Analysis: Health - Breastfeeding care faces neglect

There is a vast swathe of evidence showing the positive effects of breastfeeding on the health of mothers and babies.

More than a year ago, post-natal guidelines from the National Institute for Health and Clinical Excellence (Nice) recommended that every maternity unit should implement the Baby Friendly Initiative. This global benchmark grants the Baby Friendly Award to hospitals that put in place policies to promote breastfeeding and make sure all staff have been trained in how to help women breastfeed.

But figures just out from Unicef show that only 10 per cent of women in England give birth in hospitals accredited with the baby friendly award. And nearly four out of 10 (38 per cent) of maternity hospitals in England have failed to make efforts to put in place best practice around breastfeeding.

Getting the message across

Elsewhere in the UK the picture is less bleak in terms of improving support for mothers who want to breastfeed.

Northern Ireland has made the most progress - 90 per cent of maternity units have shown progress. Scotland has the highest proportion of fully-accredited units with 58 per cent of women giving birth in hospitals with the Baby Friendly Award. In Wales the figure is 46 per cent.

Outside England, the breastfeeding message continues to be much more strategically directed, says Unicef UK's Baby Friendly Initiative director Sue Ashmore. "In Scotland, Northern Ireland and Wales, they have acknowledged that poor health outcomes related to breastfeeding need to be tackled. In Wales the chief nursing officer even wrote to all maternity units about being baby friendly. There isn't that kind of joined-up thinking in England." Ashmore wants the government to give "a clear steer and commitment" to implementing the Nice guidelines.

The Department of Health says it fully supports the Unicef UK Baby Friendly Initiative and breastfeeding rates are monitored through the planning and performance framework for maternity units. But it is up to individual hospital trusts as to how these targets are achieved, and this includes whether or not to formally embrace the Baby Friendly Initiative.

"To make it happen it needs to be led by people who have one foot in management and one foot in clinical service," says Ashmore. "There are costs involved in terms of training and so on - but they're not massive costs. If you've got the will you find the money. If you haven't got the will you say you can't afford it."

Sue Eardley, strategy manager of children and maternity at the Healthcare Commission, agrees that maternity units are put off by the cost of promoting breastfeeding. But Nice research shows working towards baby friendly status would start to show cost savings for the NHS after only three years because of reduced childhood illnesses. "Nice has demonstrated that implementing a mechanism such as baby friendly is cost effective in terms of benefits to the health economy," says Eardley.

"Increasing breastfeeding rates has been shown to have significant benefits for babies and mothers and the Baby Friendly Initiative ensures staff are trained and provide a consistent message to women and their families," she adds.

But breastfeeding is just one of a range of priorities hospitals are having to juggle in a climate of funding restrictions. "Hospitals are looking at this, but it is one of a series of initiatives they are dealing with," says Jo Webber, deputy director of policy for the NHS Confederation. "Baby friendly is not just a hospital thing. It needs to be done as a concerted effort across the local authority area to get the maximum benefit."

Proactive approach

A peer-support scheme in east Lancashire is helping to re-establish breastfeeding, particularly among ethnic minorities.Funded by Blackburn with Darwen Council, the Little Angels support group sees every new mum that lives within the area - about 2,000 women a year. Local mums are trained to the same baby friendly standards as professionals and then work with other women throughout their time breastfeeding.

When they began in 2004, one in five women were breastfeeding at six weeks and just seven per cent by seven months. Now rates at six weeks have more than doubled and by seven months a quarter of women still breastfeed.

"It's a proactive, not reactive, service," says Little Angels co-director Michelle Atkin. "We get in touch with every new mum within a couple of days of giving birth. And then we are there to support her throughout her breastfeeding career, however long that is."

The costs are as little as £150 per year per mum, but Atkin is aware that the barriers are more than just financial, as she says: "We are fighting against 40 years of marketing by milk companies, a culture that sees breasts as sexual and a third generation of bottle feeders."

THE BABY FRIENDLY INITIATIVE

To be awarded the Unicef Baby Friendly Initiative, maternity units need to:

- Train all healthcare staff in the skills needed to implement breastfeeding policy

- Inform all pregnant women about the benefits of breastfeeding

- Help mothers initiate breastfeeding soon after birth

- Encourage breastfeeding on demand.

www.babyfriendly.org.uk.