APPENDIX 39
Memorandum by the UNICEF UK Baby Friendly
Initiative (MS 48)
1. SUPPORTING
SUCCESSFUL BREASTFEEDING
1.1 The UNICEF UK Baby Friendly Initiative
is the UK component of a global programme of the United Nations
Children's Fund, UNICEF, and the World Health Organisation which
works with the maternity and community health services to improve
practice in support of breastfeeding. The Baby Friendly Initiative
is commissioned by various parts of the health service to provide
advice, support, training, networking, assessment and accreditation.
Adoption of the Baby Friendly Initiative programme by the maternity
services is a proven mechanism for increasing breastfeeding initiation
[1-3]. We would therefore like to take this opportunity to submit
evidence to the Health Committee Maternity Services Sub-Committee
Inquiry into the Provision of Maternity Services with a view to
achieving a consistently high level of support for breastfeeding
in all Maternity Services.
1.2 There is a wealth of research [4-14]
showing that babies who are breastfed have a significantly lower
risk of illness during infancy, childhood and, potentially, adulthood,
while their mothers are less likely to suffer certain diseases.
The World Health Organisation now recommends that babies need
nothing other than breastmilk for their first 6 months of life
[15, 16] with breastfeeding continuing to provide an important
source of nutrition into the second year and beyond.
1.3 In the UK, breastfeeding rates are low,
with only two-thirds of babies breastfed at birth, and just one
in five still breastfed at 6 months. 90% of mothers who stop breastfeeding
in the first 6 weeks of their babies' lives state that they had
stopped before they wanted to. The reasons given by the majority
of the mothers who stopped breastfeeding early indicate that they
had not received the support they needed from the health care
system [17].
1.4 The maternity services play an essential
role in supporting successful breastfeeding [18, 19] yet there
is significant variation between maternity units in the support
which is actually provided.
1.4.1 There are significant inequalities
in breastfeeding uptake and duration [20]. Mothers in higher socio-economic
groups, mothers who attended higher education and older mothers
are most likely to breastfeed their babies [17]. There are also
dramatic differences in breastfeeding rates between different
regions of the country and between different maternity units.
1.4.2 Maternity services which adopt practices
to support successful breastfeeding can be assessed for accreditation
as Baby Friendly. By mid February 2003, 44 maternity units in
the UK had achieved Baby Friendly accreditation, while a further
59 had a Certificate of Commitment, denoting the development of
a policy and action plan to achieve accreditation within 24 months
[21]. While a majority of the UK's other maternity units are working
towards a Baby Friendly award and/or using the Baby Friendly Initiative's
best practice standards as a framework for improving practice,
progress is variable and mothers who choose to breastfeed will
have significantly different experiences depending on the degree
of implementation of the standards in their hospital of delivery.
2. DATA COLLECTION
2.1 The Department of Health's Priorities
and Planning Framework 2003-06 has set a target for an increase
of two percentage points per year in breastfeeding initiation
rates [22] yet there is currently no standard system in England
for the routine collection and analysis of data which would permit
this target to be monitored.
2.2 A routine system of data collection
on method of feeding at various ages during infancy would make
it easier to target breastfeeding programmes and evaluate their
effect.
2.3 A system is in place in Scotland where
feeding method is recorded on the Guthrie card at around seven
days [2]. This enables the compilation of information on the incidence
of breastfeeding by hospital of birth and postcode. The latest
national infant feeding survey [17] found breastfeeding prevalence
to be rising faster in Scotland than elsewhere in the UK.
3. THE PROVISION
OF TRAINING
FOR HEALTH
PROFESSIONALS WHO
ADVISE PREGNANT
WOMEN AND
NEW MOTHERS
3.1 The requirements for pre-registration
midwifery and health visiting programmes [23, 24] do not include
a clear provision that students will be equipped with the knowledge
and skills required to support mothers to breastfeed successfully.
Therefore, despite the fact that these are the health professional
groups which normally have the primary responsibility for supporting
mothers to breastfeed, midwives and health visitors (in common
with other student health and medical professionals) commonly
emerge from their pre-registration education without the necessary
skills to perform this role [25, 26].
3.2 Maternity services which want to improve
the care they provide to breastfeeding mothers are therefore obliged
to provide in-service training to relevant health professionals.
There is evidence that effective in-service training can improve
health professionals' knowledge as well as increasing breastfeeding
rates [1, 27-29]. However, the provision of in-service training,
and the standard of any training provided, varies significantly
between NHS Trusts.
4. RECOMMENDATIONS
4.1 The following recommendations for action
are proposed:
4.1.1 All maternity units should be encouraged
and supported to adopt recognised best practice standards in the
support of breastfeeding.
4.1.2 A standard mechanism should be adopted
by NHS Trusts and Strategic Health Authorities to record infant
feeding data for all babies at agreed ages, which correspond to
routine contact with health professionals, in order to monitor
progress towards targets for increases in breastfeeding incidence
and prevalence.
4.1.3 Teaching institutions providing pre-registration
education for midwives and other relevant health and medical professionals
should ensure that their curricula equip students with the knowledge
and skills necessary to support mothers to breastfeed successfully,
in line with recognised best practice standards.
4.1.4 NHS Trusts should provide in-service
training to ensure that their staff are fully equipped with the
knowledge and skills necessary to support mothers to breastfeed
successfully, in line with recognised best practice standards.
