Breastfeeding

There is a large body of well-established evidence that suggests breastfeeding offers benefits to both mother and baby. The World Health Organisation (WHO) recommends that, wherever possible, babies should be fed exclusively on breast milk from birth until six months of age.

Breastfeeding has some of the most wide-reaching and long-lasting effects on a child’s health and development. Babies who are breastfed have a lower risk of:

• Gastroenteritis
• Respiratory infections
• Sudden infant death syndrome
• Obesity
• Type 1 & 2 diabetes
• Cardiovascular disease
• Allergies (e.g. asthma, eczema)
• Acute otitis media (ear infections)
• Some childhood cancers
• Necrotising Enterocolitis

(Source: National Health and Medical Research Council)

Improving breastfeeding rates in the UK can play a significant role in reducing health inequalities, as the protective health benefits are especially impactful in communities experiencing higher levels of deprivation and poorer health outcomes.

The 2012 UNICEF Preventing Diseases and Saving Resources Report and Appendices evidence how investment in supporting women to breastfeed can improve the quality of life for women and children by reducing acute and chronic diseases.

Benefits to mothers include protection against breast and ovarian cancer, a reduced incidence of hip fractures, low bone density and osteoporosis in later life. Evidence also suggests that breastfeeding has a positive impact on mother-baby relationships, leading to improved mental health and wellbeing for both (Source: NHS). Breastfeeding is important for reducing the incidence and severity of maternal postpartum depression. In addition, breastfeeding is associated with improved maternal sleep. (Source: Mental Health Benefits of Breastfeeding: A Literature Review – PMC)

UNICEF resources can be found at: UNICEF Baby Friendly Resources.

The NHS Best Start in Life resource can be found at: Breastfeeding – NHS.

• Current UK policy is to promote exclusive breastfeeding (feeding only breast milk) for the first 6 months, continuing for as long as the mother and baby wish, while gradually introducing a more varied diet. When parents have made an informed choice to use formula milk, they and their infants should be supported to use formula milk following the National Institute for Health and Care Excellence (NICE) guideline on Maternal and Child Nutrition [NG247].
• NICE has produced the pathway for postnatal care overview [NG194] for guidance, quality standards, recommendations and local policies relating to breastfeeding. The main recommendation is to adopt a multifaceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates.
• Local plans for women’s and children’s services are part of Lincolnshire’s Joint Forward Plan: Living Well and Staying Well.
• Better Births: National Maternity Review (2016) sets out a vision for safer, more personalised, and family-friendly maternity care. It highlights seven priorities, including continuity of care, informed choice, and reducing inequalities.
• Three-Year Delivery Plan for Maternity and Neonatal Services (2023) outlines actions for 2023–2026 to improve safety, personalisation, and equity in maternity and neonatal care. Focuses on four themes: listening to families, workforce support, safety culture, and standards.
• Equity and Equality Guidance for Local Maternity Systems (2021) provides a framework for addressing health inequalities in maternity care. Includes evidence-based interventions, metrics, and pledges to improve outcomes for mothers and babies from diverse backgrounds.
• The Lincolnshire Joint Health and Wellbeing Strategy (2024) maintains a strong focus on prevention and early intervention, embedded across health and care services through a life course approach and system-wide collaboration to reduce health inequalities.

In Lincolnshire, the percentage of babies whose first feed is breastmilk remains significantly lower than both the regional and national averages. In 2023/24, 67.1% of babies received breastmilk as their first feed. (Source: OHID)

Breastfeeding prevalence at 6–8 weeks after birth is also below national figures, with 45.3% of infants in Lincolnshire being totally or partially breastfed at this stage. While these rates are comparatively low, the prevalence at 6–8 weeks is showing a steady upward trend, mirroring the national pattern.

Significant amounts of evidence reveal short-term and long-term health benefits for mother and baby resulting from breastfeeding. However, a disparity in the prevalence of breastfeeding exists. A greater number of affluent mothers successfully breastfeed than mothers living in areas subject to higher levels of deprivation. Breastfeeding is a crucial mechanism for decreasing inequalities in children’s health, including:

• Lowering rates of infant mortality,
• Reducing preventable infections,
• Reducing unnecessary hospital admissions in infancy,
• Lower rates of obesity and overweight,
• Improving emotional attachment.

