Tag: World Breastfeeding Week

The Baby Friendly Initiative – a Global Building Block to Support Breastfeeding #WBW2022

The Baby Friendly Initiative – a Global Building Block to Support Breastfeeding #WBW2022

WHO and UNICEF launched the Baby Friendly Initiative (BFHI) over thirty years ago; three years later, UNICEF UK Baby Friendly Initiative (BFI) was born. The original BFHI framework of Ten Steps was created to improve maternity and hospital practices that undermined breastfeeding, such as separating mothers and their newborns or routine formula supplements, as well as implementing the International Code of Breastmilk Substitutes in maternity settings, in order to eliminate conflicts of interest with the baby feeding industry (companies that manufacture or distribute infant formula/milks, baby foods, feeding bottles and teats) such as promotion of formula milk in healthcare settings, or direct contact by companies with parents.

The Baby Friendly Initiative has changed the face of maternity practices and midwifery training in the UK – breastfeeding initiation has gone up about 20% since UNICEF UK BFI was founded in 1994. In this country, BFI has grown beyond maternity settings to create standards for infant feeding support programmes in the community and for universities training the next generation of midwives and health visitors. The BFI standards were revised in 2012, based upon the twin pillars of breastfeeding and the UN Convention on the Rights of the Child.

BFI standards in the community call for the integration of several levels of breastfeeding care:

  • Routine care: all staff in the universal services (midwives, health visitors, support workers etc) are trained to BFI standard with sound, evidence-based, basic training in supporting breastfeeding and responsive infant feeding. 
  • Additional services: every area should have additional support available, such as trained, skilled peer supporters who can act as an “informed friend” for new mothers, and a network of local peer support groups where new parents can find social support alongside help with everyday breastfeeding issues.
  • Specialist services: every area should also have a referral pathway for specialist care for more complex breastfeeding problems; breastfeeding specialists should have extensive experience or training such as the IBCLC qualification or a recognised breastfeeding counsellor/supporter credential, and either be a registered health professional themselves, or co-lead the specialist service with a registered health professional.
WBTi poster on Integrated Services to Support Breastfeeding, 2019

A good example of how the BFI community standards work is Harrow. Read more HERE about how WBTi UK Steering Team member and specialist health visitor Alison Spiro led Harrow’s local community health services through BFI accreditation, to develop a well integrated services and become 

“the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies”

UNICEF assessment

More recently, UNICEF UK BFI have produced Learning Outcomes for a wider range of health professions: medical students, paediatricians, pharmacists, paediatric/ children’s nurses, maternity support workers and nursery nurses. These will help to address the gaps in high level health professional training standards found in WBTI’s 2016 report. Every health professional who works with women, infants and children should understand the basics of lactation and breastfeeding management, prescribing during lactation, and how to refer parents on to local breastfeeding support.

#WBW2022 Webinar

On Wednesday 3 August, we will all have the chance to learn more about the Ten Steps of BFHI in a webinar produced by the Global Breastfeeding Collective, an alliance of NGOs from around the world led by WHO and UNICEF.

In addition, there will be sessions on the care of young breastfed infants who are small or with faltering growth (the MAMI Pathway) and on infant feeding in emergencies. 

The entire webinar runs from 7-9 AM BST and again from 4-6 PM BST, and will be recorded.

Register HERE

Our WBTi #WBW2022 blog will cover these additional topics later in the week.

See you there!

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Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.

Strengthen Health Professional Training in Infant Feeding #WBW2022

Strengthen Health Professional Training in Infant Feeding #WBW2022

Skilled health professionals are a fundamental building block for successful breastfeeding. Parents expect all healthcare professionals to have the knowledge and skills to help them overcome practical challenges and to offer them emotional support. The reality in the UK is that many have not received the training they need to do this, so parents do not always receive the support they need. While improvements have been seen, UK health professional training still shows gaps in training in infant feeding. Relevant, evidence-based training is needed for all those who work with women, infants and young children.

