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Breastfeeding Rates

Introduction

Breast milk provides the ideal nutrition for infants in the first stages of life. Breastfeeding has a major role to play in promoting public health and reducing inequalities. The case for investing in services to support breastfeeding to reduce health inequalities is well documented, evidence based and compelling: increases in breastfeeding are expected to reduce illness in young children, have health benefits for infants and their mothers and results in cost savings to the NHS through reduced admissions for the treatment of infection in infants (Quigley et al, 2007). Breastfeeding saves lives and protects the health of babies and mothers, and increases children's future life chances. There is evidence that babies who are breast fed experience lower levels of gastro-intestinal and respiratory infection. Observational studies have shown that breastfeeding is associated with lower levels of child obesity. Benefits to the mother include a faster return to pre-pregnancy weight and possibly lower risk of breast and ovarian cancer (BMA Board of Science, 2009).

What do we know?

Breastfeeding statistics are collected at two time points: breastfeeding initiation data is collected within 48 hours of the birth of a baby, data is also collected by health visitors when the baby is 6-8 weeks of age on whether the baby is fully or partially breastfed.

Breastfeeding initiation falls under the remit of maternity services which is a Clinical Commissioning Group (CCG) commissioned service. Data on breastfeeding initiation is reported directly from hospital trusts to NHS England to allow reporting at a CCG and trust level.

Breastfeeding at 6 to 8 weeks falls under the remit of health visiting services and prior to October 2015 this was a NHS England commissioned service with data reported directly from child health information systems to NHS England to allow reporting at a CCG level. These data at initiation and at 6 to 8 weeks could be compared to provide an estimate in the drop-off of breastfeeding rates between these two time points.

Since April 2003, data on the local breastfeeding prevalence at 6-8 weeks have been requested on a quarterly basis, historically from all Primary Care Trusts (PCT), via the Department of Health (DH), Integrated Performance Monitoring Returns. This provides more timely, frequent and local information on breastfeeding prevalence at 6-8 weeks than the Infant Feeding Survey.

Changes to NHS and Local Authority commissioning over recent years have affected the collection of breastfeeding statistics and it should be noted that these changes will affect the quality of breastfeeding data until they are fully embedded. From October 2015 health visiting became a Local Authority commissioned service with provision moving from being GP registered based to being Local Authority resident based. Therefore, data is now reported at a Local Authority level. Although the transfer occurred from October 2015, data is been retrospectively reported by Local Authorities to Public Health England from 1st April 2015 to determine the baseline in data at a Local Authority level prior to the transfer.

Since April 2013 these data are now being collected directly from providers via the data collection tool that is part of Unify2, a web based system set up to collect performance and other central returns directly from the NHS. The figures are obtained from maternity providers, from midwives in acute trusts and information recorded at deliveries (PHOF, 2015).

Facts, Figures, Trends

Published data on breastfeeding for the most recent complete year (2014/15) are shown in Table 1 and Figure 1 below for Reading, the South East and England. Reading's breastfeeding initiation rates have generally been increasing over recent years (except for 2012/13) and have been well above the England averages. Breastfeeding initiation in Reading for 2014/15 was 79.0% which is higher than the South East area (78.0%) and also higher than the England average (74.3%).

Table 1: Breastfeeding initiation - Percentage of all mothers who breastfed in the first 48 hours after delivery: E&W, SE and Reading - 2010/11 to 2014/15

 

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

Reading

77.9

78.0

77.6

78.5

79.0

 

 

 

South East

78.0

78.1

77.1

77.0

78.0

 

 

 

England

73.7

74.0

73.9

73.9

74.3

 

 

 

Source: Public Health Outcomes Framework, 2015

Figure 1: Breastfeeding initiation - Percentage of all mothers who breastfed in the first 48 hours after delivery: E&W, SE and Reading - 2010/11 to 2014/15

image1

Source: Public Health Outcomes Framework, 2015

It is very encouraging that breastfeeding initiation rates are higher than regional and national averages. This means that, proportionately, more infants will be getting the health benefits from their mother's milk. We need to continue the increasing trend so that even more newborns benefit from breastfeeding initiation.

