16 May

Breastfeeding and Obesity

Breastfeeding Network CEO Shereen Fisher responds to the recent press coverage on the link between breastfeeding and reduced chances of childhood obesity.

Late April saw a flurry of articles from the Guardian covering breastfeeding. It’s useful to see the media give attention to the subject but especially so when it highlights robust research alongside the very sorry state we are in when it comes to supporting women and families with breastfeeding.

The standout piece for me was the article of April 30th, ‘Breastfeeding reduces child obesity risk by up to 25%’. This article gives new evidence to the very real contribution that breastfeeding makes in reducing child obesity while at the same time supporting a wide range of improved health outcomes for women regardless of their backgrounds.

The data came from nearly 30,000 children monitored as part of the WHO Childhood Obesity Surveillance initiative (COSI). Launched in 2007, COSI is continuously being updated and now receives data from about 40 countries on children aged six to nine. But rather awkwardly not the UK. With one in five children in the UK already overweight or obese before they start school, the measures offered by the UK at 4 and 11 seem too little – too late.

In a society that struggles to accept breastfeeding as a universal norm, the contribution that independent evidence can make to help shape public opinion is powerful. However, it must be used proactively by Governments to invest in measures to protect breastfeeding and invest in the support services that enable mothers and families to carry out their choices.

We have a problem in the UK in that we fail to support a woman’s intention to breastfeed.

Here’s the story. In the UK most women start to breastfeed, (initiation rates are over 70%). However, many women reduce or stop breastfeeding in the first few days and weeks. The majority of mothers want to carry on. Many mothers say that they stopped because of lack of support – no time or skilled guidance was around to help them learn to do it. For many women who want to breastfeed but struggle to do it through lack of support this becomes a personal failure. The injustice of it is that they are being failed. The rapid drop off rates in breastfeeding represent feelings of crashing disappointment for many women who tell us they carry the pain of their breastfeeding struggles for years. Lack of timely, quality and consistent early days support leaves them ill-equipped to deal with the challenges of coping with a newborn, they then return home to struggle on in communities where breastfeeding culture varies widely and support around them may exist or not, and may not be easy to access.

We agree with Kate Brintworth, head of maternity transformation at the Royal College of Midwives, who said the study reinforced the need to put more resources into supporting women to breastfeed: “We need both more specialist breastfeeding support for women after the birth and more time for midwives to offer the support women are telling us they need. It is important that we respect a woman’s infant feeding choices, and that if a woman chooses not to breastfeed, for whatever reason, she will need to be supported in that choice.”

In the UK, obesity costs are estimated to be at least £27 billion every year and obesity is poised to overtake smoking as a key cause of cancer. It’s critical that national leaders champion for change and for investment in obesity prevention and for support services to start much earlier. However, the UK government does not have a strong track-record in addressing infant feeding as part of the obesity agenda, despite there being a wealth of evidence about the importance of it. In the childhood obesity strategy published in 2016 the top line was introducing the soft drinks industry levy.

The Breastfeeding Network would like to see the Government go further. While focus on the problem of pervasive junk food advertising at children and families is essential, we must not ignore the role of breastfeeding in contributing to improved health outcomes for children and mothers and offering protection against obesity. The positive research from WHO is another crucial building block of evidence of the health protection benefits that breastfeeding offers, and it is one that Government should not ignore.

References:

UK breastfeeding rates are low. Although 81% of mothers in the UK begin to breastfeed, by six weeks that has fallen to 24% in England, 17% in Wales and 13% in Northern Ireland, 8 in 10 women said they gave up breastfeeding before they wanted to, according to the latest data, from 2010 Infant Feeding Survey: https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

A full list of studies can be found on the Unicef Baby Friendly site here (infant health) and here (maternal health).

Contact: Shereen Fisher, Chief Executive Breastfeeding Network

08 May

Consensus Statement on Sustainable Funding for Public Health

We call on Government to increase investment in public health in England to prevent ill health, reduce health inequalities, and support a sustainable health and social care system.

Public health is facing a funding crisis. The NHS Five Year Forward View argues that “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health”.[i]Despite this, the Government has continued to cut the Public Health Grant year-on-year. Because of this, local authorities’ ability to provide the vital functions that prevent ill health are being severely compromised.

