Open letter on the current crisis in breastfeeding in the UK – UK mothers are being let down
Full text of the open letter available here: http://ukbreastfeeding.org/open-letter/
An open letter on the crisis in breastfeeding in the UK has been issued today, signed by midwives, health visitors, paediatricians, lactation consultants, breastfeeding counsellors, peer supporters, university researchers and others who work for professional organisations and charities that support families.
The letter follows the recent series in The Lancet on breastfeeding – the most comprehensive review of all the evidence on breastfeeding to date.
The open letter states: “The breastfeeding crisis in the UK is in fact a crisis of lack of support for those mothers who choose to breastfeed.” It highlights the recent cuts to breastfeeding support services and the infant feeding specialist posts, which are driven by cuts to public health, which amount to £200 million in total in England. (See detailed list of cuts in Notes to Editors.)
The letter calls on government, as a matter of urgency, to safeguard the public health budget.
The signatories make clear that the message of The Lancet series is that increasing breastfeeding rates is everyone’s responsibility, quoting report co-author Dr Nigel Rollins of the World Health Organisation (WHO), who said: “The success or failure of breastfeeding should not be seen solely as the responsibility of the woman. Her ability to breastfeed is very much shaped by the support and the environment in which she lives. There is a broader responsibility of governments and society to support women through policies and programmes in the community.”
It is not a matter of persuading mothers to breastfeed – most mothers begin breastfeeding and initiation rates are around 80 percent. “However, rates plummet in the first weeks and months after birth, and most mothers say they stopped breastfeeding before they wanted to,” says the letter.
The letter goes on to highlight the strategy that the government must adopt in order to increase breastfeeding rates in the UK. Research from other countries that have achieved this shows that a multifaceted approach is needed, with interventions delivered in combination. The authors call on the UK government and the national assemblies to
- establish a multi-sectoral National Breastfeeding Committee to develop a National Breastfeeding Strategy
- all maternity and community settings must meet Baby Friendly standards, as per NICE guidelines
- all mothers in the UK must receive skilled, evidence-based breastfeeding support, as per NICE guidelines
- safeguarding the public health budget for universal health visiting services and breastfeeding support
- fully enact in UK law the International Code of Marketing of Breastmilk Substitutes, which would end the advertising of follow-on formula
- require employers to provide breaks to breastfeeding mothers to breastfeed or express milk at work
The Lancet report was clear about the long-term health protection from breastfeeding, even in richer countries like the UK. Breastfeeding helps protect babies from diarrhoea, respiratory and ear infections, necrotising enterocolitis, sudden infant death syndrome, and reduces their chance of obesity and diabetes in later life. It also helps protect mothers from breast and ovarian cancer and diabetes.
It also said that low rates of breastfeeding for countries like the UK cost our economy billions of pounds.
According to The Lancet, “Losses [from not breastfeeding] for high-income countries are $231·4 billion, or 0·53% of their GNI.” The UK Gross National Income was $2.5183 trillion in 2014, according to World Bank statistics, 0.53% of which is $13.35 billion.
The letter adds: “If this were not enough, in the UK poorer mothers are far less likely to breastfeed than richer mothers, which increases health and social inequality.”
The open letter will be sent to all four governments of the UK and in particular to: Jane Ellison (Minister for Public Health), Ben Gummer (Minister for Care Quality), Duncan Selbie (Chief Executive, Public Health England) and Simon Stevens (Chief Executive of NHS England).
Quotes in support of the open letter
Rosemary Dodds, Senior Policy Adviser, NCT
“It’s clear many women feel under pressure, however they feed their baby. Lack of national and public health support for breastfeeding in England and Wales, in particular, is letting women down. The majority stop breastfeeding before they actually want to and we know this is due to a lack of skilled support. The Lancet series highlights that governments need to do more to protect and support women’s feeding decisions.”
Emma Pickett IBCLC, Chair, Association of Breastfeeding Mothers
“We know from the government’s own infant feeding survey that 63% of mothers at 8-10 months wish they had breastfed for longer. There is a crisis in lack of support for breastfeeding. Mothers, and those who support them, are angry. No individual mother should feel like a failure. They are being failed by others who lack commitment and understanding. The rights of mothers and babies are being denied and women feel forced into making choices that increase risk of postnatal depression and both short and long term health problems.”
