Leadership and collaboration – WBTi actions, Indicator 1

The World Breastfeeding Trends Initiative (WBTi) is a tool to help countries assess their implementation of key policies and programmes. These are drawn from the WHO Global Strategy for Infant and Young Child Feeding, which was adopted by the World Health Assembly, including the UK. The first UK World Breastfeeding Trends Initiative report was published in November 2016 and launched at the Houses of Parliament. Its ten policy and practice indicators address the extent to which there is an infrastructure in a country to support breastfeeding. The process brought together organisations and agencies working in maternal and infant health to monitor progress, identify gaps and generate joint recommendations for action to address those gaps.

What is Indicator 1 about?

Indicator 1 asks if there is a national infant feeding policy, supported by a government programme, with a coordinating mechanism such as a national infant feeding committee and coordinator. The UK assessment found:

key-gaps-and-recommendations

Women have autonomy over their own bodies so decide for themselves how to feed their babies but it can be very hard to carry a specific intention when the environment is unsupportive. It’s similar to the situation faced by someone who wants to avoid becoming overweight in an environment where tempting food is heavily advertised and easily available. A UK mother who wishes to breastfeed is likely to face barriers to achieving her goal throughout her breastfeeding journey.

National leadership

How can the situation be changed? An efficient way that can help to achieve consistency across the country is to have national leadership – a national coordinator with sufficient authority, a representative high level committee and a plan or strategy for change, as described in Indicator 1. Breastfeeding Policy Matters in 2015 highlighted the importance of this and the processes needed [1].

Scotland and Northern Ireland have national leadership in place but England does not. Yet the rhetoric is there. The 2016 government guidance from Public Health England, Health matters: giving every child the best start in life explains why the early years are so crucial [2]. It lists some of the health benefits and states that ‘creating the right environment to promote and support breastfeeding is crucial’. It highlights the importance of good maternal mental health so that the mother can be sensitive to the baby’s emotions and needs, helping the baby to develop secure attachment. Breastfeeding enhances a mother’s mental health while mothers who want to breastfeed but stop before they planned to are at greater risk of postnatal depression [3]. However, instead of increasing the support available to mothers, many support services were cut in 2016 because of reduced funds available. Such preventative services were not seen as a priority.

Freedom to choose how to feed one’s baby is valued in the UK and some people are concerned that mothers might feel pressured to breastfeed if it is encouraged. Ironically, advertising of follow on formula milks that might persuade mothers to switch from breastfeeding seems to cause less concern. Yet thousands of mothers make the often upsetting decision to stop breastfeeding before they wanted to. Where is the focus on these mothers and their suffering? Supporting breastfeeding is not about persuasion but about providing the infrastructure to enable them to continue; since some three quarters of mothers already opt to start breastfeeding, persuasion is irrelevant for them. If more mothers continued as long as they wished to, the proportion starting may well increase as expectant mothers will be less likely to hear negative messages.

Unicef UK’s widely endorsed Call to Action in 2016 included developing a national infant feeding strategy board in each nation [4]. What would a strategic plan encompass? The other WBTi indicators offer key points to include, such as Baby Friendly status being a universal goal, legislation in line with World Health Assembly recommendations, adequate protection for breastfeeding in the workplace, local support that is of high quality and integrated, and health professionals who have adequate training is supporting breastfeeding. If representatives of the four UK nations meet regularly they can also share ideas. Back in 2003 the World Health Organisation produced the Global Strategy for Infant and Young Child Feeding, which includes recommendations for national leadership, and this was followed in 2008 by the European Blueprint document [5,6]. Thus there are plenty of ideas available for developing a plan. The challenge is then implementation.

Alongside national leadership by governments, as described above, the breastfeeding support charities, relevant royal colleges and other similar professional bodies, campaigning organisations and interested individuals can both amplify calls for change and help to bring it about by collaborating. The infant feeding coalition meeting in June 2016, reinvigorating the idea of the former Breastfeeding Manifesto Coalition, demonstrated the keenness there is to work together [7]. Unicef UK’s Baby Friendly consultation on developing an inclusive Foundation provides an urgent opportunity to influence this – urgent because the deadline is 31 January 2017 [8].

