhs.uk/

9. National Institute for Health and Care Excellence (2013) Postnatal Guideline NICE, London https://www.nice.org.uk/guidance/cg37

10. National Institute for Health and Care Excellence (2012) Improved access to peer support NICE, London

11. Rollins N, Bhandari N, Hajeebhoy N, et al (2016) Why invest, and what it will take to improve breastfeeding practices? The Lancet 387 491-504

12. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. 1998 Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. Jan 3;316(7124):21-5.

13. Brown, A, Finch, G, Trickey, H, Hopkins, R (2019) ‘A Lifeline when no one else wants to give you an answer’ – An Evaluation of the BFN’s drugs in breastmilk service. https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf

#WBW2019: Empower parents, enable breastfeeding

The theme for World Breastfeeding Week this year is “Empower parents, enable breastfeeding,” which fits the philosophy of our WBTi work very well. The WBTi recommendations have been produced by a Core Group of 18 of the UK’s key government agencies, health professional organisations and charities working in infant and maternal health. The 46 recommendations, across ten areas of policy and programmes, parallel many of the recommendations of previous national breastfeeding initiatives such as the UNICEF Baby Friendly Call to Action, the Becoming Breastfeeding Friendly project (completed in Wales and Scotland so far), and the Breastfeeding Manifesto.

The WBTi assessment and recommendations for action are all about providing the structures, policies and programmes that families need in order to support mothers and infants to be able to breastfeed successfully. It is not a woman’s responsibility on her own, it is the responsibility of ALL of us, across society, to provide the support that mothers and babies need.

This has been echoed by the UN Human Rights experts, who have stated that breastfeeding is a human right of the breastfeeding dyad, and that states/ society is responsible for providing the structural support they need. Likewise this is the key message of the Lancet 2016 Series on Breastfeeding.

Gaps and barriers

Our UK report found many gaps and barriers in ten areas of policy and programmes across the UK:

Lack of national leadership and national strategy on infant feeding, except in Scotland.
Areas where maternity settings still do not meet the minimum UNICEF Baby Friendly standards, in particular in England.
Weak regulations governing marketing by baby milk companies, no regulations governing bottle and teat marketing, and little enforcement of existing provisions.
Lack of provisions to support new mothers to continue breastfeeding when they return to work.
Gaps in health care professional training in infant and young child feeding (See both Part 1 and Part 2 of the WBTi report for full details)
Cuts to peer support and other community breastfeeding support.
No national communications strategy on breastfeeding.
Lack of understanding of current guidance on breastfeeding for HIV+ mothers.
No national guidance on planning for the care of infants and young children in emergencies or disasters.
Poor data collection and monitoring of breastfeeding rates.

Highlights of progress

There are several bright spots, however, and in the two years since the WBTi report and recommendations were published, there have been improvements in several areas

National policy work: Scotland already had strong national policy leadership. Scotland, Wales and England have taken part in the Becoming Breastfeeding Friendly project on scaling up breastfeeding interventions, with a government commitment to act on recommendations.
With the latest NHS England Long Term Plan, all of the UK has now pledged to reach full UNICEF Baby Friendly accreditation in all maternity settings.
Increased awareness of International Code issues in the UK include a relaunch of the UK Baby Feeding Law Group, a coalition of UK organisations working in infant and maternal health, to advocate for implementation of the International Code in UK law.
The Alliance for Maternity Rights has included the protection of flexible breastfeeding/ expressing breaks and suitable facilities in their Action Plan.
Several health professional councils have begun to review their training standards on infant feeding, and a working group led be UNICEF Baby Friendly has launched a new set of learning outcomes for the training of medical students, paediatric nurses, dietitians, pharmacists and maternity support workers/ nursery nurses.
Continued cuts to local authority and public health budgets has continued to severely impact community breastfeeding support such as trained peer support. The WBTi team organised a conference on the public health impact of breastfeeding with the Institute for Health Visiting, exploring in particular the UNICEF Baby Friendly community requirements for “basic” health professional BFI training, “additional” local trained support such as peer support groups, and a “specialist” referral pathway at IBCLC level. The BFI, NICE and Public Health England guidance are clearly explained in the “Guide to the Guidance” by Better Breastfeeding. However there is potential for strengthening the commissioning of integrated breastfeeding services, through the increased profile of breastfeeding in England in the NHS Long Term Plan, breastfeeding representation now being included in the NHS England National Maternity Transformation Programme Stakeholder Group, and in Scotland and Wales with renewed national leadership and funding.
Although no national communication strategies on breastfeeding have been developed, the national governments and public health agencies have developed breastfeeding campaigns and have supported national breastfeeding weeks again across all four nations.
New guidance on infant feeding for HIV+ mothers from the British HIV Association has included detailed guidance on how to support mothers who wish to breastfeed (see also our guest blog from Pamela Morrison IBCLC explaining the new guidance here)
Infant feeding in emergencies is still not covered by national guidance or universally in local disaster resilience planning, however a national forum hosted by Alison Thewliss MP, and led by the UK WBTI team and Dr Ruth Stirton from the University of Sussex Law School has kick-started the discussion to improve awareness and standards.
Monitoring of breastfeeding rates remains uneven across the UK; Scotland has continued to conduct robust infant feeding surveys, while, in England, the PHE data on breastfeeding rates still have gaps in reporting. The UK government has now proposed to reinstate the national infant feeding survey in a new consultation on prevention. See also our blog by Patricia Wise on gaps and changes in our data (including how YOU can access the fingertips data), and guest blog by Phyll Buchanan MSc on how we can use the infant feeding data to reveal insights into health inequalities.

