Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life

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

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

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

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

 

Breastfeeding: cornerstone of the First 1000 Days

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

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

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

 

Breastfeeding: more than just food

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

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

 

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

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

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

 

What does the future hold?

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

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

 

 

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

 

 

 

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

Protecting Infants and Young Children: WBTi Forum on Planning for Emergencies in the UK

Protecting Infants and Young Children: WBTi Forum on Planning for Emergencies in the UK

On Tuesday 28th, Dr Ruth Stirton of the University of Sussex joined forces with the World Breastfeeding Trends Initiative (WBTi) Steering Group, along with Marie McGrath of the Emergency Nutrition Network, to present on the topic of safe provision for feeding infants and young children in emergencies in the UK. This WBTi UK first anniversary forum was hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament.

Participants included infant feeding specialists and policy makers, emergency planners, international academics, and third sector organisations such as UNICEF UK Baby Friendly Initiative and Save the Children.
We heard from Clare Meynell and Helen Gray (WBTi UK) on the findings, gaps and recommendations from the WBTi UK report surrounding infant feeding in emergencies. Ruth Stirton presented on the legal and regulatory framework and the minimal place of infants and young children in the current framework. Marie McGrath then described the recently published 2017 Operational Guidance on Infant Feeding in Emergencies, and explored how it might be adapted to the UK context.

WBTI Forum 2017 discussion mapping LCGB Faulkner

The audience engaged in lively group discussion, considering:

  • the issues in the immediate response phase
  • how best to support formula feeding families in emergency situations
  • mapping the existing local capabilities that emergency plans could call upon
  • issues surrounding communication with the public and front line responders about how best to support infants and young children in emergencies
  • the wider policy framework and how best to ensure that infants and young children are specifically provided for
  • issues for the longer term recovery phase after the emergency

A report will be published in 2018 making recommendations for improvements. If you would like to contribute written comments to the report, please look at the presentations and group materials and send comments by email to Ruth Stirton r.stirton@sussex.ac.uk

WBTi Forum 2017 and GPIFN THewliss
WBTI Steering Group Helen Gray, Patricia Wise, Alison Spiro, (Clare Meynell in absentia), with host Alison Thewliss MP, and Dr Louise Santhamum and Dr Rosemary Marsh (GP Infant Feeding Network) and Dr Ruth Stirton (University of Sussex Law School)

Ruth Stirton, University of Sussex

Helen Gray, WBTi UK

Clare Meynell, WBTi UK

Alison Spiro, WBTi UK

Patricia Wise, WBTi UK

 

References and resources:

Presentations and group discussion materials

Storify with tweets from the event at Parliament:

Operational Guidance on Infant Feeding in Emergencies 

World Health Assembly Resolution 63/23 

WBTi UK report

 

Blog posts:
Overview of WBTi Indicator 9, Infant Feeding in Emergencies

Our Guest blog on UNICEF UK Baby Friendly 

Safely Fed UK Facebook page and social media campaign 

 

 

WBTi UK report – first anniversary celebration – a Forum

WBTi UK report – first anniversary celebration – a Forum

It’s a year since the first WBTi UK report was launched in November 2016 at the Houses of Parliament, giving the first snapshot of the state of breastfeeding support in the UK across the indicators. The report has been used as a basis to advocate for improvements in legislation, in strategy, and in training. It has been shared with MPs, with government ministers, as well as shared widely throughout the breastfeeding community through our website.

During the year, we have hosted monthly blogs on our website, focussing on the various indicators in turn. We have an active social media planning group that publicises the WBTi findings, our blog and activities. The team have also produced numerous journal articles, posters and conference presentations in the UK and beyond. Our talented team of volunteers have also developed a video  about our findings. We continue to contribute to ongoing consultations about improving health professional training in infant feeding

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Policy Forum: Protecting Infants in UK Planning for Emergencies

On November 28th 2017, we will be holding a policy forum at the Houses of Parliament, in collaboration with Ruth Stirton of the University of Sussex and hosted by Alison Thewliss MP: “Protecting Infants in UK Planning for Emergencies.” This event both celebrates the anniversary of the report and aims to achieve change in Indicator 9, “Infant and young child feeding during emergencies,” which is the policy with the lowest scores across the UK. At present, there are no UK-wide or national strategies addressing the issue and it is not explicitly mentioned in local planning.