Shereen Fisher, Chief Executive, Breastfeeding Network
“Scaling up of infant feeding support not scaling down is needed by parents and families. Peer supporters offer timely, independent, skilled support that compliments health professionals. To help families believe breastfeeding can work for them we need to keep working together and keep skills in communities.”
Helen Gray IBCLC, Joint Coordinator, World Breastfeeding Trends Initiative (WBTi) UK
“The majority of mothers in the UK want to breastfeed, but they face many hurdles to reach their own breastfeeding goals. Successful breastfeeding requires a good start at birth, with health professionals and maternity settings that meet Baby Friendly standards. When mothers get home with their new babies, they need support from skilled local health professionals and mother-to-mother support in their own communities. They need their friends and family to be well informed and supportive of breastfeeding. They need to be able to lead their own lives, able to go out and breastfeed their babies with confidence, able to return to work supported by their employers to continue breastfeeding, with facilities and breaks at work.
This is why it is the responsibility of all of us, all of society, to break down the many barriers that mothers face. We need to implement multi-faceted strategies across all of society, in the health care system, at home and in the community, as recommended by the Acta Pediatrica and the Lancet. The World Breastfeeding Trends Initiative (WBTi) UK team calls on governments across the UK to put our babies’ welfare at the top of the agenda for the future.”
Professor Russell Viner, Officer for Health Promotion for the Royal College of Paediatrics and Child Health
“The benefits of breastfeeding have been widely publicised yet with [The Lancet’s] paper showing that just 1 in 5 children are breastfed in high income countries and 1 in 3 in low and middle income countries, it’s clear that efforts are still falling far too short and the grave reality is that this is costing children’s lives.
“At home in the UK we know that babies born to mothers living in poverty are less likely to be breastfed. We also know these families are at higher risk of mortality, are more likely to be admitted to hospital and have higher incidences of mental health problems. Whilst breastfeeding can’t prevent all these issues, it certainly supports many – breastfeeding reduces sudden infant death by more than a third and it has benefits for intelligence and protection against obesity and diabetes. For mothers themselves, breastfeeding reduces the risk of ovarian and breast cancer.
“Britain has one of the lowest levels of breastfeeding compared to other rich countries – we worry that things will get much worse with Government’s proposed budget cuts.
“Government’s proposed slashing of the public health budget by £200m places a major barrier in front of efforts to improve breastfeeding rates. Health visiting services will no doubt suffer as a consequence and these are the very people who work with families during the crucial early days and months of a child’s life. We therefore call on Government to do a u-turn, safeguard these services and improve the lives of thousands of vulnerable children in the process.”
Professor Mary Renfrew, Director, Mother and Infant Research Unit, University of Dundee
“We need to focus on enabling environments – dealing with the difficulty of breastfeeding in public, the lack of widespread informal support after decades of low rates, support for women in the workplace, improved staff training, and adhering to the Code – as well as support.”
Alison Baum, Chief Executive, Best Beginnings
“Best Beginnings supports this call to action, following the series of articles and meta-analyses in the Lancet showing that the UK has the lowest rates of breastfeeding in the world and this is causing preventable diseases in both mothers and babies. As an organisation, we work to give every baby in the UK the healthiest start in life. We acknowledge that many mothers find that they do not receive the consistent, evidence-based support they need to breastfeed their babies. Most mothers in the UK wish to breastfeed (over 80% initiate) and many stop before they wish to (Infant Feeding Survey 2010). The seems a very opportune time for all organisations that support parents to join together with one voice.”
Zoe Faulkner, Coordinator, Lactation Consultants of Great Britain
“Good work to date is threatened by cuts and the failure to recognise the need for a multifaceted approach to protecting breastfeeding. We need governmental and local authority support to continue the improvements in breastfeeding initiation and to increase continuation rates up to one year.”
Obi Amadi, Lead Professional Officer, Community Practitioners’ and Health Visitors’ Association
“It is very clear that the government must commission the range of services that have been proven to support women to establish and sustain breastfeeding. The health benefits of breastfeeding are well known so implementing the steps outlined should be an obvious choice. The UK government needs to follow the lead of the Scottish and NI assemblies’ commitment to policy and structural support, including appointing a national infant feeding coordinator.”
Shel Banks, Deputy Chair, UK Association for Milk Banks
“UKAMB fully supports this open letter. We recognise the importance of breastmilk and breastfeeding for all infants, and in supporting the most vulnerable infants through the provision of human breastmilk to support mothers where there is insufficient of their own milk. We believe that we must invest in all babies and improve long-term health outcomes by ensuring all babies can access breast milk.”
