Breastfeeding, Obesity and Health Inequalities

Janet Calvert Health and Social Well-being Improvement Manager

(Regional Breastfeeding Lead) janet.calvert@hscni.net

New BreastfeedingStrategy

www.dhsspsni.gov.uk

“Breastfeeding is the social and biological norm, and mothers will be supported to give their babies a good start in life. ”

Breastfeeding Strategy Strategic Outcomes Outcome 1 Supportive environments for breastfeeding exist throughout Northern Ireland

Outcome 2 HSC has the necessary Knowledge, skills and leadership to protect promote, support and normalise breastfeeding

Outcome 3 High quality information systems in place that underpin the development of policy and programmes, and which support Strategy delivery

Outcome 4 An informed and supportive public

‘Breastfeeding remains undervalued and under-

practiced. The primary barrier to more and longer

breastfeeding is societal ignorance both of human

milk’s unique, species specific properties and of the

inescapable implications for the health of all people

throughout the life course’ James Akre 2006

Breastfeeding and Health Eidelman, A.J. & Schanler, R.J.(2012) AAP Policy Statement ‘Breastfeeding and the Use of Human Milk’. Pediatrics. Vol.123, no.3, pp. 827 - 841

Ip S et al. Breastfeeding and maternal and infant health outcomes in developed countries. (AHQR), 2007. http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf Horta BL et al.Evidence on the long -term effects of breastfeeding. Systematic reviews and meta-analyses. Geneva: (WHO), 2007.http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf

World Cancer Research Fund Report 2007.http://www.dietandcancerreport.org/?p=ER

Outcome Risk

Gastro-enteritis 64%

Ear infections 50%

Chest infections 72%

Atopic dermatitis 42%

Obesity 7-24%

Breastfeeding and Child Health

Outcome Risk

Type 1 diabetes 19-27%

Type 2 diabetes 39%

Childhood leukaemia 15-19%

Sudden Infant Death 36%

Intelligence 4.9 IQ points less

optimum nutrition for infants is 6 months exclusive breastfeeding, appropriate weaning and continued breastfeeding until at least a year (WHO 2002)

• breastfed babies get lower protein intake

• formula feeding - insulin response - fat deposition

• breastfed babies may accept new foods better

Breastfeeding and Obesity

Breastfeeding and maternal health

Outcome Risk Comments

Breast cancer 28% 4.3% for every year or 28% if > one year

Ovarian Cancer 21% Duration not yet certain ? one year to benefit

Maternal Type 2 diabetes

4-12% Large study of nurses

Fair Society, Healthy Lives The Marmot Review (2010)

Reducing health inequalities will require action across the life course

Policy Objective A Highest priority recommendation:Give every child the best start in life

• increase spend on early years • priority to pre- and post-natal interventions that

reduce adverse outcomes

Focus on Health Inequalities

Those least likely to breastfeed include: • Unemployed • Low income • Left school at 16 • Travellers • Young mothers

<20 years old

• Breastfed baby (Social class 5)

is more healthy than • Bottle-fed baby (Social class 1)

Dundee Infant Feeding Study

Seven year follow-up, 1998

Breastfeeding and Health Inequalities

Incidence (%) of breastfeeding by age, comparison of NI and UK, Infant Feeding Survey 2005 and 2010.

Northern Ireland UK

2005 2010 2005 2010

Under 20 35 34 51 58

20-24 49 48 67 68

25-29 63 62 76 83

30+ 70 74 84 87 All+ 63 64 76 81 Weighted base: all Stage 1 mothers 12,290 15,722 1,886 2,650

+ includes some mothers for whom age was not recorded

Maternal characteristics: age

40.0 40.140.4

42.4

43.6

44.444.9

43.9

43.8

42.4

37

38

39

40

41

42

43

44

45

46

2004 2005 2006 2007 2008 2009 2010 2011 2012

Brea

stfee

ding

rate

at d

isch

arge

(%)

CHS (2004 - 2011) NIMATS (2011 – 2012)*

2004 2005 2006 2007 2008 2009 2010 2011 2011 2012

Any breastfeeding (n) 8,750 8,964 9,496 10,435 11,118 11,134 11,493 11,196 10,414 10,905

