Breastfeeding in England

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
  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 the strong evidence supporting the importance of initiatives targeted at the first years of life in improving a child’s future outcomes. These initiatives include the promotion of breastfeeding to support the health infant and maternal health and relationship building.

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

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Current government policy on infant feeding

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.

The 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 to protect, promote and support breastfeeding

Best start in life: Cost-effective commissioning: this ROI tool 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 (2018): 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 recommends Unicef UK.

NICE guidance

NICE guidelines for antenatal care for uncomplicated pregnancies (CG 62): 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 guidelines for postnatal care up to 8 weeks after birth (CG37): 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.

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 Multiple pregnancy guidance (CG129): covers the management of twin and triplet pregnancies in the antenatal period.

NICE Pregnancy and complex social factors (CG110): 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 milk banks (CG93): 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 (QS4): 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.

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.

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

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

Further information

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

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 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.