Scottish Government

POLICY

POLICY

1.1.1 National policy based on Global IYCF.

1.1.2 Policy focusing on social disadvantage.

1.1.3 Professional organisations produce recommendations and practice guidelines.

An Infant Feeding Strategy for Scotland will be launched In 2006. The wording 'Exclusive breastfeeding for around 6 months' is in the current draft of the new infant feeding policy. At present policy remains that solids are introduced at 4-6 months.

Social disadvantage and Peer support recommendations in strategy and policy documents. NBA engaged Sure Start Scotland (June 2004) to raise awareness of benefit to socially disadvantaged groups.

Yes.

PLANNING

PLANNING

1.2.1 Set priorities and objectives and targets.

1.2.2 Long-term planning, evaluation and re-plan.

1.2.3 Short-term planning, monitor, re-plan.

1.2.4 Co-ordinate breastfeeding initiatives with other public health and health promotion activities.

Draft Infant Feeding Strategy for Scotland sets priorities and objectives.
Scotland first UK country to set target in 1994. New target likely to be set after Infant Feeding Strategy consultation.

In proposed Infant Feeding Strategy.

Annual audit of NHS Board Action on Breastfeeding 2001-2004. Monitoring and evaluation in new strategy.
Yes, addressed in Infant Feeding Strategy.

MANAGEMENT

MANAGEMENT

1.3.1 National Co-ordinator

1.3.2 National Committee

1.3.3 Continuity co-ordinator, committee.

1.3.4 Monitor and evaluate results of national plan

Yes, ending 30.11.05.New lead post with changed remit may be created in 2006.

Yes, review and reforming 2006.

Yes, likely new structure in 2006.

National audit of NHS Board strategies 2001-4. Monitoring and evaluation written into IF Strategy.

FINANCE

FINANCE

1.4.1 Adequate human and financial resources

1.4.2 No formula company or distributor funding.

Will be reviewed in 2006.

None accepted at national level.
NHS Board Strategies support the WHO Code. However there are examples of other resources within NHS still being funded by formula manufacturers.

Information, Education, Communication IEC (Individuals)

Information, Education, Communication IEC (Individuals)

2.1.1 Provision of face to face support by trained health workers including peer and group support.

2.1.2 Materials produced accurate and consistent with national policies.

2.1.3 Identify and address information and skills needs of women least likely to breastfeed (groups named)

2.1.4 Identify and address needs of family and kinship members.

2.1.5 Prevent distribution of marketing materials on infant feeding from inappropriate sources.

Yes. Well established including 150 support groups and 11 peer programmes.

Health Professionals and Voluntary sector work together.

Yes, achieved and ongoing.

Process begun. Peer support. BFI. Further focus on women least likely to breastfeed will be addressed through Infant Feeding Strategy.

Yes, in part through literature and TV advertising. Need to address other key influencers highlighted within Strategy.

NHS breastfeeding strategies, BFI accredited healthcare establishments, voluntary organisations abide by WHO Code. The UK law still allows distribution of these materials and advertising of follow on formula. UK Government taking part in EU recast directive meetings.

Information, Education, Communication IEC (Communities)

Information, Education, Communication IEC (Communities)

2.2.1 Develop IEC packs consistent with national policy for health, social and school services and infant care providers and the media. Free of charge.

2.2.2 Present exclusive breastfeeding for 6 months and continued b/f up to 2 years as normal.

2.2.3 Use BFAW as opportunity to stimulate public debate, the media and disseminate information.

2.2.4 Monitor, inform and use all organs of the media and ensure b/f portrayed as normal

NHS Health Scotland literature and some good examples from the field.
Health Professionals and breastfeeding education resource CD.
Growing through Adolescence (2005) schools package contains breastfeeding information.
Review of existing materials and identification of further information needs ongoing.

Reflected in Infant Feeding Strategy and policy documents - launch imminent.

Funding issues around BFAW need to be addressed but excellent resources from Health Scotland in use throughout the year.

