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					              Increasing breastfeeding prevalence




Phyll Buchanan & Lorna Hartwell
Infant Feeding Best Practice Advisers
Department of Health
08.11.08
                                        The Government recognises …


                                        … that breastmilk is the best form of
Breastfeeding prevalence at 6-8 weeks




                                          nutrition for infants

                                        It is committed to -
                                        • supporting women to continue
                                            breastfeeding
                                            exclusively for the first six
                                            months then alongside an
                                            increasingly varied diet for as
                                            long as wished

                                        • WHO recommends that
                                          breastfeeding should be               Each month of breastfeeding duration was
                                          continued for two years or            associated with a 4% decrease in the odds
                                          beyond (WHO 2003)                      of overweight (OR: 0.96, 95% CI: 0.94-0.98)
                                                                                                        Effect plateaus at 9 months
                                                                                Evidence on the long-term effects of breastfeeding WHO. Horta B et al 2007

                                                                                                                                                             2
                                         Breastfeeding is a key priority for the Government,
                                         and embedded in its Public Service Agreements
Breastfeeding prevalence at 6-8 weeks




                                                             • Child Health and Wellbeing PSA indicator 12: Prevalence of
                                        EARLY YEARS            breastfeeding at 6-8 weeks after birth



                                                            • Child Health and Wellbeing PSA indicator 3: by 2020, reduce the
                                        OBESITY               proportion of overweight and obese children to 2000 levels.




                                        HEALTH              • PSA: by 2010 to reduce health inequalities by 10% as measured
                                        INEQUALITIES          by infant mortality and life expectancy at birth




                                                            • Reduce smoking among pregnant women from 23% (1995) to 18%
                                        SMOKING
                                                              by 2005 & 15% by 2010



                                                                                                                                3
                                                            Breastfeeding initiation rates are rising across
                                                            UK, but are still linked to poverty...

                                                 Incidence of breastfeeding by country,
Breastfeeding prevalence at 6-8 weeks




                                                              1985-2005
                                                                         80

                                                                         70
                                        Incidence of breastfeeding (%)




                                                                                                      1990   1995     2000    2005
                                                                         60

                                                                         50

                                                                         40

                                                                         30

                                                                         20

                                                                         10

                                                                         0
                                                                              England & Wales   Scotland            Northern Ireland
                                                                                                                                       Younger mothers, mothers from lower
                                                                                                                                       socio-economic groups and mothers with
                                                                              Breastfeeding initiation rates                           lower educational levels appear to be least
                                                                              have increased since 1990. The                           likely to initiate and continue breastfeeding.
                                                                              Infant Feeding Survey 2005                               Mothers from these groups are also more
                                                                              showed current breastfeeding                             likely to introduce solids, follow-on formula
                                                                              initiation is 76% across the UK,                         and additional drinks at an earlier age -
                                                                              compared to 69% in 2000.                                 factors associated with childhood obesity.
                                                                                                                                                                                        4
                                          Breastfeeding rates drop off too early and still do not
                                          compare well with other countries

                                        • Prevalence of breastfeeding at ages up to 9                        In Norway prevalence at 6
                                          months, United Kingdom 1995-2005                                    months is 80% compared
                                                                                                                   to 22% in UK
Breastfeeding prevalence at 6-8 weeks




                                                                                        Breastfeeding in Norway (1998) and UK
                                                                                        Lande B et al Acta Paediatr, 2003; 92: 152-61.

                                                                                        % Mothers   100                                        Norway, any
                                                                                                                                               Norway, excl.
                                                                                                    80
                                                                                                    60
                                                                                                    40
                                                                                                                                               UK, any
                                                                                                    20                                         UK, excl.


                                                                                                     0
                                                                                                         0   5   10   15    20    25    30
                                                                                                                           Weeks after birth




                                            Source Infant Feeding Survey 2005
                                                       Bolling 2007




                                                                                                                                                               5
                                         Baby Friendly Initiative (BFI) and community peer support programmes
                                                  are effective interventions to increase breastfeeding

                                        •NICE recommends hospitals and community settings implement a structured programme
                                        using UNICEF Baby Friendly Initiative as a minimum standard.
                                        •BFI is a comprehensive package of measures and training of staff necessary to increase
Breastfeeding prevalence at 6-8 weeks




                                        breastfeeding with ongoing audit, assessment and external accreditation.
                                        •Peer support programmes integrated within maternity care services gives more vulnerable
                                        families additional support.
                                        •Breastfeeding rates rise faster in hospitals that achieve UNICEF Baby Friendly accreditation
                                        and those with lowest rates show greatest gains.
                                                                                                                 % Change in breastfeeding initiation rate                                    PCT (Initiation rate 2004/05)
                                                                                                         from 2004/05 to 2007/08 by PCTs with hospitals accredited
                                                                                                                                                                                               Gloucester (70%)
                                                                                                                             as Baby Friendly
                                                                                                                                                                                               Ct Durham & Tees Valley (44.3%)
                                                                                                                                                                                               Blackburn w ith Darw en (68.2%)
                                                      % Change in initiation rate from 2004/05 to




                                                                                                    10
                                                                                                               8.5             8.3                                                             Salford (53.2%)
                                                                                                                           8
                                                                                                    8                                                                                          Manchester (60.1%)
                                                                                                                                                              6.5
                                                                                                                                           5.6                                                 Oldham (62.3%)
                                                                                                    6
                                                                                                                                     4.6                4.6                      4.3
                                                                                                         3.2         3.5                                                                       North Yorkshire & York (64.9%)
                                                                                                                                                                    3.3
                                                                        2007/08




