Sustaining breastfeeding together: Partnerships for the Goals

Sustaining breastfeeding together: Partnerships for the Goals

The theme for this year’s World Breastfeeding Week  is all about the importance of building multi-level partnerships to work together to support and protect breastfeeding and achieve the UN’s Sustainable Development Goals.

The final Sustainable Development Goal, number 17, calls for cross sectoral and innovative multi-stakeholder partnerships to achieve sustainable development.

Research has shown that the most effective way to improve breastfeeding rates is to implement policies and programmes at every level, from hospital to home and community, with support available from health professionals, peer supporters, friends, families and society.

One of the main WBTI recommendations outlines how this could be led from the top in the UK:

A national sustainable Strategy Board, including representatives from all the voluntary groups, health professional organisations, and NGOs to share best practice between devolved nations coordinated by a high level funded lead specialist.

A good breastfeeding journey for a family begins with birth in a Baby Friendly accredited hospital, and continues at home, surrounded by supportive family and friends, with easy access to skilled health professionals and mother support groups in the community. Once they return to work, mothers are supported by their employers to continue to breastfeed as long as they wish. Legislation protects families from misleading marketing by the baby feeding industry, and ensures safe and high quality breastmilk substitutes are available for those babies who need them.

A strong partnership between all sectors is essential to supporting families throughout their journey. The WBTi project was centred around building a strong partnership between organisations and agencies involved in maternal and infant health in order to monitor and assess the UK’s implementation of key infant feeding policies and programmes. The decision-making Core Group was responsible for determining the gaps and recommendations for the WBTi report and its member organisations had to be free from conflict of interest with regard to funding from the formula, baby food, bottle and teat industries. Organisations covering the full spectrum of maternal and infant health were invited to participate in the wider WBTi consultation.

Together, we can build a better future for Britain’s babies.

 

The WBTi Core Group

Association of Breastfeeding Mothers   https://abm.me.uk/

Baby Feeding Law Group    www.babyfeedinglawgroup.org.uk/

Baby Milk Action www.babymilkaction.org/

Best Beginnings   www.bestbeginnings.org.uk/

Breastfeeding Network   www.breastfeedingnetwork.org.uk/

Child and Maternal Health Observatory   www.herc.ox.ac.uk/downloads/health_datasets/browse-data-sets/child-and-maternal-health-observatory-chimat

Department of Health   www.gov.uk/government/organisations/department-of-health

First Steps Nutrition   www.firststepsnutrition.org/

Institute of Health Visiting ihv.org.uk/

Lactation Consultants of Great Britain   www.lcgb.org/

La Leche League GB   www.laleche.org.uk/

Maternity Action www.maternityaction.org.uk/

Northern Ireland infant feeding lead

NCT   www.nct.org.uk/

National Infant Feeding Network www.unicef.org.uk

Public Health England  www.gov.uk/government/organisations/public-health-england

Scotland Maternal and Infant Nutrition Coordinator www.gov.scot/

Start4Life www.nhs.uk/start4life/

Unicef UK Baby Friendly Initiative www.unicef.org.uk/babyfriendly/

 

Other organisations who participated in the WBTi consultation

British Dietetic Association. https://www.bda.uk.com

Cabinet Office https://www.gov.uk/government/organisations/cabinet-office

Department of Health http://www.gov.uk

General Medical Council  http://www.gmc-uk.org

General Pharmaceutical Council   https://www.pharmacyregulation.org

Nursing and Midwifery Council   https://www. nmc.org.uk

Public Health Agency Northern Ireland www.publichealth.hscni.net/

Public Health Scotland   http://www.gov.scot/

Public Health Wales http://www.wales.nhs.uk/

Royal College of General Practitioners http://www.rcgp.org.uk

Royal College of Midwives http://www.rcm.org.uk

Royal College of Paediatrics and Child Health https://www.rcpch.ac.uk

Royal College of Obstetricians and Gynaecologists http://www.rcog.org.uk

Unite, the Union of Community Practitioners and Health Visitors Association www.unitetheunion.org/

U K Standing Conference on Specialist Community Public Health Nurse Education

 

Relevant quotes:

The Lancet Series on Breastfeeding concluded that breastfeeding is the responsibility of all of society, not just the individual woman. http://www.thelancet.com/series/breastfeeding

It takes a village to raise a child………so says the African proverb.