Being addressed through IF Strategy. Need to be more proactive in ensuring breastfeeding recognised for protective role in maternal health.

PRE-SERVICE TRAINING

PRE-SERVICE TRAINING

3.1.1 Review and develop standards for breastfeeding education to ensure competency in lactation management.

3.1.2 Review literature and textbooks to ensure in line with policy and practice.

Yes. Health Scotland, NHS Education Scotland (with Scottish Executive support) commissioned education resource from UNICEF for Higher Education Institutes. (Launched September 2004).

Literature in line with policy e.g RCM Successful Breastfeeding + updating of textbooks in process.

IN- SERVICE TRAINING

IN-SERVICE TRAINING

3.2.2 Continuing interdisciplinary education based on WHO/ UNICEF or other appropriate courses for frontline staff.

3.2.3 Review existing textbooks and literature

3.2.4 Encourage advanced education in lactation management and to acquire IBCLC or equivalent qualification.

3.2.5 Encourage e working amongst breastfeeding specialists

In place as part of partnership with UNICEFBFI in >85% of maternity units. Now progressing into community setting.

More clinical mentors and educators now resourced to make use of the new ( BFI) educational resource CD.

Yes, in process. Some of the growing number of infant feeding specialists some of whom have IBCLC accreditation. Scottish Infant Feeding Adviser Network ( SIFAN) hosts biannual educational meetings. Most European countries do not have community health professionals supporting breastfeeding mothers as is the norm in the UK. This role is carried out by health visitors, public health nurses and in cooperation with voluntary breastfeeding support organisations.

SIFAN established September 2003. Biannual meetings and e mail communications.

GLOBAL SRATEGY IYCF

GLOBAL SRATEGY IYCF

4.1.1 Implement policies and plans based on WHO/ UNICEF Global Strategy.

4.1.2 Communicate policies and plans to all relevant bodies, groups and organisations.

In part, e.g. no right to breastfeeding breaks in the workplace. Exclusive breastfeeding for around six months will become policy in Scotland.

Current policies disseminated widely and in public domain. This process will continue when policies consistent with Global Strategy are in place.

THE INTERNATIONAL CODE

THE INTERNATIONAL CODE

4.2.1 To develop EU regulations compatible with WHO Code as minimum requirement.

4.2.2 Ensure Code is reflected in EU position at meetings of Codex Alimentarius.

4.2.3 Develop national legislation including mechanisms for enforcement.

4.2.4 Encourage full implementation of the Code even before EU requirement.

4.2.5 Inform pre and post graduate health professionals and health service providers.

4.2.6 Develop code of ethics for Individual and institutional sponsorship of courses, educational materials, conferences and other activities.

4.2.7 Disseminate information to the public about principles and aims of the Code.

4.2.8 Phase out distribution of free formula to low income families and replace with initiatives to promote breastfeeding.

Reserved to UK Westminster Parliament.

Baby Milk Action lobby for this in UK and Europe. Reserved to UK Westminster Parliament.

Reserved to Westminster UK Parliament. Reserved issue as above.

Reserved to UK Westminster Parliament.

Continuing education throughout Scotland by those providers of care participating in the BFI (>85% mat units and extending to the community).

There is sponsorship of conferences and other events and resources by formula companies but not accepted by those participating in BFI at individual and institutional level.

Not done but links in website to Baby Milk Action and WHO.

No free distribution in Scotland. However free feeding bottles given to asylum seeking families in maternity pack. Current voucher favouring formula feeding families could be construed as free formula. This will cease under Healthy Start in 2006.

Legislation for working mothers

Legislation for working mothers

4.3.1 To upgrade legislation to meet ILO minimum standards.

4.3.2 To ensure sufficient legislative support to enable exclusive breastfeeding for 6 months and continue thereafter.

4.3.3 To extend maternity protection To those not currently entitled. Short term contracts, part-time, etc.

4.3.4 Ensure employers , health workers and public informed about protection legislation and healthy and safety as applies to pregnant and breastfeeding women.

4.3.5 Inform employers of benefits to them and their breastfeeding employees of facilitating breastfeeding (flexible hours, part time, facilities to express and store).

