Covid-19 exposes fragility of infant feeding support in the UK

A printer-friendly pdf version of this statement can be found here.

With breastfeeding support under strain, service providers propose plan to tackle inequalities

This World Breastfeeding Week (1-7 August 2020), we are calling on the UK government to address the fragility of breastfeeding support services.

Our organisations have seen first-hand how the Covid-19 crisis has exposed the fragility of infant feeding support available for women, parents and families.

Over the past few months, the need to support babies and families has escalated and support services have been stretched beyond anything in our experience.

Existing variations in provision for infant feeding support have increased as services have been cut, health visiting teams redeployed and provision moved online, leading to unknown outcomes on infant nutritional health, worsening maternal mental health and widening health inequalities.

Tremendous efforts from the NHS and Third Sector organisations, including many volunteers on the National Breastfeeding Helpline and other charity-run helplines, along with swift adaptation to offer online support, have provided many families with support but this is not sustainable without a longer term strategy.

Meanwhile, the need to protect infant and young child feeding in pandemic emergencies has not previously been considered and has been entirely missing from the Scientific Advisory Group for Emergencies’ reports

Investing in the health of new families, including supporting and protecting breastfeeding and supporting safe and responsive formula or mixed feeding, enables children not just to survive, but to thrive.

Rebuilding infant feeding support for communities after Covid-19 and giving important attention to the needs of mothers and children from Black, Asian and minority ethnic backgrounds will help tackle inequalities.

Infant feeding is a critical component of first 1001 Days and Early Years Health

We welcome the appointment of Andrea Leadsom MP as the Government’s Early Years Health Adviser and the announcement of a review at a time when infant feeding support services for women, parents and families have been stretched to an unprecedented degree.

Protecting breastfeeding and ensuring safe and responsive formula and mixed feeding during those first 1001 days would make a significant contribution to reducing inequalities in health. As a result, it also upholds the work of the NHS and helps build a healthier population.

While COVID-19 has undoubtedly placed a strain on support systems, it has also highlighted a huge omission in UK policy on planning for the care and feeding of infants and young children in case of emergencies, leaving our youngest members of society vulnerable.

While the benefits of breastfeeding are well-evidenced, merely stating these benefits does not ensure breastfeeding is protected or supported. At a time of global health crisis, and increasing recognition of the impact of human behaviour on the health of our planet, support for breastfeeding is also an environmental imperative.

10-point Infant Feeding Action Plan to address Inequalities

We call on the UK government to adopt the following 10-point Infant Feeding Action Plan below which has a particular focus on working to reduce inequalities:  

1. For the new Government Early Years Advisor to appoint a permanent, multi-sectoral maternal, infant and young child nutrition strategy group to implement a national strategy to support good nutrition across the first 1001 days. 

2. To commission and sustainably fund universal, accessible, confidential breastfeeding support delivered by specialist/lead midwives, health visitors and suitably qualified breastfeeding specialists, recognising the role of charitable organisations and community groups and their strong links with communities. 

3. Ensure there are children’s centres or family hubs, disproportionately located in areas of disadvantage, offering joined-up universal services from pregnancy onwards, that include breastfeeding peer support,
guidance on the introduction of solids and eating well in the early years.

4. To ensure that health visiting services are properly funded and the number of health visitors increased to ensure consistent timely nutritional support for all families to support good maternal and infant mental and physical health. 

5. To integrate planning to support infant and young child feeding in emergencies into legislation, the Civil Contingencies Act, and Local Resilience Forums across the country. 

6. To recognise the importance of breastmilk for preterm and vulnerable babies and the need for equitable access to donor breastmilk for these babies through the establishment of a fully funded regional donor milk banking service

7. To implement the Unicef UK Baby Friendly Initiative across community, hospital and neonatal services, building on the recommendation for all maternity services to be accredited in the NHS Long Term Plan. 

8. To make it a statutory right of working mothers to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage. 

9. To support the commitment to re-instate the quintennial Infant Feeding Survey which builds on data previously collected every five years since 1975, most recently in 2010. 

10. To protect babies from harmful commercial interests by bringing, as a minimum, the full World Health Organisation International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.

