The Politics of BreastfeedingThe Politics of Breastfeeding

Janette WestmanJanette Westman

Midwife/Lactation ConsulatantMidwife/Lactation Consulatant

La Tempesta by Giorgione15th century Venice

““Access to a safe, healthy diet is Access to a safe, healthy diet is one of the most important one of the most important public health actions that a public health actions that a country can take to improve country can take to improve health and increase economic health and increase economic gain”. (WHO, 1999) gain”. (WHO, 1999)

5 times as likely to be hospitalised with gastroenteritis5 times as likely to be hospitalised with gastroenteritis

5 times as likely to have a urinary tract infection5 times as likely to have a urinary tract infection

Twice as likely to suffer from ear infectionsTwice as likely to suffer from ear infections

Twice as likely to have a respiratory infectionTwice as likely to have a respiratory infection

Twice as likely to develop allergies (if there is a family Twice as likely to develop allergies (if there is a family history)history)

Some evidence suggests a reduction in the incidence of Some evidence suggests a reduction in the incidence of NEC in preterm infantsNEC in preterm infants

Artificially-fed babies are:Artificially-fed babies are:

So how are we doing?.....So how are we doing?.....

……..not very well !..not very well !

In the UK 9 out of 10 women stop In the UK 9 out of 10 women stop breastfeeding before their baby is 6 weeks breastfeeding before their baby is 6 weeks oldold

Fewer than 2% of babies are exclusively Fewer than 2% of babies are exclusively breastfed at 6 monthsbreastfed at 6 months

Statistics hide inequalitiesStatistics hide inequalities

Mothers in social classes III-V less likely to Mothers in social classes III-V less likely to breastfeedbreastfeedMothers who remained in full time Mothers who remained in full time education until they were 18 are 3 times education until they were 18 are 3 times more likely to breastfeed more likely to breastfeed Three quarters of first time mothers aged Three quarters of first time mothers aged 30 or over breastfeed their babies 30 or over breastfeed their babies compared to less than half aged 20 or compared to less than half aged 20 or underunder

Effect of breastfeeding on gastro-Effect of breastfeeding on gastro-intestinal illness by social classintestinal illness by social class

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

bottle Breast<6w

Breast 6-12w

Breast>12w

I-IIIaIIIb-V

Type of Milk Feed

GI illnesses per Infant in first year of life

““Inappropriate feeding practices – Inappropriate feeding practices – suboptimal or no breastfeeding and suboptimal or no breastfeeding and inadequate complementary feeding – inadequate complementary feeding – remain the greatest threat to child health remain the greatest threat to child health and survival globally”and survival globally”

Innocenti Declaration 2005 on Infant and Innocenti Declaration 2005 on Infant and Young Child FeedingYoung Child Feeding

The Global Picture

The Global Strategy from 1990The Global Strategy from 1990

Appoint national breastfeeding coordinator and Appoint national breastfeeding coordinator and establish multisectoral national breastfeeding establish multisectoral national breastfeeding committee committee Ensure every maternity facility practices Baby Ensure every maternity facility practices Baby Friendly Initiative 10 stepFriendly Initiative 10 stepImplement all provisions of International Code in Implement all provisions of International Code in its entiretyits entiretyLegislation to protect breastfeeding rights of Legislation to protect breastfeeding rights of working womenworking womenEnsure appropriate guidelines and skills for staffEnsure appropriate guidelines and skills for staff

Develop, implement and evaluate policyDevelop, implement and evaluate policyEnsure protection, promotion and support of exclusive Ensure protection, promotion and support of exclusive breastfeeding for 6 months and continues breastfeeding for 6 months and continues breastfeeding up to 2 years or beyondbreastfeeding up to 2 years or beyondPromote timely, adequate safe and appropriate Promote timely, adequate safe and appropriate complementary feeding with continued breastfeedingcomplementary feeding with continued breastfeedingProvide guidance on feeding infants and young Provide guidance on feeding infants and young children in exceptionally difficult circumstanceschildren in exceptionally difficult circumstancesConsider what new legislation may be needed to give Consider what new legislation may be needed to give effect and to principles and aims of Code of Marketing effect and to principles and aims of Code of Marketing of Breastmilk Substitutesof Breastmilk Substitutes

Five additional targetsFive additional targets

The National PictureThe National Picture The breastfeeding Manifesto The breastfeeding ManifestoImplement the global strategy for infant and Implement the global strategy for infant and young child feedingyoung child feedingImplement postnatal care guidance from NICE Implement postnatal care guidance from NICE and public health evidence into practice and public health evidence into practice documentdocumentImprove training for health professionalsImprove training for health professionalsWork with employersWork with employersDevelop policy and practice to support Develop policy and practice to support breastfeeding in public placesbreastfeeding in public placesInclude breastfeeding education in curriculumInclude breastfeeding education in curriculumAdopt International code of marketing breastmilk Adopt International code of marketing breastmilk substitutes substitutes

What are we doing in Bradford?What are we doing in Bradford?

Hospital largest hospital, with most diverse Hospital largest hospital, with most diverse population in the UK to achieve UNICEF population in the UK to achieve UNICEF Baby Friendly accreditationBaby Friendly accreditation

Featured in publications for examples of Featured in publications for examples of good practicegood practice

Multi-lingual Video/DVDMulti-lingual Video/DVD

Breastfeeding Strategy for the Bradford Breastfeeding Strategy for the Bradford DistrictDistrict

The International Code and The International Code and the UK law - key differencesthe UK law - key differences

The International CodeThe International Code No advertising or promotion - No advertising or promotion -

anywhereanywhere No free samples or gifts to No free samples or gifts to

mothers / the publicmothers / the public No free or subsidised supplies No free or subsidised supplies

to hospitals unless for to hospitals unless for researchresearch

No free gifts to health No free gifts to health workers; information must be workers; information must be scientific and factualscientific and factual

No contact between mothers No contact between mothers and company representativesand company representatives

The UK RegulationsThe UK Regulations Advertising allowed in the Advertising allowed in the

health care systemhealth care system Gifts to the public allowed - if Gifts to the public allowed - if

not not designed todesigned to promote sales promote sales Less clear specification - Less clear specification -

loophole easily exploitedloophole easily exploited Gifts to health care workers Gifts to health care workers

allowed; ‘information’ not allowed; ‘information’ not strictly controlledstrictly controlled

Contact between mothers and Contact between mothers and company representatives company representatives allowed allowed if instigated by the if instigated by the mothermother - hence carelines etc. - hence carelines etc.

What the companies doWhat the companies do

Start before they are bornStart before they are born

Co-opt health workers to promote brandsCo-opt health workers to promote brands

Bombard women with formula promotionBombard women with formula promotion

What YOU can doWhat YOU can do

Visit Visit

www.breastfeedingmanifesto.org.ukwww.breastfeedingmanifesto.org.uk

Sign upSign up

Get your MP to sign upGet your MP to sign up

Report violations to the International CodeReport violations to the International Code

As a health professionalAs a health professional

Ensure no formula leafletsEnsure no formula leafletsUse professional code of conductUse professional code of conductEncourage other colleagues to refuse freebiesEncourage other colleagues to refuse freebiesLimit access of formula company repsLimit access of formula company repsPress for policies to forbid formula Press for policies to forbid formula advertising/sponsorship or display of logosadvertising/sponsorship or display of logosLobby journals to not accept advertising from Lobby journals to not accept advertising from formula companiesformula companiesEnsure education is free from commercial Ensure education is free from commercial influenceinfluenceRaise these issues at local meetingsRaise these issues at local meetings

The challenge is to move from this

To this…………