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.

Normalising breastfeeding in the community: peer support and professional training

Normalising breastfeeding in the community: peer support and professional training

 

The inspiring story of breastfeeding support in a London borough

What changed?

I have been reflecting recently on my experiences as a specialist health visitor and infant feeding lead in an outer London borough. The story began twelve years ago, in 2005, when there was a lack of confidence among mothers and staff about the reliability of breastfeeding, which was hidden and rarely seen in public. Over the next eight years, the initiation rate increased from 67% in 2005 to 86% in 2013, and the continuation rate at 6-8 weeks from 50% to 75% (52% breastfeeding exclusively). Breastfeeding became the way most mothers fed their babies. Gradually breastfeeding mothers became visible in cafes, shopping centres, supermarkets, streets, GP surgeries and children’s centres.   The Unicef Baby Friendly Initiative assessors stated in a report that, in this borough, breastfeeding had become ‘the normal way to feed babies’.

How did it happen?

How did this change come about in a relatively short period of time? It began in 2005, as a joint project between the NHS and NCT, which secured local health authority funding to set up a breastfeeding support group in an area of social deprivation with low breastfeeding rates.   This group became very well attended and was facilitated effectively by two NCT breastfeeding counsellors and a health visitor. A similar group was set up in another part of the borough and was run by me, together with other health visitor colleagues. Many of the mothers were very grateful for the support they received in the groups and some of these women expressed the wish to train as volunteer peer supporters, so that they could help other mothers enjoy breastfeeding their babies, as they had. Two training courses were organised and, that year, 20 peer supporters were trained, registered by the voluntary services of the local Primary Care Trust (PCT), and started working in breastfeeding support groups, in the children’s centres and health service clinics. The news of the training spread rapidly and soon there was a waiting list of mothers wishing to train!

Reaching out

The numbers of groups expanded to be easily accessible to mothers across the borough, running every weekday, in children’s centres, cafes, and health premises. The new peer supporters brought fantastic skills with them, one setting up a website, another a mothers’ Facebook page and another designing our leaflets and posters!   One had breastfed twins and set up antenatal sessions for parents expecting multiple births plus a weekly support group for mothers with twins and more. She also visited these mothers at home and lent them cushions, which helped them tandem feed. Soon the exclusive breastfeeding of twins and even triplets became common. A group of Somali mothers was trained and an outreach peer supporter started seeing Somali pregnant women in the hospital.   A teenage ‘buddy’ scheme was also started by some of the younger peer supporters, working with the specialist midwife and running antenatal sessions and postnatal support for young mothers. Two peer support co-ordinators were employed to job-share this important role and to deal with concerns of the peer supporters as well as helping with training and supervision. Over the next ten years, more than 200 voluntary peer supporters were trained in the borough and the training continues until the present day.

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Unicef UK/Mead

Public Health prioritises breastfeeding

In 2006, under the government scheme of “Every Child Matters’, the Director of Public Health made breastfeeding the top priority for all children in the borough with accompanying ‘stretch targets’ and funding.

London services are monitored through the ‘Good Food for London’ report on their Baby Friendly status, with details on how each borough is achieving and sustaining the Baby Friendly standards

Baby Friendly accreditation

In 2012 Unicef UK Baby Friendly Initiative carried out a major review that resulted in new, more holistic, child rights-based standards relating to the care of babies, their mothers and families, with a strong emphasis on building responsive loving relationships. A new award has also been introduced to encourage a focus on sustainability after the accreditation.

In parallel with the rapidly increasing numbers of peer supporters, the journey in the borough to become Unicef Baby Friendly (BFI) accredited started and professional training in the community and local hospital began with the two health trusts starting their journeys jointly. A model of multidisciplinary training of midwives, maternity assistants, neonatal nurses, nursery nurses and health visitors began initially with BFI-facilitated training. This enabled hospital and community staff not only to improve their breastfeeding knowledge and skills, but also each other’s roles, co-operate on work challenges and break down any barriers which may have existed previously. Communication skills and talking about their own life experiences, in order to gain an understanding of their impact, especially with infant feeding, became an important part of the in-service training. Interactive group exercises on different breastfeeding situations became an integral part of the training, emphasising the importance of empathy and seeing the problems through the eyes of the mothers.   A neonatal breastfeeding co-ordinator was appointed and started training all the neonatal staff in the hospital, including the doctors, and by 2014, Unicef had awarded both the community and hospital trusts their Baby Friendly accreditation.

Peer support

Peer supporters were also employed by an adjacent borough to work in the hospital, supporting mothers on the postnatal ward, one even working all night once a week; others taught hand expressing and colostrum harvesting in the antenatal clinic, especially for mothers with diabetes.