Falls short. No right to breastfeeding breaks.

Maternity leave extended to 26 weeks in April 2003.

Improved in 2003. Teenagers under 18 years now included.

Yes, through HR personnel, unions and health workers.

Health Scotland literature for employers and for women and families.

Health Scotland resource disseminated to employers in 2000.

Baby Friendly Hospital Initiative

Baby Friendly Hospital Initiative

4.4.1 Ensure collaboration at all levels to establish BFI as best practice. Includes government, NHS Boards, NGOs , maternity & child care Institutions).

4.4.2 To ensure resources (funding, personnel and time)and technical support for training and assessment.

4.4.3 Encourage maternity units not participating to ensure practice is in line with BFI best practice standards

4.4.4 Incorporate BFI criteria into standards national maternity service quality accreditation system

4.4.5 Develop systematic approach to conveying breastfeeding information in antenatal period consistent with BFI.

4.4.6 Involve fathers and families to ensure appropriate support at home.

4.4.7 Improve cooperation between hospitals and other health and social care facilities to ensure adequate actation support. (step 10)

4.4.8 Ensure adequate training and support in community health and social services.

4.4.9 Encourage implementation of good practice beyond maternity setting (community, social services, paediatric and workplace).

Mostly achieved. More communication with child care settings would be beneficial.
Example of collaboration with nursery care settings in Glasgow.

This varies widely in that some facilities have a full-time lead person with time and support whilst others have a part-time post with as few as 7 hours allocated. Adequate funding remains problematic in many areas.

Recommended through policy and other Scottish Executive communications. >85% participation in BFI. More than 54 % Scottish babies born in a UNICEFBFI maternity unit.

Recommended in policy documents

Yes. NHS Health Scotland TV advertisements BFI participating healthcare establishments. Other units putting 10 steps in place or use the guiding principles.

Yes, through Health Scotland literature, advertisements and antenatal classes

In place. Peer, group and voluntary sector support. Specialist infant feeding clinics in three of Scotland's major cities. The IF Strategy will engage wider societal support.

In process. BFI extending into Community settings.

Process begun and will be extended through new Infant Feeding Strategy.

Examples of partnership working available from around Scotland and networking encourages further achievement in this area. Paediatric good practice examples available. Workplace information from Health Scotland is widely used.

Support by trained Health Workers

Support by trained Health Workers

4.5.1 To ensure health and social services staff including health professionals and volunteers have skills to build maternal ability and confidence

4.5.2 To encourage and support staff to achieve specialist knowledge and problem solving skills.

4.5.3 Ensure services to support breastfeeding including qualified lactation consultants or other suitably competent health care staff.

4.5.4 Assistance for mothers to provide or acquire breastmilk for preterm or sick infants including assistance for travel and accommodation if unit is at a distance.

4.5.5 Establish centres of excellence as a source for health workers and mothers including free access to web based resources.

Continuing education in place in most areas for HPs, peer supporters and volunteers. Need to continue and increase partnership working.

Continuing education in place in most areas. Breastfeeding Educational Resource CD available to educators.

Scotland has increased the numbers of competent health professionals (maternity units and community) and peer supporters. Group support available in most parts of Scotland (150 groups).Voluntary breastfeeding support organisations actively involved.

Not at present. Only one unit has milk bank. NBA raised this issue with Blood Transfusion Service in Scotland in March 2005

Specialist breastfeeding clinics in Glasgow, Edinburgh and Aberdeen.
150 support groups staffed by competent health professionals and volunteers.
Breastfeeding in Scotland website available to all at www.show.scot.nhs.uk/breastfeed

Peer Counsellors and M2 M support

Peer Counsellors and M2 M support

4.6.1 Establish and increase trained peer and M2M support especially for women less likely to breastfeed.

4.6.2 To develop review and update curricula for peer and M2M support training.

4.6.3 Strengthen cooperation and communication between health workers and peer counsellors and M2M groups.

Well established. 150 support groups (with research currently taking place) and 11 peer support programmes.
Randomised Control Trial of peer support in process.

