Breast feeding and infant feeding

Breastfeeding provides all the nutrients babies need (WHO: Breastfeeding). Nearly all mothers can breastfeed provided accurate information is available and support to start breastfeeding begins within the first hour after birth. The benefits of breastfeeding range from physical and emotional to practical and financial.

Breastfed babies are less likely than non-breastfed babies to suffer from gastro-intestinal or respiratory infections requiring hospitalisation or to suffer from middle ear infections. In addition, non-breastfed babies are at greater risk of developing allergies such as asthma and eczema.

As well as influencing childhood illness, breastfeeding has also been shown to impact on health in later life, with infants who are not breastfed tending to have higher blood pressure, cholesterol levels and be at greater risk of developing type 2 diabetes in adulthood. Breastfeeding has also been shown to have benefits for mothers, lower risk of developing breast cancer (UNICEF UK, 2013).

Breastfeeding also saves time and money involved in bottle-feeding, including the costs of bottles and sterilising equipment as well as the formula itself.

What do we know?

Despite advice from WHO that infants should be fed by breastfeeding only (exclusive breastfeeding) until the age of 6 months, with ‘complementary foods’ i.e. solids and other drinks to be introduced gradually from 6 months, the majority of women in England stop exclusively breastfeeding much earlier than this, in fact over half are not breastfeeding at all by 6 weeks. A survey in 2012 found that while 79% of mothers wanted to start breastfeeding, only 66% did.

Though the for the majority of mothers and babies breastfeeding is possible with the correct support and guidance, for some there are some medical conditions which make breastfeeding either very difficult or not possible such as structural mouth and tongue problems e.g. cleft palate, tongue-tie or acute illness of the infant affecting its breathing as well as infections e.g. HIV. In the UK, mothers known to have HIV are advised to avoid breastfeeding.

Attitudes to breastfeeding in the UK were explored in a Global survey of 2012 which showed that of those mothers who stated that they wanted to start breastfeeding, a key motivation for over half was the health of their infant. The main reasons for stopping in the UK sample were insufficient milk (32%), the baby stopping wanting to feed (24%), pain (20%), time needed to breastfeed (16%). 13% needed to go back to work and 16% felt uncomfortable breastfeeding outside of the home.

Facts Figures and Trends

In 2013/14, the proportion of new mothers in Slough who started breastfeeding their babies in the first 48 hours was 76.8%. This is higher than the national average of 74% but lower than the average across the South East.

Figure 1. Breastfeeding initiation Slough (2010/11-2013/14)

Figure 1

Though the data is not available for how many in 2013/2014 continued to breastfeed at 6 weeks, we do have data for the first quarter of 2015/16. This data shows that only 31% of mothers were continuing to breastfeed exclusively at 6 weeks in Slough, though another 30% were partially breastfeeding. This means that 39% of babies were not breastfed at all at 6 weeks compared to the national average for the previous year of 64% (2013/14).

Figure 2

National & Local Strategies (Current best practices)

National Guidelines

Exclusive breastfeeding (giving your baby breast milk only) is recommended for around the first six months (26 weeks) of your baby's life.

After 6 months, other foods or can be introduced alongside breast milk for a balanced diet. The WHO recommends that solid foods should be gradually introduced, initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months, with additional nutritious snacks offered 1-2 times per day, as desired.

Guidance is also available for public services to ensure that breastfeeding is supported:

National Strategy

Healthy Lives, Healthy People: Our strategy for public health in England (2010) highlights the importance of ‘starting well’ through early intervention and prevention such as breastfeeding support. A number of programmes are listed in this strategy as key to improving breastfeeding uptake and continuation, some are listed below

  • The Healthy Child Programme (HCP)
    The Healthy Child Programme is a public health programme led by health visitors that offers every family in England a package of screening tests, immunisations, developmental reviews, information and advice to insure all children are able to achieve their optimum health and wellbeing.
    An important part of this programme is promotion of breastfeeding. This is supported by other related programmes including
    • Department of Health’s social marketing campaign Start4Life
    • Family Nurse Partnership which gives targeted support to teenage mums
  • The UNICEF UK Baby Friendly Initiative (BFI)
    The UK Baby Friendly Initiative was launched in 1994 to work with public services to support breastfeeding and parent infant relationships. The initiative includes standards for good care against which services can be measured to receive ‘Baby Friendly’ accreditation.

Local Activities

Three evidence based programmes of breastfeeding support are operating in Slough. The first is the Family Nurse Partnership which has achieved similar rates of breastfeeding at 6-8 weeks, among a highly vulnerable group of women, to the national average.

The second is a peer support programme offered by the Breastfeeding Network which has trained 12 volunteer peer supporters in Britwell. Breastfeeding Peer Supporters are involved in running drop-in sessions along with Health Visitors at Slough Children’s Centres.

The third programme is UNICEF’s Baby Friendly Initiative. At present, Frimley Health, the acute trust responsible for Wexham Park Hospital is fully accredited with a BFI award while the maternity department of the hospital itself is currently in the process of achieving full accreditation.

What is this telling us?

Breastfeeding rates in Slough are better than the national average though there is still a gap between the number of women who want to start breastfeeding and those that succeed in starting. An even bigger gap exists between those who manage to continue breastfeeding for the recommended 6 months.

There are huge health benefits to be gained from improving breastfeeding uptake particularly in those groups who are least likely to start breastfeeding, as these are groups who tend to have poorer health overall. Improving breastfeeding rates, therefore, has the potential reduce inequality – a key objective of the Slough Joint Wellbeing Board.

By understanding reported barriers to continuing breastfeeding and supporting evidence-based programmes Slough can continue to use its local assets to sustain a supportive environment for new mothers.

What are the key inequalities?

Infant feeding patterns are strongly influenced by ethnicity, maternal age, educational attainment and socio-economic position, as shown in the data from the National Infant Feeding Survey in 2010 and in the UNICEF report (UNICEF UK, 2013).

  • Age of mother
    There is a strong association between breastfeeding and age of mother with older mothers being more likely to breastfeed. Teenage mothers were the least likely to breastfeed.
  • Socio-economic status
    Breastfeeding rates are highest among mothers in professional occupations and lowest among those who had never worked, similarly rates are higher among those who completed education after the age of 18 compared with those who left education at 16 or under.
  • Ethnicity
    Mothers from all minority ethnic groups are more likely to breastfeed than White British mothers.

Recommendations for consideration by other key organisations:

  • Investing in services to support breastfeeding as part of a local child health strategy is recommended. This is particularly important for mothers from low income groups.
  • Support for breastfeeding needs to be sustained both prior to and over the early weeks after birth. Health visiting teams are working towards having more contact with families in the antenatal period.
  • Cost benefits can be achieved from modest increases in breast feeding rates and the impact on service demand could be modelled locally using the UNICEF estimates.
  • Achieving Baby Friendly (BFI) status both in maternity units and children's centres will be a significant achievement and have a positive effect on infant feeding patterns.

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