In the 2015 Budget, the Chancellor announced a £200 million in-year cut to the Public Health Grant, followed by a further real-terms cut averaging 3.9% each year (until 2020/21) in the 2015 Spending Review.[ii] Overall, the Public Health Grant is expecting to see a £700 million real-terms reduction  between 2014/15 and 2019/20—a fall of almost a quarter (23.5%) per person.[iii] In 2019/20, every local authority has less to spend on public health than the year before. According to analysis by the Health Foundation, almost all local authority public health services faced cuts between 2014/15 and 2019/20: for example, spending on stop smoking services and tobacco control are expected to fall by 45%; sexual health spending is expected to fall by 25% and specialist drug and alcohol services for young people is expected to be cut by over 41%.iii

Local authorities have made efficiencies through better commissioning, but cuts are nevertheless impacting frontline prevention services. As an example, research conducted by Action on Smoking and Health and Cancer Research UK shows that, following year-on-year reductions to the Public Health Grant since 2015, stop smoking services have been persistently cut across local authorities. Now, the majority (56%) of local authorities are no longer able to offer a stop smoking service to all smokers in their area.[iv]

Taking funds away from public health is a false economy. Unless we restore public health, our health and care system will remain locked in a ‘treatment’ approach, which is neither sustainable nor protects the health of the population as it should. In the UK, smoking caused an estimated 115,000 deaths in 2015,[v] whilst alcohol caused around 7,700 deaths in 2017.[vi] In England, there were around 617,000 hospital admissions where obesity was a factor in 2016/17.[vii] These preventable factors increase the risk of certain cancers, type 2 diabetes, lung and heart conditions, musculoskeletal conditions and poor mental health. Obesity alone is estimated to cost the NHS £5.1 billion every year, with wider costs estimated to be around three times this amount.[viii]

The Government must equip local authorities with adequate resources to provide vital public health functions. The Government currently plans to phase out the Public Health Grant by 2020/21, after which they propose to fund public health via a 75% business rates retention scheme. Whatever model is ultimately implemented, it must generate enough funding for local authorities to deliver their public health responsibilities, enable transparency and accountability, and be equitable so that areas with greater health needs receive proportional funding.

In her speech on 18 June 2018, the Prime Minister called for a renewed focus on the prevention of ill-health: “Whether it is cancer, heart disease, diabetes or a range of mental illnesses, we increasingly know what can be done to prevent these conditions before they develop – or how to ameliorate them when they first occur. This is not just better for our own health, a renewed focus on prevention will reduce pressures on the NHS too.”[ix]

We urge the Government to deliver on this promise by increasing investment in public health in England.

This statement is supported by:

Action on Smoking and Health

Action on Smoking and Health Wales

Age UK

Alcohol Change UK (formally Alcohol Research UK)

Alcohol Health Alliance

Association of Breastfeeding Mothers

Association of Directors of Public Health

Association for the Study of Obesity

Beat Charity

Breast Cancer Care & Breast Cancer Now

Breastfeeding Network

British Association of Sexual Health and HIV

British Heart Foundation

British HIV Association

British Liver Trust

British Lung Foundation

British Medical Association

Brook

Cancer Research UK

Centre for Mental Health

Children’s Liver Disease Foundation

CLIC Sargent

Collective Voice

County Councils Network

Dementia UK

Diabetes UK

Faculty of Sexual and Reproductive Healthcare

First Steps Nutrition Trust

FPA

Health Action Campaign

Health Equalities Group

Health Foundation

Healthy Stadia

Helping Overcome Obesity Problems

HENRY

Hope UK

Institute of Alcohol Studies

Institute of Health Visiting

IPPR

IPPR North

Jo’s Cervical Cancer Trust

Kidney Research UK

La Leche League GB

LGBT Foundation

Local Government Association

Local Government Information Unit

Localis

Macmillan Cancer Support

Mayor, Greater Manchester

Mayor of London

Mayor, Sheffield City Region

Mental Health Foundation

Mental Health Research UK

Mentor

Metro Mayor, Liverpool City Region

Mind

NAM aidsmap

National AIDS Trust

New Local Government Network

NHS Clinical Commissioners

NHS Providers

Obesity Health Alliance

Positive East

Release

Royal College of Anaesthetists

Royal College of Emergency Medicine

Royal College of General Practitioners

Royal College of Nursing

Royal College of Physicians

Royal College of Surgeons

Royal Pharmaceutical Society

Royal Society for the Prevention of Accidents

Royal Society for Public Health

SANE

School and Public Health Nurses Association

Substance Misuse Management Good Practice

Sustain

Terence Higgins Trust

UK National Kidney Federation

Versus Arthritis

World Cancer Research Fund

YoungMinds


References

[i] NHS England. Five Year Forward View.

