25 Aug

Black Lives Matter: how the Breastfeeding Network is working to tackle racial inequality

To coincide with Black Breastfeeding Week 2021, BfN CEO Shereen Fisher gives an update on our ongoing work to tackle racial inequality.

The Black Lives Matter movement of 2020 shone a spotlight on the world of racism within UK culture and institutions, leading to worldwide protests to end racial inequality. BLM combined with shocking information coming out on the deep inequalities that exist within our maternity systems for Black and Asian Women through the MBRRACE Report, have caused many charities involved in supporting parents to think about whether our services really are meeting the needs of all parents, babies and families.

This is true for BfN and this blog seeks to state our progress against our published statement that we shared in 2020 in response to BLM and in solidarity against racism.

Here is that statement again:


Black breastfeeding matters

We stand alongside all Black mothers and families, and are willing to do anything we can to ensure mothers and babies get real change for the better.

At the heart of BfN’s values is empowerment of women, and none of us can feel empowered if we are raising our children with threat from racism.

As a charity we have always believed in social justice for mothers and babies, but often we have felt limited in what to do, in part due to our own ignorance – which is our responsibility to correct.

We hear our fellow Black mothers and families and we are committed to doing more – using our core values of empowerment, empathy and actively listening.

We are committed to learning and educating ourselves.

We will share and amplify Black women’s voices.

We are here for you.


Since we made that statement, what have we done?

Nearly a year on from publishing the statement we have already published an update on our progress against an agreed action plan (the previous update can be accessed here). So, this update you are reading is our second and we will continue to keep you apprised of our progress.

For the second year we will provide monetary support to the organisers of Black Breastfeeding Week, we will encourage peer supporters to access training organised during this week and at other times that challenges thinking and supports their skills to support all families. We will continue to promote and raise awareness of the FIVEXMORE campaign in our communications and work.

Following a listening exercise with our own peer supporters we have heard first-hand about the experience of being a peer supporter in BfN and the additional challenges for peers from Black and Asian backgrounds to feel that their experience is represented. While generally being part of the BfN family is overwhelmingly positive we can see deficiencies in some of our group dynamics and limitations in our knowledge and skills reflected in our training.

So, this has led us to review our training materials with some help from an external organisation. We were pleased to see that only a small number of changes were needed so far but we acknowledge that the adjustments to our training content and inclusion of examples will have made a big impact for peer supporters who may have not seen themselves reflected in the experience and knowledge we were conveying. A commitment to ongoing review with the right representatives will help ensure our training and approach to support reflects diverse experience.

Our goal is to be a charity that is able and committed to supporting ALL families and for ALL families to feel comfortable and safe accessing our support, training, volunteering and working for us. This is at the heart of our work and we know that we can only truly achieve it by becoming a more representative and diverse charity.

Going forward, all BfN information will be developed and reviewed by a panel reflecting the skills and lived experience of parents. We hope to have the panel set up by the end of this year.

Guided by the insights from the volunteer working group, Black, Asian and Ethnic Minority peer supporters from BfN, and colleagues from BRAP, we have mapped the areas and actions that we want to work on. This has informed our plan to roll out training for key staff and peer supporters within our network, starting with our Tutor and Supervisor group. This programme of training is ongoing and includes training of BfN Directors this summer. The training for Directors seeks to help BfN’s trustees develop a greater understanding of what it means for BfN to be anti-discriminatory in its practice and discuss the role of leaders in developing and leading an organisation that is committed to culture change.

While progress had been made to engage younger mothers with lived experience of breastfeeding on the Board as Directors, there has been a clear lack of diverse ethnic representation on our Board of Directors for some time. In November 2020 we were pleased to welcome two new board members – Ernestine Gheyoh Ndzi and Joy Hastings – and there is an ongoing commitment to ensure strong representation on the Board to support effective decision-making. Since then we have undertaken another round of recruitment and we are pleased to welcome a further 3 new Directors to the BfN Board soon, reflecting the skills and lived experience that BfN needs to govern.

In respect of our workforce and volunteers we know that BfN attracts a diverse range of candidates for jobs but we need to do more work to see if the people who get offered jobs are also representative and diverse. In July 2021 we launched our first employee survey which will provide an important benchmark to help inform planning and recruitment going forward.

We are committed to diversity and inclusion being on all agendas – wherever we meet we will actively discuss and invite feedback and learning on diversity and inclusion. This includes our Board, manager meetings and meetings of our project leads, tutors and supervisors.

Our communications team do and will continue to ensure that our values around diversity and inclusivity are publicly demonstrated.  This covers our newsletters, all social media channels, blogs, campaigns and printed materials.

Externally, we see the potential for the positive impact to come through our openness to partners and willingness to work with others. In late 2020 we joined a collaboration made up of several other organisations including Oxford Breastfeeding Support Group, ABM, GPIFN and others to build an open resource of images depicting different clinical issues of the lactating breast represented on different skin tones. The issues of a lack of diverse images have been highlighted by Nekisha Killings ( Nekisha Killings on Breast Assessment and Non-White Skin Tones | GOLD Learning 2020 Speaker – YouTube) we hope to be able to collectively support the progress and availability of ‘Spectrum’ in the near future.

What happens next?

We are committed to taking lasting and ongoing action and progressing our plans publicly. The Board approved action plan on inclusion and diversity reflects ongoing commitment and progress in this area.

We are grateful to the many peer supporters in BfN from Black, Asian and other Minority Ethnic backgrounds who took the time to talk with us about their lived experience of our support, training and volunteering. We welcome any other feedback, especially where you think we could do better. Please contact us ceo@breastfeedingnetwork.org.uk


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02 Aug

Why does academic research have an important role in protecting breastfeeding?

