Sue Ashmore on breastfeeding and public health

One challenge is the UK's deeply engrained bottle feeding culture

• Increase image
• View all images

To convey the public health benefits of breastfeeding, authors sometimes ask readers to imagine a miracle drug that prevents numerous childhood illnesses, has continued benefits into adulthood, is free to manufacture and readily available.

It is, of course, breastmilk, and all these claims are true.

But consider another less well-known but equally true claim of breastmilk: a millionaire's baby who is not breastfed is less healthy than an exclusively breastfed baby whose mother is in the poorest social group. That is to say, there is evidence that a child in social class five who is exclusively breastfed will have better health outcomes than a child in social class one who is bottle fed. This complex living fluid protects against infection, lowers blood pressure, prevents diabetes and so much more.

This is surely important to anyone involved in policy making around public health in the UK, as it has the potential to buck the trend of poor health outcomes being associated with the most disadvantaged members of society.

The Department of Health document Health Inequalities: progress and next steps made the welcome announcement that the government is committing new resources to improve breastfeeding practice. The report recommends implementing the Unicef baby friendly initiative - an accreditation programme aimed at improving breastfeeding practice in the health system.

Mounting evidence

Since the baby friendly initiative started in the UK 12 years ago, demand for its services has rocketed as policy makers have started to realise the impact of breastfeeding on public health and taken note of the increasing body of evidence showing the initiative consistently increases breastfeeding rates.

In 2006, the initiative was recommended by the National Institute for Health and Clinical Excellence due to its clinical effectiveness, and also because NICE calculated the (relatively very low) cost of implementing the programme would be quickly outweighed by savings in treatment costs. Since then, it has been recommended in several other public health plans, including those concerned with obesity, maternal and child nutrition, and health inequalities.

Improving breastfeeding rates is possible. A good example is in Blackburn, Lancashire, where breastfeeding rates have risen from 27 per cent 10 years ago to 72 per cent today. In contrast, there are also areas where little seems to have happened at all. Sadly, we still hear numerous tales from mothers and health professionals of extremely poor routine practices.

The differences between the best and the worst can be hard to spot. It is not the better-staffed and resourced units in areas of social advantage that have the best practices. In fact, the opposite is often true, with struggling units in areas of significant disadvantage demonstrating the most improvement.

Aiming for success

There appear to be two main factors associated with success. The first is an infant feeding lead with the ability, time and resources to influence change in the clinical area; the second is a manager who genuinely thinks breastfeeding is important.

New resources will help create suitable infant feeding posts and Unicef has a range of services and materials to help with capacity building. However, sustainable change will not occur without committed leadership.

There are many challenges ahead. Scepticism and reluctance will occur with any change, but breastfeeding is such an emotive subject that change becomes doubly difficult. And not least of the challenges is the UK's deeply engrained bottle feeding culture, to which health professionals are as susceptible as anyone else.

But one thing is for sure. The simple and cheap changes in practice that could vastly reduce health inequalities in this country will never take place unless a clear and unambivalent message is sent out from the top of NHS trusts - that breastfeeding is an organisational priority, and those working towards this end will have the full support of senior management.  

See www.babyfriendly.org.uk for more information.