WBTi findings: mapping UK high level health professional training standards in infant feeding against the WHO Educational Checklist

WBTi’s research has found numerous gaps in the pre-registration training in infant feeding in almost all UK health professional specialisms. Only midwifery training covers most of the topics on the WHO’s Educational Checklist on infant and young child feeding.

Alarmingly, the worst gaps are in the high level training standards for nurses, including paediatric nurses. Since the publication of our first report in 2016, there have been a few improvements in the training standards set for paediatricians and GPs, and our upcoming reassessment will be mapping these against the WHO checklist.

What can YOU do?

If you are a health professional, urge your governing body to strengthen the requirements on infant feeding in your professional standards and examinations by:

Volunteer to help WBTi carry out the reassessment of UK health professional training standards.

Contact us: wbti@ukbreastfeeding.org

Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.

#StepUpForBreastfeeding: We are the Building Blocks #WBW2022

#StepUpForBreastfeeding: We are the Building Blocks #WBW2022

It takes a village to raise a child – we all have a role to play to support breastfeeding mothers and babies. 

We all are the building blocks responsible for supporting new families: partners and family members, health workers, neighbours and community members, religious leaders, employers, academics, governments and policy makers. We can all make a difference. We need to step up to our responsibilities. Everyone needs to understand the importance of breastfeeding – for maternal and infant physical and mental health and wellbeing, for public health, for our economy, and for our planet.

For WBW this year, WABA has produced an extensive suite of materials looking at all these roles and responsibilities. They have outlined the challenges that breastfeeding families face at every stage from conception, through birth, getting breastfeeding off to a good start, and maintaining breastfeeding all the way through starting solids and going back to work, and the solutions we need in each situation – all backed up by links to the latest evidence. 

The #WBW2022 Action Folder pulls all this together: it is a useful resource for anyone using evidence to build policies and best practice. You can download it as a PDF and all the links to research and references will be live.

The UK WBTi team will be highlighting just a few of the concepts this week:

  • Health workers: the importance of relevant, evidence-based. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months.  The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding. training for all those who work with women, infants and young children
  • UNICEF UK Baby Friendly Initiative and the BFHI worldwide sets out ways in which healthcare staff can receive sound, evidence-based, basic training in supporting breastfeeding. 

ALSO join a special webinar from the Global Breastfeeding Collective on BFHI, with some added specialist topics on supporting small and underweight breastfeeding infants, and on infant feeding in emergencies. (7-9 AM BST and again at 4-6 PM BST). Register HERE

  • Community support: Access to skilled, integrated support for all, with a special focus in the GBC webinar on how to support breastfeeding infants who are not gaining well (NICE NG 75,2017). All parents should have easy access to trained healthcare staff- midwives, paediatricians, health visitors and GPs- breastfeeding peer supporters and specialist support (IBCLC, BFCs). Supporting breastfeeding in complex circumstances: Specialist support from IBCLCS, BFCs, or infant feeding leads, integrated with specialist healthcare teams 
  • Protecting infants and young children in emergencies. National policies should guide Local Resilience Forums but these do not exist at present. 
  • The impact of misleading marketing: The International Code. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months.  The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding.
  • Governments with national and local policy makers need to protect all families and support them to make informed feeding decisions free of commercial influence.

What can YOU do?

It is time for a reassessment of the UK’s national infant feeding policies and programmes. YOU could help! Volunteers are welcome with knowledge in any of the ten policy areas (Indicators 1-10), or with skills such as research, writing, graphics, social media and more – feel free to contact us for a chat!

WBTi Key Indicators:

Indicator 1: National policy, programme and coordination
Indicator 2: Baby Friendly Initiative
Indicator 3: International Code of Marketing of Breastmilk Substitutes

Indicator 4: Maternity protection 
Indicator 5: Health professional training
Indicator 6: Community-based support 
Indicator 7: Information support 
Indicator 8: Infant feeding and HIV 

Indicator 9: Infant and young child feeding during emergencies 

Indicator 10: Monitoring and evaluation 

Which one will YOU choose?