Anthea Tennant-Eyles, Research Lead and Breastfeeding Peer Supporter

New research published here by Cardiff University and The Breastfeeding Network highlights inequity of access to breastfeeding support for families across England and Wales, a pattern of decreased funding since 2015 across England and loss of funded peer support training across Wales. One peer supporter describes changes to local support as ‘a skeleton with all the flesh removed’.

Click here to read the full report.

This research looks at data from local authorities, CCGs, health boards, infant feeding leads, peer supporters and service-users on breastfeeding support services. The need to value breastfeeding support (including peer support) at all levels has been a key finding.

World Breastfeeding Week 2021 has a fitting theme ‘Protect Breastfeeding: a shared responsibility’.

Good practice of this has been reported. One Infant Feeding Lead describes a maintained level of funding, with BFI accreditation, a staff team to support the infant lead role and a peer support service that is ‘fully integrated and offers comprehensive very high level support across all areas of maternity and health visiting services.’

High-level investments are needed across England and Wales to ensure that there is equity of access to breastfeeding support.

One peer supporter noted, “it was different in every local authority or health board … it was a post code lottery … until after you had your baby, you didn’t really realise how much that mattered in terms of what support you would get”.

So why is academic research on breastfeeding so important?
To inform policy makers on the importance of providing dedicated breastfeeding support services to local families and that services are protected for the well-being of future generations.


This time last year, we published a joint statement with a number of other organisations, expressing our concern at the fragility of infant feeding support in the UK, exposed by the Covid-19 pandemic. Unfortunately, not a lot of progress has been made towards remedying this situation in the past year, and this new report only serves to highlight the continuing need for change. We stand by our statement and are still calling on the UK government to work towards reducing health inequalities and improving provision of adequate breastfeeding support for all. You can read our original statement here:
https://www.breastfeedingnetwork.org.uk/2020statement/


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30 Jun

Drugs in Breastmilk Information Service: Update

BfN’s plans to support Wendy Jones’s retirement came to fruition last weekend when our new team of trained volunteer pharmacists took up the baton of responding to enquiries to the BfN Drugs in Breastmilk Service Facebook page

Shereen Fisher, Chief Executive for the BfN said, ‘In 2019 we asked evaluators at Swansea University ​to set out the key recommendations for taking our Drugs in Breastmilk service forward – I am pleased to say the number one recommendation was to train more supporters and ensure longer term stability, and last Saturday showed the progress we are making.’

The new team of volunteer pharmacists, who are all trained BfN breastfeeding support helpers, have shared in our vision as we look to the future, supporting breastfeeding parents and healthcare professionals with queries about drugs in breastmilk. 

We are so fortunate to be able to bring a huge amount of expertise and energy to the service, with our new group of 11 pharmacists, many of whom already work in women’s health and have experience supporting breastfeeding families via social media, both voluntarily and professionally.  

As BfN continues to work with the new Safer Medicines in Pregnancy and Breastfeeding Consortium led by the Medicines in Health Regulatory Authority, this new team is supporting an enormously valuable and valued service to provide information, empathy and understanding to the thousands of enquirers who contact the service each year.

The volunteer team have got off to a great start with the guidance and support from supervisors and Wendy remains on hand throughout the summer while the service transitions. BfN are making plans for a proper celebration to mark Wendy’s unwavering commitment and contribution to supporting breastfeeding families over the last two decades. 

Wendy Jones says “I am delighted to leave the BfN Drugs in Breastmilk service in safe hands.  My dream over the past 26 years has been that all women are empowered to make evidence based decisions on medication whilst continuing to feed their babies and that all healthcare professionals feel fully informed when prescribing to them. My passion for this subject continues.  I feel very proud that another 11 pharmacists share my feelings. I’m looking forward to more time with my family, my animals and my garden, but yet another book might be needed before I put away my computer!’

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03 Jun

BfN Awarded Good Governance Award

It’s been an unforgettable year for the Breastfeeding Network, with record breaking numbers of mothers and parents supported on the National Breastfeeding Helpline and by our peer supporters across England, Wales and Scotland, who have adapted to supporting new parents and families online. The way the charity has responded under pressure and to the challenges has been truly amazing. So I am thrilled to be sharing yet another success on top of this….

In April this year, just over a year from the first lockdown, BfN achieved the Good Governance Award!

Under the guidance of the BfN Board, we started the journey of reviewing our governance practice many years ago. But we only felt able to formalise a process for seeking external review for BfN in late 2019, when Ann Kerr (BfN Chair) spotted details on the Good Governance Award at a training event for charities in Scotland. Good governance is fundamental to a charity’s success. It enables and supports a charity’s compliance with the law and relevant regulations. It also promotes a culture in which everything works towards fulfilling the charity’s vision.

The Good Governance Award is the Quality Standard for Scottish charities, recommended by OSCR. The Award supports and celebrates governance best practice, recognising the importance of good management to the efficacy and efficiency of Scottish Charities. Dundee Voluntary Action developed the Award, and Chief Executive Shereen Fisher said, “We know that BfN is well thought of for its breastfeeding information and support by Mothers, Parents and Families, but we can also now show parents and families and the wider public that we are well-run and well-governed – this will bring a new layer of trust and confidence”.  

What was the process?

The Board of Trustees and the Central team have spent the last eighteen months following a clear, structured approach to assessing and improving the charity’s policies and procedures. The charity has looked closely at the following areas to compile an eportfolio which evidences competency and best practice in:

  • Charitable Status
  • Trustees
  • Planning, Delivering, & Monitoring
  • Recruitment
  • Managing Staff & Volunteers
  • Managing Finances
  • Managing Resources
  • Marketing & Communications

Completion of the award provides proof that BfN is actively engaging in excellent governance through our Award Certification. It adds value and enables us to build a sustainable, better future for all of the families that we support. BfN have been awarded three years of Good Governance Award status and will be involved in a forum to support re-assessment.