Unicef UK Baby Friendly Initiative

The jewel in the crown of breastfeeding support in the UK is the Unicef Baby Friendly Initiative. All maternity units in Scotland and Northern Ireland are accredited and most in England and Wales are working towards it. Many community NHS trusts and boards are also on the ladder towards accreditation. Some neonatal units, university midwifery and health visiting/specialist community public health nursing courses are also involved. All are helping to raise the standards of infant support provided by these health professionals.

Cuts to breastfeeding support around the country

Sadly, the WBTi assessment found that cuts in infant feeding lead posts, drop-ins and peer support programmes as well as specialist services were occurring and this has continued. For example, Blackpool’s service was decommissioned in June and the service in Kent is under threat. It appears that there is an assumption by some commissioners that health visitors can provide a sufficient service. Health visitors do have a responsibility to provide effective support with infant feeding, and should do so at statutory visits and other contacts. However, a significant number of mothers also require specialist support, which needs time as well as skill, and all mothers can benefit considerably from the social support that trained peer supporters can provide. It seems it is not well understood how challenging some breastfeeding situations are and the amount of training required to help effectively in those situations.

Ask YOUR MP to join the Call to Action!

These cuts in services for women and babies are likely to have a negative impact on Baby Friendly accreditations. Unicef UK is holding an event for MPs at the Houses of Parliament on December 5th, asking them to pledge their support for breastfeeding. How would it be if every current MP were contacted? Are you willing to contact your MP?

 

 

 

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

A winner! Working together to support families

A winner!  Working together to support families

If you attended the 2015 Unicef UK Baby Friendly conference you may have noticed, or taken part, in the informal World Breastfeeding Trends Initiative (WBTi) competition to guess the final assessment score. Sue Ashfield is the winner as her estimate was closest to the actual score of 50.5 out of 100 for Indicators 1-10.

The score is a measure of how the UK is performing against the implementation of key policies and programmes to support mothers who want to breastfeed and the healthcare professionals who help them.

Sue is the lead and Specialist Health Visitor (Infant Nutrition) of First Community Health and Care in East Surrey. Sue is a winner in a much bigger way than the WBTi competition because her community team was reaccredited by Baby Friendly earlier this year and they also supported 10 local children centres in achieving full BFI accreditation in one year. The formal presentation of the award was on March 14th. Sue pays tribute to the hard work of her colleagues for the achievement but it also reflects her commitment and leadership.  Read more here.

Her team is a brilliant example of what the WBTi UK report recommends for Indicator 6 (community-based support). There is close, integrated working between 0-19 public health team, breastfeeding counsellors, peer supporters and children centres at the three Baby Cafes, which have been runnning for 10 years.

Practitioners from the 0-19 team work at the Baby Cafes on a rota basis, alongside the breastfeeding counsellor. When they see mothers at home or at drop-in clinics they encourage them to attend the Baby Cafes for social support or more specialised support or just to chat to one of the peer supporters. The breastfeeding counsellors at the Baby Cafes have now trained over 200 peer supporters and this has increased the breastfeeding knowledge and skills within the local community.

Winner blog
Credit: Eleanor Stock

The photo above shows Sue holding the Baby Friendly Initiative (BFI) accreditation plaque along with some members of the 0-19 team, some senior managers and their BFI Guardian. Since April, all three community services in Surrey have come together as Children and Family Health Surrey to deliver children’s services.

Sue comments that she found particularly useful the information in the WBTi report about interventions and investment offered in the past and also Report Cards and the summary gaps and recommendations. She will use the findings in the report to inform local commissioners and disseminate information to staff and other stakeholders.

An integrated service like this is needed in all areas, yet in so many places services are being cut, particularly peer support programmes and breastfeeding support drop-ins.

