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.

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

  1. 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.
  2. UNICEF report states 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”. 
  3. 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.
  4. 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       

New e-book on breastfeeding for doctors and trainees

New e-book on breastfeeding for doctors and trainees

Background

Doctors have an important role to play in supporting mothers who are breastfeeding, through providing encouragement, accurate information and signposting to sources of specialist and peer support. Their impact can be significant because doctors and their advice are held in such high regard, and this is particularly important in the UK, where a mother’s intention to breastfeed can so easily be undermined.

There are doctors who have made themselves really knowledgeable but sadly the UK universal standards for pre-registration medical training in breastfeeding have significant gaps, as shown by Indicator 5 of the WBTi 2016 report (see Part 1 for the summary table below, and Part 2 for the details of standards for different health professions)

Curriculum developments

However, there have been some positive changes since the publication of the WBTi UK report.

Paediatrician training

Level 2 of the RCPCH general curriculum for paediatricians (section Capabilities in Health Promotion and Illness Prevention) has been revised and lists more breastfeeding topics (https://www.rcpch.ac.uk/sites/default/files/2018-03/rcpch_progress_curriculum_level_2_generic_syllabus_for_use_from_1_aug_2018.pdf).

GP training

GP training has also been revised by the RCGP with more mentions of breastfeeding/ infant feeding in the topic guides on Children and Young People and Maternity and Reproductive Health (https://www.rcgp.org.uk/-/media/Files/GP-training-and-exams/Curriculum-2019/Curriculum-Topic-Guides-300819.ashx?la=en).

The WBTi UK team contributed to both curriculum consultations.

GP Infant Feeding Network and Hospital Infant Feeding Network

Dr. Louise Santhanam founded the GP Infant Feeding Network (GPIFN) in 2016 and in 2019 Drs Vicky Thomas and Ilana Levene launched the Hospital Infant Feeding Network (HIFN), which are valuable resources for medical professionals. See our series of three guest blogs from HIFN: Launch of HIFN, #DontStopLookItUp campaign on prescribing for breastfeeding women, and free posters on breastfeeding issues in the hospital setting.

New learning outcomes published by Unicef UK Baby Friendly Initiative

Doctors have a long training so there needs to be input at different stages of training and also encouragement for already qualified doctors to update. A group looking at this was initiated by the WBTi team and went on to be led by Unicef UK Baby Friendly Initiative, and chaired by paediatrician Charlotte Wright. Unicef UK Baby Friendly launched the resulting infant feeding learning outcomes in World Breastfeeding Week, with accompanying resources expected to follow soon (see our August 2019 blog). These are intended as a guide for training for various health professions from undergraduate courses through to the point of qualification.

New online book for trainee doctors

My book, Supporting mothers who breastfeed: a guide for trainee and qualified doctors, is primarily for trainee doctors but relevant to qualified doctors too. At the trainee stage they have specialised and are working clinically. The book provides a combination of factual knowledge about breastfeeding and an insight into mothers’ experiences. It includes some examples of good practice in responding to common situations and ends with a short quiz. It is available on the WBTi website (https://ukbreastfeeding.org/supporting-mothers-who-breastfeed-a-guide-for-trainee-and-qualified-doctors/) as a free PDF. Being electronic, it is easy to click on links to be taken to references and sources of further information, and can be updated more readily than a paper book. 

I am very grateful to Charlotte Wright, who is Professor of Community Child Health at the University of Glasgow and a consultant paediatrician, for writing the foreword.

If you know any trainees or qualified doctors, perhaps you would pass the weblink to them.

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Patricia Wise is an NCT Breastfeeding Counsellor and tutor, and a member of the WBTi UK Steering Group

Empowering communities through integrated sustainable solutions #WBW2019

Empowering communities through integrated sustainable solutions #WBW2019

I’m a lactation consultant and writer who has just finished a Masters degree in Health Promotion at Leeds-Beckett University. This blog touches on some of the insights that my studies have given me, not least how data, like WBTi’s reports, can help health promoters create integrated, sustainable solutions that make health a resource to be shared by everyone.

In 1986, the World Health Organization (WHO) Ottawa Charter for Health Promotion defined Health Promotion as “the process of enabling people to increase control over, and to improve, their health.” Whether the focus be on breastfeeding, preventing obesity, supporting mental health or any of the complex (so called ‘wicked’) problems that challenge our societies, it is health promotion’s recognition of the social determinants of health that has most affected my thinking.  All too often our society is quick to blame the individual for unhealthy behaviours; my increased awareness of the social determinants of health, that is, how socio-economic, cultural and environmental conditions determine individuals’ well-being, has changed my perception. It’s given me a heightened awareness of how prevailing political ideologies influence the way we think about society, and how this plays out into how likely (or not) individuals are to be able to make healthy choices throughout the course of their lives. 

“This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements …and bad politics.” WHO[1]

To give an example, indicator 6 of the WBTi looks at community-based support, so key to women continuing to breastfeed.[2]In the UK, the recent NHS Long Term Plan’s recommendation of UNICEF UK Baby Friendly accreditation is cause for celebration and will boost the capacity of midwives and health visitors to support breastfeeding in the community.

However, cuts to peer-support services, and the closure of over 1000 Sure Start centres have disproportionately affected poorer members of society. If a mother in the community has persistent nipple pain, no car, no public transport, no money for a lactation consultant and her nearest breastfeeding group is 20 miles away, even with the support of the hard-working volunteers on the National Breastfeeding Helpline, her capacity to protect the health of her family through breastfeeding will be limited. 

Incidentally, the discipline of Health Promotion, while focusing on the up-stream causes of health inequalities, is also focused on empowering communities to participate in the creation of healthier societies. The UK’s WBTi report, under Indicator 6, points out that in England and Wales there is often little coordination between NHS services and peer-supporters, who can offer so much to new mothers. It recommends a range of integrated postnatal services that include voluntary sector breastfeeding support, meet local needs and provide clear access to specialist support.

Integrated breastfeeding support is outlined in the criteria for UNICEF Baby Friendly accreditation for community services:

  • Basic: universal services such as midwives, health visitors, and support workers are trained to BFI standards
  • Additional: a network of trained local peer supporters and support groups
  • Specialist: a referral pathway to specialist help at IBCLC level, for complex cases that cant be resolved by “Basic” and “Additional” support

The guidance and standards on community breastfeeding support from NICE, Baby Friendly and Public Health England are summed up in this “Breastfeeding Support Within Maternity Transformation Plans: Guide to the Guidance” by Better Breastfeeding.

As an individual health promoter, the scale and complexity of the social determinants of health can feel overwhelming. Nonetheless, recognising them sets the challenge to health promoters (in all disciplines, not just those who work in traditional health services or policy) to work empathetically, creatively and collaboratively. After all, ‘Success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective societal responsibility’ (The Lancet).


[1]Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF). World Health Organization. 

[2]Dennis C (2002) The Effect of Peer Support on BreastFeeding Duration among Primiparous Women: A Randomized Controlled Trial. Canadian Medical Association Journal 166(1):21-8.

Alice Allan is a lactation consultant, writer and communication specialist who has worked in Ethiopia and Uzbekistan on maternal and child health. Her novel, Open My Eyes, (Pinter and Martin) set in an Addis Ababa NICU, recently won The People’s book Prize for Fiction. She currently lives near London with her family and an Ethiopian street dog called Frank.