For further information, email ceo@breastfeedingnetwork.org.uk

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24 Feb

Black Lives Matter: how the Breastfeeding Network is working to tackle racial inequality

In June 2020, against the backdrop of the worldwide protests advocating for an end to racial inequality on a mass scale, the Breastfeeding Network shared a statement on Black Lives Matter in solidarity against racism. It felt especially relevant for BfN to do this given our work with all mothers and our knowledge of the deep inequalities that exist for Black and Asian women in our maternity services highlighted in the MBRRACE report.

Here is that statement again:


Black breastfeeding matters

We stand alongside all Black mothers and families, and are willing to do anything we can to ensure mothers and babies get real change for the better.

At the heart of BfN’s values is empowerment of women, and none of us can feel empowered if we are raising our children with threat from racism.

As a charity we have always believed in social justice for mothers and babies, but often we have felt limited in what to do, in part due to our own ignorance – which is our responsibility to correct.

We hear our fellow Black mothers and families and we are committed to doing more – using our core values of empowerment, empathy and actively listening.

We are committed to learning and educating ourselves.

We will share and amplify Black women’s voices. We are here for you.


Since we made that statement, what have we done?

We have made the commitment publicly to push for anti-racism within infant feeding and across maternity and the early years agenda. We have done this through becoming a more visible ally to the people and organisations who give voice to anti-racism, including providing monetary support for Black Breastfeeding Week and promotion and awareness raising of the FIVEXMORE campaign in our communications.

Across the charity we have questioned ourselves and heard from others to understand our responsibilities to drive up equality and eliminate racist behaviour. While we, like many other breastfeeding support organisations, don’t consider ourselves to be racist, by virtue of the UK’s shocking inequalities we recognise that by remaining passive on these issues we perpetuate the same behaviours that allow racism to flourish. We all need to do more and given what we know about the inequalities that persist within breastfeeding we in particular actually need to do more than most to help correct this. We aim to drive up racial equality in breastfeeding by further committing to supporting ALL families to feel comfortable accessing our support, training, volunteering and working for us. This is at the heart of our work and we know that we can only truly achieve it by becoming a more representative and diverse charity.

So, informed by early work undertaken by volunteers on a working group in 2018/19, we have been asking ourselves …

  • What are the changes that we need to make?

Last summer we heard from many of our peer supporters out in communities who knew more than we did to understand how we can implement a lasting inclusion and diversity action plan for the charity.

  • Where we are now and, and what actions must we take?

Guided by the insights from the volunteer working group, Black, Asian and Ethnic Minority peer supporters from BfN, and colleagues from BRAP, we have mapped the areas and actions that we want to work on. Our Board-approved Inclusion and Diversity Action Plan will document change in the following areas:-

People we support

We have always recognised that some women face higher barriers to breastfeeding support. This is why we have and will continue to keep our training for mothers free. We have also always targeted our work in areas where breastfeeding rates are at their lowest. We routinely collect ethnicity data on our helplines and across our commissioned services but we don’t have a complete picture for our volunteers across the charity. We believe that increasing access to our training is key to building a more diverse charity. However, we recognise that even the act of volunteering is problematic for individuals and communities who are not able to afford to volunteer.

We provide a universal service meeting mothers on-wards, and we know that our home visits reach a diverse community, but many services are based at our community groups and attendance at groups is not representative. Through our action plan we are seeking partnerships with others to help us build representation across our community groups and drop-ins. We recognise that with a few exceptions the majority of the people we support across our helplines and in our commissioned services are white and we want to change this through encouraging wider access to our training. The charity has a tradition of offering minority language lines. We proactively maintain specific helpline support for Welsh, Polish, Bengali/Syheti women and families – and are able also to offer helpline support in various other languages, because of the diversity and strength in languages that our networks possess. While we see this as a strength it can also be a practical weakness as language lines rely on volunteers. We will proactively report on the take-up of our language lines and develop less volunteer-reliant ways of supporting families who require support in a different language. 

Board

While progress had been made to engage younger mothers with lived experience of breastfeeding on the Board as Directors there has been a clear lack of diverse ethnic representation on our Board of Directors for some time. In November 2020 we were pleased to welcome two new board members and there is an ongoing commitment to ensure strong representation on the Board to support effective decision-making.

Workforce and volunteers

BfN attracts a diverse range of candidates for jobs but we need to do more work to see if the people who get offered jobs are also representative and diverse. We commit to doing an employee survey in 2021 and benchmarking with other appropriate organisations.

We will also explicitly recruit staff from diverse backgrounds for a range of specialist and skilled roles across the organisation.

Training and Supervision

We are working with a partner to undertake a review of our Helper training and resources to ensure equality, diversity, inclusion and accessibility. This will be complete by February 2021 and then we will look to extend the review across the rest of our training resources over the course of the year.

Our commissioned work in Cheshire and Merseyside, where some trainees were recruited through the Black Mum Magic Project, will provide invaluable ongoing learning for our training. As the vast majority of our trainees are white, attracting, training and retaining women from more diverse ethnic backgrounds is a key focus of our work in many communities. We intend to offer targeted training to these communities independently or in collaboration with a partner. 

Internal Culture

We recognise that we have not done enough to help our workforce adopt and implement inclusive and diverse practices and to build knowledge and cultural sensitivity. In early 2021 we are training our tutors and supervisors in inclusion and diversity, we are doing this with two external providers – BRAP, an equality charity, and Vanisha Virgo, Mama and Me, who has trained with BfN. We will extend training on inclusion and diversity to all staff by the end of 2021.

We have reviewed our mandatory training requirements to cover training that is important to our volunteers and staff and this now includes inclusion and diversity training.