So we are in interesting times – we still face budgetary and cultural challenges, and families still face many barriers.

However change is clearly happening!

Coming up on the WBTi blog for #WBW2019

For World Breastfeeding Week, we are hosting a number of guest blogs detailing some exciting innovations:
The launch of the Hospital Infant Feeding Network, with a website and a collection of posters and resources for health professionals working with mothers, infants and young children in hospital.

A new set of educational resources on breastfeeding and medications for pharmacists, from the wonderful Wendy Jones.

And a blog looking at some of the public health issues around breastfeeding support in the community, from Alice Allan IBCLC MPH.

Helen Gray IBCLC is Joint Coordinator of the WBTi UK team, with a special interest in supporting families in emergencies.

WBTi’s Twelve Days of Christmas: part 2

See Part 1 of WBTis’ Twelve Days of Christmas, covering our Indicators 1-6, here

Day 7 – seven swans a-swimming

Swans evoke an image of serenity, even if they’re paddling hard under the water. Support to make breastfeeding more effective can help mothers be calmer and more serene, even though they’re working hard caring for their child or children.

Indicator 7 is about information. There is plenty available, particularly on the internet, but mothers often need help selecting reliable websites. Resources developed since the WBTi report include a new book by Amy Brown (The Positive Breastfeeding Book), a chatbot available on Facebook and and as an Alexa app from PHE, and more breastfeeding information on the Baby Buddy app.

Indicator 7 also asks whether there is a national communications strategy on infant feeding – while there are strategies in place in Scotland, Northern Ireland and Wales, there is still no communications strategy on infant feeding in England.

In the song, the seven swans represent the seven sacraments, which are Christian rites. There are perhaps seven occasions for a mother when she is in particular need of accurate information about feeding her baby – antenatally, at birth, early days, the challenges when her baby is a few months old, introducing complementary foods, returning to work and stopping breastfeeding.

Day 8 – eight maids a-milking

The maids symbolise beatitudes (blessings) for people considered as unfortunate. Indicator 8 addresses support for HIV+ mothers. There needs to be both appropriate policy and familiarity with the policy by people working with HIV+mothers. In 2016 WHO published revised guidelines recommending that in countries where health services ‘provide and support lifelong anti-retroviral therapy (ART), including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.’ In the UK, BHIVA published revised guidelines in 2018. As in its previous guidelines, these still recommend formula feeding for women living with HIV but also explicitly support women who choose to breastfeed, provided they fulfil certain criteria. The new guidelines are more detailed than the previous ones; they encourage openness and respect the importance of breastfeeding for a mother’s own mental health.

If there were more donor milk available, mothers who don’t meet the clinical criteria for breastfeeding outlined by BHIVA could use it and enable their babies to have breastmilk. Then ‘Maids a-milking’ can be thought of as ‘donor mothers expressing’.

