WHO and UNICEF launched the Baby Friendly Initiative (BFHI) over thirty years ago; three years later, UNICEF UK Baby Friendly Initiative (BFI) was born. The original BFHI framework of Ten Steps was created to improve maternity and hospital practices that undermined breastfeeding, such as separating mothers and their newborns or routine formula supplements, as well as implementing the International Code of Breastmilk Substitutes in maternity settings, in order to eliminate conflicts of interest with the baby feeding industry (companies that manufacture or distribute infant formula/milks, baby foods, feeding bottles and teats) such as promotion of formula milk in healthcare settings, or direct contact by companies with parents.
The Baby Friendly Initiative has changed the face of maternity practices and midwifery training in the UK – breastfeeding initiation has gone up about 20% since UNICEF UK BFI was founded in 1994. In this country, BFI has grown beyond maternity settings to create standards for infant feeding support programmes in the community and for universities training the next generation of midwives and health visitors.The BFI standards were revised in 2012, based upon the twin pillars of breastfeeding and the UN Convention on the Rights of the Child.
Routine care: all staff in the universal services (midwives, health visitors, support workers etc) are trained to BFI standard with sound, evidence-based, basic training in supporting breastfeeding and responsive infant feeding.
Additional services: every area should have additional support available, such as trained, skilled peer supporters who can act as an “informed friend” for new mothers, and a network of local peer support groups where new parents can find social support alongside help with everyday breastfeeding issues.
Specialist services: every area should also have a referral pathway for specialist care for more complex breastfeeding problems; breastfeeding specialists should have extensive experience or training such as the IBCLC qualification or a recognised breastfeeding counsellor/supporter credential, and either be a registered health professional themselves, or co-lead the specialist service with a registered health professional.
WBTi poster on Integrated Services to Support Breastfeeding, 2019
A good example of how the BFI community standards work is Harrow. Read more HERE about how WBTi UK Steering Team member and specialist health visitor Alison Spiro led Harrow’s local community health services through BFI accreditation, to develop a well integrated services and become
“the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies”
More recently, UNICEF UK BFI have produced Learning Outcomes for a wider range of health professions: medical students, paediatricians, pharmacists, paediatric/ children’s nurses, maternity support workers and nursery nurses. These will help to address the gaps in high level health professional training standards found in WBTI’s 2016 report. Every health professional who works with women, infants and children should understand the basics of lactation and breastfeeding management, prescribing during lactation, and how to refer parents on to local breastfeeding support.
#WBW2022 Webinar
On Wednesday 3 August, we will all have the chance to learn more about the Ten Steps of BFHI in a webinar produced by the Global Breastfeeding Collective, an alliance of NGOs from around the world led by WHO and UNICEF.
In addition, there will be sessions on the care of young breastfed infants who are small or with faltering growth (the MAMI Pathway) and on infant feeding in emergencies.
The entire webinar runs from 7-9 AM BST and again from 4-6 PM BST, and will be recorded.
Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.
This page will serve as a repository for resources for those planning services and those providing feeding support for Ukrainian families with infants and young children.
Breastfeeding provides infants with food security, immune protection, and emotional comfort during disasters. Basic priorities in an emergency:
1) Support new mothers to hold their babies skin to skin and begin breastfeeding within the first hour.
2) Support mothers who are breastfeeding, partially or fully breastfeeding, to continue breastfeeding and increase their milk supply if needed: provide access to skilled feeding support.
3) Protect infants who are not breastfed: Trained infant feeding / nutrition support teams from trusted NGOs like UNICEF will provide access to safe supplies of appropriate infant formula for babies that need it, and support with safe preparation under hazardous conditions.
4) Protect all infants: breastmilk substitutes and feeding equipment (infant formulas and other milks, bottles, teats, breast pumps and also donor human milk) will be provided by trusted NGOs like UNICEF; the public should AVOID sending donations of these into high risk settings, but send donations of funds to trusted NGOS instead. This will enable them to provide families with what is needed on the ground.
These organisations are members of the Infant Feeding in Emergencies Core Group and have created the international Operational Guidance on Infant Feeding in Emergencies. Please consider supporting their work with families with infants and young children.
We have collected links to infant feeding resources in Ukrainian, and also in the languages of countries housing refugee families, for breastfeeding helpers and aid workers in those countries.
Please send us any suggestions for additional resources
We have a few other resources not included here; please email us any enquiries.