Please read the consultation document and respond to the survey, thus helping to influence the future.

Also, check out our campaigning guidance for you to contact your MP and discuss issues highlighted in our report [9].

 

References

  1. McFadden A, Kenney-Muir N, Whitford H, Renfrew M (2015) Breastfeeding: Policy Matters London: Save the Children
    http://www.savethechildren.org.uk/resources/online-library/breastfeeding-policy-matters
  2. https://www.gov.uk/government/publications/health-matters-giving-every-child-the-best-start-in-life
  3. Brown A, Rance, Bennett P (2016) ‘Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties’ J Adv Nurs. 2016 Feb; 72(2): 273–282 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738467/
  4. Unicef UK (2016) Call to action for breastfeeding in the UK.
    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/
  5. WHO (2003) Global Strategy for Infant and Young Child Feeding.
    http://www.who.int/nutrition/topics/global_strategy/en/
  6. European Commission, Directorate Public Health and Risk Assessment (2008) Protection, Promotion and Support of Breastfeeding in Europe: A Blueprint for Action.
    http://www.aeped.es/sites/default/files/6-newblueprintprinter.pdf
  7. Breastfeeding Manifesto The Coalition
    http://www.breastfeedingmanifesto.org.uk/the_coalition.php
  8. Unicef UK Baby Friendly Initiative (2016) Creating a Baby Friendly Foundation: A Consultation Document
    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/foundation-consultation/
  9. Baby Milk Action (2017) Ask your MP to help enable mothers to breastfeed as long as they wish
    http://www.babymilkaction.org/wbtiuk-mps0117

The first World Breastfeeding Trends Initiative UK report is launched!

commonsThe launch at the House of Commons on 15 November of the first UK-wide World Breastfeeding Trends Initiative (WBTi) report on infant feeding policies and programmes gave some clues to which “stepping stones” along a family’s feeding journey are missing, where families are struggling to meet their own breastfeeding goals. While most mothers in the UK (around 80%) do set out to breastfeed, breastfeeding rates plummet within weeks until fewer than 1% of babies in the UK are exclusively breastfed at 6 months.

MPs from across the political spectrum attended the parliamentary launch, hosted by Alison Thewliss MP, along with guests from Unicef UK Baby Friendly Initiative (who provided a screening of their new short video on their Call to Action) health professional bodies, voluntary organisations, breastfeeding experts and academic researchers. Nearly 20 organisations were involved in developing the report’s recommendations for action.

These recommendations cover the family’s whole feeding journey, and range from the fundamental importance of full Unicef UK Baby Friendly accreditation of maternity settings, to health professional training and access to skilled breastfeeding support in the community, all the way to maternity protection and the provision of breastfeeding breaks in the workplace.

Dr Amy Brown gave a keynote address demonstrating how the structure of joined up policies and programmes forms essential underpinning to the cultural change that is badly needed in the UK.

Lack of political and national leadership, uneven health professional training, formula milk marketing, poor data collection and patchy community support for mothers were identified as gaps in UK policies and programmes. The degree of variability in the minimum standards of training in infant and young child feeding training among different health professions – even those working most closely with mothers and infants – was surprising.

Eyebrows were also raised at finding that, while there is guidance on the care of zoo and circus animals in case of emergency or disaster, there is no national guidance for the care of mothers and babies in an emergency situation. Formula-fed babies would be at particular risk if access to clean water and electricity were interrupted, and it is vital that national guidance be communicated to all local authorities and emergency responders.

Scotland and Northern Ireland were found to have strong strategies and national leadership in place, but England and Wales fell short.

nicola-blackwood
Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding, hands the new WBTi UK Report to Nicola Blackwood MP, the Minister for Public Health

The Unicef UK Baby Friendly Initiative, however, was singled out as a “world leader” in its commitment to children’s rights and for the excellence of its training programmes, both in hospital settings and in the NICU and community.