The improving breastfeeding initiation rates are positive however increased benefits for the baby and mother are achieved if breastfeeding is sustained for longer periods of time. It is recommended that babies should be breastfed exclusively for 6 months however an alternative key measure is breastfeeding status at 6-8 weeks after birth.

'Totally breastfed' is defined as infants who are exclusively receiving breast milk at 6-8 weeks of age - that is, they are not receiving formula milk, any other liquids or food. 'Partially breastfed' is defined as infants who are currently receiving breast milk at 6-8 weeks of age and who are also receiving formula milk or any other liquids or food. 'Not at all breastfed' is defined as infants who are not currently receiving any breast milk at 6-8 weeks of age.

There are some problems with national monitoring in that all data cannot be validated due to reporting issues. 114 out of 152 local authorities submitted data for the Q1 2015/16 breastfeeding at 6-8 week data return. 43 local authorities passed all three stages of validation. The breastfeeding rate for England based on 89 local authorities who passed the initial stage of validation was 43.8%. Non- validated data result in null returns which are shown in Public Health Outcomes Framework (PHOF) reports. These appear as gaps in our local reporting as shown in Table 2 and Figure 2 below.

For 2012/13 and earlier, the data for this indicator was only available at PCT level. Therefore in some cases local authority values were estimated. For local authorities that were wholly contained within a PCT, the value for the whole PCT was used for that local authority. For those local authorities that were split across PCT boundaries, the local authority value was estimated using weighted PCT data. From 2013/14, this indicator is available directly at local authority level. As a result, between 2012/13 and 2013/14 there might be unexpected increases or decreases in the trajectory of this indicator for particular local authorities.

Table 2: Breastfeeding at 6-8 weeks - Percentage of all mothers who are still partially or totally breastfeeding at 6-8 weeks: E&W, SE and Reading - 2010/11 to 2014/15

 

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

Reading

55.4

 

55.6

 

 

 

 

 

South East

48.4

50.9

50.1

 

 

 

 

 

England

46.1

47.2

47.2

45.8

43.8

 

 

 

Source: Public Health Outcomes Framework, 2015

Figure 2: Breastfeeding at 6-8 weeks - Percentage of all mothers who are still partially or totally breastfeeding at 6-8 weeks: E&W, SE and Reading - 2010/11 to 2014/15

Breastfeeding rates at 6-8 weeks
Breastfeeding rates at 6-8 weeks

Source: Public Health Outcomes Framework, 2015

We know locally that the rate of breastfeeding at 6-8 weeks is higher than the England average (Figure 3 below). However work needs to be done to ensure that submitted local data can pass the validation tests, and subsequently reported by the national mechanisms and avoiding similar gaps as shown in the table above and chart below.

The difference in prevalence from breastfeeding initiation to breastfeeding at 6-8 weeks reduces significantly. We want to encourage more new mothers to sustain breastfeeding for longer, ideally for 6 months or more, so that both baby and mother receive the health benefits described above.

There are distinct differences in rates of sustained breastfeeding and this is monitored locally by Children's Centres where new babies are registered at. The tables and chart in Figure 3 on the following page show a 'snapshot' of numbers and percentages of breastfeeding status at the 6 - 8 week health visitor check by Readings Children's Centres, as of Quarter 4 in 2014/15.

As can be seen, the rates of babies still been totally or partially breastfed at 6-8 weeks vary dramatically across Reading. The chart shows that Surestart Whitley (36%), Norcot (41%) and Blagrave (48%) have the three lowest rates and that Emmer Green (72%), East Reading (71%) and Hamilton Road (71%) have the three highest rates. As mentioned, the data above is from a single quarter period and numbers do fluctuate slightly over time, however, the trend in lowest and highest rate areas have remained fairly static. There is clearly an inequality in breastfeeding uptake and further efforts are needed to encourage new mothers to breastfeed in the usually lower uptake areas, to hopefully bring them up towards the higher performing areas. This would help to reduce the inequality gap and enable more new babies, and their mothers, to reap the health benefits from initiating and sustaining breastfeeding in line with recommendations.

