A winner! Working together to support families

A winner!  Working together to support families

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

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

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

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

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

Winner blog
Credit: Eleanor Stock

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

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

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

Many congratulations Sue.

 

Cover photo credit: Paul Carter

PW Photo for WBTi MAINN presentation

 

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

Building Loving Relationships – Indicator 2: The Baby Friendly Initiative

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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 neuroscience evidence behind this is getting stronger every year. Sue Gerhardt explained that in her book Why Love Matters: How Affection Shapes a Baby’s Brain in 2004. Margot Sunderland explained the impact of this knowledge for parenting in 2006, in What Every Parent Needs to Know: The incredible effects of love, nurture and play on your child’s development.

Humans are very adaptable and babies respond to how they are treated, feeling secure and appreciated if they feel loved. Francesca Entwistle explains the importance of helping the baby develop secure attachment in the 2013 Evidence and rationale for the Unicef UK Baby Friendly Initiative standards.

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 a Baby 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.

 

References

  1. Gerhardt S (2004) Why Love Matters: How Affection Shapes a Baby’s Brain E.Sussex: Brunner-Routledge
  2. Sunderland M (2016) What Every Parent Needs to Know London: Dorling Kindersley
  3. Entwistle F (2013) Evidence and rationale for the Unicef UK Baby Friendly Initiative standards
  4. WBTi UK (2016) World Breastfeeding Trends Initiative UK Report 2016
  5. NICE (2006) Postnatal care up to 8 weeks after birth
  6. Unicef UK BFI Support for Parents 

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.

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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!)

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.