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The Politics of Breastfeeding

         Janette Westman

   Midwife/Lactation Consulatant
La Tempesta by Giorgione
15th century Venice
“Access to a safe, healthy diet is
 one of the most important
 public health actions that a
 country can take to improve
 health and increase economic
 gain”. (WHO, 1999)
Artificially-fed babies are:
5 times as likely to be hospitalised with
gastroenteritis
5 times as likely to have a urinary tract infection
Twice as likely to suffer from ear infections
Twice as likely to have a respiratory infection
Twice as likely to develop allergies (if there is a
family history)

Some evidence suggests a reduction in the
incidence of NEC in preterm infants
So how are we doing?.....

…..not very well !

In the UK 9 out of 10 women stop
breastfeeding before their baby is 6 weeks
old
Fewer than 2% of babies are exclusively
breastfed at 6 months
Statistics hide inequalities
Mothers in social classes III-V less likely to
breastfeed
Mothers who remained in full time
education until they were 18 are 3 times
more likely to breastfeed
Three quarters of first time mothers aged
30 or over breastfeed their babies
compared to less than half aged 20 or
under
Effect of breastfeeding on gastro-
          intestinal illness by social class
               2
             1.8
             1.6
GI           1.4
illnesses    1.2
per Infant     1
in first                                                 I-IIIa
             0.8                                         IIIb-V
year of      0.6
life
             0.4
             0.2
               0
                   bottle   Breast   Breast     Breast
                             <6w      6-12w     >12w

                            Type of Milk Feed
The Global Picture

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

    Innocenti Declaration 2005 on Infant and
                        Young Child Feeding
The Global Strategy from 1990
Appoint national breastfeeding coordinator and
establish multisectoral national breastfeeding
committee
Ensure every maternity facility practices Baby
Friendly Initiative 10 step
Implement all provisions of International Code in
its entirety
Legislation to protect breastfeeding rights of
working women
Ensure appropriate guidelines and skills for staff
Five additional targets
Develop, implement and evaluate policy
Ensure protection, promotion and support of exclusive
breastfeeding for 6 months and continues
breastfeeding up to 2 years or beyond
Promote timely, adequate safe and appropriate
complementary feeding with continued breastfeeding
Provide guidance on feeding infants and young
children in exceptionally difficult circumstances
Consider what new legislation may be needed to give
effect and to principles and aims of Code of Marketing
of Breastmilk Substitutes
The National Picture
The breastfeeding Manifesto
Implement the global strategy for infant and
young child feeding
Implement postnatal care guidance from NICE
and public health evidence into practice
document
Improve training for health professionals
Work with employers
Develop policy and practice to support
breastfeeding in public places
Include breastfeeding education in curriculum
Adopt International code of marketing breastmilk
substitutes
What are we doing in Bradford?

Hospital largest hospital, with most diverse
population in the UK to achieve UNICEF
Baby Friendly accreditation
Featured in publications for examples of
good practice
Multi-lingual Video/DVD
Breastfeeding Strategy for the Bradford
District
The International Code
   and the UK law - key
       differences
The International Code             The UK Regulations
 No advertising or promotion ­     Advertising allowed in the 
 anywhere                          health care system
 No free samples or gifts to       Gifts to the public allowed ­ if 
 mothers / the public              not designed to promote 
 No free or subsidised supplies    sales
 to hospitals unless for           Less clear specification ­ 
 research                          loophole easily exploited
 No free gifts to health           Gifts to health care workers 
 workers; information must be      allowed; ‘information’ not 
 scientific and factual            strictly controlled
 No contact between mothers        Contact between mothers 
 and company representatives       and company representatives 
                                   allowed if instigated by the 
                                   mother ­ hence carelines etc.
What the companies do


Start before they are born
Co-opt health workers to promote brands
Bombard women with formula promotion
What YOU can do

 Visit
www.breastfeedingmanifesto.org.uk

 Sign up
 Get your MP to sign up
 Report violations to the International Code
As a health professional
Ensure no formula leaflets
Use professional code of conduct
Encourage other colleagues to refuse freebies
Limit access of formula company reps
Press for policies to forbid formula
advertising/sponsorship or display of logos
Lobby journals to not accept advertising from
formula companies
Ensure education is free from commercial
influence
Raise these issues at local meetings
The challenge is to move from this