The report provides the first broad-based assessment of the UK’s implementation of ten key policies and programmes to support women and babies during their feeding journey. The policies are drawn from the World Health Organisation’s (WHO) Global Strategy for Infant and Young Child Feeding, which the UK has endorsed since 2003.

Some of the recommendations from the WBTi Core Group were actions that MPs could lead on, including the full implementation in UK law the International Code of Marketing of Breastmilk Substitutes as well as its full enforcement, and the protection of breaks for breastfeeding or expressing milk for mothers returning to work. Recent studies from Save the Children and WHO have also shown that political will is pivotal in driving forward improvement in key strategies across the board to support infant feeding.

One of the key drivers for the WBTi project in the UK is women’s choices. Although the majority of mothers in the UK want to breastfeed, many of them are struggling. The majority of these mothers wanted to breastfeed for longer but did not get the support they needed to meet their goals. Mothers who stop breastfeeding early due to unresolved problems have double the risk of postnatal depression.

The impact of infant feeding on child and maternal health is well documented, but the impact on the national economy is less well understood. In addition to costing the NHS more than £40 million for five common diseases alone, the long-term impact of the UK’s low breastfeeding rates on cognitive ability, human capital and productivity across the whole population is estimated to cost the economy at least 0.53% of gross national income.

Breastfeeding rates in the UK are lowest in its most-deprived communities, exacerbating health inequalities. Breastfeeding could prove to be a powerful means of combating inequality.

The environmental footprint of formula feeding amounts to nearly 22 kilograms of CO2, and 4700 litres of water, for every kilogram of milk powder produced. [12]

This first WBTi UK report provides a road map for policy makers and commissioners to target gaps in order to provide families with the support they need all the way through their feeding journey.

UN human rights bodies call for global action on breastfeeding

“Breastfeeding is a matter of human rights for both mothers and children,” say United Nations experts in an unprecedented joint statement today. Gaps identified by the UN mirror many of the gaps identified in the recently published World Breastfeeding Trends Initiative (WBTi) report on the state of breastfeeding in the UK, specifically:

  • Gaps in knowledge and skills among healthcare providers (WBTi Indicator 5)
  • Lack of access to accurate information or support (WBTi Indicators 6 and 7)
  • Family, community, and cultural practices and traditions that are not necessarily pro-breastfeeding (WBTi Indicator 7)
  • Limited or non-existent maternity protection in the workplace (WBTi Indicator 4)
  • Misleading marketing of breastmilk substitutes, and the lack of corporate accountability for the adverse consequences of such marketing practices (WBTi Indicator 3)
  • In cases where a woman cannot breastfeed or is not willing to do so, even after having been duly informed about the benefits of breastfeeding, access to good quality breast milk substitutes should be regulated and affordable, without condemnation or judgment (WBTi Indicators 3, 5, 7)
  • Investments to support breastfeeding are often marginal and far from adequate (WBTi Indicator 1)

Previous UN recommendations specific to the UK also included the recommendation to systematically collect data on infant and children’s food and diet (WBTi Indicator 10).

Human rights, and the UK’s obligations under the Convention of the Rights of the Child, underpin the WBTi UK Report, which states: “The mother and the baby are a dyad, and they have rights as a dyad; [neither trumps the other]. Each has explicit rights; both mother and baby require protection and support to make successful breastfeeding a reality.”

UN Special Rapporteurs on the Right to Food, Right to Health, the Working Group on Discrimination against Women in law and in practice, and the Committee on the Rights of the Child issued the statement through the Office of the United Nations High Commissioner for Human Rights today.

Taking it to the top – All Party Parliamentary Group on Infant Feeding

Do you want to help bring about real changes to breastfeeding in the UK? If so, read on, because every baby born in this country needs your help.

parliament-AO
Write to your MP to ensure that the All Party Parliamentary Group on infant feeding gets off the ground

If you’ve been a regular on the UK Breastfeeding blog then you’ll know all about the WBTi, and how it is identifying every aspect of breastfeeding policy and practice that is falling short and generating recommendations for how they can be improved.