We are committed to diversity and inclusion being on all agendas – wherever we meet we will actively discuss and invite feedback and learning on diversity and inclusion. This includes our Board, manager meetings and meetings of our project leads, tutors and supervisors.

We are collecting and updating resources, policies and documents on inclusion and diversity and we will make these available for all staff and volunteers as part of the induction process.

Website

The working group in 2019 guided us on changes that have largely been implemented but we want to do more. Our website requires an overhaul both in design, images and content and this is a goal to achieve in 2021/22.

Marketing and Communications

Our communications team do and will continue to ensure that our values around diversity and inclusivity are publicly demonstrated.  This covers our newsletters, all social media channels, blogs, campaigns and printed materials.

Next Steps …

We are committed to taking lasting and ongoing action and progressing our plans publicly. We will share progress. We have dedicated resources within our team and a commitment from the charity to implement real change. We will work with partners and agencies to help guide us as we bring on these changes to ensure that the impact of the changes we make is evaluated and prove to be effective.

We are grateful to the many peer supporters in BfN from Black, Asian and other Minority Ethnic backgrounds who took the time to talk with us about their lived experience of our support, training and volunteering. BfN at its heart is a listening organisation and we believe that it is really only through listening that we can fully understand the needs of the women and families whom we serve.  However, it is through action that we can really build trust and confidence. We welcome any other feedback, especially where you think we could do better. Please contact us ceo@breastfeedingnetwork.org.uk

25 Nov

Joint Statement on Protecting Breastfeeding

Statement issued by:


We want the new government to invest in the health of women and children by supporting and protecting breastfeeding.


The new government needs to prioritise the first 1001 days of a child’s life, from conception to age two, to enable children to survive and thrive. How an infant is fed and nurtured strongly influences a child’s future life chances and emotional health. Importantly, if a woman breastfeeds there are substantial health benefits for her – having impacts on her future long after breastfeeding has stopped.


Independent, practical, evidence-based information and support is essential for every family. Supporting women with breastfeeding can go a long way to protecting children and mothers from a wide range of preventable ill health, including obesity and mental health problems.


This window of opportunity cannot be missed for the future health outcomes of mothers and the next generation. In addition to well documented health outcomes, supporting breastfeeding will also contribute to a stronger economy – potential annual savings to the NHS are estimated at about £40 million per year from just a moderate increase in breastfeeding rates.

Support for breastfeeding is also an environmental imperative and recognition of the contribution breastfeeding can make to avoiding environmental degradation should be a matter of increasing global and political attention.

In the UK, the majority of women start to breastfeed but breastfeeding rates drop rapidly – our continuation rates are some of the lowest in the world and are even lower amongst women living in deprived areas, where increasing rates could make a real difference to health inequalities. Support for all women, parents and families with breastfeeding falls short of what is wanted and needed.

Women tell us they encounter difficulties with the public perceptions of breastfeeding out of the home. 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 women may be left without the support they need however they choose to feed their infants.

Despite robust evidence showing that investment in breastfeeding support and protection makes sense, politically breastfeeding has been viewed by governments as a lifestyle choice and so left to parents to work out for themselves. For too many women, trying to breastfeed without support, or stopping before they want to, is deeply upsetting and the situation is made worse by fragmented care, and poor and often conflicting advice from those they are seeking to support them. To ensure an increase in breastfeeding rates, to help reverse obesity rates and to reduce widening health inequalities will require significant investment in breastfeeding.


It is essential that our new government prioritises breastfeeding and invests in its support and protection.


We call on all political parties to commit to the following actions, if elected:-

  • To appoint a permanent, multi-sectoral infant and young child feeding strategy group and develop, fund and implement a national strategy to improve infant and young child feeding practices.
  • To include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • To implement the Unicef UK Baby Friendly Initiative across community and paediatric services, building on the recommendation for maternity services in the NHS Long Term Plan.
  • To protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
  • To commission, and sustainably fund, universal breastfeeding support programmes delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists, such as IBCLC lactation consultants and breastfeeding counsellors, alongside trained peer supporters with accredited qualifications.
  • To maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline and sustaining the Drugs in Breastmilk Service.
  • To deliver universal health visiting services and the Healthy Child Programme by linking in with local specialist and support services.
  • To establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.
  • To make it a statutory right of working mothers and those in education to work flexibly as required and to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
  • To commit to resourcing for charitable organisations who play a key role within the health agenda working at a national and local level to support families and communities with infant feeding.
  • To support the commitment to undertake an Infant Feeding Survey which builds on the data previously collected in the Infant Feeding Survey 2010 (now discontinued). To implement the recommendations of the Becoming Breastfeeding Friendly (BBF) study.

Case for Action

  1. Breastfeeding benefits all babies, and studies have shown that just a small increase in breastfeeding rates could cut NHS expenditure considerably. It is vital to invest in breastfeeding support in the early months and this will reap rewards in the future that are likely to exceed the initial cash flows associated with putting proper support in place.
  2. A UNICEF report states that “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”.
  3. 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.
  4. 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.