Day 9 – nine ladies dancing

Ladies dancing is how the song represents ‘fruit of the Holy Spirit‘ – beneficial attributes of a person or community, such as love, patience, kindness and self-control.

Indicator 9 assesses the extent to which policies and programmes are in place to ensure that infants and young children will be fed appropriately during emergencies. Those acting on behalf of the community in emergencies need to plan ahead to provide care that is beneficial and supports optimal infant feeding.

The WBTi report found that infants and young children had largely been overlooked in emergency planning in the UK. The WBTi team and Ruth Stirton from the University of Sussex Law School organised a well-attended forum at the Houses of Parliament in November 2017 to start raising awareness of the issue, with LCGB holding a study event the following week, and a policy briefing is due to be published in 2019.

WBTi UK joint coordinator Helen Gray has also presented on the issue at several conferences in the UK and internationally, and contributed a chapter on infant feeding in emergencies for parents in Amy Brown’s The Positive Breastfeeding Book.

Day 10 – ten lords a-leaping

In the song these refer to the Ten Commandments, which are principles for living. Surely that involves monitoring and evaluating actions to ensure they fit with intentions. And Indicator 10 is about collecting data to monitor and evaluate the systems. Scotland carried out its own Maternal and Infant Nutrition Survey in 2017. England currently still just collects data on initiation of breastfeeding and prevalence at 6-8 weeks postpartum, and there is missing data.

The WBTI UK recommendations include extending data collection to include breastfeeding rates at 6 months and one year, by incorporating questions in the existing health visitor contacts.

Day 11 – eleven pipers piping

The pipers symbolise the eleven faithful apostles. There are many people willing to advocate better support for mothers who want to breastfeed, but far more than eleven!

Indicator 11 asks what percentage of babies are breastfed within the first hour following birth. At the time of the report it was 60%. The key action immediately after birth is unhurried, uninterrupted skin-to-skin contact. During skin-to-skin contact in that first ‘magical’ hour the baby shows nine instinctive, distinct and observable stages, which with the mother-baby dyad makes eleven elements. Interrupting skin-to-skin even briefly for routine care disrupts this essential sequence and can impact the baby’s success at reaching the stage of latching on and suckling the first time.

In 2017 Kajsa Brimdyr and colleagues published a paper about the implementation algorithm they have developed for improving skin-to-skin practice immediately after birth; this was also presented at Unicef Baby Friendly UK’s 2018 conference.

Presentation: https://edu.ilactation.com/seminars/47

Will the algorithm be used in UK maternity units?

Day 12 – twelve drummers drumming

The drummers symbolise the Apostles’ creed, which was an early statement of Christian belief.

Indicator 12 is a measure of the amount of exclusive breastfeeding that happens in a country among babies up to 6 months old. The report had to use 2010 data as these were the most recent; the data gave 17%, meaning the total amount of breastfeeding was the same as if 17% of babies were exclusively breastfed to 6 months and the other 83% totally formula-fed.

There is enough evidence for the better outcomes if infants are exclusively breastfed to 6 months for WHO to recommend it since 2003, yet there seems a lot of doubt in UK society about the value of doing so. Somehow the evidence hasn’t become belief for many people.

WBTi Indicators 1-6 are covered in part 1

Sign up for our mailing list HERE

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Prevention intention

A Vision for Prevention

Matt Hancock, UK Secretary of State for Health and Social Care since July 2018, launched his prevention vision on 5 November.

His other priorities are to advance health technology and provide better support for the health and social care workforce. He sees prevention as having two aspects. Partly it is about keeping well physically and mentally, to prevent ill health, but also about the environment around people, their lifestyle choices and how existing health conditions are managed. The aims are for the average person to have 5 more years of healthy independent living by 2035, and to reduce the gap between the richest and poorest. At present there is a large discrepancy in spending with £97 billion (public money) spent on treating disease and £8 billion on prevention across the UK!

The proposed actions in the vision are:

“Prioritising investment in primary and community healthcare
Making sure every child has the best start in life (our emphasis)
Supporting local councils to take the lead in improving health locally through innovation, communication and community outreach
Coordinating transport, housing, education, the workplace and the environment – in the grand enterprise to improve our nation’s health
Involving employers, businesses, charities, the voluntary sector and local groups in creating safe, connected and healthy neighbourhoods and workplaces”

The Department of Health and Social Care’s (DHSC) paper is called ‘Prevention is better than cure: Our vision to help you live well for longer‘.