But how can we make sure that those recommendations get put into practice? That’s where you come in – by influencing your MP and making sure they understand that this issue is important to you and to thousands of other families in their constituency.

In November, the WBTi steering group was delighted to be invited to the first-ever meeting of the All Party Parliamentary Group for Infant Feeding and Inequalities. This was organised by Alison Thewliss MP, who is as committed as we are to bringing about real improvements to infant health through breastfeeding.

All Party Parliamentary Groups are an excellent way to educate and inform interested MPs, who can then take questions to the floor of the House of Commons, help to push issues to the top of the political agenda, and hold government ministers to account. There are APPGs for every subject under the sun, but until now there has not been one dedicated to infant feeding, which affects every baby in this country!

At the meeting in November, Helen Gray and Clare Meynell gave an excellent presentation on the WBTi project, explaining why politicians should care about breastfeeding and how current practices result in so many mothers stopping breastfeeding much earlier than they wanted to.

But, by the time they had begun their first slide, Alison Thewliss was the only MP still in the room!

Clearly, we need more MPs to come along and listen to these important messages and to push for change on behalf of the mothers and babies in their constituencies and around the country.

So please spare 5 minutes to write to your MP to make sure they attend the next meeting (for MPs only), which is on Tuesday 19th January at 9.30am in Room W1 of Westminster Hall. Can you spare those few moments to help make a difference?

As MPs are more likely to respond to your own letter than to a standard letter, the best approach is to adapt the short letter below using your own words. If you can add information about your own experience and why you think the APPG is needed, that would have even more impact.

It is essential to include your name and address (and postcode) as MPs can only respond to requests from their own constituency.

Here’s what you need to do:

  1. Go to http://www.parliament.uk/mps-lords-and-offices/mps/
  2. Input your postcode
  3. Once you have identified who your local MP is, send them the following message.   Remember to include your full name and postcode.
  4. Please feel free to send us any response you receive from your MP.

Model letter (please adapt):

Dear [insert MP’s name]

As my local MP, I am writing to ask if you will represent me, and an interest close to my heart, in the House of Commons?

There have been efforts to establish an All Party Parliamentary Group on Infant Feeding & Inequalities in the UK Parliament. Although the group tried to form in November, I understand that there wasn’t enough cross-party representation, particularly from Conservative and Labour MPs. I was really disappointed to learn that this actually prohibited the group from getting off the ground.

However, I gather that there is another short meeting for MPs to establish the APPG on Tuesday 19th January at 9.30am in W1 of Westminster Hall.

Will you attend the meeting on my behalf and ensure this group gets off the ground? Will you add your name to join the group?

There are so many important discussions and campaigns which should be considered around the area of infant feeding, and I would be delighted if you, as my MP, could attend and help raise this issue on my behalf.

I look forward to hearing from you.

Yours sincerely,

Name
Address
Postcode (essential!)

World AIDS day: breastfeeding and HIV-positive mothers (Indicator 8 WBTi)

World-AIDS-Day-1-300x300Today is World Aids Day, so what better time to look at the issue of breastfeeding and HIV? Indicator 8 of the World Breastfeeding Trends initiative (WBTi) examines what policies countries have in place to protect HIV-positive mothers and their babies.

Read what the World Alliance for Breastfeeding Action has to say today on this important topic.

Thirty years since the first report appeared documenting transmission of the Human Immunodeficiency Virus (HIV) through breastfeeding, breastfeeding by HIV-Positive mothers has never been as safe as it is now in 2015. So long as several easily achievable conditions are fulfilled, the risk of transmission of the virus through mother’s milk can be reduced to almost zero (0-1%). [Read more…]

Supporting mothers to breastfeed – more on Indicators 5 & 6

baby-holding-hand

74 percent of mothers initiated breastfeeding
44 percent of mothers were still breastfeeding at 6–8 weeks

– Public Health Outcomes Framework (England) 2014/15

90 percent of women who stop breastfeeding in the first six weeks report giving up before they wanted to

– David Bull, Executive Director UNICEF UK

Most mothers in the UK want to breastfeed, yet most mothers stop breastfeeding before they want to. Why?