References

  1. Laurence M. Grummer‐Strawn Nigel Rollins, (2015), Impact of Breastfeeding on Maternal and Child Health. https://onlinelibrary.wiley.com/toc/16512227/2015/104/S467
  2. Borra C, Iacovou M, Sevilla A (2015) Maternal Child Health Journal(4): 897-907. New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions.
  3. 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 Nursing72 (2): 273-282
  4. https://www.brunel.ac.uk/research/News-and-events/news/Breastfeeding-for-longer-could-save-the-NHS-40-million-a-year
  5. Li R, Fein SB, Chen J, Grummer-Strawn LM, (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 122: S60-S76
  6. Joffe, N., Webster, F., & Shenker, N. (2019). Support for breastfeeding is an environmental imperative. BMJ 2019;367:l5646 https://www.bmj.com/content/367/bmj.l5646
  7. McAndrew F et al (2012) Infant Feeding Survey 2010
  8. NHS (2019) NHS Long term Plan https://www.longtermplan.nhs.uk/
  9. National Institute for Health and Care Excellence (2013) Postnatal Guideline NICE, London https://www.nice.org.uk/guidance/cg37
  10. National Institute for Health and Care Excellence (2012) Improved access to peersupport NICE, London
  11. Rollins N, Bhandari N, Hajeebhoy N, et al (2016) Why invest, and what it will take to improve breastfeeding practices? The Lancet387 491-504
  12. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. 1998 Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. Jan 3;316(7124):21-5.
  13. Brown, A, Finch, G, Trickey, H, Hopkins, R (2019) ‘A lifeline when no one else wants to give you an answer’ – An Evaluation of the BFN’s Drugs in Breastmilk service. https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf

For further info, contact CEO@breastfeedingnetwork.org.uk
November 2019

06 Nov

Guest Blog: Shared Parental Leave & Breastfeeding

Dr Ernestine Gheyoh Ndzi

As part of our #MakingItWork campaign, this guest blog by Dr Ernestine Gheyoh Ndzi (York St John University) explores the impact that shared parental leave can have on breastfeeding.

Introduction

The reduction of maternity leave by way of shared parental leave raises the question of what impact it could have on breastfeeding. The WHO recommends two years breastfeeding with exclusive breastfeeding for the first 6 months of the baby’s life. Since the introduction of shared parental leave, the uptake has been low (2%), and the question is whether breastfeeding could be one of the reasons for the low uptake.

I am a mother of two, I breastfed my first daughter for 10 months and stopped because she just wouldn’t take it anymore. I felt bad because I wanted to be able to breastfeed for longer. I breastfed my second daughter for 15months. The bond and the emotional attachment to the baby when breastfeeding could not be the same if I had to bottle feed. Breastfeeding my first daughter was so hard at the beginning because I was very ill after giving birth, but the support my husband gave me helped me to carry on. I recognise the importance of breastfeeding and I recognise the importance of dads being there to support the mother and bond with the baby (which was what happened in my case). I was super excited when shared parental leave was introduced but questioning how it might impact on breastfeeding. I then set how to investigate which I here present the key findings.

The research was conducted through an online survey to investigate the impact of shared parental leave on breastfeeding. The survey was restricted to mothers who were pregnant or had babies after the 5th of April 2015 (when shared parental leave started). The survey was designed to collect qualitative data on mother’s experience and opinion on shared parental leave and breastfeeding. The survey retained 460 responses with rich qualitative data.

Key findings:

  • 95% of the mothers agreed that breastfeeding was the preferred choice for young babies and were aware of the benefits
  • 72.7% breastfed or planned to breastfeed for 49 weeks which is still less than the recommended two years by the WHO.
  • 96.1% of the mothers breastfed their babies on demand in the first 6 months.
  • 88.5% of the mothers knew what shared parental leave was
  • 17.2% had heard of shared parental leave from their employers
  • 59.7% said they had a workplace policy on shared parental leave
  • 43.6% of the mothers felt they would have to stop breastfeeding if they took shared parental leave.
  • 24.9% of the mothers took shared parental leave
  • 57.4% of the mothers were happy to express breastmilk at work
  • 42.6% of the mothers said they were not happy to express
  • 34% of the mothers said they were supported in the workplace to breastfeed
  • 48.9% of the mothers were not provided with any resources at work to encourage breastfeeding.
  • 47% said they were provided with a private room and sockets but no fridge

Key themes:

  • Most employers are not supporting breastfeeding mothers at work. Consequently, some mothers stop breastfeeding after returning to work.
  • Mothers who are not happy to express breastmilk will not take shared parental leave
  • Mothers who are happy to express breastmilk at work would take shared parental leave if the employer is supportive of breastfeeding at work.
  • Some mothers thought that shared parental leave and breastfeeding had no impact on each other. However, the thoughts were slightly limited to the first six months because most of the mothers (85.6%) were on maternity leave for at least the first six months and breastfed their babies exclusively in the first six months as recommended by WHO.
  • Most of the mothers who took shared parental leave or went back to work after 6 months massively reduced breastfeeding frequency and some stopped breastfeeding altogether.
  • Mothers who placed more value on breastfeeding dismissed the idea of shared parental leave entirely especially if they wanted to breastfeed for longer than 48 weeks.
  • Some mothers felt they were put under pressure to be to express breastmilk because if shared parental leave.
  • Societal pressure and ‘unacceptance’ of breastfeeding make some mothers not to breastfeed and shared parental leave was viewed as one of such ‘unacceptance’ of breastfeeding.

Conclusion

Breastfeeding is a contributory factor to the low uptake of shared parental leave and shared parental leave is also contributing to the low rate of breastfeeding in the UK.


To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:

25 Oct

BfN Central Evaluation 2019 – Results Highlights

Nina White, BfN Programme Manager

Every year, BfN release a survey to help us see what we are doing well, where we can improve and also give us the evidence we need to help secure future funding. 

This year, the survey was live throughout March 2019 and we received 572 responses.  Thank you to everyone who shared the survey link and encouraged people to complete the survey.  We were pleased to be able to send BfN travel mugs to 10 lucky winners from the prize draw.

Responses to the survey came from:

Survey responses

– 89% mothers
– 5% health professionals
– 6% others

Of these, 36% were supported by the BfN Drugs in Breastmilk Service and 12% from the National Breastfeeding Helpline. 

Matching last year’s results exactly, 64% of this year of mothers contacted BfN because they were experiencing breastfeeding problems.