It states there is strong evidence that prevention works and recognises that a healthy population is both vital for a strong economy and for reducing pressure on services like the NHS (almost 10% of the national income is spent on healthcare). Average life expectancy is now 81 years, helped by:

advances in healthcare
changing attitudes so there is less stigma with some conditions
improvements in the environment, at home, work and in neighbourhoods
antibiotics and mass vaccination
public health programmes.

However, there are major challenges in the huge discrepancies between areas – ‘A boy born today in the most deprived area of England can expect to live about 19 fewer years in good health and die nine years earlier than a boy born into the least deprived area.’ (p.7)

Duncan Selbie, Chief Executive of Public Health England, welcomed the change of focus to more emphasis on prevention and pointed out the need for collaborative working – NHS, national government, local government, voluntary and community sector, and industry. It will be important to monitor industry involvement to ensure that it does not create conflicts of interest, undermining health. Infants, young children, pregnant and breastfeeding mothers are particularly vulnerable, which is why the World Health Organisation developed guidance to protect them from conflicts of interest (WHO 2016 Guidance on the Inappropriate Promotion of Foods for Infants and Young Children) and other inappropriate commercial influence (International Code of Marketing of Breastmilk Substitutes, 1981, and subsequent WHA resolutions).

Improvements will depend both on encouraging individuals to choose healthy lifestyles and manage their own health, and expecting local authorities to take the lead in improving the health of their communities. The challenges of smoking, mental ill health, obesity, high blood pressure and alcolol-related harm are mentioned, along with the benefit of having a more personalised approach to health.

The section on ‘Giving our children the best start in life’ (p.20) mentions healthier pregnancies, improved language acquisition, reducing parental conflict, improving dental health, protecting mental health and schools involvement, but infant feeding is not mentioned at all!

However, in the Parliamentary debate on the vision (Prevention of Ill Health: Government Vision) on 5 November, Alison Thewliss MP made the case for supporting breastfeeding by investing in the Baby Friendly Initiative to bring all maternity and community services up to the minimum standard. Matthew Hancock’s reply sounds positive: ‘The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.’

‘Prevention, Protection and Promotion’ at Public Health England

Earlier in the year (March 2018), Professor Viv Bennett, the Chief Public Health Nurse, and Professor Jane Cummings, the Chief Nursing Officer, came together to launch a campaign on the ‘3Ps – Prevention, Protection and Promotion’, which is about actions to improve public health and reduce health inequalities. Breastfeeding is mentioned in the Maternity Transformation Campaign and Better Births and there appears to be increased govenment commitment to the key role breastfeeding plays in improving public health.

Directors of Public Health have a key role

The DHSC paper expects Directors of Public Health to ‘play an important leadership role’ (p.15). As an example, the Annual Report of Croydon’s Director of Public Health, published in mid-November, We are Croydon: Early Experiences Last a Lifetime, focusses this year on the first 1000 days of a child’s life.

It includes three breastfeeding recommendations:

Reset targets for increasing breastfeeding rates at 6 to 8 weeks and 6 months across the Borough and within particular localities
Achieve level 3 of the UNICEF Baby Friendly award
Turn Croydon into a breastfeeding friendly Borough, so women feel comfortable breastfeeding when they are out and about

How can progress on prevention occur unless it starts at the beginning – with infants? Will other Directors come up with similar recommendations?

Make London a ‘Baby-Friendly’ city

The Mayor of London, Sadiq Khan, aims to “make London a ‘Baby-Friendly’ city” in the London Food Strategy. This strategy aims to increase the health of all Londoners from infancy onwards, including supporting and normalising breastfeeding across London Transport and across government buildings and workplaces, and encouraging all London boroughs to become Unicef UK Baby Friendly-accredited in maternity and community services.

The UK government is due to publish a Green Paper on Prevention in 2019 to set out more detailed plans and, together with the NHS Long Term Plan, which is due to be published soon, is relevant to a future with better health for all.

What can YOU do?
Sign up for our mailing list and to volunteer in our campaigns here!

