3 Success and activity so far
Success
3.1 Activity around breastfeeding and wider infant-feeding issues is not new but there has been a real and sustained campaign of activity over the past decade in particular. A wide range of innovative projects and activities have taken place largely supported by NHS Board Breastfeeding Strategy Groups and reflecting increasing co-operation between clinicians, health promotion experts, local authorities and voluntary organisations. For example:
- In 1996 only one NHS Board had a breastfeeding strategy, in 2005 only one does not.
- In 1993 there were four breastfeeding support groups - there were 150 in 2005.
- In 1994 there was only one peer support programme, increasing to 11 by 2005.
- 58% of Scottish babies are now born in a UNICEFUK Baby Friendly Initiative accredited hospital. This compares with 34% in Wales and Northern Ireland and 9% in England.
- The University of Paisley Midwifery Directorate has become the first teaching department to receive a UNICEF Baby Friendly award.
3.2 It is difficult to reflect the full range of local activities and projects but it should be recognised that local practitioners and activists have historically driven the breastfeeding agenda forward in Scotland. Further details are in ANNEX A.
3.3 It is important to note these achievements, however the main way in which we measure success is through monitoring our breastfeeding rates and various sources of information allow us to do this.
Child Health Surveillance Programme - Pre-School
3.4 Scottish Executive's official source of breastfeeding data is collated by the Information and Statistics Division of NHS National Services Scotland. It records breastfeeding data at birth; discharge from hospital; at 10-12 days, 6-8 weeks and 8 months and is used by 10 of our 15 NHS Boards, covering 84% of the pre-school population. In 1999 this rate was 34.6% at the 6-8 week review and increased to 35.9% by 2004.
Infant Feeding SurveyUK
3.5 Scotland participates in the 5-yearly UK-wide Infant Feeding Survey which collects data on breastfeeding, alternative feeding practices and influencing factors and is sample based. In 1990, the Infant Feeding Survey found that 30% of babies in Scotland were breastfed at 6 weeks, increasing to 36% in 1995 and 40% in 2000.
Guthrie Data
3.6 Finally data is also recorded on the Guthrie card at or around 7 days after the baby's birth. This shows a steady upward trend in breastfeeding with 35.7% in 1990 and 45% in 2004
Activity
3.7 The Scottish Executive, previously the Scottish Office, has supported breastfeeding over this period in four key ways - through the National Breastfeeding Adviser, the Scottish Breastfeeding Group, the Breastfeeding in Scotland Website, and through NHS Health Scotland. 2005 also saw the advent of the important Breastfeeding (Scotland) Act (see information at 4.14).
)NBANational Breastfeeding Adviser (
3.8 The role of National Breastfeeding Adviser has existed since 1996 and has been responsible for informing policy development; contributing to resource development; stimulating, supporting and monitoring NHS Board activities; encouraging best practice; and networking both nationally and internationally.
)SBGScottish Breastfeeding Group (
3.9 This group came together in 1995 to focus on breastfeeding in Scotland. It has achieved this through contributing to policy development, publishing a bi-annual newsletter, holding an annual conference, managing short-life working groups, and members have acted as conduits for the dissemination of relevant news and information.
Breastfeeding in Scotland Website
3.10 Stemming from the work of the SBG, this was launched in 1999 and hosts information for clinicians, consumers, practitioners and researchers. The information includes newsletters, evidence and best practice, breastfeeding rate data and a contacts directory. More detailed information on all activity can be found at: http://www.nhsscotland.com/breastfeed/
Health ScotlandNHS
3.11 NHS Health Scotland is the national resource for Scotland's health and contributes to policy development, delivers health improvement programmes and disseminates evidence and best practice in close partnership with NHS Boards. NHS Health Scotland has taken forward a range of activities to support policy development and resource development in relation to infant feeding.
3.12 NHS Health Scotland's infant feeding work includes producing breastfeeding publications such as Off to a Good Start; Ready, Steady Baby and Breastfeeding and returning to work; developing evidence into action papers on 'Maternal and Gestational Nutrition' and 'Nutrition in the Under 5s'; running two successful TV advertising campaigns and helping produce an education resource for health professionals' education and training.
3.13 Recent activity has included the review of the Scottish Diet Action Plan, developing a practitioner evidence paper on the length of exclusive breastfeeding, pre-testing the Breastfeeding (Scotland) Act leaflet for employers, and drawing together the conclusions of the Breastfeeding Expert Group who were tasked with assembling best available evidence to support Scotland's efforts to increase rates in breastfeeding initiation and duration.
Breastfeeding (Scotland) Act 2005
3.14 This Act makes it an offence to prevent or stop a person in charge of a child under the age of 2 years, who is otherwise permitted to be in a public place, from feeding milk to that child. This legislation is the first of its kind in the UK and Scotland is one of the only countries worldwide to enshrine such protection in national legislation.
3.15 There has been a great deal of activity in the field of infant feeding over the past 10 years, however this is not necessarily borne out by our breastfeeding rates. The lack of progress shown by Child Health Surveillance Programme - Pre-School figures is particularly disappointing and it is clear we still have a lot to do. However, there is reason to think that change is happening.
3.16 Central to driving up these rates has to be a huge shift in social and cultural attitudes and there is evidence that this is happening. Research carried out following the first TV campaign showed that people were much more aware of the benefits of breastfeeding and most were able to name some of them which was not the case before the first advert was developed in 2000. At a more local level, we are also seeing significant changes in attitudes and behaviours.
3.17 However, we need to start looking at fresh approaches to support infant feeding, so that we can continue to:
- Promote optimal maternal nutrition
- Increase initiation and duration of breastfeeding
- Minimise health risks of formula feeding and ensure support for parents who choose to formula feed
- Support timely and appropriate weaning practices
- Support informed choice
- Increase public knowledge and acceptance of breastfeeding
- Raise awareness of nutritional needs of vulnerable babies
- Raise awareness of legal rights relating to infant feeding
- Highlight evidence of effective support
and most importantly do all of these by ensuring integrated, multi-sectoral support. To do this, we need to consider the national and local policy contexts.