Breastfeeding rates in the UK have stagnated, as they have in many places around the world.

Effective action is needed now.

Thanks to a number of significant global initiatives breastfeeding rates around the world have slowly risen over the last few decades.The UNICEF Baby Friendly Initiative, the International Code of Marketing of Breast-milk Substitutes (the Code), and the Innocenti Declaration and WHO’s Global Strategy for Infant and Young Child Feeding have played a major role.We can celebrate some small improvements, but less than 40% of babies worldwide benefit from six months exclusive breastfeeding and in the UK still only 1% of babies are exclusively breastfed for six months.

Some countries have achieved marked increases in breastfeeding rates when a combination of several actions guided by the Global Strategy have been implemented such as:

  • A combination of national legislation on the Code and maternity protection for working women.
  • Ensuring initiation of breastfeeding in all maternity facilities by using the Baby Friendly Initiative.
  • Building capacity to offer skilled infant feeding counselling to all mothers.
  • Providing more mother support groups in the community and well planned communication strategies to promote breastfeeding throughout society.

What is the World Breastfeeding Trends Initiative (WBTi)?

In 2005, the International Baby Food Action Network (IBFAN) launched the World Breastfeeding Trends Initiative (WBTi): a collaborative initiative to assess and monitor key breastfeeding policies and programmes (shown below), all drawn from the WHO Global Strategy and the Innocenti Declaration.

The assessment and strategies are developed by partner stakeholder agencies working together to highlight gaps and stimulate action to bridge them. Each country’s results are publicly displayed on the WBTi website, providing further impetus to government leaders to act decisively.

Currently 82 countries are participating in the WBTi; the latest report and details are available online at www.worldbreastfeedingtrends.org

For breastfeeding to be successful families need the right support along the whole course of breastfeeding, from giving birth in a Baby Friendly Hospital, going home to find skilled local support from Health Visitors, GPs, and having access to support groups throughout their communities.  It means accurate information, without marketing pressure from manufacturers, throughout society, from friends, family,health professionals and the media, all the way to policy makers and employers supporting women returning to work.

Mothers and babies need the full network of support that is measured by the WBTi.

  1. National Policy, Programme and Coordination
  2. Baby Friendly Hospital Initiative: UNICEF Baby Friendly UK
  3. Implementation of the International Code of Marketing of Breast-milk Substitutes: Baby Milk Action and Baby Feeding Law Group
  4. Maternity Protection in the Workplace (maternity leave and breastfeeding/ expressing breaks at work): Maternity Action
  5. Health and Nutrition Care System (health professional training in infant and young child feeding): Lactation Consultants of Great Britain, First Steps Nutrition Trust
  6. Mother Support and Community Outreach (community–based support for pregnant and breastfeeding mothers): Association of Breastfeeding Mothers, La Leche League GB, NCT
  7. Information Support (consistent high standard of breastfeeding information and public health messages): Best Beginnings
  8. Infant Feeding and HIV: Pamela Morrison IBCLC
  9. Infant Feeding during Emergencies: Sarah Saunby
  10. Mechanisms of Monitoring and Evaluating Systems
  1. Percentage of babies breastfed within one hour of birth
  2. Percentage of babies 0<6 months of age exclusively breastfed in the last 24 hours
  3. Median duration of breastfeeding in months
  4. Percentage of breastfed babies less than 6 months old receiving other foods or drinks from bottles
  5. Percentage of breastfed babies receiving complementary foods at 6-9 months of age
  • Because we need a tool to measure UK breastfeeding policies and programmes
  • Because we can’t ask the world to reach for WHO goals of 50% exclusive breastfeeding for six months when we only reach 1% exclusive breastfeeding for six months ourselves!
  • Because the UK is a leader in the developing world; other countries look to the UK for infant and young child feeding education programmes that will have a global impact. Many of the world’s leaders in government and health professions come to the UK for training.
  • Because even in a developed country like the UK, poor breastfeeding practices are costing the UK at least £40 million in costs for infant health and £18 million in costs for women’s health (UNICEF reports***)
A growing group of UK organisations are working together to start the UK assessment, supported by LCGB and UNICEF Baby Friendly UK.