Once again – the most popular topic of discussion with BfN Peer Supporters was positioning and attachment for feeding, with more than half of mothers struggling with painful breasts and nipples.  The next three common topics were frequency of feeding, baby’s weight gain and expressing milk.  Nearly half of mothers asked for information about medication/medical intervention and impact on breast milk/ breastfeeding.  We hope we were able to ensure all these mothers were able to continue feeding their babies if they wished to, since many reported being told to stop breastfeeding unnecessarily.

We asked a variety of ‘before/after’ questions and were delighted with the answers, which proved the value of peer support:

61% agreed they had the information needed to make decisions about feeding their baby before contact with BfN, rising to 95% after support from BfN.

45% of mums could breastfeed without pain before contacting BfN, increasing to 80% after support from us. 

Once again, more than half of the mums questioned (54%) claimed BfN supported them to breastfeed for longer than they otherwise would have done.  Reasons given for this included evidence based information about medication, information about attachment, expressing milk, managing blocked ducts and mastitis, meeting other like-minded mums and knowing what is ‘normal’ newborn behaviour.  There were also lots of comments about general support, building confidence and encouragement.

90% of mums said they felt listened to, that their choices were respected, they were not pressured to do one particular thing and that the support/information they received was specific to them.

98% of mothers were satisfied with the support they received from BfN and 98.5% would recommend us to family or friends.

We feel that these results help to demonstrate how important the support we offer to families really is – and how appreciated our volunteers and staff are. 

09 Oct

“Advancing Our Health: Prevention in the 2020s” – BfN’s Response

BfN sees supporting women and families with breastfeeding as an important way to tackle some of the causes of preventable ill health in England. Here is BfN’s charity response to the Government’s Advancing Our Health: Prevention in the 2020s. Our response focuses on several themes important to the protection and promotion of breastfeeding, making a special call for early days support for all women and families. For our full response read on below. The consultation closes on 14th October so there is still time to submit an individual response. 


From Life Span to Health Span

Which health and social care policies should be reviewed to improve the health of people living in poorer communities or excluded groups?

Young, poor and less-educated women are less likely to breastfeed. This is also true of minority groups such as gypsy, traveller and Roma communities. Not breastfeeding widens the health inequalities gap for groups who already experience hardship and compromises maternal and infant health outcomes. The Healthy Start welfare food scheme needs an overhaul as eligibility has declined and it fails to catch the most vulnerable groups in society. Also, the scheme offers no breastfeeding support.

Improvements to breastfeeding support overall would make a difference, but targeted efforts to encourage and support these excluded groups to breastfeed needs investment and engagement with the voluntary sector as delivery partner as often charities have established local buy-in from communities.

More broadly, education policy doesn’t adequately address choices around infant feeding at primary or secondary level. It would be a great advantage to future generations if discussions around infant feeding could be introduced at an earlier age.

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Intelligent Health Checks

Do you have any ideas for how the NHS Health Checks programme could be improved?

Family culture and beliefs are passed through the generations within families and influence how an infant is then cared for. This includes infant feeding decisions where a family history and support network congruent with women’s infant feeding intentions has been shown to be important to women’s breastfeeding experience. This is reflected in breastfeeding rates where women who were not breastfed themselves are less likely to initiate and continue with breastfeeding. Given the importance of family infant feeding history in the initiation and duration of breastfeeding, and the limited ability of some families to provide support; it is unclear why infant feeding family history and support networks are not explored during pregnancy. There should be routine information collection on infant feeding history as part of family history data. An infant feeding genogram could be included as a time efficient tool to assist health professionals and support workers to stimulate discussions around breastfeeding and help design support interventions.

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Supporting Smokers to Quit

What ideas should the government consider to raise funds for helping people stop smoking?

Helping people to stop smoking is a fundamental part of preventative health work in the UK and should be funded by government without need for external funding. While BfN welcomes the steps the UK has taken to ban and control use of tobacco the loss of many local authority funded cessation services has been a retrograde step. We would like to see smoking cessation services be reinstated and include dedicated antenatal smoking cessation support.

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Eating a Healthy Diet

How can we do more to support mothers to breastfeed?

Women tell us they struggle to breastfeed because of pain, worries about milk supply and because there was no skilled support to help them. Women frequently report a lack of consistent information on feeding their babies given at the right time including on the safety of medication in breastmilk.

The vast majority of the issues women raise as barriers are amenable to good support and the following actions would help:

  • Develop a National Infant Feeding Strategy Board with all relevant government departments, health and third sector stakeholders driven by appropriate leadership.
  • In a national infant feeding strategy/plan include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • Implement the Unicef UK Baby Friendly Initiative across all relevant services.
  • Protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law.
  • Commission and fund universal, evidence-based breastfeeding support programmes and services delivered by peer supporters with accredited qualifications and specialist/lead midwives and health visitors.
  • Maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline.
  • Deliver universal health visiting services and the Healthy Child Programme (including the 5 mandated contacts, plus an additional review before the 10-day visit to resolve early feeding issues)
  • Establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.

We support the commitment to undertake an Infant Feeding Survey and this should build on the data previously collected in the 2010 cancelled IFS.

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How can we better support families with children aged 0 to 5 years to eat well?

One in five children are already overweight or obese before they start school. There is a wealth of evidence about the importance of breastfeeding, support for responsive bottle feeding and timing of starting solid food and the difference this can make to both child and maternal obesity levels. Recent government policy on obesity has failed to address the importance of how we feed our babies and early years nutrition. The Government should improve the legal protection and support for breastfeeding, improve availability of caregiving / parental education around introduction of solid foods and feeding responsively.

Where babies are not breastfed, given formula and commercial foods there should be strong legislation in place to regulate nutritional composition and tight regulation of labelling and marketing of commercial foods in line with Public Health recommendations and WHO Europe with implementation of WHO Code.