NOTE: we will continue to add links and resources to this page, and these organisations are continuing to add further translations into more languages – please make sure that you clear your cache, or ‘refresh’ the page, each time you open any of these links to ensure that you find the most up to date page.
NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.
Guidance for helpers not trained in supporting infant feeding
This short leaflet was written for local authorities and those supporting Afghan refugee families but could be useful for those supporting Ukrainian refugees in the UK. It sets the context, lists some useful resources for parents, provides information about making up powdered infant formula correctly and describes useful actions in some possible scenarios.
Infant feeding support resources – multiple languages
Pictorial counselling cards in many languages including Russian, adapted to include COVID19 recommendations. Some are full pictorial sets, while some are simply the translation matrix.
Infant Feeding flyer for families in transit (including English, Ukrainian, Polish, Russian, updated for COVID19). Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed
Pictorial book about breastfeeding (no words) from La Leche League Netherlands. The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.
Breastfeeding Matters – A Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Russian and other languages
La Leche League International: Variety of resources and infographics in infant feeding in emergencies translated into multiple languages – most are directed at mothers and parents
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTI UK Steering Team, and Policy and Advocacy Lead at Lactation Consultants of Great Britain. Her research interests include human rights and infant and young child feeding in emergencies.
Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.
This page will serve as a repository for resources for those planning services and those providing feeding support for families in crisis in the UK.
Currently there are many gaps in the support for families who have been evacuated from Afghanistan, so resources in Afghan languages are collected here.
Please send us any suggestions for additional resources
We have a few other resources not included here, including Rapid Assessment Tools and Simple Phrases about feeding, and a Peer Counsellor Training Curriculum in Dari; please email us any enquiries.
CONTACT: wbti@ukbreastfeeding.org
NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.
Guidance for helpers not trained in supporting infant feeding
This short leaflet sets the context, lists some useful resources for parents, provides information about making up powdered infant formula correctly and describes useful actions in some possible scenarios.
Infant feeding resources – multiple languages
Rapid Assessment tools in various languages – contact wbti@ukbreastfeeding.org
Infant Feeding Counselling resources Pictorial counselling cards in many languages, adapted to include COVID19 recomendations
The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.
Breastfeeding Matters – An Important Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Farsi
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTI UK Steering Team, and Policy and Advocacy Lead at Lactation Consultants of Great Britain. Her research interests include human rights and infant and young child feeding in emergencies.
How can communities change to give parents consistent support with breastfeeding?
Our Harrow model of integrated working across hospital and community services showed that when professionals, lay supporters and specialists worked effectively together under a shared strategy and infant feeding policy, that more parents felt supported to breastfeed their babies. Over two years higher breastfeeding initiation, continuation and exclusivity rates were beginning to be reported. Parents found that they experienced less conflicting advice and breastfeeding gradually began to be seen as the normal way to feed babies in Harrow.
This was achieved through joint training sessions involving community and hospital staff. Midwives, midwifery managers, paediatricians, neonatal nurses, paediatric nurses, A&E nurses, health visitors, peer supporters and breastfeeding counsellors all attended the same sessions. Through these, they were able to understand each other’s roles and responsibilities and plan care together.
Peer supporters helped to run daily community drop-in groups with health visitors, and some worked in the antenatal clinic and postnatal wards of the hospital. Specialist, targeted peer support was offered to teenage parents, those with multiples and Somali mothers. A copy of Best Beginning’s ‘Bump to Breastfeeding’ DVD was given to all antenatal parents, who were also invited to a popular Saturday morning breastfeeding workshop.
Over a period of ten years, mothers felt comfortable breastfeeding their babies all over the borough and became visible in shopping centres, cafes, supermarkets, parks, and school grounds.
The National Maternity Review reported in 2016:
‘In Harrow, a multi-ethnic London borough with high infant mortality rates, and areas of deprivation and poverty, the Director of Public Health identified breastfeeding as a top priority for 2006. A multi-professional approach was adopted with Harrow Community Health Services working with the local hospital to improve breastfeeding rates. UNICEF Baby Friendly training was commissioned for midwives, health visitors and support staff in 2007. A peer support training programme began and mothers were recruited from a local support group. A network of breastfeeding support groups was established running from children’s centres, eventually achieving one every day within walking distance for all mothers. In 2008, Bump to Breastfeeding DVDs were given to every pregnant woman by midwives, health visitors and peer supporters. Harrow became accredited as Baby Friendly in 2012 and the local hospital gained the award in 2013. The staff training, peer support programme and free DVDs increased breastfeeding rates, so by 2010 initiation rates had risen to 82% and 6-8 weeks to 73%. By 2013, Harrow had 87% of mothers initiating and 75% breastfeeding at 6-8 weeks (50% exclusively), with one of the lowest drop-off rates in the UK. UNICEF assessed Harrow for its re-accreditation in 2014 and stated that it was the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies’.[1]
Other examples of Integrated community breastfeeding support:
A network of trained peer support is an essential part of high quality integrated breastfeeding services.