Established, continuing process. Research underway

Well established.

Support - family, community and workplace

Support - family, community and workplace

4.7.1 Information to support breastfeeding mothers, partners and families including support networks

4.7.2 Encourage family support through public education and cooperation between NHS and voluntary sector and other partnerships.

4.7.3 Identify and address support needs of mothers in special circumstances or special groups, e.g. adolescent, immigrant and other groups.

4.7.4 Encourage breastfeeding friendly policies/facilities and protect right of women to breastfeed whenever and wherever they need to.

Well established. Support information through Health Scotland, NHS and website and weblinks

Well established. NHS literature and TV advertisements. Peer and group information through NHS and on website.

Not established but some good examples of effective practice and networking to share experiences is ongoing. NBA engaged Sure Start Scotland ( SSS) June 2004 to encourage support for breastfeeding. Only a small number of infant feeding related projects have received SSS funding.

Facilities encouraged through Healthy Eating Awards and at local level through local awards by NHS Board Breastfeeding Strategy Groups.

Breastfeeding (Scotland) Law March 2005 protects a child's right to be milk fed in any public place where (s)he has a right to be.

Breastfeeding Rates

Breastfeeding Rates

5.1.1 Set up monitoring system with universally agreed definition standards.

5.1.2 To gather other information on social variables to help address inequality and deprivation issues.

5.1.3 Publish and disseminate results and use in future planning of breastfeeding initiatives.

Monitoring carried out through SMR02
Guthrie, CHSP and BFI participating healthcare establishments. However these data do not, at present, adhere to universally agreed definitions. Further data harmonisation process begun in 2005.

Guthrie data includes postcode and post district.
CHSP includes postcode.
IFS includes social class variables.

Results published. ( IFS, SMR 02, Guthrie, CHSP, ISD).
In documents, websites and other sources.

Practices of Health and Social Services

Practices of Health and Social Services

5.2.1 Draw up protocols to assess hospital and primary care facilities based on BFI standards.

5.2.2 Put in place patient feedback on breastfeeding information and support.

5.2.3 To monitor and evaluate coverage, standard and effectiveness of IEC materials and activities.

5.2.4 Monitor adequacy of public knowledge, attitudes and practices on importance of breastfeeding, ways to support and protect it.

5.2.5 Monitor coverage and effectiveness of in-service training.

5.2.6 Publish and disseminate results and use in future planning of breastfeeding initiatives.

>85% participation in UNICEFUKBFI. Other maternity units putting 10 steps in place. Community initiative extending

Part of BFI process.
Evaluation of resources carried out by Health Scotland.
Action projects are evaluated.

Health Scotland carry out these activities in relation to their resources, materials and events

Health Scotland monitors. Various action projects also monitor.

Carried out as standard in BFI participating healthcare establishments.

Information available in various publications and settings.

International Code, laws and policies.

International Code, laws and policies.

5.3.1 Monitoring system with responsibility for checking compliance with International Code. Investigate and prosecute breaches, information for the public and relevant authorities.

5.3.2 Monitor implementation of policies and legislation including maternity protection laws relating to breastfeeding.

Not done at present although it is widely known among health workers that the UK law is much (Food and Formula Regulations 1995) weaker than the Code.
Awaiting outcome of EU Recast Directive

Monitoring through various organisations including NBA audit, Health and Safety Executive, Maternity Alliance.

Research

Research

6.1.1 Foster and support research on breastfeeding, based on agreed priorities, definitions of breastfeeding and free of competing and commercial interests.

6.1.2 To support and ensure exchange of expertise in breastfeeding research among research institutions in Member States.

Currently through CSO and other fund holding bodies. General awareness that commercial bodies may not be appropriate sources of funding but some examples of this still arise.

The Breastfeeding Expert Group in Scotland is currently carrying out a review which will complement that published by NICE 2005. It will be published in 2006 and will inform practice.

Networking among UK researchers is widespread. Papers published as appropriate.