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 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 continued for two years or beyond (WHO 2003) Each month of breastfeeding duration was associated with a 4% decrease in the odds 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

Breastfeeding is a key priority for the Government, and embedded in its Public Service Agreements Child Health and Wellbeing PSA indicator 12: Prevalence of breastfeeding at 6-8 weeks after birth EARLY YEARS Child Health and Wellbeing PSA indicator 3: by 2020, reduce the proportion of overweight and obese children to 2000 levels. OBESITY PSA: by 2010 to reduce health inequalities by 10% as measured by infant mortality and life expectancy at birth HEALTH INEQUALITIES SMOKING Reduce smoking among pregnant women from 23% (1995) to 18% by 2005 & 15% by 2010

Incidence of breastfeeding by country, 1985-2005 Breastfeeding initiation rates are rising across UK, but are still linked to poverty... Incidence of breastfeeding by country, 1985-2005 Younger mothers, mothers from lower socio-economic groups and mothers with lower educational levels appear to be least likely to initiate and continue breastfeeding. Mothers from these groups are also more likely to introduce solids, follow-on formula and additional drinks at an earlier age - factors associated with childhood obesity. Breastfeeding initiation rates have increased since 1990. The Infant Feeding Survey 2005 showed current breastfeeding initiation is 76% across the UK, compared to 69% in 2000.

In Norway prevalence at 6 Source Infant Feeding Survey 2005 Breastfeeding rates drop off too early and still do not compare well with other countries In Norway prevalence at 6 months is 80% compared to 22% in UK Prevalence of breastfeeding at ages up to 9 months, United Kingdom 1995-2005 Weeks after birth 5 10 15 20 25 30 % Mothers 40 60 80 100 Norway, any Norway, excl. UK, any UK, excl. Breastfeeding in Norway (1998) and UK Lande B et al Acta Paediatr, 2003; 92: 152-61. Source Infant Feeding Survey 2005 Bolling 2007

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 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.

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 - 12% stop breastfeeding in this time A third of women have stopped breastfeeding by week 6 so that only 50% of babies get any breastmilk at this stage. By 6 months only 26% of babies continue to be breastfed Two PCTs; the blue line shows the impact of a coordinated strategy involving community & hospital, the pink line shows hospital involvement only. Tackling low breastfeeding rates needs clear leadership and coordinated working, to include peer support, across the PCT. Reasons for stopping are preventable or treatable and can be overcome by sustained and accessible skilled support by frontline staff and peer supporters

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 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.

We need societal change Social determinants of health In order to support breastfeeding all the factors in each layer needs to be protecting & promoting breastfeeding for every mother and baby

Delivery through Partners LOCAL CO-ORDINATION LA, CCs & Primary care & community health providers in partnership with NGOs Regional Infant Feeding Co-ordinators to provide Strategic leadership NATIONAL REGIONAL Government Office, Regional Public Health Groups &Strategic Health Authorities Regional Directors of Public Health, Regional Infant Feeding Co-ordinator, Regional Children’s, Maternity, Food & Health & Obesity Leads DH & DCSF working with OGDs & Local Authorities Nutrition & CHPP teams providing overall co-ordination LOCAL DELIVERY Universal service with capacity to identify and target those less likely to start and sustain breastfeeding Primary care & community health providers Baby Friendly practice in hospitals & Community to sustain breastfeeding, led by an infant feeding coordinator Employers Engagement with employers to facilitate the continuation of breastfeeding on return to work Children’s Centres Antenatal and Postnatal services Voluntary Sector Peer support training and ongoing supervision through peer support programmes, led by peer support coordinator Schools Early education on breastfeeding as part of healthy living Media coverage of breastfeeding issues along with positive examples of success National action