Figure 3. Breastfeeding status at the 6-8 week health visitor check by Reading Children's Centre: Qtr 4 - 2014/15

image2

National & Local Strategies (Current best practices)

  • Unicef UK Baby Friendly Initiative - Implementing the Unicef Baby Friendly Initiative in hospital and primary health care is one of six key recommendations in the National Institute for Health and Care Excellence (NICE) Postnatal Care clinical guidelines.(CG37) There has been joint work locally to increase breast feeding prevalence in Reading for a number of years. BFI is an evidence-based world-wide programme that works with health care providers to achieve a set of quality standards that will ensure high quality care for pregnant women and breastfeeding mothers and babies in supporting the initiation and continuation of breastfeeding. The implementation of these breastfeeding quality standards is practiced and delivered by the Health Visiting and midwifery services serving Reading and are co-ordinated and led by an Infant Feeding Co-ordinator.
  • NICE Public Health Guidance (2008) on Maternal and Child Nutrition (PH11) recommends encouraging breastfeeding by providing information, practical advice and ongoing support - including the help of breastfeeding peer supporters and advice on how to store expressed breast milk safely.
  • The breastfeeding peer support service volunteers work at the Royal Berkshire Hospital supporting new mothers, if they want it, to breastfeed. Referrals are made to the service for further support if wanted. There is a specific focus in wards where breastfeeding initiation and at 6-8 weeks rates are lowest. A telephone advice/helpline service and volunteer run drop-ins within the local community are also available. The service aims to make contact with women who have started breastfeeding within 72 hours of giving birth, to provide help and tailored 1:1 support at a time when many may otherwise stop breastfeeding. The primary objective of this service is to reduce the level of drop off rates from those who initiate breastfeeding and to encourage sustained breastfeeding for a minimum of 6 - 8 weeks. This service is provided in line with best practice and evidence based interventions as described by NICE guidance Maternal and Child Nutrition (PH11).

What is this telling us?

Locally in Reading, we are doing well in terms of initiating breastfeeding and positive actions are been implemented in terms of increasing prevalence rates. We should strive to at least maintain this trend and hopefully increase the rate of improvement.

Breastfeeding has a major role to play in promoting public health and reducing health inequalities. There are long-standing stark differences locally in prevalence by ward area (Figure 3 above) identified at the 6-8 week check.

To increase the number of mother's breastfeeding, a sustainable, co-ordinated approach is needed requiring effective partnerships between statutory, voluntary and community services, with a focus in areas of Reading where prevalence is lower.

What are the key inequalities?

There are differences by socio-economic groups. Living in more deprived communities or being disadvantaged can significantly affect individual lifestyle behaviour choices and subsequently the health of individuals and their new born children. Focused attention on service/intervention delivery should be given in those areas where outcomes are not as good as areas that are performing well...so that inequality gaps start to reduce. The focus on targeted preventative services will help to achieve this.

What are the unmet needs/service gaps?

  • Greater opportunities to provide breastfeeding education and promotion along with ante-natal information on the support and services available to support breastfeeding mothers.
  • Increased opportunities for Health Visitors to provide early intervention and support to breastfeeding mothers within the first few days of giving birth and/or discharge from hospital to reduce the drop off rate from initiation.
  • Increased capacity in the peer support service provided by the Breastfeeding Network so they are able to provide greater access to their 1:1 support services.
  • Greater opportunities for breastfeeding mothers to attend breastfeeding drop-ins

This section links to the following sections in the JSNA:

Maternity

Perinatal Mental Health

Infant Mortality

Obesity - adult & child

Cancer

References

BMA Board of Science, 2009. Early life nutrition and lifelong health

National Institute for Health and Care Excellence, 2006. Postnatal care up to 8 weeks after birth (CG 37). Available at: https://www.nice.org.uk/guidance/cg37

National Institute for Health and Care Excellence, 2007. Maternal and child nutrition(PH 11). Available at: https://www.nice.org.uk/guidance/ph11

Public Health Outcomes Framework, 2015. Definitions - Breastfeeding prevalence at 6-8 weeks. Available at: http://www.phoutcomes.info/public-health-outcomes-framework#page/6/gid/1000042/pat/6/par/E12000008/ati/102/are/E06000038/iid/20202/age/170/sex/4

Quigley et al, 2007. Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17403827

UNICEF UK, 2015. Baby Friendly Initiative website. Available at: http://www.unicef.org.uk/babyfriendly/

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