To this…………

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Breastfeeding and Obesity

  • 1. The Politics of Breastfeeding Janette Westman Midwife/Lactation Consulatant
  • 2. La Tempesta by Giorgione 15th century Venice
  • 3. “Access to a safe, healthy diet is one of the most important public health actions that a country can take to improve health and increase economic gain”. (WHO, 1999)
  • 4. Artificially-fed babies are: 5 times as likely to be hospitalised with gastroenteritis 5 times as likely to have a urinary tract infection Twice as likely to suffer from ear infections Twice as likely to have a respiratory infection Twice as likely to develop allergies (if there is a family history) Some evidence suggests a reduction in the incidence of NEC in preterm infants
  • 5. So how are we doing?..... …..not very well ! In the UK 9 out of 10 women stop breastfeeding before their baby is 6 weeks old Fewer than 2% of babies are exclusively breastfed at 6 months
  • 6. Statistics hide inequalities Mothers in social classes III-V less likely to breastfeed Mothers who remained in full time education until they were 18 are 3 times more likely to breastfeed Three quarters of first time mothers aged 30 or over breastfeed their babies compared to less than half aged 20 or under
  • 7. Effect of breastfeeding on gastro- intestinal illness by social class 2 1.8 1.6 GI 1.4 illnesses 1.2 per Infant 1 in first I-IIIa 0.8 IIIb-V year of 0.6 life 0.4 0.2 0 bottle Breast Breast Breast <6w 6-12w >12w Type of Milk Feed
  • 8. The Global Picture “Inappropriate feeding practices – suboptimal or no breastfeeding and inadequate complementary feeding – remain the greatest threat to child health and survival globally” Innocenti Declaration 2005 on Infant and Young Child Feeding
  • 9. The Global Strategy from 1990 Appoint national breastfeeding coordinator and establish multisectoral national breastfeeding committee Ensure every maternity facility practices Baby Friendly Initiative 10 step Implement all provisions of International Code in its entirety Legislation to protect breastfeeding rights of working women Ensure appropriate guidelines and skills for staff
  • 10. Five additional targets Develop, implement and evaluate policy Ensure protection, promotion and support of exclusive breastfeeding for 6 months and continues breastfeeding up to 2 years or beyond Promote timely, adequate safe and appropriate complementary feeding with continued breastfeeding Provide guidance on feeding infants and young children in exceptionally difficult circumstances Consider what new legislation may be needed to give effect and to principles and aims of Code of Marketing of Breastmilk Substitutes
  • 11. The National Picture The breastfeeding Manifesto Implement the global strategy for infant and young child feeding Implement postnatal care guidance from NICE and public health evidence into practice document Improve training for health professionals Work with employers Develop policy and practice to support breastfeeding in public places Include breastfeeding education in curriculum Adopt International code of marketing breastmilk substitutes
  • 12. What are we doing in Bradford? Hospital largest hospital, with most diverse population in the UK to achieve UNICEF Baby Friendly accreditation Featured in publications for examples of good practice Multi-lingual Video/DVD Breastfeeding Strategy for the Bradford District
  • 13. The International Code and the UK law - key differences The International Code The UK Regulations No advertising or promotion ­  Advertising allowed in the  anywhere health care system No free samples or gifts to  Gifts to the public allowed ­ if  mothers / the public not designed to promote  No free or subsidised supplies  sales to hospitals unless for  Less clear specification ­  research loophole easily exploited No free gifts to health  Gifts to health care workers  workers; information must be  allowed; ‘information’ not  scientific and factual strictly controlled No contact between mothers  Contact between mothers  and company representatives and company representatives  allowed if instigated by the  mother ­ hence carelines etc.
  • 14. What the companies do Start before they are born Co-opt health workers to promote brands Bombard women with formula promotion
  • 15. What YOU can do Visit www.breastfeedingmanifesto.org.uk Sign up Get your MP to sign up Report violations to the International Code
  • 16. As a health professional Ensure no formula leaflets Use professional code of conduct Encourage other colleagues to refuse freebies Limit access of formula company reps Press for policies to forbid formula advertising/sponsorship or display of logos Lobby journals to not accept advertising from formula companies Ensure education is free from commercial influence Raise these issues at local meetings
  • 17. The challenge is to move from this To this…………

Notas do Editor

  1. Well, we have good research evidence for all of these … (read out list) And this is just the start: Mothers who breastfeed are also protected against breast and ovarian cancer and hip fractures in later life. Children who have been breastfed have less risk of obesity, high blood pressure and juvenile onset diabetes.
  2. Refocussing upstream is a key theme of this report and of public health generally. It was popularised in the 1970s by Professor John McKinlay, the New Zealand medical sociologist who established the New England Research Institute in Boston. It refers t o the idea that the practice of medicine is equivalent to people who are constantly finding more efficient ways of pulling drowning people from a river. They are so engaged with improving their methods and technologies for doing this that they have no time to look upstream to see who it is that is pushing the people into the river in the first place (in other words the social, economic and political forces causing ill-health). Graphic courtesy of New England Research Institute, Boston; adapted by Paul Blackburn, Division of Public Health, University of Liverpool.
  3. In the 15 years since adoption of original innocenti declaration a lot of progress has been made but improved breastfeeding practices could save the lives of more than 3,500 children every day, more than any other preventative intervention!!! Guided by the human rights principles, esp those in the Convention of the Rights of the Child the vision is of an environment that enables mothers, families or caregivers to make an informed choice about optimal feeding defined as exclusive bf for 6 months followed by the introduction of appropriate comp feeding and continuation of bf for 2 years. Requires skilled support
  4. Research published in Economic Journal finds that increasing paid maternity leave to one year cold cut the UK infant death rate by 6.8% Study of maternity provision in 18 industrial countries found that each additional 10 weeks of maternity leave cuts the infant mortality rate by 2.6%.
  5. OHT 12K (3-day course, 2005) Outline of the ways in which the UK Law is weaker than the International Code. Note particularly that allowing advertising within the health care system, and gifts to health workers, are huge loopholes in the UK law. Note Remind participants that these differences are in the restrictions on the marketing of infant formula . Only under the Code do they also apply to follow-on formula, drinks, weaning foods etc. Emphasise that, in the UK, companies do not have to abide by the Code but that, when seeking Baby Friendly accreditation, health care facilities must practise in accordance with it. NB: Participants should be encouraged to read Chapter 7A of the workbook for further information on the International Code.
  6. Start before they’re born – get pregnant women to sign up for info Gifts and prizes. One company even targets registry offices Have uses Healthy start scheme to peg their products