For enquiries, please email CEO@breastfeedingnetwork.org.uk

The Breastfeeding Network
Association of Breastfeeding Mothers
National Childbirth Trust
La Leche League GB
Henry
Best Beginnings
Diversity in Infant Feeding
Local Infant Feeding Information Board
Lactation Consultants of Great Britain
World Breastfeeding Trends Initiative UK
Hospital Infant Feeding Network
GP Infant Feeding Network
UK Association of Milk Banking
Better Breastfeeding
Nursing Matters
Save Time Support Breastfeeding
Swansea University
Human Milk Foundation
Institute of Health Visiting
Breastfeeding Twins and Triplets

References in support of this statement
  1. Surviving and thriving: Focus on the first 1001 days of a child’s life from pregnancy to age two enables children to survive and thrive. How an infant is fed and nurtured strongly influences a child’s future life chances and emotional development. Importantly, if a woman breastfeeds there are substantial health benefits for her – having impacts on her future long after breastfeeding has stopped. (1001 days, 2020. Laurence, 2016, Chowdhury, 2015, Chapman, 2016)
  2.  Return on investment: Breastfeeding benefits all babies, and studies have shown that just a small increase in breastfeeding rates could cut NHS expenditure considerably (Pokhrel, 2014). We know breastfeeding support works so it is vital to invest in this support in the early months and this will reap rewards in the future that are likely to exceed the initial investment. (McFadden,2017, Pokhrel, 2014, Rollins, 2016)
    • Pokhrel S, Quigley MA, Fox-Rushby J, et al Potential economic impacts from improving breastfeeding rates in the UK. Archives of Disease in Childhood 2015;100:334-340.
    • McFadden A, Gavine A, Renfrew M, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie A, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub5
    • Rollins N, Bhandari N, Hajeebhoy N. et al (2016) Why invest, and what it will take to improve breastfeeding practices? The Lancet 387 491-504

  3. Life chances: As a UNICEF UK report stated in 2013: “no other health behaviour has such a broad-spectrum and long-lasting impact on public health. The good foundations and strong emotional bonds provided in the early postnatal period and through breastfeeding can affect a child’s subsequent life chances”.
  4. Equity: Evidence has also demonstrated that a child from a low-income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula-fed. Breastfeeding provides one solution to the long-standing problem of health inequality (Wilson, 1998).
  5. Environmental Impact: A significant impact on our planet and on climate change – Overall, breastfeeding for six month saves an estimated 95-153 kg CO2 equivalent per baby (Joffe, 2019).
  6. Data: Research into the extent of the burden of disease associated with low breastfeeding rates is hampered by data collection methods. This can be addressed by investment in good quality research and investment in local public health to increase coverage of infant feeding data.
  7. In addition to well documented health and environmental outcomes, supporting breastfeeding will also contribute to a stronger economy – potential reduced annual healthcare costs totalling nearly $400 million in the U.S., UK, Brazil and urban China from just a moderate increase in breastfeeding rates (Victora, 2016).

  8. In the UK, the majority of families start to breastfeed but breastfeeding rates drop rapidly – our continuation rates are some of the lowest in the world and are even lower amongst families living in deprived areas, where increasing rates could make a real difference to health inequalities (McAndrew, 2012).
  9. Families tell us they are still regularly exposed to conflicting messaging and marketing for formula milks that drowns out advice from healthcare professionals. Women tell us they receive little to no help with infant feeding and that their health visitors, midwives and doctors often have little training or knowledge about breastfeeding and limited time to support them. Recent cuts in health visitor numbers and breastfeeding peer support services mean many parents may be left without the support they need however they choose to feed their infants. COVID19 has closed down all the local children’s centres and community support groups. https://www.unicef.org.uk/babyfriendly/cost-of-infant-formula-inquiry/

  10. Lack of support with breastfeeding problems can really increase a mother’s risk of postnatal depression (Borra, 2015, Brown, 2015). Skilled support to overcome breastfeeding problems, and easy access to local community support groups, could reduce the risk of postnatal depression, but these have been slashed during the COVID19 pandemic by the wholesale closure of community support groups and the redeployment of midwives and health visitors to core services. The emotional impact of isolation and restrictions on being together as a family in hospital settings such as NICU will take time to understand.
    • Borra C, Iacovou M, Sevilla A (2015) New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Maternal Child Health Journal (4): 897-907
    • Brown, A, Rance J, Bennett, P (2015) Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing 72 (2): 273-282

  11. Feeding in Emergencies, including COVID-19: The lack of emergency preparedness for new families is stark. The UK scored 0/10 in the 2016 WBTi report. COVID-19 has undoubtedly placed a strain on support systems with health visitors redeployed away from the community. Services moved online which means digital exclusion for those unable, or without access to these resources.

    Unicef Baby Friendly UK and First Steps Nutrition have put together basic guidance for local authorities on supporting families more safely with infant feeding, but there is a serious need to have national guidance in place before any further COVID-19 lockdowns, flooding or other natural disasters hit.