Contact us: wbti@ukbreastfeeding.org

Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.

Launch of learning outcomes for health workers

Launch of learning outcomes for health workers

At the start of World Breastfeeding Week, Unicef UK Baby Friendly Initiative launched a new set of resources: recommended learning outcomes for several health professional groups.

New Unicef Baby Friendly learning outcomes for health professional training

It had been announced at the Baby Friendly conference in 2018 that learning outcomes and resources were being produced.

Addressing gaps

WBTi UK Indicator 5: Health professional training

The WBTi report in 2016 (see Indicator 5 in Part 1 of the WBTi UK report for the above table, and Indicator 5 in Part 2 for the detailed findings for each UK health profession) showed that for most health professions in the UK, the coverage of infant feeding in pre-registration training was inadequate. In some case only broad standards are given and the individual universities develop their own curricula.

The infant feeding learning outcomes launched by BFI are for a range of newly qualified health professionals so they ‘articulate the minimum knowledge and understanding of infant feeding that it would be reasonable to expect from a health practitioner at the point of qualification’. There are slightly different ones for the following five groups:

  • doctors
  • dietitians
  • pharmacists
  • children’s nurses
  • maternity support workers/nursery nurses.

For each of these professional groups the learning outcomes are grouped into three broad themes:

  1. The value of human milk and breastfeeding.
  2. Supporting infant feeding.
  3. Infant feeding in context, which includes understanding the importance of the International Code. 

They are intended as ‘a stimulus to universities and others to start to consider what should be covered in relevant curricula and training, and then to take action to make that a reality.’ 

One useful recommendation is that ‘A mapping exercise can help the university to assess how far the topics are already covered and assessed in the curriculum, and to identify and plan for any additions to modules or design alternations needed.’ Plans for the resources ‘include a slide pack to help lecturers deliver the content to students, e-learning for students and assessment examples’. 

Specific learning outcomes like these, provided they are taken on board by the training institutions, will surely help to achieve a higher and consistent level of knowledge and skills within and between health professions.

Cover photo licensed by Adobe Stock

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

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

Following on from yesterday’s blog about the launch of the Hospital Infant Feeding Network website, today we are looking in more detail at the joint GPIFN, Breastfeeding Network and HIFN campaign “Don’t Say Stop Look It Up”.

DontStopLookItUp

This campaign, started by the GP Infant Feeding Network in 2017, aims to make sure healthcare professionals know how to check whether specific medicines can be taken by breastfeeding women. Most healthcare professionals know that with regard to breastfeeding and medication they should check what the British National Formulary (BNF) says. The BNF is a phenomenal resource, respected around the world, with comprehensive information about medication doses, side effects and cautions. However, in some cases it takes a very cautious line on breastfeeding – for example, for the antidepressant sertraline, recommended by specialist services as a preferred option in breastfeeding, the BNF says “not known to be harmful but consider discontinuing breastfeeding”. For ibuprofen, accepted by specialist services as appropriate during lactation, the BNF says “use with caution during breastfeeding. Amount too small to be harmful but some manufacturers advise avoid”. It isn’t hard to see that well-meaning healthcare professionals are nervous about recommending medicines for breastfeeding women when seeing these descriptions in a trusted source of information, and why they may advise that breastfeeding should be stopped, or that the medication cannot be taken.

The #Don’tSayStopLookItUp campaign seeks to highlight the position of the National Institute for Health and Care Excellence (NICE), which states “Ensure health professionals who prescribe drugs to a breastfeeding mother… seek guidance from the UK Drugs in Lactation Advisory Service… the ‘British National Formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions… Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse”. The campaign poster set can be downloaded, and covers common classes of drugs such as antibiotics, antidepressants, painkillers and anaesthetics. The rest of the blog will cover in more detail how health professionals can effectively use the UK Drugs in Lactation Advisory Service (UKDILAS).

UKDILAS is an NHS service specifically set up to help health professionals make informed decisions about the use of medicines during breastfeeding. It is provided by a team of highly specialised pharmacists. The website is not the easiest one to navigate so we’ll go through the three particularly useful services they provide, step by step.