(Sources: NHS, UNICEF, Health Inequalities Dashboard)

These protective effects are particularly significant for families living in deprived areas, where health outcomes are poorer and the burden of chronic disease is higher. However, breastfeeding rates vary markedly between groups. Breastfeeding rates in the UK are low compared to other countries and mothers who are younger, of white ethnicity, living in areas of high deprivation, or with lower educational attainment are least likely to breastfeed. A woman’s ability to choose to breastfeed is far from being a simple matter of an ‘informed choice’ as there are physical, social and psychological factors which influence this choice, e.g. maternal age, socioeconomic status, marital status, and ethnicity along with peer, social and family pressures (Source: OHID). These factors further compound disparities in health outcomes and access to support (Source: PHE).

Critical periods for the continuation of breastfeeding are encountered at 5, 10, and 28 days. These time points are widely recognised as “risk windows” for breastfeeding drop-off because they coincide with physiological changes and social stressors. Common challenges include milk supply concerns, infant growth spurts, and maternal fatigue. NICE and UNICEF guidance often highlight early and ongoing support during these critical periods to sustain breastfeeding. An increased understanding of the impact of cultural and ethnic attitudes may also reduce attrition rates and support women to continue breastfeeding.

Discussions about ways into breastfeeding are initiated by midwives and Children’s Health 0-19 health visitors during antenatal and post-natal contacts as determined by NICE Pathway guidance and the Healthy Child Programme. All midwives and Health Visitors have been trained in infant feeding and many have considerable expertise in offering support and advice. This helps improve consistency of support for vulnerable groups.

The local Trust (United Lincolnshire Teaching Hospital Trust) has a dedicated Infant Feeding Team that provides specialist support to families. The team has developed an antenatal infant feeding toolkit and postnatal toolkit, designed to promote and sustain breastfeeding from the earliest stage. Their commitment to best practice has been recognised through the achievement of Baby Friendly Initiative (BFI) Level 2 accreditation, with further plans underway for the Neonatal Unit to work towards its own BFI status.

As part of the Family Hub commitment, the Health Visitors service, supported by a dedicated group of peer supporters, is being piloted. This initiative is designed to strengthen breastfeeding support beyond birth, ensuring families receive consistent, informed guidance throughout the postnatal period. This will inform the Children’s Health Service review around infant feeding, with an ambition to continue funding some elements following the pilot.

Commissioned by Lincolnshire Family Hubs, the Lincolnshire Maternity and Neonatal Programme led a year-long breastfeeding awareness campaign aimed at promoting the benefits of breastfeeding, improving access to support for expectant and new parents, and encouraging workplaces to create breastfeeding-friendly environments. The “Latch on Lincolnshire” campaign was co-produced with local families, including those from deprived areas and target demographics to ensure culturally relevant messaging and resources, and to help tackle inequalities most effectively. It was also developed in collaboration with Family Hubs and Local Maternity and Neonatal Systems (LMNS) stakeholders, with insights from a Healthwatch Lincolnshire survey helping to shape its direction and resources.

A network of breastfeeding support groups are run by Children’s Health 0-19 at Children’s centres throughout Lincolnshire. The groups benefit from attendance by a health visiting service professional and, where available, an LCC breastfeeding parent volunteer. LCC has developed a “champion” network of health staff to strengthen the breastfeeding and infant feeding offer in Lincolnshire. United Lincolnshire Teaching Hospitals Trust (ULTHT) employs an infant feeding specialist, to support midwives in improving rates of breastfeeding initiation. There are infant feeding champions in all health visiting teams. In addition, there is one qualified lactation consultant health visitor and a further 4 health visitors working towards their qualification. Joint pathways between ULHT and LCC ensure the right support is provided at the right time by the most appropriate professional and that this support is able to reach those who may otherwise find it difficult to engage.

A two-day breastfeeding training course is delivered to all Health Visitors, registered nurses and Family Health workers in LCC. Training is repeated every five years with annual refreshers. After training, staff undergo a practical skills assessment in practice. ULTHT also provides a two-day breastfeeding and relationship-building course for midwives, neonatal nurses and support staff, which is repeated every 5 years. In addition, maternity and neonatal colleagues attend an annual infant feeding update and breastfeeding practical skills training.

The Lincolnshire Breastfeeding and Infant Feeding Ambition Strategy 2025–2032 sets out a system-wide commitment to improving breastfeeding rates and reducing health inequalities across the county. Developed through a co-produced approach involving health professionals, voluntary sector partners, and service users, the strategy aligns with national guidance and the UNICEF UK Baby Friendly Initiative. It is structured around five key themes: championing breastfeeding across the system, building a skilled and integrated workforce, ensuring accessible support for all families, fostering a breastfeeding-friendly culture, and addressing barriers to breastfeeding. The strategy is underpinned by a robust governance framework, clear data monitoring systems, and an action plan that includes the development of breastfeeding champions, enhanced training, and the establishment of integrated referral pathways. The overarching ambition is to achieve full Baby Friendly accreditation across all relevant services and to embed breastfeeding support within wider health and wellbeing policies.

