1. The changing patterns of infant feeding in Scotland – exclusive or mixed messages? ‘Tomi Ajetunmobi, Bruce Whyte Glasgow Centre for Population Health/ ISD Scotland 10 th November, 2011

2. Outline Introduction/Background Aims and objectives Definitions Results Conclusions

3. Introduction The WHO recommends exclusive breastfeeding for the first 6 months. The benefits of breastfeeding to both mother and infant are well established. In Scotland, although there have been programs and policies set up to improve and monitor breastfeeding, the proportion of exclusively breastfed infants remains one of the lowest in Europe and has remained relatively stable over the past 10 years.

4. Background: GCPH Breastfeeding Project 2 main aims: –To carry out analysis using a new using linked dataset in order to investigate breastfeeding trends nationally and locally and to inform future monitoring –To investigate the unexpected increase in breastfeeding in selected deprived neighbourhoods within Greater Glasgow and Clyde

5. Overview of data schemes Predictor Variables Outcome Variables Geography (NHS Board, CHP, Neighbourhood area, hospital) Maternal characteristics (e.g. maternal age, marital status, ethnicity, socioeconomic characteristics, deprivation, smoking status) Pregnancy/Delivery characteristics (e.g. gestation, previous pregnancies, parity, length of stay, mode of delivery, outcome, multiple birth, caesarean section,) Infant characteristics (e.g. APGAR score, birth weight, congenital anomaly, neonatal/infant admission, length of stay) Infant feeding – initiation (first feed, feed on hospital discharge) Infant feeding - duration (feed on hospital discharge, feed at community discharge, feed at first visit, 6 to 8 week review, 8-9 month review) NRS( GROS ) SMR02 CHSP-PS SBR/SMR11 SSBID NRS(GROS) – Births; SMR02 – Maternal hospital records ; CHSP-PS - Child Health Surveillance (pre-school); SBR/SMR11 - Scottish Birth Record/Neonatal and infant health; SSBID - Scottish Still Birth and Infant Death Records

6. Infant feeding definitions Exclusive breastfeeding Bottle (Formula) feeding Mixed formula and breastfeeding –Complementary/supplementary –Flexible, partial or minimal* *Morse JM & Harrison MJ (1988) Patterns of mixed feeding. Midwifery 4:19-28

7. Infant feeding trends

8. Scotland: Exclusive breastfeeding trends

9. Scotland: Mixed feeding trends

10. Infant feeding amongst first time mothers

11. Scotland: Mixed feeding trends amongst first-time mothers

12. First-time mothers: Infant feeding trends 2001 and 2009 20012009

13. First-time mothers: Mixed feeding and maternal age 2001 and 2009

14. First-time mothers: mixed feeding as a proportion of any breastfeeding by maternal age

15. First-time mothers: mixed feeding as a proportion of any breastfeeding by area deprivation

16. First-time mothers: infant feeding trends by neonatal admission

17. Mixed feeding as a proportion of any breastfeeding by neonatal admission

18. Factors that increased the likelihood of mixed feeding compared to exclusive breastfeeding at the first visit Demographic – Parents of Non-British origin/birth – Mothers aged 40 years or older – Mothers of lower socio-economic class – Unemployed fathers – Residence in a more deprived area Maternity care and health behaviour – Instrumental delivery or caesarean section – Maternal post-natal hospital stay >2 days – Maternal smoking Infant health – Infants with ill health/a neonatal event – Small weight for gestational age

19. In other studies… Mixed feeding is associated with: (Further) reduced milk supply Infants separated from mothers due to ill health, work/child care arrangements Flexibility/social contexts Commencing weaning/early weaning practices

20. Conclusion Exclusive breastfeeding rates have remained relatively static while mixed feeding rates are increasing. Mixed fed infants are similar to exclusively breastfed infants. However compared to exclusively breastfed infants mixed feeding is associated with: –Infant ill-health/admission to neonatal ward –Maternal health care/delivery characteristics –Demographic background of parents (e.g. place of birth, deprivation) Further research will be required to understand the patterns of mixed feeding and its influence on infant health.

21. Acknowledgements GCPH Breastfeeding project is jointly funded by the Scottish Centre for Public Health Research and Policy (SCPHRP) and GCPH. The project is being managed by Bruce Whyte (GCPH) With support from an advisory group: –James Egan (Public Health Programme Manager, GCPH) –Jim Chalmers (Public Health Consultant, ISD Scotland) –Rachel Woods (Public Health Consultant, ISD Scotland) –Diane Stockton (Public Health Specialist, ISD Scotland) –Judith Tait (Child Health Information Team Leader, ISD Scotland) –Linda Wolfson (Infant Feeding Advisor, NHS GG&C), –Jill Muirie (Public Health Advisor, NHS Health Scotland) –Ruth Campbell (Consultant Dietitian, NHS Ayrshire & Arran) –Helen Yewdell (Scottish Government) –David Tappin (Senior Clinical Lecturer, PEACH unit, Royal Hospital for Sick Children, Glasgow)

22. Thank you!