You can helpby:

  • Filling in the gaps (see our newsletters/website & social media)
  • Collecting data for WBTi UK on breastfeeding policies and programmes.
  • Investigating how your university, hospital or organisation is meeting the standard for Infant and Young Child Feeding Policy and Practice. Let us know.
  • Calling for action on implementation of the International Code and maternity protection including breastfeeding breaks at work
  • Raise awareness with UK policy makers and health professional leadership
  • Donating to support our work

Contact us at: wbtiuk@gmail.com

  • Follow the Baby Friendly Initiative and the International Code recommendations.
  • Develop and practice/ policies free from conflicts of interest
  • Organise public lectures on identified gaps and create awareness
  • Work within your institution to support Baby Friendly standards of best practice and education
  • Strengthen pre-service education in human lactation and breastfeeding in universities and health professional education institutions.
Widely disseminate the findings of assessments by:

  • Holding workshops or seminars nationally to share the findings with policy makers and other organisations.
  • Calling for action on key indicators at local level, eg maternity entitlement and national policy and legislation.
  • Holding media briefings.
  • Informing your local and national representatives of the importance of breastfeeding and your own country’s performance.
  • Organising public rallies and breastfeeding sit-ins to focus on the importance of the assessment.
  • Holding public hearings and mock trials (against companies, businesses, professional associations or health care institutions that are violating the International Code and related legislation).
  • Conduct formal assessments every 3-5 years.
  • Make public commitments to enhance breastfeeding rates.
  • Hold inter-sector/ inter-department meetings and workshops to devise creative ways to support women to breastfeed.
  • Design and launch media campaigns on services provided as a response.
  • Support family friendly policy changes that promote, support and protect breastfeeding.
  • Support a system of human milk banking to help women initiate/maintain exclusive breastfeeding, and to support vulnerable infants.
1 National Policy, Programme and CoordinationIn 1990 one of the Innocenti Declaration targets was for countries to appoint a national breastfeeding coordinator. Countries which did this made much faster progress with the BFHI. The Global Strategy requires all countries to have a comprehensive policy on IYCF. Countries without a policy find it difficult to make consistent progress. Having a policy and a coordinator to ensure implementation helps a country move ahead much more effectively.(See http://www.who.int/nutrition/topics/global_strategy/en/ )

 

2 Baby Friendly Initiative (BFHI)

A Baby Friendly hospital implements all the ‘Ten Steps to Successful Breastfeeding’ (see http://www.unicef.org/newsline/tenstps.htm), the second Innocenti Declaration target, and follows The Code by not accepting free or subsidized supplies of infant formula, or any promotional items. All staff have breastfeeding training, and the hospital is assessed regularly to ensure the standards are followed. All mothers and babies in a Baby-Friendly hospital are holistically cared for in a way which supports breastfeeding. This gives the best chance of successful breastfeeding. The Baby Friendly Initiative also includes establishment and fostering of community outreach support for breastfeeding mothers. Breastfeeding rates have been shown to be higher among babies born in Baby-Friendly hospitals than among babies born in other hospitals. More than 20,000 hospitals world-wide have achieved Baby Friendly status.

 

3 The International Code

The devastating effects of bottlefeeding, aggressive marketing of breastmilk substitutes by manufacturers, and general decline in breastfeeding caused great concern and motivated a movement to raise the alarm.In 1981 it led to the World Health Assembly’s adoption of the International Code of Marketing of Breastmilk Substitutes (also known as the Code). The aim of the Code is to protect and promote breastfeeding, and help provide for safe adequate nutrition for infants by regulating all marketing of breastmilk substitutes. Subsequent World Health Assembly Resolutions have clarified and strengthened the Code. The resolutions have the same status and are included within it. A notable problem continues to be the lack of motivation and skill to support mothers to breastfeed, in light of competition from well funded, often aggressive, marketing of breastmilk substitutes and other products. Clever slogans, striking images, giving free samples or supplies, and many attractive gifts have been used to persuade mothers, health professionals and health workers that bottle feeding is as good as breastfeeding. Both the Innocenti Declaration and the Global Strategy stress the need for countries to restrain infant formula manufacturers from aggressively marketing and promoting their products by adopting and implementing the Code. To be really effective, the provisions of the Code need to be fully enforced by being enacted in national legislation.

 

4 Maternity Protection in the Workplace

One of the most common reasons mothers give for stopping breastfeeding is their return to paid employment. Many countries are working towards laws to enable mothers to have paid maternity leave for exclusively breastfeeding for 6 months.Support to continue exclusive breastfeeding, for example, by provision of a workplace crèche, a room for private expression, and paid breaks during working hours would help.