UK Shadow Health Minister Jon Ashworth recently said ‘Children’s health is central to improving wellbeing and economic status of a country’.

 

By Clare Meynell and Helen Gray

Joint Coordinators

WBTi UK Working Group

#KingsBrelfie for World Breastfeeding Week 1– 7August

#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 25th 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.

Brelfie1

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.

Nabilabrelfie2

 

#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

 

 

Sustaining Breastfeeding: A Challenge for the UK

Sustaining Breastfeeding: A Challenge for the UK

Position Statement On Breastfeeding From The RCPCH

 Today is the start of World Breastfeeding Week. An open letter was published in The Guardian today, from the Royal College of Paediatrics and Child Health (RCPCH), co-signed by the WBTi team and 17 other organisations working in maternal and infant health. The letter calls for improved social attitudes towards breastfeeding to help reduce the barriers so that women are more able to sustain breastfeeding.

The revised RCPCH position statement on breastfeeding, also launched today, points out the rapid decline in breastfeeding rates (leading to fewer than half of all babies receiving any breastmilk at all by 6-8 weeks after birth), the research evidence on improved health outcomes and intelligence scores, and the economic impact. It lists key messages for health professionals and recommends government action to increase initiation and continuation rates. Roles and responsibilities of paediatricians include:

“All paediatricians should be aware of the RCPCH position on breastfeeding and encourage and support mothers, including those with preterm or sick infants, to breastfeed. They should avoid undermining breastfeeding through the inappropriate use of infant formula “top-ups”, and advise women that the use of infant formula may make it more difficult to establish exclusive breastfeeding.”

While the position statement mentions that the current training curriculum for general paediatricians “requires trainees to understand the importance of breastfeeding and lactation physiology, be able to recognise common breastfeeding problems”, the WBTi assessment found significant gaps in comparison to the WHO Education Checklist for infant and young child feeding topics. However, the curriculum is currently being revised and we very much hope this will improve such training for paediatricians.

Family-centred care

Indicator 5 in the WBTi UK report is about health and nutrition care systems.

Are the services provided by maternity units truly mother- centred? Are health professionals such as health visitors, GPs and relevant hospital staff, with an in-patient mother, baby or young child, really mother centred?

To achieve parent-centredness, the policies and protocols need to incorporate that ethos, and staff training needs to provide the necessary attitudes, knowledge and skills. The crucial element of Indicator 5 is, therefore, health professional training.

Training for health professionals

Our report showed significant gaps in training for most of the relevant professions. Those who support mothers with breastfeeding have much anecdotal evidence between them of extensive variation between health professionals in attitudes and knowledge, from being hugely supportive on the one hand to dismissive of breastfeeding on the other. If all had a positive attitude towards breastfeeding, accompanied by basic knowledge, that would surely help to improve breastfeeding rates, particularly for continuation?

 

Time for action

The recommendations by the WBTi Core Group mirror those of the RCPCH – action is needed at every level, from governments to health professional bodies. from the community to the workplace. Protecting our babies’ future is a responsibility we all share.

 

wbti ind 5 gaps recs
Key gaps and recommendations from the 2016 World Breastfeeding Trends Initiative report on UK infant feeding policies and programmes https://ukbreastfeeding.org/wbtiuk2016/

 

PW Photo for WBTi MAINN presentation

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

Maternity Protection in the workplace: Tribunal fees ended!

Maternity Protection in the workplace: Tribunal fees ended!

WBTI Recommendations on tribunal fees

The World Breastfeeding Trends Initiative UK Report in 2016 includes the statements that “employment tribunal fees were introduced in 2013 (except in Northern Ireland) and it now costs £1200 to bring a discrimination claim. Employment tribunal fees constitute a significant financial barrier to accessing justice. The number of employment tribunal claims decreased by 70% following introduction of the fees.”

The unanimous recommendations by the WBTi Core Group organisations included:
“that governments ensure that tribunal access is available to women from all income brackets.”