[ii] Public Health England. Annual budget allocations 2016/17.

[iii] The Health Foundation. Briefing: Taking our health for granted – plugging the public health grant funding gap.

[iv] Action on Smoking and Health & Cancer Research UK. A changing landscape: Stop smoking services and tobacco control in England.

[v] Peto R, Lopez A, Boreham J, et al. Mortality from smoking in developed countries 1950-2010.

[vi] Office of National Statistics. Alcohol-specific deaths in the UK: registered in 2017.

[vii] NHS Digital. Statistics on Obesity, Physical Activity and Diet – England, 2019.

[viii] House of Commons Health Committee. Childhood obesity – brave and bold action. 2015.

[ix] Prime Minister’s Office. PM speech on the NHS.

18 Apr

Guest post: What We Mean When We Call For More Support For Breastfeeding Mothers

Professor Amy Brown

Yes, support for breastfeeding can mean someone to sit and help you latch your baby on – but it also means acceptance, a better environment to feed in, and investing in infrastructure to make it easier.

The phrase ‘we need better support for breastfeeding’ can sometimes feel like a suggestion that if women just had a little more help latching their baby on, and tried a little harder, then all their problems would disappear. It can attract a lot of backlash, and with that perception you can understand why.

But when we call for ‘more support’ we don’t mean that at all. Yes, support for breastfeeding can mean someone to sit and help you latch your baby on, moving them a little left or right so that latch is more effective and comfortable for you. And timely, skilled support like this can make all the difference to breastfeeding working out.

But it’s certainly not the only thing we mean. We mean that women deserve high quality information about how to know when breastfeeding is working… and when it isn’t. A better environment to breastfeed in. Acceptance. Value in what they are doing. Investment in the infrastructure that makes it that bit easier. And more than that again.

So here’s a run down of what ‘more support’ actually encompasses.

1. In the early hours and days…

High quality information antenatally about what breastfeeding is like – how milk is produced, how often babies feed, what normal baby behaviour looks like. 

Individualised support during birth that reduces risk of unnecessary complications and interventions. Information on how any interventions might affect milk supply.

Support after the birth to breastfeed as soon as possible. Continued support with picking up and positioning if the mother is in pain or immobilised.

Infant feeding specialists on the hospital ward and in the community, who can visit as often as needed. Peer supporters working alongside them. And time. Time for them to sit, really listen and give emotional support too.

Accurate information on how to increase milk supply. The importance of responsive feeding is. How to spot effective milk transfer. When is feeding often, too often?

2. For more complex cases…

If babies aren’t gaining weight, support with increasing supply or transfer of milk. Support with topping up. Guidance on when formula might be necessary, and how to ensure you carry on increasing your own milk supply alongside using it.

Good advice on how to use a pump if required. A high-quality pump being available. Information for women who decide to exclusively pump. And information for women who need to mix feed for whatever reason.

If a baby has tongue tie, then rapid identification and treatment where necessary. And for other complications that might make breastfeeding more challenging like cleft lip and palate. Identification, expert support, and accurate information.

Accurate advice for women who need to take a medication, including alternatives, rather than misinformation that they always need to stop.

More research into unexplained low milk supply and other complications.

A full explanation, debrief and support with formula feeding for those who wanted to breastfeed but were unable to do so.

Enhanced donor milk provision so that all sick and premature babies whose mother cannot produce enough milk, can be offered it rather than just the most vulnerable.

3. From friends and family…

Better support for mothers to recover after birth and get to grips with feeding. That might be from a partner or family. Or it might be from a doula. Or peer supporter. Or all of them. Anything that means new mothers are nurtured in a way that focuses on caring for her, not offering to give the baby a bottle.

Knowledge of how breastfeeding works, how to spot difficulties, and that there are other ways to bond with than using a bottle.

Advocates that stand up for the mother if she cannot get the support she needs or is feeling pressured unnecessarily to stop breastfeeding.

A shoulder to cry on when things are tough rather than an automatic suggestion to stop breastfeeding if she is not ready.