Using UKDILAS

Firstly, UKDILAS provides thorough lactation-specific information on individual medications. When a health professional wants to check a single medication, where they would normally look it up in the BNF, they can go to www.sps.nhs.uk (or Google UKDILAS) and use the search box at the top of the page:

Searching for codeine, for example, will bring up first the individual drug name and any lactation (and other specialist service) factsheets as well:

Clicking on the individual drug name codeine brings the reader to a long list of articles and other specialist information so the last step is to click on the “Lactation Safety Information” link under the medication name to go straight to the relevant section.

In this case, the final result is “Use when breastfeeding – No” with useful comments about how much data this is based on and what effects are seen. This will also link you through to any other relevant lactation safety information held about this medicine:

The other two UKDILAS services are the factsheets and the ability to ask specific questions. Question & Answer factsheets are available via a link from the UKDILAS part of the SPS website (www.sps.nhs.uk/ukdilas) and cover general topics like “which oral antihistamines are safe to use while breastfeeding?”. There are also general “safety in lactation” articles covering specific classes of medication – these will come up when you search for an individual medication, as shown above with codeine, which is an opioid analgesic.

To ask UKDILAS a specific question, health professionals can telephone (9am-5pm Mon to Fri) or email – full details are on the website. The team will answer any breastfeeding and medicine-related question, but particularly specialise in highly complex areas such as multiple medications and premature infants.

Other sources of information on drugs in breastmilk

As lactation professionals know, there are many other ways to access information about medications in lactation – for example the wonderful Drug Factsheets put together by Wendy Jones at the Breastfeeding Network, American national resource LactMed and textbooks such as Medications and Mothers’ Milk (Hale). This blog has focused on UKDILAS because it is an NHS source, which is reassuring to busy UK health professionals who may not have time to check the credentials of other sources.

So, in summary, health professionals naturally use the BNF to check information about lactation, but by using the Don’t Say Stop Look It Up campaign, we can help them find out about specialist sources of information to help families make informed decisions.

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

#WBW2019: Empower parents, enable breastfeeding

#WBW2019: Empower parents, enable breastfeeding

The theme for World Breastfeeding Week this year is “Empower parents, enable breastfeeding,” which fits the philosophy of our WBTi work very well.  The WBTi recommendations have been produced by a Core Group of 18 of the UK’s key government agencies, health professional organisations and charities working in infant and maternal health. The 46 recommendations, across ten areas of policy and programmes, parallel many of the recommendations of previous national breastfeeding initiatives such as the UNICEF Baby Friendly Call to Action, the Becoming Breastfeeding Friendly project (completed in Wales and Scotland so far), and the Breastfeeding Manifesto.


The WBTi assessment and recommendations for action are all about providing the structures, policies and programmes that families need in order to support mothers and infants to be able to breastfeed successfully. It is not a woman’s responsibility on her own, it is the responsibility of ALL of us, across society, to provide the support that mothers and babies need.

This has been echoed by the UN Human Rights experts, who have stated that breastfeeding is a human right of the breastfeeding dyad, and that states/ society is responsible for providing the structural support they need. Likewise this is the key message of the Lancet 2016 Series on Breastfeeding.

Gaps and barriers

Our UK report found many gaps and barriers in ten areas of policy and programmes across the UK:

  1. Lack of national leadership and national strategy on infant feeding, except in Scotland.
  2. Areas where maternity settings still do not meet the minimum UNICEF Baby Friendly standards, in particular in England.
  3. Weak regulations governing marketing by baby milk companies, no regulations governing bottle and teat marketing, and little enforcement of existing provisions.
  4. Lack of provisions to support new mothers to continue breastfeeding when they return to work.
  5. Gaps in health care professional training in infant and young child feeding (See both Part 1 and Part 2 of the WBTi report for full details)
  6. Cuts to peer support and other community breastfeeding support.
  7. No national communications strategy on breastfeeding.
  8. Lack of understanding of current guidance on breastfeeding for HIV+ mothers.
  9. No national guidance on planning for the care of infants and young children in emergencies or disasters.
  10. Poor data collection and monitoring of breastfeeding rates.

