Breastfeeding in England

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In England, the Department of Health (DH) measures a broad range of indicators under A Public Health Outcomes Framework for England (2016), 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 and
  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.

Broadly, English national policy is based on an understanding of the strong evidence supporting the importance of initiatives targeted at the first years of life in improving a child’s future outcomes. These include the promotion of breastfeeding to enhance the quality of relationships between parents and their babies, recognising how attachment behaviours in these early years influence a child’s future educational attainment, social skills, self-efficacy and self-worth.

More information and references are available on p. 21 of our Evidence document.

Policy documents

The Public Health Outcomes framework 2016: prioritises breastfeeding initiation and breastfeeding prevalence at 6-8 weeks as indicators of health improvement.

Public Health England’s Health Matters: 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 England High Impact Areas report 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.

The NHS Outcomes Framework 2014-15: supporting breastfeeding will help to reduce infant mortality. Implementing Baby Friendly will help to improve women’s experience of maternity care.

The Healthy Child Programme (2009): The English policy framework ‘Giving all children a healthy start in life’, is underpinned by the Healthy child programme which recommends the Baby Friendly Initiative as a minimum standard to support breastfeeding and reduce obesity.

The Chief Medical Officer report (2013) Our children deserve better: Recommends increasing involvement with WHO and UNICEF’s 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.

The 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.

NICE guidance

The NICE guidelines for antenatal care for uncomplicated pregnancies: recommend the provision of breastfeeding information from the Unicef UK Baby Friendly Initiative, including technique and good management practices that would help a woman succeed.

NICE Quality standard, Postnatal Care (2013): Implementing Baby Friendly Initiative is recommended as a minimum standard. Of the 11 quality statements, four can be delivered directly through achieving Baby Friendly.

NICE Social & Emotional Wellbeing early years guidance (2012): 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 Multiple pregnancy guidance (2011): The management of twin and triplet pregnancies in the antenatal period recommends using the Baby Friendly initiative as a minimum standard to support mothers. 

NICE Maternal and Child Nutrition guidance (2011): Encourages breastfeeding, and introducing Baby Friendly Initiative as a minimum standard.

NICE Pregnancy and complex social factors (2010): This guideline 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 breast milk banks (2010): This guidance sets out how to screen and support women who donate breast milk, and how to handle and process the milk donated.

NICE Quality standard, Specialist neonatal care (2010): Supporting parents to be involved in their infant’s care, promoting breastfeeding, data collection and improving health outcomes are all supported by implementation of the Baby Friendly neonatal standards.

NICE Intrapartum Care (2014): This guidance 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.

NICE Postnatal care guidance (2006): Recommends that all maternity care providers implement the Baby Friendly Initiative as a minimum standard to support breastfeeding.

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.

In the long term, data on these indicators will be collected as part of the Maternity and Children’s Dataset (MCDS), which is expected to reach full coverage and maturity by 2017. In the meantime, data has been collected using an interim reporting system, and the results for the first three quarters of 2015-16 (April-December 2015) have been published as “experimental statistics” given the significant changes to the reporting method.

The main findings are:

  • The aggregate breastfeeding rate for England for Quarter 3 2015/16 (October to December 2015) is 42.2% (with confidence intervals of 42.0 – 42.5%) This is based on 138 out of 151 reporting local authorities submitting a return and passing initial validation.
  • This compares to 42.9% for Quarter 2 (July to September 2015) and 43.1% for Quarter 1 (April to June 2015) based on refreshed figures in this publication.
  • Breastfeeding prevalence at a PHE centre level cannot be published as they all fail to meet validation at stage 3 (known breastfeeding status for infants age 6-8 weeks is lower than the 95% quality standard).
  • Breastfeeding prevalence can be published for 68 local authorities (passing all 3 stages of validation) and percentages range from 17.7% to 79.7%.

Read the full findings.

Mapping local breastfeeding data

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.

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

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 page also contains the option of providing feedback on the compendium. See the righthand column on the page, entitled “feedback”.