4. In the community…

A knowledgeable community that understands how breastfeeding works. That understands frequent feeding, normal infant sleep and a baby’s need to be held. That shares this knowledge with others, so that it becomes common knowledge.

Well-funded peer support groups so that mothers can spend time with others who are going through the same challenges, or have come out the other side.

A society that recognises breastfeeding as an utterly normal thing to be doing in public. One that sees it as a baby needing to eat, rather than an act of exhibitionism by a woman.

A society that values mothers, recognising that what she is doing is important. Not one that suggests she is failing if she doesn’t get her ‘life back’, ‘body back’ or ‘get back’ to paid work asap. One that celebrates her new normal rather than suggesting she is somehow failing.

Educational programmes that ensure children grow up knowing how the female body works, how breastmilk protects babies, and how breastfeeding is a reproductive right.

5. At a government level, one that invests in breastfeeding by ensuring…

Hospitals and communities are well staffed, so that every mother who needs support gets it.

Generous and well-paid maternity and paternity leave, so that families have the time to establish breastfeeding.

Full legislation to support breastfeeding mothers on return to work, and workplaces are encouraged to support them.

Educational programmes based on the best possible research to update professionals across the spectrum.

Legislation to ensure formula milk is an accessible, high quality affordable product, not pushed on families by industries wanting to capture their ‘market share’.

‘More support’ doesn’t suggest that with a bit of help and determination that all women can breastfeed. Rather it highlights how women are currently being let down at every level. The list is long, and likely incomplete. We have far to go but while women are still falling through the gaps at every stage we will keep fighting for ‘more support’ across every dimension this entails.

Professor Amy Brown is based in the Department of Public Health, Policy and Social Sciences at Swansea University in the UK where she leads the MSc in Child Public Health.  This article was originally published on Huffington Post, here, and is reproduced here with the author’s permission.


31 Jan

BfN in the news: Shereen Fisher appears on BBC Woman’s Hour

Shereen Fisher, our CEO, featured in a panel discussion on BBC Woman’s Hour this week, on infant feeding experiences and how they made women feel. Shereen was joined by GP Dr Ellie Cannon and maternity matron Gill Diskin. The discussion covered all aspects of infant feeding, and addressed some of the challenges faced by new mums, as well as the health care professionals and organisations who aim to support them. Here’s what Shereen had to say about the experience.

I was thrilled to be invited to be part of the panel for BBC Radio 4’s Woman’s Hour this week, representing BfN. The opportunity was unique and the feature would be part of a 3 day-long focus on infant feeding – no flash in the pan for women’s stories about breastfeeding this time, but 3-plus hours of national radio air time devoted to getting the triumphs and heartache across – and for me – the injustice of women who don’t get the support they so deserve.

Invitation accepted then the worry began, as the facts of the show and angle the producers were aiming for were slow to emerge, along with details of the other panel members. I liken the experience of preparation to that of ‘getting a genie into a bottle’ – I am not a doctor or Public Health specialist, so a fair amount of reading and revising ensued (taking me back to my Law degree finals, when I promised myself that I’d never put myself through it again), as did heartfelt conversations with some sound, strong and sensible minds – you know who you are.

The challenge was, when the cork was taken off the bottle, to make sure that at least five clear messages were unleashed and not just a mist of vapour … The preparation, guidance from others and commitment I have held to this issue for over six years came good in the end and I was calm and relaxed in the studio (broom cupboard!), waiting to hear Jenni Murray say my name and invite me to speak.

Predictably the slant has been somewhat focused on the problems and the negatives of breastfeeding, but the presence that BfN was afforded has given me hope that all voices are valid and with a concerted effort we will be able to improve support for all women to pursue their choices and reach their own individual goals. That, I am certain, will be the secret to happy mums and babies.

To hear the full podcast featuring Shereen Fisher, Chief Executive, visit:
https://www.bbc.co.uk/programmes/m00027ml

09 Jan

Dr Wendy Jones, The Breastfeeding Network’s pharmacist, awarded MBE in Queen’s New Year’s Honours List

One of the founding members of the Breastfeeding Network (BfN), and our resident Pharmacist for over 20 years, Dr Wendy Jones, has been awarded MBE in Queen’s New Year’s Honours List for 2019.