Many congratulations Sue.

 

Cover photo credit: Paul Carter

PW Photo for WBTi MAINN presentation

 

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

The amazing story of West Herts Breastfeeders

The amazing story of West Herts Breastfeeders

I received too much breastfeeding support – said no mother ever!

Your vibe attracts your tribe

#BFfriend17

I did not realise the power of that statement until I became a breastfeeding mother. Nursing my child became a life philosophy, a kaleidoscope lens, spinning my family, bringing like-minded people together and painting the colours of my parenting. About 3 years ago there was a story all over the media about a mother who was asked to leave a certain store because she chose to breastfeed openly in there. Breastfeeding mothers on social media were furious. Simultaneous protests in branches of that store were set up and I organised one of them. Some great friendships were born out of that movement. This simple act sparked a discussion about the needs of the breastfeeding community. This could not end there.

For Olgas community support

Protest was the beginning.

We wanted to make sure mothers knew their rights. We wanted to educate, empower and bring families together. Slowly a community has been born. It kicked off with a picnic to celebrate National Breastfeeding Week, followed by some meetings in a children’s centre. A year passed and having my third baby gave me a huge boost of confidence to put my peer support training into practice. After another season of outdoor gatherings, I hired a room in a community centre. One of the mothers got inspired and started another group in a nearby town, followed by more of them. All were hosted by mothers who breastfed their own babies and felt they could support others and offer a safe space for befriending.

A few months later we decided to organise peer support training. The services offered by the local health visiting team and children’s centres were not sufficient at the time. And there definitely was a niche for peer support. Having experienced first hand how unique it is having another mother support you through hardships, I fell in love with the idea. We approached other service providers using the Maternity Services Liaison Committee. At first, not many believed in us but, as time passed, we proved to be worthy of their trust. We asked for help from generous friends, who delivered the training at no charge, and we found a venue for free thanks to a children’s centre manager. But mostly we were incredibly lucky to recruit, through our groups, amazing women who agreed to offer their time to volunteer in the local hospital.

We decided it was the right time to create something more formal. West Herts Breastfeeders community came to life thanks to the many mothers who nurtured it deeply. This ‘baby’ was very lucky. It was a firstborn who had all the attention and support from local Infant Feeding teams and the Children’s Services department of Hertfordshire County Council. We came a long way. It took us just over a year to train 18 peer supporters, establish six monthly regular meetings in the West Herts area, recruit nearly 550 members to our virtual community to provide them with 24 hour support through Facebook and all that with no official funding. We are all volunteers. You could be too!

Be the Change

As mentioned in the Open Letter of February 2016, organised by the WBTi UK team, a woman’s ability to breastfeed is often determined by the support she receives and the environment in which she lives. While we cannot change everything, we try to help normalise breastfeeding out and about. We also play an important role in normalising feeding older babies and encouraging mothers to carry on, while often dealing with family pressures to wean or the challenges of returning to work. Most children’s centres provide breastfeeding support only in groups for babies under one year, and health visitors do not see mothers as often as they would like. Not having a healthcare professional label also changes the balance of the dialogue and helps mothers to open up.

Together we can do more

What we strive for in the face of recent cuts and challenges is the partnership between all local services. Our success is owed largely to the power of networking. We can see where we are needed most and what else can be done to make sure no woman is left alone at any stage of her nursing journey. You can help to be part of the change, by simply sharing your thoughts with your newly elected MP. Use the WBTi sample email to tell them what breastfeeding mothers need in your local area. Ask them to use their influence on the Local Authority to showcase the importance of breastfeeding to public health and safeguard their budget for health visiting and breastfeeding support.

Your voice matters.

 

 

Please sign up HERE to receive email updates on our WBTi work!

Olga Danyluk-Singh photo for community support

Bio

Olga Danyluk –Singh, Chairperson, West Herts Breastfeeders

NHS Breastfeeding Peer Supporter and mother of three breastfed children

Enthusiastic lactivist!

One key question before the election?

