Breast milk is the best form of nutrition for infants, and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life. Thereafter, breastfeeding should continue for as long as the mother and baby wish, while gradually introducing the baby to a more varied diet.
In recent years, research has shown that infants who are not breastfed are more likely to have infections in the short term such as gastroenteritis, respiratory and ear infections, and particularly infections requiring hospitalisation. In the longer term, evidence suggests that infants who are not breastfed are more likely to become obese in later childhood, which means they are more likely to develop type 2 diabetes and tend to have slightly higher levels of blood pressure and blood cholesterol in adulthood. For mothers, breastfeeding is associated with a reduction in the risk of breast and ovarian cancers. A recent study also suggests a positive association between breastfeeding and parenting capability, particularly among single and low-income mothers.
Evidence also demonstrates that improving breastfeeding rates not only improves longer- term health for children and reduces risks of future disease, but can also have rapid financial return on investment to the health service, reducing hospital admissions and attendances in primary care.
National data on breastfeeding is currently only available at PCT level (Sutton and Merton combined). This data shows that in 2012-13 breastfeeding initiation was 86.2% compared with 86.8% for London and 73.9% for England. Breastfeeding at 6-8 weeks was 60.6% in Sutton and Merton compared with 46.6% for England. London data is incomplete, therefore an average is not available. The drop-off rate between initiation and 6-8 week prevalence in Sutton and Merton was about 26%. There has been no increase in levels of women initiating breastfeeding at birth since 2010-11, when the prevalence was 60.5%.
Prevalence of breastfeeding initiation at birth, 2012-13.
Prevalence of breastfeeding at 6-8 weeks after birth, 2012-13.
Local data indicates that rates of breastfeeding are higher in Merton than Sutton. In Merton local data for 2012-13 suggested the prevalence of breastfeeding at 6-8 weeks after birth was 64%. There is also variation in breastfeeding by ethnicity and area. Just over half of white British women were recorded as breastfeeding at 6-8 weeks, compared with over 80% of black mothers and over 76% of Asian mothers. This is based on recording the ethnicity of 70% of mothers; 30% was not recorded (548/1, 822 mothers).
Proportion of mothers breastfeeding at 6-8 weeks by ethnic group, 2012-13.
Analysis of local data by area indicates that women are less likely to breastfeed at 6-8 weeks in the eastern wards of the borough including Cricket Green, Figges Marsh, Pollards Hill, St Helier and Lower Morden.
Prevalence of breastfeeding at 6-8 weeks by wards in Merton 2012-13 (Source: Sutton and Merton Community Services RIO, 2013).
Key facts on service
Increasing rates of breastfeeding requires a multi-faceted approach. Services to support mothers to breastfeed in Merton are provided by Midwifery Services, health visiting and children’s centres, in line with the national Healthy Child Programme: Pregnancy and the first five years of life. Supported by commissioners, Sutton and Merton Community Services has signed up to UNICEF Baby Friendly accreditation, which aims to improve breastfeeding rates.
A recent review of Breastfeeding Services in Sutton and Merton identified the need to increase inter-organisational working and information sharing; establish a core data set; and focus on developing interventions to support breastfeeding across a pathway, including more antenatal education.
A Sutton and Merton Breastfeeding Steering Group has been established to develop a local action plan and increase breastfeeding, targeting mothers in greatest need of support.
What works and best practice
NICE has developed a
maternal and child nutrition pathway (2012), which brings together current guidance on nutrition and breastfeeding. This includes support for the UNICEF baby friendly standards. Recommendations for commissioners and managers are to:
- adopt a multi-faceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates. It should include:
- activities to raise awareness of the benefits of, and how to overcome the barriers to, breastfeeding
- training for health professionals
- breastfeeding peer-support programmes
- joint working between health professionals and peer supporters
- education and information for pregnant women on how to breastfeed, followed by proactive support during the postnatal period
- work with local partners to ensure mothers can feed their babies in public areas.
Key commissioning recommendations
- Investing in services to support breastfeeding is particularly important for mothers from low income groups, as it is known that they are less likely to breastfeed. Breastfeeding protects the health of babies and mothers, and reduces the risk of illness.
- A multi-agency Merton Breastfeeding Action Plan should be developed and monitored to increase rates of breastfeeding at 6-8 weeks, targeting mothers in greatest need of support.
- Current data indicates that support should be targeted at mothers living in more deprived wards with lower rates of breastfeeding, including Cricket Green, Figges Marsh, Pollards Hill, St Helier and Lower Morden.
- There is a need to establish a core data set and performance indicators to monitor performance effectively, including the ‘drop off’ period between initiation and 6-8 weeks.
- All providers should work towards achieving stage 3 UNICEF Baby Friendly Initiative.
- Increased training for professionals to promote and support breastfeeding.
- Increased support on breastfeeding for pregnant women in the antenatal period.
- A Breastfeeding Welcome campaign should be developed to support more mothers to breastfeed in public places.
^ National Institute for Health and Clinical Excellence (NICE) (2008).
Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households NICE, London. Gutman L et al. (2009).
Nurturing parenting capability – the early years, Institute of Education, Centre for Research on the Wider Benefits of Learning, London
Renfrew, M.J. et al. (2012).
Preventing Disease and Saving Resources: the potential contribution of increasing