Wendy set up the BfN drugs in breastmilk information service in 1997 after being asked to update an information pack about the safety of drugs in breast milk. Gradually the service grew and now she now leads a small team of volunteers who offer individual support to more than 10,000 families and healthcare professionals each year via email and social media.

Commenting on the award which Wendy receives for services to mothers and babies, Shereen Fisher, CEO of the Breastfeeding Network, said:

“We are delighted with the news that Wendy is receiving this award in recognition of her work. Wendy is an inspiration to us all.  She has dedicated the last twenty years to supporting mothers and families through the drugs in breastmilk service she founded.  Day in day out, she responds to phone calls, emails and now social media messages from parents and healthcare professionals who need reliable, evidence based information about the safety of medications and treatments while breastfeeding.  The work she does allows parents to make their own informed decisions and has undoubtedly saved lives.”

A soon to be published evaluation of the drugs in breastmilk information service was overwhelmed by responses from mums and healthcare professionals when they were asked for their thoughts on the service. A mum of four said: “Wendy has saved me and my daughters many times over. I can honestly say I would have committed suicide after my second baby was born had it not been for her support to keep taking my meds and to keep breastfeeding.”

A consultant paediatrician said: “Wendy’s information is presented in a way which is accessible to non-medical mothers to understand, but also written in a way that doctors who know little about breastfeeding will take seriously.”

Wendy said: “I couldn’t be more proud than I am today that I have been awarded an MBE in the New Year’s Honours List as Founder of the Breastfeeding Network Drugs in Breastmilk Service for services to Mothers and Babies.

“In 1995 when I wrote the first information on drugs in breastmilk I could never in a million years have imagined this happening. I followed my dreams and the opportunities given, massively supported by my family and particularly my husband Mike [pictured above with Wendy] who gave me the opportunity to leave paid work and develop my passion.

“Nothing I can do would be possible if breastfeeding advocates didn’t spread the word that you can breastfeed as normal when you take most medication or there are ways around it. So, this MBE is for all of you too for all the hard work you do in groups, on the helplines, face to face, via social media and just at the school gate or supermarket checkout. You are all amazing.

“Thank you everyone for your wonderful comments today. I’m treasuring them in my heart and taking inspiration from them to keep challenging and to carry on supporting mums, dads, grandmas, peer supporters and everyone to keep breastfeeding these special precious babies. I’m hoping that this is the beginning of a year when breastfeeding and its support gets the recognition it deserves and just maybe some funding as a public health issue.”

Earlier this year Wendy was also awarded a Points of Light award by the Prime Minister.

Wendy’s story

Over the past 40 years, Community Pharmacist Dr Wendy Jones has made a huge impact on the lives of thousands of families across the UK. In this time she has helped people manage issues such as weight loss, cardiovascular disease and smoking cessation alongside her general pharmaceutical duties, but her real impact has been felt by new mothers. Wendy has dedicated her life to researching the effects of medication and medical treatments on breastfeeding mothers and their babies.

In 1997 she was one of the founder members of The Breastfeeding Network, and in 1999 she set up the Drugs in Breastmilk helpline. This telephone helpline was set up in response to the number of questions the charity was receiving from breastfeeding mums about prescribed medications. At that time there was no easily accessible, reliable information for mums who had been told to stop breastfeeding in order to take certain forms of medication. Wendy has single-handedly filled this gap.

In many cases where a mum is told to stop breastfeeding, there is no evidence to support the need for this. The mum can be left feeling she has no choice but to stop breastfeeding (even if she wants to continue), or she may choose not to take the medication prescribed. The impact of having to make a decision like this can be far reaching for some mums. In a very few cases, evidence shows the mum does need to stop breastfeeding, and then, being able to understand the reasons behind this may help the mum with this process. In most cases, the evidence shows the mum can continue breastfeeding safely and for many, to know this is possible is a huge relief.

Over the years, the service Wendy provides has grown – she now leads a small team of volunteers who offer individual support to more than 10,000 families each year via email and social media.  She is contacted by mums and families, as well as health care professionals.

She has also written more than 50 information sheets about the most common medications breastfeeding mums ask about – these infosheets cover everything from postnatal depression and anxiety to cold and cough remedies, to contraception, hayfever, headlice and norovirus.

She was awarded a PhD in 2000 and has written several books on this topic, as well as speaking at numerous national and international conferences, study days and other events.

