Breastfeeding in the UK
A range of evidence-based policy developments have been put in place over the past 10 years in an effort to promote the initiation, duration and exclusivity of breastfeeding. NICE public health guidance recommends that the UNICEF UK Baby Friendly Initiative should be the minimum standard for the NHS, and that a combination of interventions including antenatal education, peer support, and education and training for health professionals should be put in place. There is a strong evidence base to inform such recommendations (1, 2, 3, 4).
Considerable social and cultural barriers to breastfeeding in the UK remain. Breastfeeding in the UK is highly sexualised in the media, which has a powerful adverse impact particularly on young women and men. Promotion of formula to professionals and the public is in contravention of the WHO Code on Marketing of Breastmilk Substitutes (1981), yet even very young children have negative views on breast feeding, indicating that they have absorbed negative messages (5). There is a longstanding lack of education for all health professionals, with many health professionals not being appropriately informed about the (i) health outcomes related to infant feeding, or (ii) care required to enable women to breastfeed and avoid preventable complications, factors which can result in women and men believing that breastfeeding does not matter enough to overcome the barriers they encounter.
Systematic reviews have identified a wide range of behavioural interventions to promote the initiation and duration of breastfeeding for both term, healthy babies (1, 2, 3) and neonatal unit babies (4). These demonstrate that a combination of interventions is needed to counter the complex socio-cultural and health service barriers to breastfeeding in the UK, including offering informal, small-group antenatal education and both lay and professional antenatal and postnatal support. Although recommended in NICE public health guidance these interventions are not consistently available. A NICE Briefing identified that the effectiveness of such behavioural interventions would be improved if the broader socio-cultural environment were addressed (6), particularly for women from low-income communities where formula feeding has been the norm for several generations.
1. Dyson L, McCormick F, Renfrew MJ. (2007) Interventions for promoting the initiation of breastfeeding (Cochrane Review)
2. Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub3
3. Renfrew MJ, Wallace LM, D’Souza L, McCormick F, Spiby H and Dyson L 2005. The effectiveness of public health interventions to promote the duration of breastfeeding: systematic reviews of the evidence. National Institute for Health and Clinical Excellence, London
4. Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, et al. 2009 Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technol Assess;13(40)
5. Angell C, Alexander J, Hunt J 2010 Researching breastfeeding awareness in primary schools. British Journal of Midwifery, Vol. 18, Iss. 8, 05 Aug, pp 510 - 514
6. Dyson L, Renfrew MJ, McFadden A, McCormick F, Herbert G, Thomas J 2006 Promotion of breastfeeding initiation and duration. Public Health Evidence into Practice briefing. National Institute for Health and Clinical Excellence