A wide range of partners are involved and are able to reflect the views of the local population in relation to breastfeeding through the delivery and planning of local services.  To support efforts to improve breastfeeding rates in Lincolnshire, Healthwatch Lincolnshire was commissioned to carry out a two-phase infant feeding study. Phase one involved a digital survey with 850 responses, while phase two included 12 one-to-one interviews and two focus groups. The study aimed to understand breastfeeding rates and durations, identify barriers and enablers, and gather feedback on the postnatal toolkit. Special attention was given to areas with lower breastfeeding rates, such as Gainsborough and the East Coast, with the goal of informing evidence-based recommendations to enhance local support and reduce existing inequality. Insights from this report were used to shape and guide the development of the Infant Feeding Strategy.

Current data collection is fragmented and not routinely reported at a granular level, limiting the ability to target interventions effectively. There is insufficient understanding of how cultural, social, and economic factors influence breastfeeding decisions in Lincolnshire’s diverse communities, particularly in areas of high deprivation and rural isolation. Breastfeeding data by postcode exists within the health and care system. Work has been established to embed this data across the system, so further analysis can take place.  However, routine data reporting is yet to be established. This data would allow a better understanding of the impact of local population characteristics on breastfeeding uptake and continuation, as well as identifying areas where the benefits from services would be highest. Crucially, postcode-level analysis will enable targeted interventions in communities with the lowest breastfeeding rates, helping to reduce health inequalities across Lincolnshire.

Workforce training is well established but requires ongoing development to embed cultural competence and equity-focused practice.

Finally, monitoring frameworks do not consistently include equity metrics, making it difficult to evaluate whether interventions are reducing disparities between socioeconomic and ethnic groups.

Encouraging and supporting more women to breastfeed involves action across three key areas; establishing breastfeeding as the social norm; providing intense support in the first few hours and days after delivery; and providing long-term support in the weeks and months that follow.

Improving awareness of the benefits of breastfeeding with new and expecting mothers is a first step in ensuring all children get the best possible start in life and an opportunity to achieve their potential.

It is also critical that, across Lincolnshire, all professionals work together, to take a systematic approach to supporting the uptake and continuation of breastfeeding, ensuring that the key areas identified in Better Births are included in all antenatal and postnatal services, including early years. These key areas are:

• Preconceptual Care
• Antenatal Care
• Postnatal Care
• Ready for school

Lincolnshire Maternity and Neonatal Programme, commissioned by Lincolnshire Family Hubs, led a year-long breastfeeding awareness campaign in 2024/25 to:

• Raise awareness about the benefits of breastfeeding.
• Provide accessible information to pregnant individuals and new parents on where to find breastfeeding support.
• Encourage businesses to foster a more supportive environment for breastfeeding employees.
• Campaign messages were co-produced with Lincolnshire families, with resources developed in partnership with Family Hubs and LMNS stakeholders. Local engagement, including a Healthwatch Lincolnshire survey, helped shape the campaign.

It is important to continue to maintain the momentum from the progress made and utilise resources to continue raising awareness and consistency in messaging.

Resources can be found at: Better Births Lincs: Breastfeeding

Resources can be found at: Better Births Lincs: Breastfeeding and Work

Improved data collection will provide an improved picture of breastfeeding practice in Lincolnshire. Given the inconsistency in the evidence for effective interventions, measures taken to improve the uptake and continuation of breastfeeding should be evaluated thoroughly to inform the development and delivery of future local services.

The following actions should be considered to tackle inequalities in breastfeeding rates:

• Data-informed targeting: Use available data to identify high-need areas and monitor progress.
• Cultural awareness: Expand training to address cultural and social barriers to breastfeeding.
• Workplace equity: Promote breastfeeding-friendly policies, particularly in sectors employing large numbers of low-paid women.
• Equity metrics: Embed equity measures into monitoring frameworks to ensure interventions are evaluated for their impact on reducing disparities between socioeconomic and ethnic groups.

By focusing on these actions, Lincolnshire can ensure that breastfeeding support not only improves overall rates but also narrows the gap between the most and least advantaged families.

The launch of the Lincolnshire Infant Feeding Ambition Strategy in 2026 will play a pivotal role in advancing this agenda, aiming to boost breastfeeding rates and tackle related inequalities across the county.