She is extremely well known and highly regarded by breastfeeding supporters across the world. Her knowledge, patience, understanding and support has been felt and appreciated by thousands of families.

With her unending, selfless commitment and passion Wendy is an inspiration to many. Her work is so far reaching, it is impossible to measure the difference she has made.

 

For more information/press enquiries:
Contact Felicity Lambert, BfN Comms Officer felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

https://www.facebook.com/BfNDrugsinBreastmilkinformation/

14 Nov

MBRRACE-UK Report, “Saving Lives, Improving Mothers’ Care” – BfN Response

Shereen Fisher, BfN CEO

MBRRACE–UK released their 5th report ‘Saving Lives, Improving Mothers’ Care’. It describes the lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity from 2014-2016. Here’s The Breastfeeding Network’s response. 

The Breastfeeding Network (BfN) welcomes the report. While the research has found that the number of women dying as a consequence of complications during or after

Wendy Jones

Wendy Jones, lead pharmacist, BfN Drugs in Breastmilk service

pregnancy remains low in the UK – with fewer than 10 out of every 100,000 pregnant women dying in pregnancy or around childbirth, the report highlights the unacceptable disparity in care for black and ethnic minority women. Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘The almost five-fold higher mortality rate amongst black women compared with white women requires urgent explanation and action. BfN welcome further exploration into this unacceptable disparity to ensure there is real change for black and ethnic minority women’.

A key concern, is the tragic case of a mother dying several weeks after her baby was born (Commencing treatment, dose and compliance page 39). There were delays in prescribing thromboprophylaxis because of concerns over  breastfeeding.

Dr Wendy Jones, lead pharmacist for the BfN Drugs in Breastmilk Information service, said ‘I have long feared such a scenario.  Physicians need to be aware how to check that a drug treatment is compatible with breastfeeding quickly, using evidence-based sources. The drugs in this case are widely used in the immediate postnatal period yet emergency medicine teams are often unable to access readily available evidence-based information on medication and breastfeeding as quickly as they need. The information should have been readily available in guidelines or a reference source including specialist information. The wording of the BNF: “Due to the relatively high molecular weight and inactivation in the gastro-intestinal tract, passage into breast-milk and absorption by the nursing infant are likely to be negligible, however manufacturers advise avoid” needs to be updated where the manufacturer is merely not taking responsibility in licensing the product. The removal of the words “manufacturer advises avoid” makes the information read very differently to a busy practitioner’.

Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘This sad case highlights the need for mothers to be able to access skilled support in their local communities, with staff alert for symptoms needing attention; the mother in question had multiple ‘fainting’ episodes postnatally that were not investigated until day 44. This emphasises the need for health care professionals in all front-line services to understand how to treat pregnant and breastfeeding mothers – until this happens women will continue to be exposed to risk and potentially loss of life. It feels that no-one listened to the mother or observed her and her baby as a dyad as closely as they should have done, possibly because breastfeeding was seen as a barrier to medication. Women should not be disadvantaged in the management of acute illness just because they are pregnant or breastfeeding, and communication needs to be improved throughout the multidisciplinary team.’

To read more you can download the full report, lay summary and the infographic here: https://www.npeu.ox.ac.uk/mbrrace-uk/reports

06 Nov

Prevention is better than cure

Shereen Fisher, BfN’s CEO, responds to Health and Social Care Secretary Matt Hancock’s vision for prevention released yesterday, and how it relates to investment in breastfeeding support.

The future of health in the UK is dependent on us all getting really serious about prevention[1]. Currently the NHS spends £1 in every £5 on health problems that are a direct result of our lifestyle such as obesity and poor diet[2]. We are told that not only will prevention help reduce the strain on the NHS but it will also improve all our health.

Getting serious about prevention must include getting serious about community level investment to enable all mothers who choose to breastfeed to do so, given the substantial evidence that links breastfeeding with improved health.

The Lancet[3] series on breastfeeding offers the most comprehensive review of all the evidence on breastfeeding to date and highlights breastfeeding’s role in the UK prevention agenda.

The authors state: “…how important breastfeeding is for all women and children, irrespective of where they live … Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media [ear infections]. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancers and diabetes [Type 2] in mothers.”

Importantly UK women and babies offer policy and health leaders an attractive opportunity. While breastfeeding rates in the UK are the lowest in the world the rates of initiation – women starting to breastfeed – have been increasing for the last 20 years (81%)[4].