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Support for individuals to achieve and maintain a healthier weight

How else can we help people reach and stay at a healthier weight?

Children who are obese are likely to become obese adults. More should be done to help prevent children from becoming overweight or obese in the first place. Breastfeeding has a very significant effect on childhood obesity, with some studies indicating that breastfeeding to a year or more could reduce rates by 25-50%. Support for breastfeeding, particularly breastfeeding to 12 months or more, must be part of any obesity reduction strategy.

For some women breastfeeding makes it easier to lose weight, since additional calories are used. This can help some women to return to pre-pregnancy weight more quickly. The role that breastfeeding can play in managing maternal weight should be discussed with a health care professional or peer support worker.

The Department of Education should ensure that all young people learn about the importance of healthy body weight and good diet before and after pregnancy.  Breastfeeding as a normal human behaviour should be more thoroughly explained as part of the curriculum to remove stigma.

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Taking care of our mental health

How can we support the things that are good for mental health and prevent the things that are bad for mental health, in addition to the mental health actions in the green paper?

Up to 20% of women are affected by mental illness either during pregnancy or in the 12 months after giving birth. A woman’s risk of postnatal depression can be lowered by successful breastfeeding. On the contrary, when women who wanted to breastfeed are unable to meet their goals, their mental health can be adversely affected. Given that 8 out of 10 mothers stop breastfeeding before they wanted to, one means of safeguarding the mental health of new mothers is to improve breastfeeding support and protection. This is particularly important soon after birth. https://www.breastfeedingnetwork.org.uk/breastfeeding-ad-perinatal-mental-health/

Being born in a Unicef UK Baby Friendly accredited hospital and supported to breastfeed there has been linked to improvement in child emotional development and maternal mental health.

Data from the Millennium Cohort Study found that term children breastfed for four months or longer had lower odds of abnormal scores on a strengths and difficulties questionnaire compared with never breastfed children. There is also evidence that breastfeeding for less than 6 months compared with 6 months or more is an independent predictor of mental health problems, both internalised and externalised through childhood and into adolescence. Reviews of many studies linking breastfeeding with mental health of mothers and children can be found here https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-mental-health-and-emotional-development/.

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Sleep

We recognise that sleep deprivation (not getting enough sleep) is bad for your health in several ways. What would help people get 7 to 9 hours of sleep a night?

New parents or parents of young children will rarely get 7-9 hours’ of unbroken sleep a night. New parents should be supported to understand that normal infant sleeping patterns involve frequent night waking. New parents should be able to access advice and support to cope with lack of sleep and tiredness from their health care professional, peer supporter or maternity support worker. It is also useful to highlight that exclusively breastfeeding mothers report sleeping for longer than mothers who mix feed or formula feed as a positive effect of hormones. Therefore actions to better support and protect breastfeeding may also have benefits for sleep among new parents.

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Prevention in the NHS

Have you got examples or ideas for services or advice that could be delivered by community pharmacies to promote health?

Pharmacists have a key role to play in promoting and protecting breastfeeding in the community. Women contacting us through BfN’s Drugs in Breastmilk Service for information and support on the effects of medication on their breastfeeding tell us that pharmacists in their community lack sufficient knowledge and understanding of breastfeeding and the effects of medication on it. This means families in the community struggle to get advice on breastfeeding and how to maintain breastfeeding through illness of mother or baby. Often we see that this leads to breastfeeding ending unnecessarily or a mother denying herself medication so she can continue to breastfeed her child. See ‘A lifeline when no one else wants to give you an answer’ An evaluation of the Breastfeeding Network drugs in breastmilk service Professor Amy Brown, March 2019 https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf

Unicef’s infant feeding learning outcomes for pharmacy students set a standard for the level of knowledge and understanding that could be reasonably expected of a newly qualified pharmacist; see: https://www.unicef.org.uk/babyfriendly/accreditation/universities/learning-outcomes/learning-outcomes-pharmacy-students/. Pharmacists should also be aware of local breastfeeding support services and be able to signpost accordingly.

Worryingly, many pharmacists receive information about breastmilk substitutes (BMS) from sponsored materials provided by the BMS industry. This is a clear conflict of interest and means that advice provided by a pharmacist may be inconsistent with advice from other health workers. All pharmacists should be encouraged to work within the WHO Code of Marketing of Breastmilk Substitutes.

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What could the government do to help people live more healthily: in homes and neighbourhoods, when going somewhere, in workplaces, in communities?

Supporting women to breastfeed and for as long as they choose requires societal action and support. All too often responsibility is placed on women to breastfeed when so much more can be done in communities, work, health and education settings to support breastfeeding.

To improve community support for new and young families the Government should provide all Local Authorities with ring-fenced funding to establish, re-establish or support the development of universal Children’s Centres. These should focus on areas of deprivation, with Centres able to offer a range of support services including breastfeeding peer support. Building community support encourages breastfeeding to be more visible. This is key to changing attitudes in the UK to breastfeeding and improving all parents to feel more comfortable when out and about with their infants. Whilst the Equalities Act means that women have the right to breastfeed in public, many women remain anxious about feeding their baby outside the home. Consistent efforts are needed to normalise and support breastfeeding anywhere that a baby needs to be fed.

The Department of Education should ensure all young people, boys and girls, learn in school that breastfeeding is a normal human activity should be explained and de-stigmatised. Government should also follow initiatives in the London Food Strategy implementation plan which aim to improve breastfeeding across London, including looking at how Transport for London can better support women travelling with infants on the network.

Often returning to work or education is seen as a barrier to breastfeeding and a reason for women to stop before they want to.

