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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 10
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