Anna Burbidge, La Leche League GB (LLLGB)
“La Leche League GB (LLLGB) welcomes the publication of The Lancet breastfeeding studies. This extensive research has consolidated evidence collected in recent years on the significance of breastfeeding. It makes it clear that breastfeeding has an impact on the health and well-being of everyone, regardless of where they live or their income; as well as on economic and environmental factors.
One of the most important points raised by the report is that ‘success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective societal responsibility’.
We hope that knowing breastmilk is of long-term significance will encourage more funding into the establishment and support of breastfeeding in the early days. Women also need more support to continue breastfeeding if they return to paid employment. Being aware of the significance of breastfeeding is important and having help and support available when difficulties arise will enable more women to breastfeed for as long as they wish to.”
Related blog by Sue Ashmore, programme director of the Unicef Baby Friendly Initiative.
“Lancet series launch: Breastfeeding saves lives and it’s time for action” click here to view blog
NOTES FOR EDITORS
The following is a list (not comprehensive) of recent cuts to breastfeeding services that we have been made aware of:
There have been cuts to a wide range of services in the last 2 years: loss of national leads, local infant feeding leads, paid breastfeeding specialists, paid peer supporters, voluntary peer support services. Several areas awaiting decisions at the end of this financial year, so further details may emerge after March.
Children centres also closing across the country e.g. Swindon, Haringey, which means volunteer peer support lacks a setting even if it is able to continue.
- Wales – Public Health Wales has just ended the post of Breastfeeding Lead and the Breastfeeding Welcome scheme
- Closure of Baby Café Oxford (nine separate weekly support sessions closing down in Oxfordshire). Oxford has to save £70 million and these services cost £40,000
- NHS Somerset partnership ceased roles of Infant Feeding Specialist
Cambridgeshire – all funded breastfeeding support groups closed. Committee to write breastfeeding strategy in County Hall has ended
- October 2015 Brent peer support cut in its entirety
- Breast Start Sefton, Southport Lancs, closed due to ending of funding Jan 2016
- All Essex peer support services to be closed by July 2016 http://essexbaby.co.uk/essex-county-council-to-cut-vital-breastfeeding-support-service/
- Bristol – loss of paid breastfeeding counselling support
- Bournemouth and Poole – 7 paid breastfeeding support staff being made redundant March 2016
- Service cut in Tamworth, Staffordshire http://www.theguardian.com/lifeandstyle/2015/jun/28/new-mothers-babies-support-services-cut-england-breastfeeding-midwife
- Service cut by King’s College Hospital trust in Southwark and Lambeth, London from September 2015: https://londonist.com/2015/06/breastfeeding-support-cut-in-southwark-and-lambeth
- Bradford – closure of breastfeeding support service: http://www.thetelegraphandargus.co.uk/news/13505391.Breastfeeding_support_service_falls_victim_to_cuts/
- Lewisham council cuts to community-based breastfeeding support: http://www.eastlondonlines.co.uk/2015/02/cuts-to-baby-cafes-met-with-resistance-from-peer-support-and-volunteers/
- Baby Cafes (commissioned breastfeeding support drop-ins with a paid facilitator, run by a charitable trust, now part of the NCT) dropped in number from 97 in late 2014 to 64 in late 2015
- Gosport and Havant – peer support project run by the Breastfeeding Network to end in March
There are also cuts to breastfeeding support not given through peer support programmes. There is financial pressure on the NHS, which makes providing national coverage a challenge: e.g. Heads of Midwifery asked to reduce staffing levels http://www.theguardian.com/lifeandstyle/2010/nov/16/midwife-cuts-childbirth-risk
Press contacts for interviews
World Breastfeeding Trends Initiative, Helen Gray, 020 8767 2745, 07973 262659, firstname.lastname@example.org
Association of Breastfeeding Mothers, Emma Pickett email@example.com or 08444 122 948
Baby Milk Action, Mike Brady, firstname.lastname@example.org, 07986 736179
Best Beginnings, Alison Baum, 07525 688190, 020 7443 7895, email@example.com
Breastfeeding Network, Felicity Lambert firstname.lastname@example.org
La Leche League GB, Nik Harris, 07970 066 391 or 020 8404 3821 or email@example.com
Royal College of Paediatrics and Child Health, Emily Arkell, Emily.Arkell@rcpch.ac.uk 020 7092 6005