Scotland’s infant feeding statistics[5] (November 2018) show signs of positive change – no happy accident but consequence of national leadership, strategic planning, partnership and sustained investment.

Women’s intention to breastfeed offers an important opportunity for health and wellbeing both for babies (next generation) and women themselves. However, individual will has to be met with support that effectively improves a mother’s breastfeeding experience and helps sustain her choice to breastfeed. Peer support can make a big difference here especially as over time it offers the chance for areas to recreate a culture where breastfeeding is familiar.  We also know that choice isn’t made in a vacuum but is heavily influenced by family members, hospital care, health care professional advice and societal views. Patient empowerment is an important theme in the vision of healthcare for the future yet women feel constantly disempowered in their efforts to breastfeed through the lack of support available to them.

With the NHS celebrating a landmark anniversary alongside £20 billion a year in extra cash now announced[6] NHS leaders will be putting forward a 10-year plan that will make crucial decisions about how the service will spend the money.

In the planning no doubt demands will be high, as cancer survival rates, mental health support, health inequalities and an aging population all vie for consideration, how should we use the government’s cash boost to tackle the priorities that matter most to us?

In the debate let’s remember the substantial benefits to health in breastfeeding for mother and baby as well as the sheer economic and environmental sense that breastfeeding makes.

In 2012 UNICEF UK[7] reported that just a moderate increase in breastfeeding rates could save the NHS millions. In 2016 the Lancet[8] series calculated that the overall savings would actually be in the order of billions, not millions, of pounds. Moreover, the measures required to support breastfeeding are relatively inexpensive and soon pay for themselves. Keith Hansen of the World Bank said …

“In sheer, raw bottom-line economic terms, breastfeeding may be the single best investment a country can make.[9]

The potential savings into the billions are important here because we all know that the cash boost being offered by government to the NHS and social care isn’t going to be enough. While the additional £20 billion a year (in five years) has already been welcomed, the Kings Fund has pointed out, that this does not come close to the amount required to improve services after years of underfunding[10]. On social care, the budget announcements will not be able to undo the cuts in services and underfunding of local government that has already occurred. These cuts that have caused losses to breastfeeding support services, many of which are located in areas of low breastfeeding rates and run by volunteers and supported by charities[11].

Knowing how the money works to support breastfeeding is essential and it is currently hard to know this in England. What we do know is that funding for community-led breastfeeding peer support has been cut because it sits within a shrinking public health budget devolved to local authorities. Despite excellent evidence-based commissioning guidance on infant feeding for local authorities[12] breastfeeding support services in communities is entirely optional.

This has led to mothers who choose to breastfeed being unable to access local services and leaves them failed and let down. This is just too precarious a situation for a public health priority as important as breastfeeding that if better funded and supported could serve us well in the prevention of infant mortality, obesity, type 2 diabetes, ovarian and breast cancer ….

If we are going to get serious about prevention in health then there needs to be a clear strategy and leadership for breastfeeding. Government’s role is key here in taking responsibility for building an environment that promotes, protects and supports breastfeeding[13], not just for the next year but for the next 20 years.

This should include at a minimum the following very important steps many of which are recommended by National Institute for Clinical Excellence:

  • Appoint a national multidisciplinary infant feeding board or committee with strong leadership to ensure evidence on infant feeding is understood and enshrined in policy
  • Ensure that Baby Friendly accreditation becomes a minimum requirement for all maternity settings (achieved in Scotland and Northern Ireland) (NICE recommended)
  • Ensure that all mothers regardless of where they live, receive skilled evidence-based breastfeeding support, making this provision a mandatory responsibility by protecting the public health budget that protects health visiting and breastfeeding peer support workers (NICE recommended)
  • Protect all families from aggressive marketing of formula companies by enacting into UK law the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions (NICE recommended).
  • Require employers to provide breaks to breastfeeding mothers to allow them to breastfeed or express milk at work.

With careful, long term thinking and action the prevention agenda offers great focus to help us plan the health and wellbeing of the UK for the future. The health of women and babies will be stronger still for joined-up planning and provision of quality breastfeeding support. Let us not forget all our responsibilities in supporting breastfeeding and ensuring that its role in the prevention agenda is fully acknowledged.