Total births (n) 21,899 22,359 23,481 24,584 25,527 25,083 25,598 25,517 23,750 25,702

* Provisional data

NI breastfeeding rates at discharge (%), 2004-2011

Length of post-natal stay 2008/2009 2010/11

Average length of stay after vaginal delivery (days)

Average length of stay after C/S delivery (days)

Average length of stay after vaginal delivery (days)

Average length of stay after C/S delivery (days)

All 1.8 3.3 1.4 2.8

Min 1.3 2.9 0.6 2.5

Max 2.1 3.4 1.7 3.1

Source PAS

Breastfeeding rate at discharge by Health and Social Care Trust / Local Commissioning Group, 2004-2010

46

42.6

50.8

46.4

38.7

44.9

30

35

40

45

50

55

Belfast LCG NorthernLCG

SouthEastern

LCG

SouthernLCG

WesternLCG

N Ireland

Bre

astf

eedi

ng r

ate

at d

isch

arge

(%

)

2004

2005

2006

2007

2008

2009

2010

Public Health AgencyBreastfeeding rate at discharge by Electoral Ward, 2007-2009

Belfast Local Commissioning Group

StormontCherryvalley

Tullycarnet

Galwally

Glencairn

Malone

Ligoniel

Cavehill

Finaghy

Stranmillis

Rosetta

Newlodge

Ardoyne

Crumlin

Enler

Moneyreagh

Psychosocial Aspects “None of us were breastfed. Me and my sister tried to breastfeed but my other sister thinks it’s disgusting”

“Grandparents are very resentful that you are breastfeeding. They want to be involved in feeding and make you feel guilty that you’re not feeding him enough”

“It was pure thranness on my part…our society is very unsupportive of breastfeeding, even amongst my own family…but I was determined to give him the best start”

What mothers told us ....“It was pure thranness on my part…our society is very unsupportive of breastfeeding, even amongst my own family…but I was determined to give him the best start” (Current breastfeeder, Derry)

“He was far too hungry and I had cracked nipples, it was too sore” (Ceased breastfeeder, Derry)

“I only got leaflets. There’s too much. Something more visual would be good. Like DVDs” (current breastfeeder, Derry)

What young mothers told us ....

“There is an expectation that because

we are younger we can’t cope.”

“The midwives are just telling you

what to do and not asking you.

They make you feel like you can’t do

It.”

“If I saw people my age breastfeeding

and they kept telling me how great it

was I’d probably do it.”

IMPROVING BREASTFEEDINGOUTCOMES WHAT WORKS?

Improving Breastfeeding Outcomes

NIHCE (2008) Public Health Guidance PH11 Maternal and Child Nutrition guidelines

Dyson et al (2008) Interventions for promoting the initiation of breastfeeding. Cochrane online.

Renfrew et al (2012) Support for healthy breastfeeding mothers with healthy term babies. Cochrane online.

NIHCE (2013) Post-natal Care Guidelines

Multi-faceted approach • A health care environment that supports breastfeeding

• Appropriate information to expectant and new parents

• Provision of breastfeeding education and skills training to staff

• Mother-to-mother peer support

• Protecting breastfeeding in public

• Raising public awareness about breastfeeding and health.

Peer Support

Targeted Interventions

• Ante-natal workshops

• Young mums

• Low income women

• Peer support

• Breastfeeding groups

PHA Programmes and Interventions

• Breastfeeding Coordinators Forum

• Baby Friendly Initiative

• Training, seminars, conferences

• Regional publications and DVDs

• Peer support

• Parenting programmes – FNP

• Travellers support

• Welcome Here Scheme

Going Baby Friendly increases breastfeeding rates

10% increase in breastfeeding initiation- Millennium Cohort study, 2006

28% more breastfeeding at 7 days- Broadfoot et al, 2005

More breastfeeding at 3, 6 and 12 months

- PROBIT trial, Belarus 2001

The Baby FriendlyInitiative Standards

Breastfeeding support

www.breastfedbabies.org

PHA Breastfeeding Resources

Communication

Communication about breastfeeding

Dancing

not wrestling