Tribunal fees ended with immediate effect

The excellent news is that on 26th July 2017 the UK Supreme Court ended employment tribunal fees with immediate effect. The Parliamentary Justice Committee had recommended special consideration for pregnancy and maternity discrimination claims in 2016 but as no government action followed, the trade union Unison took the issue to court. Rosalind Bragg, Director of Maternity Action, has written about this in more detail:

https://www.maternityaction.org.uk/2017/07/an-end-to-employment-tribunal-fees-a-great-step-forward-for-maternity-rights/

 

The Press summary of the judgment explains that “The Fees Order is unlawful under both domestic and EU law because it has the effect of preventing access to justice. ” It indirectly discriminates against women under the Equality Act 2010 because more women make Type B claims, which include unfair dismissal, equal pay and discrimination.

https://www.supremecourt.uk/cases/docs/uksc-2015-0233-press-summary.pdf

Maternity discrimination in employment

This is only a start in tackling employment discrimination though and the Alliance for Maternity Rights Action Plan comprises several needs:

  • to build on existing legislation and not weaken it
  • for the government to show leadership in changinge the culture away from discrimination
  • for employer practices to improve
  • to improve access to information for both employers and women
  • to ensure proper protection of the health and safety of expectant and new mothers
  • for improved access to justice
  • for better monitoring of trends

https://www.maternityaction.org.uk/wp-content/uploads/AfMRActionPlanFINALOct2016.pdf

 

Another change to improve access to justice that is listed in the Plan is to extend the timeline for making a claim from 3 months to 6 months. Joeli Brearley set up Pregnant then screwed to tackle employment discrimination and her #GivemeSix petition aims to achieve this extension so that mothers can begin a tribunal claim after they give birth and avoid risking extra stress in pregnancy. The Early Day Motion (EDM15) to increase the time limit has been signed by 87 MPs so far, approaching the target of 100.

https://www.change.org/p/greg-clark-mp-give-new-and-expectant-mothers-six-months-to-pursue-discrimination-claims?utm_content=petition&utm_medium=email&utm_source=102275&utm_campaign=campaigns_digest&sfmc_tk=OyJbS47tFVxLRElMEsk%2bNSNfCtOF6k3%2fETm0uXsnz2ju4w8G3nxfLYMR7gqAqApc&j=102275&sfmc_sub=284797866&l=32_HTML&u=20470025&mid=7259882&jb=1560

Here is a short video that you can share on why maternity protection is important:

 

 

 

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

Protecting babies in emergencies

Protecting babies in emergencies

Guidance is needed on infant and young child feeding for families in the UK affected by disasters and emergencies.

Heather Trickey and Helen Gray.

Disaster and emergency situations – floods, fires, terrorist attacks and widespread power failures – can affect any country, including the UK. In any disaster or emergency, babies are vulnerable and continued access to adequate and safe nutrition is essential. Families need support to ensure that children continue to be cared for and fed in line with their needs.

 

There is no UK government plan

The World Health Assembly (Resolution 63/2010) has recommended that all countries implement existing global guidelines on infant feeding during emergencies, including specific operational guidance to help relief agencies protect infant nutrition and minimise risk of infection. Although there is national guidance on care of animals during emergencies, a recent World Breastfeeding Trends Initiative (WBTi) report found that there are no UK-wide or national strategies addressing infant and young child feeding during a disaster. Scotland is the only part of the UK that has a named lead on infant feeding in emergencies. Emergency planning and response is devolved to local authorities; because there is no guidance on the protection of families with infants there is no way to ensure that local strategies consider infant nutrition as part of emergency response.

