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The second assessment is now underway. It will run throughout this year and be launched in 2024.
What is the WBTi?
The World Breastfeeding Trends Initiative (WBTi) is a human rights-based, evidence-informed, collaborative and participatory national assessment of the implementation of key policies and programmes from the WHO’s Global Strategy for Infant and Young Child Feeding, and is a project developed by the International Baby Food Action Network (IBFAN). Currently nearly 100 countries are taking part.
WBTIIndicators of Policy and Programmes
National policy, programme, and coordination
Baby Friendly Initiative
International Code of Marketing of Breastmilk Substitutes
Maternity protection in the workplace
Health professional training
Community based support
Information support and communications
Infant feeding and HIV
Infant and young child feeding during emergencies
Monitoring and evaluation
In 2016, the UK scored just 50.5/ 100 on these ten key policy indicators.
WBTi brings together the main government agencies, health professional bodies, and civil society organisations involved in infant and maternal health and nutrition in each country to work together to collect information, identify gaps and generate recommendations for action. This Core Group must be free of conflicts of interest from the baby feeding industry (all infant or toddler milks up to 3 years, baby foods, bottles or teats).
The Global Breastfeeding Collective, led by WHO and UNICEF, recommend that the WBTi process be repeated, at least every 5 years, to monitor implementation of key policies, and include this in each country’s score on the Global Breastfeeding Scorecard.
Many volunteers contributed to the success of the first UK WBTI assessment in 2016.
Your contribution is valuable, large or small:
Freedom of Information requests.
Mapping infant feeding training standards
Auditing numbers of breastfeeding counsellors and peer supporters
Virtual assistant skills
You can find the main WBTi UK 2016 Report Part 1, and Part 2 with supplementary material, with Report Cards for each of the four nations and for the UK overall, here: https://ukbreastfeeding.org/wbtiuk2016/
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.
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
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.
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.
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.
[2021 update: See also the infographic series from the Infant Feeding in Emergencies Core Group on managing appropriate infant feeding interventions during emergencies, including Preventing and managing inappropriate donations during emergencies: https://www.ennonline.net/ifecoregroupinfographicseries]
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.
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.
Will you be my Valentine? Love matters to all of us.
There will be millions of Valentine celebrations taking place all over the nation on 14 February. Hearts, red roses, chocolates, gifts, expensive treats and marriage proposals will be exchanged to signal love on that day.
But… babies are born every day. People embrace each other every day. Loving relationships begin every day! Lovers kiss every day and babies are universally loved.
Affection and love shape our brains from that first kiss on day one and continually along our life course. They create that extraordinary mother and baby bond, stimulate social interactions and enable long-lasting friendships. Early loving relationships are nurtured and supported by our families, friends, health professionals and wider society. Being held closely, and responded to sensitively, by those who love you more than anyone else, has far-reaching effects on long-term emotional security and health.
The Unicef UK Baby Friendly Initiative programme has been universal in changing attitudes and encouraging best practice over the last 20 years in the UK through robust accreditation. It delivers the minimum basic standards required to support new parents – no matter how they feed their babies. It aims to create the best environment for the start of every baby’s life but is not yet mandatory for all maternity facilities in England and Wales (see WBTi UK 2016 report – Part 1, Indicator 2).
The question is why isn’t it mandatory as recommended by NICE (the National Institute for Health and Care Excellence) 11 years ago? The guidance states: “All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.”
The governments of Scotland and Northern Ireland have a funded national strategy with a coordinator supporting all maternal and infant health professionals, and 100% of maternity units in Scotland and Northern Ireland are accredited, with community facilities aiming to achieve the same.
This cascade of national to local support aims to ensure all parents receive the best possible information, free from the undermining effects of commercial persuasion, with practical support to be enabled to make healthy decisions for themselves, which helps fulfil the government’s health message.
Families would benefit if England and Wales followed the best practice example of their neighbours.
What does Baby Friendly care mean for parents? Relevant information from pregnancy onwards, skin-to-skin contact immediately after birth as standard practice, and practical help with learning how to feed your baby. For more details, see You can expect the following standards of care from aBaby Friendly hospital. If all expectant parents knew about the standards, they could help press for them to be implemented universally.
The WBTi UK report points out gaps and provides recommendations to overcome the many barriers that women face in their daily lives, journeying from pregnancy through birth, the postnatal months, back to work and beyond, living in their own communities. See Part 1, Indicator 2 of the report for more information, with further details in Part 2.
Implementing the WBTi recommendations would contribute to the provision of the optimal conditions all parents need to begin raising their child in a loving and supportive society.
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!
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:
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.
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 .
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 . 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 . 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 . 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 . 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 .
The 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.
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.
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.
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.
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.
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.
Once you have identified who your local MP is, send them the following message. Remember to include your full name and postcode.
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.
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!
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  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 . She’s seen some adverts on television and buys a particular brand of formula because it’s “closer to breastmilk” . She lives in a rural area, and the nearest breastfeeding support group is 10 miles away and she doesn’t drive . Her husband has seen the adverts too so he knows that “good dads do the night feeds” . 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 . She had wanted to breastfeed for longer but she gives up .
Indicator 2 of the WBTi asks – are babies born in Baby Friendly hospitals?
Indicator 5 asks – do health professionals have adequate breastfeeding training?
Indicator 3 asks – is the International Code of Marketing of Breastmilk Substitutes fully implemented?
Indicator 6 asks– do all mothers have access to breastfeeding support in the community?
(see Indicator 3)
Indicator 7 asks – do parents have access to good information about breastfeeding and the risks of using formula?
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.
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?