14 February 2003
REFERENCES
1. Kramer MS, Chalmers B, Hodnett HD, et
al. Promotion of Breastfeeding Intervention Trial (PROBIT).
A randomised trial in the Republic of Belarus. JAMA 2001; 285:
413-20.
2. Tappin DM et al (2001). Breastfeeding
rates are increasing in Scotland. Health Bulletin 59(2):
102-113 [http://www.scotland.gov.uk/health/cmobulletin/hb592-08.asp].
3. Radford A. Unicef is crucial in promoting
and supporting BF. Letters. BMJ 2001; 322: 555.
4. Heinig M J & Dewey K G (1997). Health
effects of breastfeeding for mothers: a critical review. Nutrition
Research Reviews 10: 35-56.
5. Heinig M J & Dewey K G (1996). Health
advantages of breastfeeding for infants: a critical review.
Nutrition Research Reviews 9: 89-110.
6. Standing Committee on Nutrition of the
British Paediatric Association (1994). Is breastfeeding beneficial
in the UK? Arch Dis Child 71: 376-380.
7. UNICEF UK Baby Friendly Initiative. Health
benefits of breastfeeding. [http://www.babyfriendly. org.uk/health.asp
accessed 13 February 2003].
8. Alm B et al (2002). Breast feeding
and the sudden infant death syndrome in Scandinavia, 1992-95.
Arch Dis Child 86: 400-402.
9. Anderson JW et al (1999) Breastfeeding
and cognitive development: a meta-analysis. Am J Clin Nutr
70: 525-35.
10. Armstrong J et al (2002). Breastfeeding
and lowering the risk of childhood obesity. Lancet 359:
2003-04.
11. Collaborative Group on Hormonal Factors
in Breast Cancer (2002). Breast cancer and breastfeeding: collaborative
reanalysis of individual data from 47 epidemiological studies
in 30 countries, including 50, 302 women with breast cancer and
96, 973 women without the disease. Lancet 360: 187-95.
12. Labbok MH, Hendershot GE (1987) Does
breastfeeding protect against malocclusion? An analysis of the
1981 Child Health Supplement to the National Health Interview
Survey. Am J Prev Med 3: 227-32.
13. Oddy WH et al (2002). Maternal
asthma, infant feeding, and the risk of asthma in childhood. J
Allergy Clin Immunol 110: 65-7.
14. von Kries R et al. (1999) Breastfeeding
and obesity: cross sectional study. BMJ 319: 147-150.
15. World Health Assembly (2001). Infant
and young child nutrition. Resolution WHA54.2. WHO, Geneva
[http://www.who.int/gb/EB—WHA/PDF/WHA54/ea54id4.pdf].
16. World Health Organisation (2002) Infant
and young child nutrition. Global Strategy on Infant and Young
Child Feeding. Resolution WHA55.25. WHO, Geneva [http://www.who.int/gb/EB—WHA/
PDF/WHA55/ea5515.pdf].
17. Hamlyn B et al (2002). Infant feeding
2000. The Stationery Office, London [http://www.doh.gov. uk/public/infantfeedingreport.htm].
18. World Health Organization. Protecting,
Promoting and Supporting Breastfeeding: the special role of maternity
services. Geneva: WHO, 1989.
19. The Audit Commission (1997). First
class delivery. Improving maternity services in England and Wales.
Audit Commission, London.
20. Department of Health (1998). Independent
Inquiry into Inequalities in Health: Report. Chairman, Sir
Donald Acheson. London: HMSO.
21. UNICEF UK Baby Friendly Initiative.
List of health care facilities with a Baby Friendly award.
[http://www.babyfriendly.org.uk/list.asp accessed 13 February
2003]
22. Department of Health (2002). The
NHS Plan. Improvement, Expansion and Reform: The Next 3 Years
Priority and Planning Framework 2003-06 [http://www.doh.gov.uk/planning2003-2006/index.htm].
23. Nursing and Midwifery Council (2002).
Requirements for pre-registration midwifery programmes. NMC, London.
24. Nursing and Midwifery Council (2002).
Requirements for pre-registration health visitor programmes. NMC,
London.
25. UNICEF UK Baby Friendly Initiative (2002).
Preliminary consultation report—Proposal to introduce
best practice standards for breastfeeding education provided to
midwifery & health visiting students. UNICEF, London [http://www.babyfriendly.org.uk/pdfs/consultationpaper.pdf].
26. UNICEF UK Baby Friendly Initiative (2002).
Introducing the Baby Friendly best practice standards into
breastfeeding education for student midwives and health visitors.
UNICEF, London [http://www.babyfriendly.org.uk/pdfs/ed—stds—publication.pdf].
27. Cattaneo A, Buzzetti R. Effect on rates
of breastfeeding of training for the Baby Friendly Hospital Initiative.
BMJ 2001; 323: 1358-62.
28. Dinwoodie K, Bramwell R, Dykes F et
al (2000). The Baby Friendly breastfeeding management course.
British Journal of Midwifery 8; 362-6.
29. Wissett L, Dykes F, Bramwell R (2000).
Evaluating the WHO/UNICEF breastfeeding course. British Journal
of Midwifery 8; 294-300.
| 