 

Risks for formula fed babies

Babies who are fully or partially formula fed are at risk if their caregivers lose access to clean water, are unable to sterilise feeding equipment or suffer disruption or contamination of their formula milk supplies. A suitable environment for preparation and storage of feeds, sterilising equipment, boiling water and safe storage such as a refrigerator, are all needed to prevent bacterial contamination

Gribble IYCFE liquid photo 13006_2011_Article_127_Fig2_HTML
Emergency supplies required to care for and feed a formula fed baby for one week in a developed country, using read-to-feed milk. From Gribble & Berry 2011 “Emergency Preparedness for those who care for infants in developed country contexts.” International Breastfeeding Journal /2011 6:16

 

Risks for breastfed babies

Breastfeeding protects against infection and can be comforting to infants and mothers during difficult times. Mothers’ supply of breastmilk is resilient, however, chaos, displacement and emotional strain, coupled with commonly held misconceptions about how breastfeeding works, can undermine a mother’s confidence and result in less frequent feeding. Breastfeeding mothers need access to the option of feeding in a private space and reassurance that continuing to breastfeed is the best option for their baby.

Skilled support can help mothers resolve breastfeeding problems and maintain the protective effect of full or partial breastfeeding. If breastfeeding helpers are not pre-authorised as part of planned disaster response the immediate help that families need can be delayed.

 

Risks associated with donated formula milk

The world is a better place than we sometimes think. When a disaster strikes, ordinary people often respond with an outpouring of generosity. We give clothes, equipment and food spontaneously and in response to public calls.

Donations Balham Mosque
Donations of clothing, bedding, toys, food and water, London, June 2017. Photo Credit: @balhammosque

In the absence of guidance, agencies responsible for co-ordinating emergency response and volunteers working on the front line are often not aware that donations of formula milk can put babies at risk. Risks from donated formula milk include inadvertently distributing products that are unsuitable for babies under six months or for babies with special nutritional needs, as well as distributing milk that is contaminated or out-of-date. There is also a risk that donations will be inappropriately provided to parents of breastfed babies, which can undermine the protective effect of breastfeeding and cause parents to become dependent on a continued supply of formula milk.

International guidelines for emergency feeding caution against accepting donations of formula milk. It is recommended that emergency planners and first responders, with expert advice, take responsibility for purchase and distribution of appropriate formula milks in line with the needs of each family.

 

What’s been done so far?

International guidelines for protecting infants in disasters and emergencies are available.  There is a need to adapt these to a UK context, where, beyond the early weeks, many babies are fully or partially formula fed and which includes a rich mix of cultures and nationalities with different feeding practices.

UK-based emergencies have tended to be highly localised and short-term. However, UK guidance will need to ensure preparedness for longer-term support needs, for UK charities and for displaced families and unaccompanied children who have sought refuge from outside of the UK.

Several UK agencies have developed guidance with limited scope. The Food Safety Agency has issued guidance to support safe preparation of formula milk in response to flooding and contamination of local water supplies. A toolkit has also been developed to support food banks, including preventing and managing unsolicited formula milk donations.

 

How to help ensure babies’ nutritional needs are protected

In the absence of national guidance, relief co-ordinators and agencies and members of the public will be concerned to do the right thing in response to a disaster. There is an urgent need to improve planning and raise awareness about the best ways to support infant and child feeding. These key points from have been adapted from UK and international guidance:
1) Members of the public

  • DO donate money to key agencies. This is the best way to support parents who need to buy formula milk. Money will allow parents, caregivers or coordinating aid organisations to buy the most appropriate milk to meet the individual needs of each baby. Donated formula milk can inadvertently put babies at risk.
  • DO offer your time to help agencies co-ordinating relief. Support and encourage mothers who are breastfeeding. Breastfeeding is protective against infection, and provides the baby with the safest possible nutrition.

 

2) Relief workers and aid agencies

  • DO have a local plan to support infant and young child feeding in emergencies in place for local authorities, first responders and aid agencies. All families should be screened to ensure they receive appropriate support or supplies.
  • DO ensure that mothers who are fully or partially breastfeeding have the support they need to continue. Mothers can seek support from their midwife or health visitor. Local emergency planning should have identified appropriate infant feeding support from local health and voluntary services. There are telephone helplines which support caregivers with all aspects of infant feeding:
    • NCT helpline (0300 330 0700)
    • The National Breastfeeding Helpline (0300 100 0212).
  • DO encourage donations of money to recognised agencies so that parents, caregivers and agencies can buy any formula or supplies needed, rather than donations of formula products.
  • Appropriate support or supplies including cash cards specifically for the purchase of infant formula and complementary foods for young children could be considered.
  • DO ensure that formula milk is purchased and distributed only for babies who need formula milk, following basic screening of families (simple triage tools have been recently been developed for use in emergency situations in Greece and Canada).
  • DO NOT distribute formula milk in an untargeted way.
  • DO ensure that parents are aware of guidance on sterilisation of bottles and teats and how to prepare any powdered formula safely and have access to facilities to carry this out, to reduce the risk of contamination. Liquid ready-to-feed formula may be needed if suitable preparation facilities are not available.