Unicef UK Baby Friendly Initiative (BFI) outlines three components that good local breastfeeding services must include, in order to be awarded Baby Friendly accredited status.
Basic, or Routine Care
All health workers who work with new families (health visitors and any allied healthcare assistants in the community services) have been trained to BFI standard (approximately 18 hours of initial in service training, with yearly updates of an hour or more).
Additional services
Here BFI outlines how every health visiting and community service must be embedded in and well supported by a network of trained peer supporters, or other social and trained breastfeeding support. NICE recommends that peer support programmes be externally accredited. Good practice includes not only training, but also regular supervision and updates of skills and knowledge. Typical peer support programmes require peer supporters to be experienced breastfeeding mothers, and often expects them to come from similar communities as the population they are supporting. Training generally is part time, over 16-36 hours. Peer supporters work in a supervised setting, acting as an “informed friend,” and referring complex cases on to health professionals or an advanced breastfeeding practitioner such as an IBCLC or breastfeeding counsellor, using a referral pathway.
Breastfeeding counsellors in the UK are also experienced breastfeeding mothers, so they also provide a type of peer support, or “mother-to-mother” support. Their training typically take around two years, and they are autonomous practitioners, who can be responsible for leading their own local breastfeeding support groups, usually through one of the main UK breastfeeding voluntary organisations.
Mothers who are experiencing breastfeeding challenges often need more than one visit – and they need the time that it requires for skilled listening as well as exploration of possible breastfeeding strategies to resolve the issue. Although many health visitors have additional breastfeeding training and skills, the health visitor workforce is vastly overstretched, and it simply isn’t possible to provide the time and the number of visits that many breastfeeding mothers need.
But peer support programmes can provide this – they offer groups where lonely mothers can meet others and gain confidence in their own mothering, alongside skilled listening and well- informed support. Many mothers will find their own “village” in their local breastfeeding support group, and will return again and again. Some will go on to train as peer supporters or breastfeeding counsellors themselves.
Peer support groups are the beating heart of breastfeeding support
Helen Gray, WBTi Joint Coordinator
WBTi audit of peer support and breastfeeding counsellors provided by the voluntary sector, 2016 In Part 2 of our WBTi UK Report
Specialist support
Every area should have a referral pathway to specialist care at the IBCLC (International Board Certified Lactation Consultant) or similar level, for those complex cases where breastfeeding issues cannot be resolved at the level of basic/ routine care or by additional peer support.
The different roles of breastfeeding support in the UK have been outlined in the chart below:
WBTi’s research: Case studies of best practice The WBTi 2016 Report featured several case studies of areas who showed best practice in providing well joined up, integrated breastfeeding services: Brighton and Harrow.
More recently, our WBTi team has presented posters featuring these and additional case studies of best practices in providing integrated breastfeeding services: Medway, Harrow and Swindon.
WBTi Poster on Integrated Breastfeeding Services.
These examples of best practice in integrated breastfeeding services gave concrete results.
They demonstrated:
– a 2% rise in breastfeeding rates in a socially deprived area in 2018 (Medway),
– a 15% rise in initiation and a 12% rise in continuation of breastfeeding over a six year period (Harrow)
– and a 6% reduction in drop off rates from birth to 6-8 weeks over six years (Swindon).
Our WBTi team are always on the lookout for further examples of best practice in integrated breastfeeding services, and we submit them to Public Health England. Please do contact us if you would like to submit your local services!
Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group. She is also an accredited Leader (breastfeeding counsellor) with La Leche League of Great Britain.
For Day 2 of WBW we are very pleased to have a guest blog by Health Visitor and Clinical Research Fellow Dr. Sharin Baldwin.