The current protection for breastfeeding when a women returns to work is inadequate and the burden is placed on the individual mother to negotiate arrangements with her employer, at a time when she is feeling vulnerable and not entitled to ask for support. Explicit protections for breastfeeding protection are missing in the current legislation. Protection should also extend to provision of adequate storage for her expressed milk. Clarity through the policy on storage will be useful to women and employers alike in navigating the practical arrangements that are needed to continue breastfeeding and giving breastmilk.  

Question: What more can we do to help local authorities and NHS bodies work well together?

To ensure that women’s intentions and efforts to breastfeed are upheld and supported following initiation good breastfeeding support needs to be available at every step of a mother’s journey. As a charity that has been involved in delivering peer support services for over 20 years working in communities and also alongside health care professionals in a complimentary way we have learned that moving breastfeeding peer support services from the NHS to local authorities has not only been damaging for families accessing quality breastfeeding support but it has also damaged relationships. Many community services have been lost and an increased burden has been placed on an already struggling health visiting workforce. Supporting breastfeeding requires dedicated skills, time and patience often supporting a Mum for several hours on several occasions.

Many services funded through local authority structures are operating on reduced budgets or have been de-commissioned because of cuts. Previously, many of these services worked well because relationships with health professionals were strong and an engaged local volunteer base was supported. Going forward it is vital that breastfeeding peer support services are protected and there is a close contact between local authorities and NHS services. 

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Question: What are the top 3 things you’d like to see covered in a future strategy on sexual and reproductive health?

Just one thing from BfN’s perspective. There is good research that suggest that attitudes to infant feeding are shaped long before individuals become parents. We would like to see all children and young people learning about breastfeeding and early nutrition at school so that they have the information they need about their bodies years before they become parents. Working with school age children helps open up space to start conversations at home and help normalise breastfeeding in the wider community. To help shift attitudes and future generations to breastfeed the Department of Education should ensure all young people learn about breastfeeding as a normal human activity. This will help explain normal functions of the body and help to de-stigmatise it. The following resources are available for use in schools on breastfeeding https://www.breastfeedingnetwork.org.uk/breastfeeding-information-for-children-and-young-people/ and https://abm.me.uk/resources-for-schools/.

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05 Aug

A little less conversation, a lot more action…

Shereen Fisher

Shereen Fisher, CEO,
The Breastfeeding Network

Just last week the Department of Health and Social Care (DHSC) together with the Cabinet Office published the long awaited Green Paper setting out proposals to tackle the causes of preventable ill health in England. It signals a new approach to public health that involves a personalised prevention model. It will mean the government, both local and national, working with the NHS to put prevention at the centre of decision-making.

In November last year, before the NHS Long Term Plan was launched, I wrote a blog that set out the case to explain why support for breastfeeding and wider infant feeding considerations are so relevant to the prevention agenda. Supporting and protecting breastfeeding is not just relevant, it’s essential for realising the NHS plan and bringing about a healthy society. With the UK holding one of the worst records for breastfeeding in the world it’s important that bold and clear action is taken. Does the prevention paper deliver on this?

The results are mixed.

On the plus side the Government’s commitment as part of the NHS long term plan to make all maternity services in England Unicef Baby Friendly accredited is a real win for parents and infant feeding in England (remember Scotland has already achieved this with strong results emerging in their breastfeeding rates). It means mothers and babies of the future will be experiencing maternity services with important cultural and clinical standards where mothers will be supported to feed their baby in a way they choose and loving relationships fostered from the start.

The paper includes an important commitment to an infant feeding survey (IFS). After the cancellation of the IFS in 2015 there has been a dangerous gap in data especially a population level survey which gives a voice for parent experience. The vision to commit to this, although presently undefined, represents an important step forward to help monitor breastfeeding rates and the breastfeeding environment.

The paper is strong on vision for mental health including a commitment to parity of esteem between mental and physical health “not just for how conditions are treated but for how they are prevented.” Specific mention of the crisis of maternal mental health would have been welcome along with the poor maternal treatment of black and ethnic minority women who experience an almost five-fold higher mortality rate compared with white women.

To round up the positives I would also add strong vision on early years emphasising importance of strong foundations, parent-infant relationships, infant feeding and development.

However, for the vision to be more than just paper talk the Government must address the public health budget with local authorities. This is where health visiting programmes and breastfeeding / infant feeding peer support programmes sit in England and cuts and reductions have been a reality impacting on available family support. What will be done about the services lost and the ones currently threatened?

In order to understand how much of the Green paper vision is achievable we have to know what will  be the future of the public health grant and be clear on local governments commitment to realise the plan.

Importantly, the Green paper and its proposals are open for consultation. The closing date for responses is 14 October 2019. The Government is asking us how can we do more to support mothers to breastfeed?

This is such an important question. By knowing what kind of support can be provided to help mothers with breastfeeding, we can help mothers to solve any problems and continue to breastfeed for as long as they want to, wherever they live. We know that stopping breastfeeding early can cause disappointment and distress for women and health problems for themselves and their infants.

The Breastfeeding Network (BfN) have over 20 years of experience supporting women and families. We know that support can come in many forms including giving reassurance, skilled help, information, and the opportunity for women to discuss problems and ask questions as needed – for us it’s about being present when everyone else has gone and you are left holding the baby.

This is what we know helps women with breastfeeding:

  • organised skilled support for mothers
  • trained volunteers, nurses, doctors working as a team to UNICEF UK BFI standards
  • face – to – face contact
  • confidential, evidence-based, independent telephone support from trained peer supporters
  • trained and supervised peer support is effective especially when contact is frequent, pro-active and sustained over several sessions, including the early days with a new baby.

In summary providing women with extra organised support helps them breastfeed their babies for longer. Breastfeeding support is more effective where it is predictable, scheduled, and includes ongoing visits with trained health professionals including midwives, nurses and doctors, or with trained volunteers.

BfN intends to publish its full response. Don’t miss your opportunity to do the same!

https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document