 

5 Health and Nutrition Care System

This covers all health workers, clinics, doctors, hospital inpatient / outpatient services and nutrition services for mothers and babies on discharge from the maternity hospital. Babies born in Baby Friendly hospitals are more likely to start breastfeeding. Mothers need ongoing skilled breastfeeding support from midwives, lactation consultants, community health workers, or appropriately trained peer counsellors to enable exclusive breastfeeding for 6months. Where all mothers receive at least 7 skilled support/counselling contacts exclusive breastfeeding rates are higher. (1)

Support is necessary for all mothersto ensure breastfeeding is going well.

(1). Britton et al, Cochrane Review 2009. ‘Support for Breastfeeding Mothers (Review)’.See http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001141.pub3/pdf/standard (Accessed on 15 June 2012).

 

6 Mother Support and Community Outreach

The first mother-to-mother support groups were started more than 50 years ago, by a small group of American women who felt that support from doctors and health workers was insufficient. Mothers found that they could help each other more effectively. Mother support groups have now spread worldwide working in different ways in different places. Mothers share experiences andfind solutions for their difficulties.

 

7 Infant Feeding and HIV

In the early 1990’s, doctors discovered that HIV was transmitted from mothers to their babies during both pregnancy and breastfeeding. For 20 years, health services and families struggled with the dilemma of how to feed the baby born to an HIV infected mother. Research has shown that if a baby is exclusively breastfed, transmission is less likely than if the baby is mixed fed (partly breastmilk and other milks). The choice was between exclusive formula feeding or exclusive breastfeeding.It has been shown that antiretroviral (ARV) drugs given to the mother and the baby can reduce transmission to a very low rate even if the baby is breastfed. In many countries,where formula feeding is difficult or dangerous, mothers can be treated with ARV drugs, and encouraged to breastfeed exclusively to six months, and to continue breastfeeding with complementary feeding for 12months, or until they are able to provide a nutritionally adequate and safe diet.(2)

(2). WHO Guidelines on HIV and infant feeding 2010. See WHO Website:http://www.who.int/maternal_child_adolescent/documents/9789241599535/en/ (Accessed on 15 June 2012).

 

8 Infant Feeding During Emergencies

The number of people and babies affected by emergencies today has more than tripled since the 1990s. Often the first help offered by the outside world is formula and feeding bottles.It is difficult to use these safely in emergencies. It is preferable to support mothers to breastfeed. Humanitarian aid workers need training in basic support and relactation skills for breastfeeding mothers and foster mothers. Countries are encouraged to establish emergency preparedness arrangements, including listing lactation counsellors available to respond to emergency situations to support aid workers caring for babies. Disasters and emergency situations can happen in any country; the best preparation is good breastfeeding practices!

 

9 Information Support

In order to make informed choices about breastfeeding, it is vital that mothers have accurate, appropriate and sufficient information. Groups advocating promotion, protection and support of breastfeeding need to provide accurate information, to educate and communicate on breastfeeding issues.This needs development of strategies at national and government level for Information, Education and Communication (IEC). These IEC strategies are essential to change attitudes influenced by the formula industry, or cultural and traditional practises, that affect decisions at the community and household levels. Comprehensive IEC strategies use a wide variety of media to convey concise, consistent, appropriate, action oriented messages to targeted audiences at all levels.

 

10 Monitoring and Evaluation

All health programmes should be monitored and evaluated, so that they can be assessed and improved. If you are a health professional, you could assess if activities related to the above areas are being recorded as part of your monitoring and evaluation e.g. if mothers receive breastfeeding counselling, is it recorded and reported anywhere in the patient records?

 

The UK WBTi Working Group would like to thank WABA and IBFAN Asia for permission to use material from the World Breastfeeding Week 2012 Action Folder and Insert and from the World Breastfeeding Trends Initiative website.

Download the PDF of the WBTi document here

The UK WBTi Working Group would like to thank WABA and IBFAN Asia for permission to use material from the World Breastfeeding Week 2012 Action Folder and Insert and from the World Breastfeeding Trends Initiative website.

www.worldbreastfeedingtrends.org                                                                                                                                                             International secretariat: info@ibfanasia.org

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