 

What is needed now?

There is an urgent need for UK governments to ensure infant and child nutrition is protected as part of the planned new strategy for resilience in major disasters. Local authorities and relief agencies require national guidance to develop local strategies so that we can all be better prepared.

                                                                                         

 

Heather Trickey is a Research Associate based in DECIPHer, Cardiff University. Her research focuses on public health policy and parents, particularly Infant Feeding Policy.

Helen Gray is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group.

GPs and breastfeeding

GPs and breastfeeding

 

Doctors have to acquire a huge body of knowledge during training and for general practitioners that knowledge is particularly wide-ranging. Their ten or more years of study comprise undergraduate, foundation and specialism levels of training. As qualified GPs they are likely to have thousands of women patients who, at some stage, are breastfeeding mothers, yet the breastfeeding content of the curriculum is minimal.

Placements in the specialism training may offer useful opportunities to learn from midwives and health visitors about the practicalities of supporting breastfeeding but this is a matter of luck, and the knowledge and skills of those mentors can be variable. It would be much more effective to have a requirement for acquiring basic knowledge and skills specified in the curriculum as well.

 

GP Infant Feeding Network and resources for GPs

A number of GPs, mothers who in breastfeeding their own babies became acutely aware of the deficiencies in their training, set up the GP Infant Feeding Network, GPIFN, in February 2016. In April 2017 they launched the GPIFN website, a valuable resource for doctors.

Does your doctor know about this website?

 

Medical training

With regard to medical training (not just GP training), the General Medical Council (GMC) has recently published its Generic Professional Capabilities (GPC) Framework to provide broad outcomes for a consistent approach for postgraduate curricula. The framework was developed in partnership with the Academy of Medical Royal Colleges. Domain 4 (there are 9 domains) looks to be particularly relevant to protecting and supporting breastfeeding as its title is ‘Capabilities in health promotion and illness prevention’.

Royal colleges, such as the Royal College of General Practitioners (RCGP), are responsible for the details of their curricula. They revise them every few years and from the next revision will need to fit with the GPC Framework to be approved by the GMC.

The current standards show several gaps when evaluated by the WHO Education Checklist on infant feeding in the 2016 WBTi assessment of the UK.

Further information about standards for the different health professions can be found in Indicator 5 in Part 2 of the 2016 WBTi report.

 

Are you a doctor or trainee doctor?

If so, you might like to contact your specialty college asking for the infant feeding content of the curriculum to be improved.

 

 

PW Photo for WBTi MAINN presentation

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group, being the lead for Indicator 5, which is primarily about health professional training.

 

 

Cover image  www.stayathomemum.com.au via Szőreg hivatalos honlapja

 

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

By Kate Butler

Peer Supporter, West Hertfordshire Hospitals NHS Trust

As a mum embarking on a new breastfeeding journey with their baby, who could she turn to for support and advice that she can trust? How would she know that what she’s doing is “right”, that her baby’s behaviour is “normal”? Her midwife? GP? Obstetrician? Paediatrician? Health Visitor? Surely the advice and support you get from a qualified and trained healthcare professional can be trusted? The findings from the World Breastfeeding Trends Initiative (WBTi) UK 2016 Report (published November 2016) may surprise you.

Screen Shot 2017 wbti ind 5

Health professional training in the UK

The WBTi UK Report (WBTi UK 2016) was based on the WBTi toolkit developed by the International Baby Food Action Network (IBFAN) to help countries evaluate breastfeeding policies and practices in a systematic way. One area that the report focuses on is health professional training and subsequent impact on breastfeeding initiation and continuation rates across the UK. Worryingly the report highlights many gaps in the pre-registration training of some healthcare professions in the area of infant and young child feeding, particularly in the practical aspects of enabling mothers to initiate and continue breastfeeding. Following qualification, healthcare professionals are then expected to undertake in-service training in infant and young child feeding. The WBTi UK Report reveals that provision and uptake of these courses is limited.