Highlights of progress

There are several bright spots, however, and in the two years since the WBTi report and recommendations were published, there have been improvements in several areas

  1. National policy work: Scotland already had strong national policy leadership. Scotland, Wales and England have taken part in the Becoming Breastfeeding Friendly project on scaling up breastfeeding interventions, with a government commitment to act on recommendations.
  2. With the latest NHS England Long Term Plan, all of the UK has now pledged to reach full UNICEF Baby Friendly accreditation in all maternity settings.
  3. Increased awareness of International Code issues in the UK include a relaunch of the UK Baby Feeding Law Group, a coalition of UK organisations working in infant and maternal health, to advocate for implementation of the International Code in UK law.
  4. The Alliance for Maternity Rights has included the protection of flexible breastfeeding/ expressing breaks and suitable facilities in their Action Plan.
  5. Several health professional councils have begun to review their training standards on infant feeding, and a working group led be UNICEF Baby Friendly has launched a new set of learning outcomes for the training of medical students, paediatric nurses, dietitians, pharmacists and maternity support workers/ nursery nurses.
  6. Continued cuts to local authority and public health budgets has continued to severely impact community breastfeeding support such as trained peer support. The WBTi team organised a conference on the public health impact of breastfeeding with the Institute for Health Visiting, exploring in particular the UNICEF Baby Friendly community requirements for “basic” health professional BFI training, “additional” local trained support such as peer support groups, and a “specialist” referral pathway at IBCLC level. The BFI, NICE and Public Health England guidance are clearly explained in the “Guide to the Guidance” by Better Breastfeeding. However there is potential for strengthening the commissioning of integrated breastfeeding services, through the increased profile of breastfeeding in England in the NHS Long Term Plan, breastfeeding representation now being included in the NHS England National Maternity Transformation Programme Stakeholder Group, and in Scotland and Wales with renewed national leadership and funding.
  7. Although no national communication strategies on breastfeeding have been developed, the national governments and public health agencies have developed breastfeeding campaigns and have supported national breastfeeding weeks again across all four nations.
  8. New guidance on infant feeding for HIV+ mothers from the British HIV Association has included detailed guidance on how to support mothers who wish to breastfeed (see also our guest blog from Pamela Morrison IBCLC explaining the new guidance here)
  9. Infant feeding in emergencies is still not covered by national guidance or universally in local disaster resilience planning, however a national forum hosted by Alison Thewliss MP, and led by the UK WBTI team and Dr Ruth Stirton from the University of Sussex Law School has kick-started the discussion to improve awareness and standards.
  10. Monitoring of breastfeeding rates remains uneven across the UK; Scotland has continued to conduct robust infant feeding surveys, while, in England, the PHE data on breastfeeding rates still have gaps in reporting. The UK government has now proposed to reinstate the national infant feeding survey in a new consultation on prevention. See also our blog by Patricia Wise on gaps and changes in our data (including how YOU can access the fingertips data), and guest blog by Phyll Buchanan MSc on how we can use the infant feeding data to reveal insights into health inequalities.

So we are in interesting times – we still face budgetary and cultural challenges, and families still face many barriers.

However change is clearly happening!

Coming up on the WBTi blog for #WBW2019

For World Breastfeeding Week, we are hosting a number of guest blogs detailing some exciting innovations: 
The launch of the Hospital Infant Feeding Network, with a website and a collection of posters and resources for health professionals working with mothers, infants and young children in hospital.

A new set of educational resources on breastfeeding and medications for pharmacists, from the wonderful Wendy Jones.

And a blog looking at some of the public health issues around breastfeeding support in the community, from Alice Allan IBCLC MPH.

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Helen Gray IBCLC is Joint Coordinator of the WBTi UK team, with a special interest in supporting families in emergencies.