The fact is that while breastfeeding is natural, mothers need skilled support to be able to breastfeed. Yet many of the health professionals who work with mothers and babies do not have the knowledge or skills to help them.

Indicator 5 of the WBTi examines how well healthcare systems support breastfeeding. It looks in detail at the training of all health professionals who interact with mothers and babies – midwives, health visitors, GPs, paediatricians, lactation consultants and others – both before and after they qualify in their profession. You can see the full education checklist here.

It also asks whether health workers understand their responsibilities under the International Code of Marketing of Breast-milk Substitutes, and whether mothers and babies are able to stay together when one of them is sick.

Support for mothers comes from many sources, not just health professionals. It can come from family, friends, the community at large, and particularly breastfeeding peer-support groups. In the UK, these are run by organisations like the Association of Breastfeeding Mothers, Breastfeeding Network, La Leche League, NCT, as well as by the NHS itself. Mothers who have breastfed their own babies – and who have received training to provide breastfeeding support – are able to provide valuable help to new mothers.

In the UK, just 1 percent of babies are exclusively breastfed for the recommended six months. Common reasons that mothers give for stopping breastfeeding include:

  • finding breastfeeding painful
  • concerns about their milk supply
  • conflicting advice from health professionals
  • lack of support
LLL Mother support group
Trained support is needed at all levels, from peer supporters to lactation consultants. Click here for details of the different roles.

Peer supporters are “informed friends” who can help mothers understand what’s normal and help with many common breastfeeding concerns. They offer a compassionate and empathetic ear to new mothers.

This importance of this community-level support is recognised in Indicator 6 of the WBTi, which looks in detail at access to skilled mother support and community outreach. Good peer-support programmes can increase the length of time that mothers exclusively breastfeed their babies. In other words, they can help mothers who want to breastfeed to carry on for as long they choose.

Getting breastfeeding to work – more on Indicator 4 of the WBTi (Maternity Protection)

breastfeeding at workWhen the Industrial Revolution began, women started to go out to work in large numbers and breastfeeding began to decline, spurring the development of alternative ways of feeding babies. Yet, 200 years on, the question of how to combine breastfeeding and work still remains for women around the globe.

In the UK in 2015, MPs themselves are struggling to secure the right to breastfeed their babies in the chamber of the Houses of Parliament itself!

Once again, the Global Strategy on Infant and Young Child Feeding is clear that there are proven ways to make this work. It calls on governments to produce “imaginative legislation” to protect the breastfeeding rights of working women.

In particular, it recommends that legislation be compatible with the International Labor Organisation’s standards, which state that there should be an entitlement to:

  • health protection, job protection and non-discrimination for pregnant and breastfeeding workers
  • at least 14 weeks of paid maternity leave
  • one or more paid breastfeeding breaks or daily reduction of hours of work to breastfeed

as well as recommending that space be provided nearby for working mothers to breastfeed or express their milk.

There is also a recognition of the extra challenges faced by women who work in the “informal economy”, such as those in casual or freelance work, who don’t always have the same protections as other women.

Each year, the World Alliance for Breastfeeding Action produces a snapshot of the state of maternity protection around the world, which makes for some interesting comparisons.

WABA 2015
WABA 2015

Indicator 4 of the World Breastfeeding Trends initiative (WBTi) looks in much more detail at the laws and practices in each country to score them on the maternity protection they offer. Fathers are recognised too, because of their important role in nurturing babies and supporting breastfeeding, so the length of paternity leave is also included in the score.

How do you think the UK compares to other countries in protecting breastfeeding mothers at work? What was your experience of returning to work while breastfeeding? What would have made it easier?

More on Indicator 2 – Baby Friendly Care and Baby-Friendly Hospital Initiative

 

A baby is born and placed on his mother’s chest. His newborn reflexes kick in and he starts to crawl to her breast, calm and alert. This skin-to-skin contact triggers a surge in oxytocin – the so-called “mothering hormone” – and she responds by instinctively helping him to the breast. He latches on, and her milk flows.

breast crawl

When breastfeeding begins in this uninterrupted way, soon after birth, research shows that babies are more likely to breastfeed well, and mothers tend to continue to breastfeeding for longer.