Breast milk provides the ideal nutrition for infants and its associated benefits to the infant, mother and the wider public health are well documented. Traditionally breastfeeding promotion and advice have been targeted at expectant and new mothers, with an aim to increasing breastfeeding rates in infants. In recent years it has been acknowledged that partners play an important role in supporting women’s decision to breastfeed, while also providing practical and emotional support with the continuation of breastfeeding. Research highlights the important role of fathers in promoting and supporting their partners with breastfeeding (Tohotoa et al., 2011; Datta et al., 2012; Sherriff et al., 2014; Hansen et al., 2018), but in practice fathers continue to report inadequate levels of information and support from health professionals. Training for health professionals therefore should consider men’s needs relating to breastfeeding promotion and support, as well as women’s.
New fathers have often reported finding their partner’s breastfeeding experiences to be much more difficult than they had originally anticipated, with many not knowing how to help or support their partner with breastfeeding when they experienced difficulties (Baldwin et al, 2018; 2019). This is where health professionals can really make a difference. They can help educate and prepare expectant fathers better during the antenatal period by providing them with ‘realistic’ information about the time it may take for their partner to establish breastfeeding. It is also important to highlight some of the breastfeeding challenges they may face in early parenthood and what strategies or support are available to overcome them. This will help men to develop more realistic expectations of the processes involved with establishing breastfeeding and make them feel more empowered to support their partner when faced with any difficulties.
While fathers may not be able to be directly breastfeed their babies, they need to know that they play a crucial role in making breastfeeding a success. They can provide practical support to their partners through helping with household duties, giving them a massage, allowing them to rest, making meals and drinks for them, and giving them emotional support through regular praise, reassurance and encouragement. Good levels of breastfeeding support are likely to make the process easier and more enjoyable, while giving women the confidence to continue breastfeeding for longer. Fathers’ involvement in breastfeeding not only has the potential to increase breastfeeding rates and duration, but also contribute to better outcomes for babies, mothers and the wider public health agenda. So, let’s not forget about including fathers when having those crucial discussions and training about breastfeeding!
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2018) Mental health and wellbeing during the transition to fatherhood: a systematic review of first-time fathers’ experiences. JBI Database of Systematic Reviews and Implementation reports, 16(11):2118–91.
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2019) A qualitative exploratory study of UK first-time fathers’ experiences, mental health and wellbeing needs during their transition to fatherhood. BMJ Open 2019;9:e030792. doi:10.1136/bmjopen-2019-030792 https://bmjopen.bmj.com/content/9/9/e030792.info
Datta, J., Graham, B., Wellings, K. (2012) The role of fathers in breastfeeding: decision-making and support. British Journal of Midwifery, 20(3):159–167.
Hansen, E., Tesch, L., Ayton, J. (2018) ‘They’re born to get breastfed’- how fathers view breastfeeding: a mixed method study. BMC Pregnancy and Childbirth, 18:238 https://doi.org/10.1186/s12884-018-1827-9
Sherriff, N., Hall, V., Panton, C. (2014) Engaging and supporting fathers to promote breast feeding: A concept analysis. Midwifery, 30: 667–677.
Tohotoa, J., Maycock, B., Hauck, Y.L., Howat, P., Burns, S., Binns, C.W. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International Breastfeeding Journal, 4: 15. http://dx.doi.org/10.1186/1746-4358-4-15
Author:
Dr. Sharin Baldwin PhD, MSc, PG Dip, BSc (Hons), HV, RM, RN, QN, FiHV, IHV Research & PIMH Champion
NIHR Clinical Research Fellow, University of Warwick
Clinical Academic Lead (Nursing and Midwifery), London North West University Healthcare Trust
This is the start of World Breastfeeding Week, which runs from the 1st to the 7th August each year. Our focus this year for Day 1 is Health Professionals.
“It takes a village to raise a child; it takes a community to support mothers to breastfeed
Sue Ashmore, Unicef UK Baby Friendly Initiative
Sue Ashmore of the Unicef UK Baby Friendly Initiative (BFI) wrote in 2017 ‘Just as the saying goes: ‘It takes a village to raise a child’, it takes a community to support mothers to breastfeed.’ (blog for the Huffington Post). That community includes health professionals but also breastfeeding specialists, such as IBCLCs and breastfeeding counsellors, and trained peer supporters.
Health professionals who have contact with mothers and their babies are a crucial part of that village of support. Since the WBTi report was pubished in 2016, an improvement has been the requirement of the NHS England Long-Term Plan (p.49) that all maternity units work towards achieving Baby Friendly accreditation. In comparison, all Scotland and N.I. maternity units were already accredited by 2016. Meeting this requirement will help provide a good basic standard of infant feeding support in English maternity units but as yet there is no requirement for neonatal units or community services (primarily that means the health visiting service) to achieve Baby Friendly status.
