Breastfeeding in England

Breastfeeding statistics in England

In October 2015 the responsibility for commissioning children’s public health (age 0-5 years) transferred from NHS England to local authorities. Various key performance indicators need to be monitored and reported, of which breastfeeding prevalence at 6-8 weeks is one.

Data on these indicators is collected as part of the Maternity and Children’s Dataset (MCDS) and quarterly breastfeeding statistics at 6-8 weeks are available here. In addition, the Maternity Services Monthly Statistics include details of skin-to-skin contact and breastfeeding initiation rates.

To map your own local breastfeeding data against other child health outcomes, go to the Children and Young People’s Health Benchmarking Tool. This brings together and builds upon health outcome data from the Public Health Outcomes Framework and the NHS Outcomes Framework.

Breastfeeding policy in England

Broadly, English national policy is based on the strong evidence that early years interventions improve a child’s future outcomes. These initiatives include the promotion of breastfeeding to support infant and maternal health and relationship building.

In England, the Department of Health (DH) measures a broad range of indicators under A Public Health Outcomes Framework for England (updated August 2021), enabling them to monitor progress year on year against key health outcomes. These are grouped under four domains:

  1. Improving the wider determinants of health
  2. Health improvement
  3. Health protection
  4. Healthcare public health and preventing premature mortality.

As a specific indicator, monitoring breastfeeding (under Domain 2) requires local authorities to prioritise breastfeeding support locally and to increase breastfeeding initiation and prevalence.

Use the links below to find out more about breastfeeding policy in England.

Commissioning guidance for infant feeding

Guidance from Public Health England to help local commissioners protect, promote and support breastfeeding

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Public Health England's Commissioning Guidance for infant feeding services provides information for local support for breastfeeding

Breastfeeding in England: Policies and resources

Current government policy on infant feeding

NHS Long Term Plan: recommends Baby Friendly accreditation across all maternity services and includes a focus on improved support for families with infants in neonatal care. The plan represents a fantastic opportunity to support more health services to transform care.

Health Matters: Giving every child the best start in life: outlines current government policy on infant feeding and relationship building. It focuses on ensuring the best possible start for children from pregnancy through to age two and recommends the Baby Friendly Initiative as a robust evidence-based framework to develop a whole system approach for promoting and supporting breastfeeding.

Public health outcomes framework: measures breastfeeding initiation and breastfeeding prevalence at 6-8 weeks as indicators of health improvement.

Commissioning guidance for infant feeding: jointly produced by UNICEF UK and Public Health England, this resource provides guidance to help local commissioners protect, promote and support breastfeeding.

Best start in life: Cost-effective commissioning: examines the cost-effectiveness of public health interventions aimed at infants and pregnant women, finding a strong case to be made for investment in breastfeeding support, both in terms of cost saving and positive health outcomes.

Healthy child programme 0 to 19: Health visitor and school nurse commissioning (updated 2021): service specification for local authorities commissioning health visitors and school nurses, for public health services for children aged 0 to 19, including guidance on infant feeding care and a recommendation for UNICEF UK.

London Health Inequalities Strategy: highlights that “The Mayor encourages all London boroughs to become UNICEF UK Baby-Friendly Initiative accredited in maternity and community services. He also calls on partners to improve postnatal and perinatal support for breastfeeding … The Mayor wants the city to be more welcoming for women who can and wish to breastfeed. Working with partners, the Mayor wants to see more of London’s public spaces and workplaces enable women to breastfeed.”

London Food Strategy: includes aim to make London a ‘Baby Friendly’ city, including implementation of the UNICEF UK Baby Friendly Initiative.

NICE guidance

NICE guidelines for antenatal care (NG201): recommend the provision of breastfeeding information from the Baby Friendly Initiative, including technique and good management practices that would help a woman succeed.

NICE guidelines for postnatal care (NG194): recommend that all maternity care providers implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.