Now compare this to the typical birth scenario, repeated in so many maternity hospitals:

A baby is born, and her cord is cut. The midwife announces “It’s a girl!” and then wipes the baby clean and wraps her up. Then she passes her to her mother. Then the baby is passed to her father. After a few minutes, the midwife unwraps the screaming baby and puts her on the scales and gives her a vitamin K injection. The baby is dressed and returned to her mother.

It was the recognition of this importance of this first hour that led to the development of the Ten Steps to Successful Breastfeeding – a set of guidelines that became the cornerstone of the Baby Friendly Hospital Initiative, which began in 1992.

The ten steps encompass the practices that are needed to support a “breastfeeding culture” in hospitals. They are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within half an hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
  7. Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

In order to call itself “Baby Friendly” a hospital or institution must also adhere to the WHO International Code of Marketing of Breast-milk Substitutes (more on this in the next blog on Indicator 3).

There is clear evidence for better outcomes for babies born in Baby Friendly hospitals – for example, a study in Scotland found that these babies are 28 percent more likely to be exclusively breastfed at 7 days old.

The meaning of Baby Friendly has also evolved over time, and in recent years it has moved beyond the ten steps. In the UK, as well as protecting breastfeeding, the Baby Friendly approach now helps mothers to begin a nurturing relationship with their baby – and this protection applies to all babies, whether or not they are breastfed.

The Baby Friendly Initiative has also moved beyond maternity hospitals. In the UK, it is now possible for university courses, health visitors, children’s centres, and neonatal units to become Baby Friendly accredited.

The World Breastfeeding Trends initiative (WBTi) assessment scores each country out of 5 based on how many Baby Friendly hospitals it has. It needs have more than 89 percent of its hospitals and maternity units accredited to gain the top rating.

The assessment also looks at the quality of the Baby Friendly programme – how comprehensive the training is, whether it monitors hospitals adequately, whether mothers’ experiences are taken into account – for another possible score of 5.

How do you think your local services would score?

More on Indicator 1 – National Policy, Programme and Coordination

Two weeks ago representatives of the key organisations involved in breastfeeding sat round a table to begin the first UK assessment using the World Breastfeeding Trends initiative tool.

In the first presentation, this graphic popped up, and a collective “ooh” and then an “aah” went round the room. You may be forgiven for wondering why it generated such a response – it doesn’t look particularly inspiring!

 

gear model
Credit: Pérez-Escamilla et al, Advances in Nutrition, Nov 2012

It’s because this picture demonstrates what happens when there is a strong national strategy on breastfeeding – and also what happens when there isn’t.

In the late 1990s, Brazil made a concerted effort to improve infant health through a drive to increase breastfeeding rates in the country. They put in place legislation to protect mothers, training for health professionals, breastfeeding promotion – along with the money to pay for it all. And they had a national coordinated breastfeeding strategy to make it happen.

At the same time, Mexico had no such national strategy. Half-hearted efforts were made in some areas, such as training for health professionals and public promotion of breastfeeding.

As the graphs show, Brazil was able to significantly increase breastfeeding rates over that period while in Mexico they stagnated.

Without a strong, national, coordinated breastfeeding strategy to drive things forward, everything else is just wheels turning in the wind.

That’s the metaphor – what does this all mean in practice for the UK?

Let’s imagine a mother, who has her baby in a Baby Friendly hospital [1] and breastfeeding gets off to a good start. But then she arrives home and starts to experience some problems. Her health visitor suggests she gives the baby some formula [2]. She’s seen some adverts on television and buys a particular brand of formula because it’s “closer to breastmilk” [3]. She lives in a rural area, and the nearest breastfeeding support group is 10 miles away and she doesn’t drive [4]. Her husband has seen the adverts too so he knows that “good dads do the night feeds” [5]. After a couple of weeks the baby is getting more and more formula and is breastfeeding less and less. Her husband suggests she’s given breastfeeding a good go but maybe she should stop now [7]. She had wanted to breastfeed for longer but she gives up [8].