Summary table mapping UK health professional standards against WHO Educational Checklist on Infant and Young Child Feeding. See our report part 1 (for the table) and Part 2 (for details of individual health professions) https://ukbreastfeeding.org/wbtiuk2016/
The 2016 WBTi report highlighted the need for better training for most health professionals who work with new mothers. Since then, we’re very pleased to report that many more resources have been made available, including:
The GP Infant Feeding Network (GPIFN) and Hospital Infant Feeding Network (HIFN) were created and both have highly informative websites.
There have been some improvements to the paediatric and GP education curricula.
BFI has produced learning outcomes for students of several professions – medical, dietetic, pharmacy and maternity support workers/nursery nurses.
The University of Glasgow, working with BFI, has developed an e-learning module for first year medical students to support meeting the learning outcomes.
The Royal College of Paediatrics and Child Health has regularly updated its position statement on breastfeeding, the latest being June 2021, and includes: ‘RCPCH strongly supports breastfeeding, the promotion of breastfeeding, the provision of advice and support for women, and national policies, practices and legislation that are conducive to breastfeeding. All child health professionals should be trained to deliver simple breastfeeding advice.’
The Royal College of General Practitioners launched its position statement on breastfeeding in 2017 and then a free e-learning course on breastfeeding in 2018.
Thus some progress has been made towards the vision of all mothers who want to breastfeed being able to access seamless support from health professionals, additional breastfeeding specialists and trained peer supporters, all of whom value breastfeeding and are knowledgeable enough either to provide evidence-based information and support themselves or signpost to appropriate support.
A new study by trainee doctor Kirsty Biggs and senior colleagues has shown that 97% of the 411 medical students who responded to a survey are uncertain of their practical skills to support new mothers with breastfeeding, such as helping with latch issues, although the overall benefits of breastfeeding were moderately well-known. Yet most students (93%) perceived doctors to have an important role in supporting breastfeeding and the same percentage requested further breastfeeding education.
Over 80% of the respondents had a career interest in obstetric and gynaecology, paediatrics and/or general. While the sample was only around 1% of UK medical students, and only one-quarter of the students responding were male, it’s a very clear message that breastfeeding education overall is not adequate.
Around 80% of the 32 UK medical schools eligible responded to their part of the survey and results indicate that only 70% of medical schools provide compulsory breastfeeding education.
WBTI’s findings and vision
The WBTi UK report in 2016 indicated that medical curricula have many gaps with regard to breastfeeding, and Biggs’ study confirms that the students themselves find it inadequate. WBTi UK’s vision is that all doctors have sufficient training in infant feeding to protect the decisions of mothers who want to breastfeed.
How can the situation be improved? High level standards and Unicef BFI learning outcomes
The General Medical Council provides broad guidelines for undergraduate curricula in its Outcomes for Graduates document and each medical school devises its own curriculum to fit the guidelines. For example, the expectation under the Outcomes Health promotion and illness prevention section is: ‘Newly qualified doctors must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice’. Unicef UK Baby Friendly Initiative’s learning outcomes for several professions, including medical students, published in November 2019 are highly relevant to improving curricula and accompanying resources are being developed.
RCPCH curriculum – an encouraging sign
Medical training is long, with undergraduate, Foundation and then specialty training. The RCPCH (Royal College of Paediatrics and Child Health) states as part of its activity to promote breastfeeding: ‘The RCPCH training curriculum for General Paediatricians and all paediatric subspecialties requires training to understand the importance of breastfeeding and lactation physiology, be able to recognise common breastfeeding problems, have knowledge of formula and complementary feeding, and be able to advise mothers or refer for support.’
Mentioning infant feeding in guidance to doctors to encourage including it in consultations is also important. GP Louise Santhanam (founder of GPIFN) is the lead author of Postnatal Maternal and Infant careduring the COVID-19 Pandemic: a Guide for General Practicethat was recently added to the RCGP website. This clarifies that 6-8 week checks need to continue despite the Covid-19 pandemic and that infant feeding should be a routine clinical consideration.
Thus plenty of resources are available but doctors are busy people. While some really understand the importance of protecting breastfeeding, and know how to – such as signposting mothers to local skilled help – the challenge is how to bring this into every medical student’s training.
If you know anyone at medical school, it would be really useful if you can let them know about Kirsty Biggs’ study.