So what does this mean? The very healthcare professionals our new mums ought to be able to trust to give them the right advice may not be the right source of information to enable a mum to breastfeed successfully. It’s through no fault of the healthcare professional, but rather the fault of how their initial training and ongoing training is structured. Therefore their advice and support might often based on personal experiences and/or out of date practices. Not only that but our healthcare professionals also have to work in line with their own NHS trust policies. These differ between trusts and are based not only on NICE guidelines but also considerations such as the skill set of staff and trust finances.

Breastfeeding rates are dropping off drastically after birth

The issue with all this? Published in November 2012, the 2010 Infant Feeding Survey showed that the initial breastfeeding rate in the U.K. was 81%. Across the UK, at three months, the number of mothers breastfeeding exclusively was 17% and at four months, it was 12% (Infant Feeding Survey 2010). However, exclusive breastfeeding at six months is only around 1%. But with the infant feeding survey being cancelled last year and lack of any national leadership or strategy in infant feeding, what hope do we have to improve these figures? What hope do we have of changing the way our health professionals are trained and how their on-going training is structured?

Some people might ask what’s wrong with these figures presented above. In doing so, they reflect a society, our society, in which formula feeding has become normalised. Where friends and family see formula as “just as good” as breastmilk and don’t have their own personal experiences of breastfeeding in order to support new mothers. The World Health Organisation recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. It is not within the scope of this post to explore the reasons behind this recommendation, more this article is to raise the issue that breastfeeding families have a dwindling pool of resources from which to obtain support during their breastfeeding journeys. Breastfeeding families are unlikely to be able to rely on advice from healthcare professionals, friends or family. That’s a lonely existence.

How can we change society and health care for new mothers and babies?

All is not lost though. The Unicef Baby Friendly Initiative, launched in the U.K. in 1995 (Unicef UK Baby Friendly Initiative 1995), is based on a global accreditation programme of UNICEF and the World Health Organisation. It is designed to support breastfeeding and parent infant relationships by working with public services to improve standards of care. Maternity units and community facilities have the option to become Baby Friendly accredited and in order to do so are required to provide training for its midwives and health visitors. While the majority of maternity units (91%) and health-visiting services (83%) have achieved or are working towards Baby Friendly status, the remainder have not commenced the process. Therefore new breastfeeding mums can hope that the situation is improving and healthcare professionals that have undergone Baby Friendly training will start to provide the trusted information that mums deserve. But this will require quite a culture shift change within the NHS and this will take time.

There is also lots to be done with the image of, and marketing of infant milk so that “normal infant feeding” moves away from formula and focusses on breastfeeding.

Our society needs educating and this will also need the support and investment from the government.

wbti-ind-5-gaps-recs.png

For further information on how mums can find the most appropriate support right now for their breastfeeding journey, visit http://www.lcgb.org/why-ibclc/whos-who-in-breastfeeding-support-and-lactation-in-the-uk/

 

Kate ButlerKate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 1 and 3) day and night. She trained as a breastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust. This post was first published on Kate’s blog, The Instinctive Parent (www.theinstictiveparent.org), which she started to share knowledge and help further educate parents to help them make properly informed decisions and choices in how they choose to parent.

 

References

Infant Feeding Survey 2010 [ONLINE] Available at: http://www.content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf [Accessed 30/13/16]

UNICEF Baby Friendly Initiative 1995 [ONLINE]  https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/ [Accessed 30/12/16]

WBTi UK Report 2016 [ONLINE] Available at: https://ukbreastfeedingtrends.files.wordpress.com/2016/12/wbti-uk-report-2016-part-1-11-12-16.pdf [Accessed 30/12/16]

World Health Organisation [ONLINE] Available at: http://www.who.int/topics/breastfeeding/en/ [Accessed 30/12/16]