  1. Indicator 2 of the WBTi asks – are babies born in Baby Friendly hospitals?
  2. Indicator 5 asks – do health professionals have adequate breastfeeding training?
  3. Indicator 3 asks – is the International Code of Marketing of Breastmilk Substitutes fully implemented?
  4. Indicator 6 asks– do all mothers have access to breastfeeding support in the community?
  5. (see Indicator 3)
  6. Indicator 7 asks – do parents have access to good information about breastfeeding and the risks of using formula?
  7. Indicator 12 asks – what percentage of babies are exclusively breastfed for the first six months?

Without this central cog (Indicator 1) driving all the other cogs (Indicators 2-10) things cannot move forward. This point is also made clear in a new report from Save the Children, which looked at breastfeeding policies and practices in six countries, including the UK.

The WHO Global Strategy on Infant and Young Child Health (which the UK is signed up to) states that each country should have:

  • a national breastfeeding policy
  • a plan of action based on that policy
  • that plan must be adequately funded
  • there needs to be a National Breastfeeding Committee
  • that committee must meet on a regular basis to review progress
  • that committee needs to link effectively with public health bodies
  • that committee must have a coordinator who communicates national policy at regional and local levels

Indicator 1 of the WBTi assessment asks whether a country has each of the above and gives a total score out of 10. How well do you think the UK as whole will score? How would the countries of the UK score individually? What do we need to do to improve that score? How can policies be turned into actions at a local level?

Post your comments below or on our Facebook page.

In the next blog post we will be talking about Indicator 2 – Baby Friendly care and Baby-Friendly Hospital Initiative and will be asking for your thoughts about how things can be improved.

What is the WBTi (and why does it matter)?

uk-map-smallDon’t be fooled by the uninspiring acronym – the WBTi is the most exciting thing to happen in breastfeeding in the UK for years!

The name stands for the World Breastfeeding Trends initiative and it was launched in 2005 by IBFAN, and the idea is to take a snapshot of breastfeeding in a country – the policies, practices and breastfeeding rates – and then (and this is the important bit) to create some recommended actions to improve things.

The assessment is then repeated 3 to 5 years later and a new set of recommendations are made. The idea is to create an upward trend of continuing improvements over time so that more babies are breastfed and for longer, improving infant and maternal health.

Governments don’t need to keep reinventing the wheel because we already know what works. Back in 2003 the WHO produced (and member countries signed up for) the excellent Global Strategy on Infant and Young Child Feeding, which outlines exactly what they need to do to improve breastfeeding rates. It says that:

· All governments should develop and implement a comprehensive policy on infant and young child feeding.
· All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months and ensure the timely introduction of adequate and safe complementary foods with continued breastfeeding up to two years or beyond.
· Health workers should be empowered to provide effective feeding counselling, and their services be extended in the community by trained lay or peer counsellors.
· Governments should review progress in national implementation of the International Code of Marketing of Breast-milk Substitutes, and consider new legislation or additional measures as needed to protect families from adverse commercial influences.
· Governments should enact imaginative legislation protecting the breastfeeding rights of working women and establishing means for its enforcement in accordance with international labour standards.

The WBTi breaks down the Global Strategy into 10 areas (indicators) and asks a short set of pertinent questions to see how the country is doing in each one. Where gaps are identified, recommendations are put forward to fill them.

Studies show that countries that have enacted the Global Strategy – in all 10 areas, not just a select few – have seen great improvements in their breastfeeding rates.

Over 100 countries are involved in the WBTi but this is the first time for the UK. The beauty of the process is that it is a collaborative effort between government officials and organisations involved in breastfeeding. If you are a mother, peer supporter, midwife, health visitor or lactation consultant – we’d also like to get your views. Over the coming days we’ll be posting a key question for each Indicator and will be asking what actions you think the WBTi should recommend in its report. So stay posted…