NICE quality standard, postnatal care (QS37): implementing the Baby Friendly Initiative is recommended as a minimum standard. Of the 11 quality statements, four can be delivered directly through achieving Baby Friendly accreditation.

NICE maternal and child nutrition guidance (PH11): recommends health professional training and the implementation of a structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.

NICE social & emotional wellbeing early years guidance (PH40): states that an overall infant feeding strategy should promote breastfeeding, support safe formula feeding and help families to develop positive emotional relationships with their infants to influence a child’s future educational attainment, social skills, self-efficacy and self-worth.

NICE twin and triplet pregnancy guidance (NG137): covers the management of twin and triplet pregnancies in the antenatal period.

NICE pregnancy and complex social factors (CG110): describes how access to care can be improved for women with complex social needs, who may require additional support in relation to breastfeeding.

NICE donor milk banks (CG93): sets out how to screen and support women who donate breastmilk and how to handle and process the milk donated.

NICE intrapartum care (CG190): focuses on the care of healthy women and their babies during childbirth, with reference to the recommendations of the NICE postnatal care guidelines, breastfeeding after birth and the facilitation of skin-to-skin contact.

Child Health Profiles

Public Health England’s Child Health Profiles provide a picture of child health and wellbeing for each local authority in England using 32 key health indicators (including breastfeeding initiation and rates at 6-8 weeks), and enables comparison at local, regional and national levels. By using the profiles, it is envisaged that local organisations will be able to work in partnership to plan and commission evidence-based services based on local need. The profiles will also help to identify better performing areas, learning opportunities and case studies.

Compendium of maternity statistics and maternity services survey

The Health and Social Care Information Centre for England has published a compendium of maternity statistics, bringing together the available maternity data currently published from various data sources. The data set provides comparative, mother and child-centric data that will include information on the amount of care provided and the specific care received, including breastfeeding statistics. It is intended to be a key driver to achieving better outcomes of care for mothers and babies.

The Care Quality Commission’s maternity services survey looks at the experiences of women receiving maternity services.

Further guidance, resources and recommendations of Baby Friendly

Children’s Rights Alliance for England’s report: State of Children’s Rights in England 2018: recommends that “The quinquennial UK National Infant Feeding Survey should be reintroduced alongside the appointment of National Infant Feeding Coordinators, and the requirement for all hospitals, maternity, health visiting and neonatal services to work towards baby friendly accreditation.”

Association of Directors of Public Health: Best start in life position statement: highlights that, despite improvements in child health, the UK still has high infant and child mortality rates compared with countries of similar wealth. It calls for a whole system approach to support child health, including a focus on prevention and early intervention, and recommends Baby Friendly as an evidence-based programme working with families to encourage breastfeeding.

Public Health England High impact areas: identifies breastfeeding initiation and duration as one of six areas where health visitors have the greatest impact on the health and wellbeing of children aged 0-5.

Chief Medical Officer report (2013) Our children deserve better: recommends increasing involvement with WHO and the Baby Friendly Initiative, as a minimum standard to support breastfeeding. Recommendations include the need to monitor and examine the effects of formula advertising on child health outcomes.

iHV’s National Framework for continuing professional development for health visitors: recommends the Baby Friendly Initiative as an evidence-based programme to improve breastfeeding rates.

International comparisons of health and wellbeing in early childhood (2018): this report from the Nuffield Trust recommends that health services achieve and maintain Baby Friendly accreditation in order to better support mothers to breastfeed.

State of Child Health (2017): this report from the Royal College of Paediatrics and Child Health (RCPCH) recommends that UK governments support maternity services to implement the Baby Friendly standards in order to improve breastfeeding rates and tackle health inequalities.

A Framework for personalised care and population health for nurses, midwives, health visitors and allied health professionals (2016): recommends the Baby Friendly Initiative as an example of good practice.

Nursing and midwifery actions at the three levels of public health practice (2013): recommends that all midwifery and health visiting services implement the Baby Friendly standards.

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