One key question before the election?
By Emma Pickett
Chair, Association of  Breastfeeding Mothers

I imagine like me you have watched some pre-election television debates in the last few weeks. It’s easy to start daydreaming and picture yourself in that audience putting our leaders on the spot. If you had the opportunity to ask that one key question of the main political leaders and get it broadcast on national television, what would you choose to focus on?

For many of us who have been involved in the WBTi project, it’s a no-brainer: What would they do to improve the situation around breastfeeding and infant feeding in the UK?

Except you’ve only got one sentence to outline a situation that took WBTi more than 70 pages.

You’re talking about health care professional training and the international code of marketing of breastmilk substitutes, national leadership, maternity protection in the workplace, data collection. Plus, you are talking to people who don’t even realise there is a problem in the first place or have little understanding of the complexity. There are few soundbites developed for an issue that affects families across the UK and for a situation that many of us see is in crisis.

Breastfeeding is a public health imperative

Politicians are nervous to touch on an issue which they often see as being about individual choice rather than a ‘collective societal responsibility’, as Dr Nigel Rollins described breastfeeding in The Lancet report last year. But when you look at the reality of what is happening in the UK, there is no need to fear having a conversation about breastfeeding. It’s not controversial to be disappointed to hear that 86% of women who stopped breastfeeding in the first two weeks would have liked to have continued for longer. Or 63% of those who stopped before 10 months. It’s especially not controversial when you learn more about the impact of breastfeeding on maternal mental health and its role in reducing inequality.

Which politicians wouldn’t be interested in something UNICEF describe as ‘a natural safety net against the worst effects of poverty’ or a factor shown to have a significant impact on the national economy? We can read through the manifestos of the political parties and see references to obesity and child health and mental health and find ourselves exasperated that infant feeding hardly gets a mention. However, it IS there. In every discussion about fighting inequality or improving chances or protecting the environment or stimulating the economy or supporting parents or focusing on mental health. They just don’t KNOW it’s there.

It is our duty to get this message across.

We may not be sitting in a Question Time audience but we meet our candidates. We have their emails and Twitter accounts. We can speak to them once they are sitting MPs.

Use the WBTi sample email and add your own messages to all the candidates in your own area. What are the gaps in breastfeeding services in YOUR area? Tell YOUR story.

It’s about emphasising why funding matters and why breastfeeding support in the community isn’t a nice optional extra. We are hearing about the huge variation in community-based support across the UK. Cuts to services in England are particularly a worry. Parents are finding groups closing, peer support services disappearing and when they are struggling with more complex problems, there is often nowhere to go. Specialist positions are either being lost or the integration of services means signposting to more qualified breastfeeding specialists such as IBCLCs is confused.

There is no point sighing about the crisis in infant feeding unless we also act. No point in putting a nice meme on your social media account, without also making sure you take 5 minutes to educate a politician who may simply not understand the basics. No point having anger towards our leaders if they are uninformed. WE are the ones who can do the informing: the new parents, the breastfeeding organisations, the healthcare professionals. It’s all too easy for social media to become a place where we all just talk to people who already agree with us. It has never been easier in history for us to directly contact our candidates and politicians. They won’t understand these issues unless we educate them. It starts with one email or one tweet or one conversation.

Have you done it?

For more information about cuts to community breastfeeding services, see WBTi’s 2016 briefing

See the Open Letter signed by dozens of royal colleges, health professional bodies, researchers and voluntary organisations

Responses from political parties

Baby Milk Action have asked all the major political parties about their breastfeeding and infant feeding related policies. You can read their letter, which refers to the WBTi UK report, and the responses they have received here.

 

Photo credit: Sophie Burrows

Emma PickettEmma Pickett IBCLC is Chair of the Association of Breastfeeding Mothers. She is also an ABM breastfeeding counsellor (www.abm.me.uk) in North London. She has supported breastfeeding mums in Haringey as a volunteer since 2008.

Emma is the author of You’ve Got It In You: A Positive Guide To Breastfeeding  and blogs at Emma Pickett Breastfeeding Support