30. Photo for WBTi MAINN presentation — Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life

The First 1000 Days of Life (from conception to the age of two years) are a critical window in a baby’s development. The 1000 Days concept was first widely used by the World Health Organisation and UNICEF, and there are currently numerous campaigns building on that theme.*

There is currently an inquiry into the First 1000 Days by the UK Parliamentary Select Committee on Health and Social Care. This blog brings together a few of the key concepts and resources on the importance of breastfeeding during the First 1000 days.

A joint supplement on the importance of breastfeeding in the first 1001 Days was produced by the UK breastfeeding organisations in 2015, which summarises much of the evidence.

A focused briefing on the the role of breastfeeding on infant brain growth and emotional development can be found here.

Breastfeeding: cornerstone of the First 1000 Days

Human babies are born extremely immature compared to other mammals; they are completely dependent on their mothers for milk, comfort and warmth.

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~ Grantly Dick-Read

Scientific research has continued to underscore the vital role that breastfeeding and breastmilk play in the development of the human infant. See our WBTi blog series for this year’s World Breastfeeding Week, from 31st July – 7th August 2018 for a review of the myriad ways that breastfeeding influences human development.

Breastfeeding: more than just food

This is the title of a series of blogs by Dr Jenny Thomas which focuses on some of the ways that breastfeeding contributes to immune development and more. Beyond physical health and development, however, breastfeeding also plays a key role in the healthy mental and emotional development of the infant. Breastfeeding provides optimal nutrition for the first months and years of life, alongside suitable complementary food after six months, but it also supports the development of the child’s immune system and protects against a number of non-communicable diseases in later life as well.

The World Health Organization commissioned high level reviews on a range of health and cognitive outcomes which were published in a special issue of Acta Paediatrica in 2015; these formed the foundation of the Lancet Series on Breastfeeding which was published in 2016.

The impact of breastfeeding on maternal and infant mental health and wellbeing.

Breastfeeding can help strengthen mother and baby’s resilience against adversity, and can protect infants even when their mothers suffer from postnatal depression. It supports optimal brain growth and cognitive development. Unfortunately, if mothers don’t receive the support they need with breastfeeding, this can significantly increase their risk of postnatal depression. A summary of evidence can be found here.

The role of breastfeeding in protecting maternal and infant mental health is often poorly understood – mothers who are struggling need skilled support to resolve breastfeeding problems if they wish to continue breastfeeding

What does the future hold?

It is essential that policy makers, commissioners, and researchers understand the evidence and importance of breastfeeding, so that women who want to breastfeed get any support they need. The WBTI report outlines major policies and programmes that national infant feeding strategies need to include; other research on the psychological and cultural influences on mothers’ infant feeding decisions will help policy makers to develop sensitive and sound policies and programmes to support all families.

In the end, it will be essential that families themselves are heard, in order to create the support systems that our society needs.

*Unfortunately a number of infant milk and baby food companies have jumped on the “1000 Days” bandwagon too, despite the fact that breastfeeding is the centrepiece of the original 1000 Days concept, and replacing breastmilk with formula or baby food actually removes that fundamental building block from a baby’s development.

Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She is a founding member of National Maternity Voices. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

#KingsBrelfie for World Breastfeeding Week 1– 7August

World Breastfeeding Week (WBW) (#WBW2017) takes place from 1 – 7 August 2017. It is an initiative led by The World Alliance for Breastfeeding Action (WABA), supported by UNICEF, the World Health Organisation (WHO), and many breastfeeding organisations worldwide. It is now in its 25^th year and it is all about working together for the common good.

In 2016 WABA started the journey to achieving the United Nations’ Sustainable Development Goals (SDGs) by demonstrating the importance of breastfeeding to each SDG. However, these goals cannot be achieved without strong partnerships at all levels. The theme of SDG 17 is “Partnerships for the Goals”, which highlights the vital importance of partnerships between all organisations working towards a sustainable future. This partnership theme echoes WBTi’s own emphasis on the importance of building partnerships and collaboration. #WBW2017 calls on all those involved to forge new and purposeful partnerships. The objectives for this year’s campaign are Inform, Anchor, Engage and Galvanise.