This week (7- 12 June) is Infant Mental Health Awareness Week and the theme is ‘20:20 vision: Seeing the world through babies’ eyes’. The Week is led by the Parent-Infant Foundation (PIF) and theFirst 1001 Days Movement, a collaboration of relevant organisations with the PIF as secretariat, which is being launched during the week.
What is infant mental health? It is the emotional wellbeing of babies. The Movement’s vision is that ‘every baby has loving and nurturing relationships in a society that values emotional wellbeing and development in the first 1001 days, from pregnancy, as the critical foundation for a healthy and fulfilling life.’
What babies want is what they need and these needs are basic. As obstetrician Grantly Dick-Read wrote in the mid 20th century:
“The newborn 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.”
They do also need to receive attention from other humans. If their needs are usually met, babies can form secure relationships (attachment) with their caregivers. Usually, there is one primary caregiver, most commonly the mother. Attachment theory was developed by the psychoanalyst John Bowlby in the 1950s. An attachment figure who cares responsively for the infant provides a secure base. It is believed that behaviours by the infant to stay close when separated, like screaming and clinging, have been reinforced by natural selection (see What is attachment theory).
Babies are vulnerable – as Donald Winnicott, paediatrician and psychoanalyst, among his other insightful quotes, stated:
‘There is no such thing as a baby, there is a baby and someone’.
However, infants are not passive as they communicate by giving cues to their needs, such as the rooting reflex when hungry. If their needs are not responded to quickly, they become upset. Dr. Edward Tronick’s ‘still face’ experiments in the 1970s showed the importance of human connection for an infant. If the parent’s face is still and unresponsive to her baby, the baby looks confused and then becomes distressed. The experiments also showed that ruptures in a relationship like this are easily repaired. Parents do not need to respond perfectly.
However, when there is repeatedly no response to a baby’s distress, as in sleep training where the baby is left alone and expected to adapt, it was found that the babies’ behaviour changed so that by the third night they were no longer crying but their cortisol (stress hormone) levels were still high so there was a mismatch between behaviour and physiology; instead of learning to self-soothe it seems as though they were giving up so in despair.
The significance of the care babies receive is that their experiences, starting before birth, influence the neural connections that are formed in the developing brain – the ‘wiring’. A parent who is emotionally not really available to the baby (so not attuned to their needs) will find it difficult either to respond or to respond appropriately, providing an unintentional ‘still face’ or angry face. The parents could be ill, depressed, addicted, suffering domestic abuse, desperately worried about their financial situation, overloaded with responsibilities………It is therefore crucial for a society to care for parents so that they can be emotionally available to their children.
Feeding is a crucial part of nurturing care and breastfeeding facilitates the process.There is considerable evidence that not being breastfed is linked to poorer physical health in infants (Lancet, 2016). Breastfeeding provides personalised nutrition. Antibodies and other components in breastmilk reduce the chance and severity of infections. Oligosaccharides in breastmilk feed and thus favour beneficial bacteria in the infant’s gut and this helps the development of a healthy immune system. It is difficult to allow for confounding factors in studies on breastfeeding but reviews show it is linked with better cognitive performance, which is likely to be due to the fatty acids in breastmilk. But what about any impact on emotional development? There are studies which suggest that being breastfed is associated with paying more attention to positive emotions in others. Breastmilk contains the calming hormone oxytocin, which stimulates social interactions, and which is further released through touch and suckling, so the moods of both mother and baby benefit. Several studies indicate that mothers who are breastfeeding tend to touch their babies more, are more responsive and tend to gaze at them more, all of which will help the infant’s emotional wellbeing. The Unicef UK Baby Friendly Initiative leaflet, Building a Happy Baby, provides practical suggestions for parents to support their baby’s brain development and addresses myths and realities.
Mothers who stop breastfeeding before they want to are at greater risk of postnatal depression (Borra et al 2014) so mothers need easy access to breastfeeding support to help them continue, thereby benefitting their babies physically and emotionally. Sadly, there are barriers to breastfeeding throughout society, as outlined in the WBTi UK report.
Parents and carers urgently need more support, especially during the stresses and isolation of lockdown and the COVID19 pandemic. We call on government to make infants and their families a high priority during the pandemic and in our plans to rebuild a stronger society.
Photo used with permission
Patricia Wise is an NCT breastfeeding Counsellor and a member of the WBTi UK Steering Group
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 theInternational Breastfeeding Journal.
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.
Breastfeeding trends (UK) 