                                                                                                    4                                                                                          Somerset (77.6%)
                                                                                                                                                                                               Oxfordshire (73.7%)
                                                                                                    2
                                                                                                                                                                                               Dudley (47%)
                                                                                                    0                                                                                          Walsall (49%)

                                                                                                    -2                                                                                         Stoke on Trent (44%)
                                                                                                                                                                          -1.5         -1.4
                                                                                                                                                                                               Bradford & Airedale (58.2%)
                                                                                                    -4                                           -3.1
                                                                                                                                                                                               Calderdale (78%)



                                                                                                                                                                                                                                 6
                                        Women want to breastfeed – 9 out of 10 who stop before
                                        week six said they wanted to breastfeed for longer

                                         • Fastest drop-off in the first 4 days -                                       Change in initiation from 2005/6 to 2007/8

                                           12% stop breastfeeding in this time                                     65
Breastfeeding prevalence at 6-8 weeks



                                                                                                                   60
                                         • A third of women have stopped                                           55




                                                                                                         Percent
                                           breastfeeding by week 6 so that                                         50
                                                                                                                   45
                                           only 50% of babies get any                                              40

                                           breastmilk at this stage.                                               35
                                                                                                                   30
                                         • By 6 months only 26% of babies                                                2005/6              2006/7              2007/8


                                           continue to be breastfed
                                                                                                         Two PCTs; the blue line shows the
                                                  Reasons for stopping breastfeeding before 6 weeks      impact of a coordinated strategy
                                                                                                         involving community & hospital, the
                                                              Other reasons          Percieved
                                                                                                         pink line shows hospital involvement
                                                                  18%             insufficient milk
                                                                                        27%              only. Tackling low breastfeeding rates
                                                    Illness (mother or
                                                           baby)                                         needs clear leadership and
                                                           11%
                                                    Took too long/tiring                                 coordinated working, to include peer
                                                           11%                    Baby rejected breast
                                                         Painful breast/nipples
                                                                                          18%            support, across the PCT.
                                                                  15%




                                        Reasons for stopping are preventable or treatable and can
                                        be overcome by sustained and accessible skilled support
                                        by frontline staff and peer supporters                                                                                            7
                                        We are working to make breastfeeding the norm –
                                        key breastfeeding commitments in the Obesity Strategy

                                             Our vision for early years is as many mothers breastfeeding as
                                             possible, with families knowledgeable and confident about healthy
Breastfeeding prevalence at 6-8 weeks




                                             weaning and feeding of their young children.

                                         KEY COMMITMENTS

                                         •   Invest in an information campaign
                                         •   All mothers to have practical information on how to breastfeed – “Bump to
                                             Breastfeeding” DVD and details of the National Breastfeeding Helpline
                                         •   Encourage hospitals and community settings to become accredited
                                             with UNICEF UK Baby Friendly Initiative
                                         •   Provide access to peer support programmes to help mothers start and continue
                                             breastfeeding integrated within the Child Health Promotion Programme
                                         •   Pilot & roll out the WHO Growth Standards showing the optimum growth of infants
                                         •   Encourage all NHS facilities to be free from promotional materials from infant
                                             formula manufacturers.




                                                                                                                               8
                                        We need societal change

                                                                  Social determinants of health
Breastfeeding prevalence at 6-8 weeks




                                                                           In order to support
                                                                             breastfeeding all
                                                                           the factors in each
                                                                            layer needs to be
                                                                               protecting &
                                                                                promoting
                                                                            breastfeeding for
                                                                            every mother and
                                                                                   baby




                                                                                                 9
                                                   Delivery through Partners
                                  NATIONAL                                                                                         REGIONAL

                                                                           LOCAL CO-ORDINATION
                                                                           LA, CCs & Primary care &
                        DH & DCSF working with OGDs & Local              community health providers in                 Government Office, Regional
                                       Authorities                          partnership with NGOs                         Public Health Groups
                           Nutrition & CHPP teams providing                 Regional Infant Feeding                    &Strategic Health Authorities
                                   overall co-ordination                   Co-ordinators to provide                     Regional Directors of Public
                                                                             Strategic leadership                         Health, Regional Infant
                                                                                                                       Feeding Co-ordinator, Regional
                                                                                                                        Children’s, Maternity, Food &
                                                                                                                          Health & Obesity Leads
                                                                               LOCAL DELIVERY

                                                            Universal service with capacity to identify and target those
                                                                   less likely to start and sustain breastfeeding
Health and Well-Being




                        Primary care &
                        community health         Children’s               Voluntary                 Schools                                    Media
                                                  Centres                  Sector                                          Employers
                        providers                                                                                                             coverage
                                                                                                  Early education                            of breastfeeding
                                                                                                         on            Engagement with      issues along with
                                                 Antenatal and        Peer support training
                        Baby Friendly practice                                                     breastfeeding          employers
                                                   Postnatal         and ongoing supervision                                                      positive
                        in hospitals &                                                           as part of healthy     to facilitate the
                                                   services           through peer support                                                     examples of
                        Community to sustain                                                           living           continuation of
                                                                       programmes, led by                                                        success
                        breastfeeding, led by                                                                            breastfeeding
                                                                          peer support
                        an infant feeding                                                                              on return to work
                                                                           coordinator
                        coordinator



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