By Laura Godfrey-Isaacs

Picking up on this year’s campaign themes, a group of midwives at King’s College Hospital in London, including the Director of Midwifery, specialist midwives in Infant Feeding and myself, have come together to devise a campaign to support and celebrate breastfeeding at the Trust, and beyond.

The “Brelfie”

Our ideas are based around the social media phenomenon of the ‘brelfie’ – a breastfeeding selfie. Celebrities and women of all backgrounds have posted these, often in defiant response to breastfeeding shaming in public. Many have gone viral, and last year WHO declared that the brelfie was a significant tool in normalising and empowering women to breastfeed. This is something that would be highly desirable to see in the UK where we have some of the worst breastfeeding rates in the world, and little acceptance of it in public. This was highlighted recently in a disastrous advertising campaign by the skincare brand Dove (owned by Unilever) which featured posters that appeared to endorse negative public attitudes towards breastfeeding, stating “75% say breastfeeding in public is fine, 25% say put them away, what’s your way?” which received much push back on social media.

Embarrassment about breastfeeding in public

In addition the TV presenter Jeremy Clarkson outrageously equated breastfeeding in public to urinating, suggesting women should go ‘to a little room to do it’, presumably the toilet, and Claridge’s Hotel famously asked a woman to cover up while breastfeeding in their restaurant. Breastfeeding women have to endure these and many other ‘everyday’ incidences that include negative comments and looks, despite breastfeeding in public being protected in law by the Equalities Act since 2010, and our culture being saturated by women’s breasts being used to sell newspapers, promote music and advertise countless products – an environment, that, as performance poet and birth advocate Hollie McNish puts so well, in her award-winning poem ‘Embarrassed’ is ‘covered in tits’.

What I have also experienced first-hand, as a midwife, is many women telling me they feel nervous about breastfeeding in public, which highlights the lack of cultural support and acceptance that inevitably has a negative impact on women’s ability to sustain the practice, with all the constituent results for both her, the baby and society. More and more evidence points to the importance of breastfeeding on a cultural, public health, psychosocial, ecological and economic level, and the need to support, protect and promote it in all aspects of healthcare and society, as well as asserting breastfeeding as a human right for both babies and women.

The WBTi report identified many barriers along a mother’s breastfeeding journey. Among these there is a disconnect between exhortations to mothers to breastfeed and a prevailing negative attitude towards breastfeeding in public. This can lead to women feeling they are to blame for ‘failing’ to breastfeed, and over 80% give up before they want to. Cultural factors need to be addressed, which is where the power of the brelfie and social media campaigns can – and do – have a really positive effect in shifting attitudes and encouraging activism on the issue.

#KingsBrelfie campaign for #WBW2017

The #KingsBrelfie campaign links to Indicator 6 of the World Breastfeeding Trends Initiative Report, which calls for community mother support for breastfeeding, as it will open up discussions with women about their own, and society’s attitudes to breastfeeding. It will help us encourage, support and signpost them to online and healthcare provided sources of information and facilitation, such as our King’s Milk Spot centres in the community. Our campaign will use images of King’s midwives breastfeeding, which also points to our commitment as a community of women together – midwives and women – and hopefully steer away from some of the negative feelings around midwives’ use of ‘advocacy rhetoric’ which women can unfortunately sometimes experience as pressure and judgment. As highlighted in WBTi’s Indicator 7 (communication and information) which calls for a national communications strategy around infant feeding, and for promotional activities including World Breastfeeding Week, we are directly exploring new ways to use communication strategies, that are women-led, to address the cultural barriers to breastfeeding in the UK, through an inclusive social media campaign.

The #KingsBrelfiecampaign is an invitation to all women to post a brelfie on social media during World Breastfeeding Week using the hashtag to help change attitudes, support mothers and assert the right to breastfeed wherever, and whenever women want or need to.

So let’s create a social media storm and celebrate women and breastfeeding together!

LauraGodfrey-Isaacs2017

Laura Godfrey-Isaacs

King’s midwife and birth activist

@godfrey_isaacs

Breastfeeding trends (UK)

Working together to improve breastfeeding in the UK

Category: Indicator 7: Communication

#StepUpForBreastfeeding: We are the Building Blocks #WBW2022

Shocking gaps in emergency preparedness for Europe’s babies

We want the new government to invest in the health of women and children by supporting and protecting breastfeeding.