 

 Footnotes:
[1] https://publichealthmatters.blog.gov.uk/2018/11/05/matt-hancock-my-vision-for-prevention/

[2] Anita Charlesworth, Chief Economist, The Health Foundation interviewed for Healthy Visions BBC Podcast / https://www.health.org.uk/Running-to-stand-still-why-20-5bn-is-a-lot-but-not-enough

[3] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (30 January 2016), Victora, CG et al, The Lancet Volume 387, Issue 10017, 475-490 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

[4] Infant Feeding Survey 2010 (2012), Fiona McAndrew et al, Health and Social Care Information Centre https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

[5] Scottish Government Infant Feeding Statistics 2017/18 http://www.isdscotland.org/Health-Topics/Child-Health/Publications/index.asp#2275

[6] NHS funding: Theresa May unveils £20bn boost https://www.bbc.co.uk/news/health-44495598 17/06/18

[7] Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK (October 2012), Renfrew, M et al, Unicef UK https://www.unicef.org.uk/babyfriendly/about/preventing-disease-and-saving-resources/

[8] Why invest, and what it will take to improve breastfeeding practices/ (30 January 2016), Nigel C Rollins et al, The Lancet Volume 387, No. 10017, 491-504 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext

[9] The Power of Nutrition and the Power of Breastfeeding (2015), Keith Hansen, Breastfeeding Medicine, Volume 10, Number 8

[10] The Kings Fund, NHS Funding: What we know, what we don’t know and what comes next https://www.kingsfund.org.uk/blog/2018/06/nhs-funding-what-we-know

[11] Open Letter on the crisis in UK breastfeeding https://ukbreastfeeding.org/open-letter/

[12] https://www.gov.uk/government/publications/infant-feeding-commissioning-services

[13] https://www.unicef.org.uk/babyfriendly/about/call-to-action/

24 Aug

Guest Blog by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!

Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

24 Aug

Guest Post by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!

Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

15 Nov

A list of MPs who came to our 20th anniversary reception in Parliament

The infant feeding APPGThank you for inviting your MP to come to our 20th birthday reception in Parliament last night and the Infant Feeding APPG yesterday afternoon. Here is a list of all the MPs who came.

If your MP is on either list, please do thank them for coming along, consider following up with them by inviting them to come along to a drop in group (if you feel it’s appropriate) or meet with them to discuss issues around infant feeding in your area. Having a relationship with your MP really does help in campaigning for better breastfeeding support services.

At our 20th anniversary parliamentary reception the following MPs were there:

  • Alison Thewliss – SNP MP for Glasgow Central
  • David Linden – SNP MP for Glasgow East
  • Sharon Hodgson – Labour MP for Washington and Sunderland West
  • Mohammed Yasin – Labour MP for Bedford
  • Mike Gapes – Labour and Co-operative MP for Ilford South
  • George Hollingberry – Conservative MP for Meon Valley
  • Steve McCabe – Labour MP for Birmingham, Selly Oak
  • Stephen Morgan – Labour MP for Portsmouth South
  • Marion Fellows – SNP MP for Motherwell and Wishaw
  • Eleanor Smith – Labour MP for Wolverhampton South West
  • Bill Grant – Conservative MP for Ayr, Carrick and Cumnock

And at the APPG earlier on in the day the following MPs were there:

  • Alison Thewliss – SNP MP for Glasgow Central
  • Bim Afolami – Conservative MP for Hitchen and Harpenden
  • Jon Ashworth – Labour and Co-operative MP for Leicester South
  • Carol Monaghan – SNP MP for Glasgow North West
  • Gavin Newlands – SNP MP for Paisley and Renfrewshire North
  • Jim Shannon – DUP MP for Strangford

If you know your MP was there and we have missed them out then do let us know. We have tried to make this list as accurate as possible, but there were times when we were speaking or organising things, and may have missed somebody.

If your MP said they would come but didn’t turn up, it could well be because there was an important Brexit debate going on. It would be great if you could still follow up with them and invite them to meet you/visit your group/find out more etc.

It was very clear yesterday that the MPs who turned up had been invited by their constituents and that was the reason they had chosen to be there. It really works!

You can also ask all your MPs to drop in to the UNICEF Baby Friendly Call to Action event on the 5th December – more details on that here .

Here’s a selection of photos from our day yesterday. Thank you to everyone who made it possible. Here’s to the next 20 years!