Breastfeeding

There is a large body of well-established evidence that 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, lactose intolerance, eczema) 
• Acute otitis media (ear infections) 
• Some childhood cancers 

(Source: National Health and Medical Research Council) 

The 2012 Unicef Preventing Diseases and Saving Resources Report and Appendices evidence how investment in supporting women to breastfeed can improve 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).  

UNICEF resources can be found at UNICEF Baby Friendly Resources. 

• 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 artificial milk, they and their infants should be supported to use artificial milk following the National Institute for Health and Care Excellence (NICE) guideline on Maternal and Child Nutrition (PH11). It is an expectation that all partnership agencies adhere to the WHO International Code of Marketing of Breast-milk Substitutes. 
• NICE has produced the pathway for postnatal care overview 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. 
• The NHSE Long Term Plan (2019) sets out the Government’s expectations for the NHS in England over a 10 year period. In terms of breastfeeding, the plan refers to all maternity services aspiring to have an accredited, evidence based infant feeding programme, such as the UNICEF Baby Friendly Initiative, in place by 2019/20. 
• Local plans for woman and children’s services are part of Lincolnshire’s Sustainability and Transformation Plan. 
• The Lincolnshire Joint Health and Wellbeing Strategy (2018) has a strong focus on prevention and early intervention, with a recognition of the need to embed this across all health and care services. 

In Lincolnshire, the percentage of babies whose first feed is breastmilk, and the percentage of infants that are totally or partially breastfed at age 6-8 weeks, are significantly lower than the regional and national averages. Breastfeeding prevalence at 6-8 weeks after birth is steadily increasing, in a similar fashion to the national trend (Source: OHID). Local health visitor data shows that 76.2% of those who were breastfeeding or partially breastfeeding at the primary birth visit, are continuing to do so at 6-8 weeks. 

Data available on breastfeed rates at different ages is quite limited. The Lincolnshire Health Visitor dashboard reports breastfeeding rates for children that have received a 6–8-week visit. In 2021/22, data showed 71.9% of mothers had sustained breastfeeding/partial breastfeeding, by weeks 6-8.   

Significant amounts of evidence reveal short-term and long-term health benefits for mother and baby resulting from breastfeeding. However, a disparity in 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 

(Source: PHE) 

Between 1975 and 2010, national survey data was collected, every 5 years, through the Infant Feeding Survey. Survey results were used to provide estimates on the incidence, prevalence, and duration of breastfeeding, and other feeding practices adopted by mothers in the first eight to ten months for babies born in the UK. Although these survey data are becoming increasingly outdated for understanding current rates, they are a useful for understanding the impact of breastfeeding on the health of growing children. 

Evidence from the 2010 UK Infant Feeding Survey shows an effect of deprivation on initiating breastfeeding with 73% of mothers living in the most deprived areas, but 89% of mothers in the least deprived areas. No data is available on breastfeeding and deprivation for Lincolnshire, but it is assumed that Lincolnshire follows this national trend.  

Breastfeeding rates in the UK are low compared to other countries. Breastfeeding rates also vary between groups, with young mothers, mothers of white ethnicity, those living in more deprived areas of the country and those with lower levels of education the least likely to breastfeed (Source: OHID). 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: PHE). 

Critical periods for the continuation of breastfeeding are encountered at 5, 10 and 28 days. An increased understanding of the impact of cultural and ethnic attitudes might reduce attrition rates and support women to continue breastfeeding. 

Discussions about ways to breastfeed are initiated by midwives and health visitors at antenatal and during post-natal contacts as determined by the Healthy Child Programme and NICE Pathway guidance. All midwives and Health Visitors have been trained in infant feeding and many have considerable expertise in offering support and advice. 

A network of breastfeeding support groups are run at Children’s centres throughout Lincolnshire. The groups benefit from attendance by a health 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 Hospitals Trust (ULHT) employs an infant feeding specialist, supporting midwives to improve rates of breastfeeding initiation. There are infant feeding champions in all health visiting teams and 4 lactation consultants are in the process of training. Joint pathways between ULHT and LCC ensures the right support is provided at the right time by the most appropriate professional. 

A two-day breastfeeding training course is delivered to all health visitors and Family Health workers in LCC. Training is repeated every three years with annual refreshers. After training, staff undergo a practical skills assessment in practice. 

Breastfeeding should be seen as a biological and cultural norm within society. The Making Every Contact Count (MECC) approach can support this by promoting understanding and reinforcing positive messages. A life course approach can educate and inform by taking a realistic and practical approach to continued breastfeeding. 

A wide range of partners are involved and are able to reflect the views of the local population in relation to breastfeeding through delivering and planning local services. No local public engagement has been undertaken to understand why women in Lincolnshire do not breastfeed or stop breastfeeding before 6 to 8 weeks. 

Breastfeeding rate by postcode exists within the health and care system, but at the time of writing this commentary was not available for JSNA purposes; so, further analysis is not currently possible. Neither is there routinely available data for smaller geographical areas. This data would allow better understanding of the impact of local population characteristics on breastfeeding uptake, and continuation, as well as identifying areas where benefits from services would be highest. 

The impact of maternal mental health and post-natal depression (PND) on the continuation of breastfeeding is well understood. However, since data is not collected for women with PND who breastfeed, this cannot be evaluated locally. 

A robust data collection system within Midwifery and Health Visiting services would help to understand the impact of providing advice and information to normalise breastfeeding at antenatal services. There is need for agreement both amongst professionals and a societal shift in the way breastfeeding is portrayed in local services, the media and social media. 

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 provision of 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, taking a systematic approach to supporting the uptake and continuation of breastfeeding, ensuring the key areas identified in Better Births are included in all antenatal and postnatal services, including early years. These key areas are: 

• Fit for pregnancy 
• Antenatal Care 
• Postnatal Care 
• Ready for school 

To support a system-wide approach to breastfeeding, the Children’s Health and Clinical Quality Group have reviewed the breastfeeding policy and pathway. The policy includes a commitment from partners to provide Stage1 Make Every Contact Count (MECC) training to the wider workforce. This policy and pathway will be reviewed regularly and should help to ensure a coordinated approach to increasing the percentage of breastfed babies and ensure consistent key messaging across key partners. 

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 development and delivery of future local services.