LTP Priority: Maternity
Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service
Type of Interventions: Targeted support for breast feeding
Major driver of health inequalities in your area of work
UK breastfeeding initiation rates are poor when compared to the rest of Europe, with 34% of women breastfeeding at six months. In the UK we know that our breastfeeding initiation rates do not compare favourably with the rest of Europe: The Infant Feeding Survey (which was last run in 2010, after which it was discontinued) showed an 81% initiation rate, dropping to below 50% at two months, 34% at 6 months and 0.5% at one year. Within those rates are also marked inequalities:
Cultural norms play a significant part in influencing breastfeeding rates, and the 2016 Lancet series on breastfeeding: concluded that only consistent effort through multiple channels was likely to make a significant impact on breastfeeding initiation and duration. A 2013 PCT level analysis Oakley et al 2013: Factors associated with breastfeeding in England. BMJ found that whether or not a woman breastfeeds is significantly influenced by a range of sociodemographic factors, with young mothers, those from BME groups and those in deprived areas being much less likely to breastfeed.
Deprivation, inclusion health groups, protected characteristics: BME groups
Breast feeding support
Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available,
and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
McFadden et al’s (2017) Updated Cochrane review on support for breastfeeding mothers included over 100 RCTs, concluding that when breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased.
‘Support’ is complex and can include several elements such as emotional and esteem‐building support (including reassurance and praise), practical help, informational support (including the opportunity to discuss and respond to women’s questions) and social support (including signposting women to support groups and networks).
The evidence suggests that the most effective support for breastfeeding mothers comes from trained personnel during antenatal or postnatal care delivered through ongoing scheduled visits, tailored to settings and needs. This involves enhanced public health approach to breastfeeding support targeting women who express uncertainty around breastfeeding in routine antenatal care, and those who struggle in the first few days and weeks.