DSC_1339 copy
Unicef UK/Mead

Achieving cultural change

Within ten years, breastfeeding became a normal and accepted way to feed babies in the borough. Mothers, fathers, and grandmothers-to-be came in large numbers to the twice monthly breastfeeding workshops, gaining confidence and information, with the expectation of the support that would be available to them to help them achieve their goals. A mother said ‘the session expelled myths and I now know how milk is made and transferred to my baby. I am looking forward to skin-to-skin contact after the birth and will follow my baby’s instincts’. Parents meet peer supporters in the support groups, at toddler groups, in the school grounds, in cafes, at sports events, in churches, temples, synagogues and mosques.   Peer supporters live and work in the community and spread their knowledge through everyone they meet. Even when they move away from peer support, they take their embodied knowledge into the work place and support their colleagues there.   Cultural change can happen through peer support, resulting in breastfeeding becoming embedded in a community. This change is sustainable over time and in future generations, as it spreads through different social groups. Voluntary peer support and informed, professional support is capable of changing attitudes and behaviour within a community to make breastfeeding ‘normal’ in a very cost-effective way. Commissioners need to be aware of how health outcomes can be improved through breastfeeding, for mothers and children, in the immediate and long-term, and it is essential to protect and increase future funding for midwives, health visitors and peer supporters, in order that vital programmes like this can continue.

The World Breastfeeding Trends Initiative UK report in 2016 affirmed the borough’s actions as it recommends in Indicator 6 (Community-based support) that ‘commissioners ensure that there is a range of postnatal services that include both health professional and voluntary-sector breastfeeding support to meet local needs and provide clear access to specialist support’ and that they ‘maintain the full range of health visiting services, and maintain health visiting as a universal service’. Indeed, the borough’s transformation in breastfeeding support is used as a case study in Part 2 of the report.

One mother with an eight-month old baby told me:

‘I so much wanted to breastfeed, but found it incredibly hard at the beginning. I was convinced that it wouldn’t work and it was such a lonely feeling, like I was failing where other mothers were succeeding. Getting support made all the difference- having someone to listen to me and give me confidence to carry on. Suddenly, I didn’t feel alone any more and it changed everything. I know that I would not be breastfeeding now if I hadn’t got help in those crucial first weeks.’

What one London borough has achieved shows what is possible. Unicef UK Baby Friendly Initiative’s Call to Action spells out four key actions to create a supportive, enabling environment for women who want to breastfeed, ranging from national strategy and legal protection from harmful commercial practices to the local implementation of evidence-based practices, as described

 

Photo credits: Unicef UK/Mead

A Spiro photo

 

Dr Alison Spiro

Specialist Health Visitor

Member of the WBTi Steering Group

Action List – How YOU can make a difference to mothers and babies in the UK

What difference could you make?

Join our campaign to bring the findings and the recommendations from the WBTi assessment to your MP!

We’ve produced a one-page Report Card on the whole UK with the top recommendation for each of ten policy and programme areas. There are also individual report cards for England, Northern Ireland, Scotland and Wales. Further gaps and recommendations can be found in the full Report.

Our campaign page has all the steps and links needed to contact your MPs and national assembly members, along with tips on composing a message.

#TopTip1: The most powerful way to get your message across to your MP is to meet them in person. And hand them a copy of the WBTi Report Card along with your own top priority.

We also have tips for contacting them by letter or email.

#TopTip2: The most effective way to convince them of your message is to connect it to your own local community

  • What are the gaps in support for breastfeeding mothers in your area?
  • Are there examples of good practice to celebrate in your area?
  • Can you get a photo opportunity for your MP with local mothers and babies? (Babies are always a winner!)

Don’t forget to inform us when you contact your MP, and when you get a response!

Do sign up to our supporters’ mailing list.

Thank you for your support.

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

Open Letter in response to Lancet series on breastfeeding

Lancet coverIt’s been a busy week for the WBTi UK team.

Following The Lancet’s series on breastfeeding, published on 30 January, reports in the press largely focused on Britain having “the worst breastfeeding rates in the world”. We knew that wasn’t quite right – rates of starting breastfeeding are relatively high, but they drop off rapidly. Yet, at the same time, the UK is experiencing profound cuts to breastfeeding support services – one of the very things needed to get those breastfeeding rates rising.

So, we organised an Open Letter calling on all four governments of the UK to safeguard public health budgets and end those cuts. The letter also outlines the series of measures needed to improve breastfeeding – rates, duration, and experiences. We are delighted that the letter has been signed by midwives, health visitors, lactation consultants, infant feeding leads, GPs, paediatricians, breastfeeding counsellors, peer supporters, university researchers, and others working in the area of baby feeding and health.

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!)

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!

 

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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.