• Learning outcomes
• The benefits of breastfeeding
• Economic and environmental factors
• Who breastfeeds?
• UNICEF UK Baby Friendly Initiative
• Global and national strategies
• Concluding comments
• Practice questions
• Resources
Breastfeeding cannot be considered as a standalone subject when culture, social support and healthcare professionals’ knowledge and skills clearly have such a great impact on initiation and duration of breastfeeding rates in the United Kingdom (UK) (Renfrew, et al., 2005, 2012a). Breastfeeding must be placed in the wider socio-political context to understand why mothers make the choices they do with regard to infant feeding and to enable healthcare professionals to adequately support them in practice. The aim of this chapter is to identify the role breastfeeding has in promoting public health and reducing health inequalities for both mother and infant by exploring the health benefits of breastfeeding and the dangers of not doing so. It goes on to explore the results of the Infant Feeding Survey 2010 (McAndrew, et al., 2012) to highlight which mothers are most likely to breastfeed, and those least likely to initiate breastfeeding, or who do so for a shorter period of time. This information is useful for both strategic developments of services as well as for planning individualised care. This chapter also introduces some of the main global, national and local strategies to promote, support and protect breastfeeding.
Mapping to UNICEF BFI Education learning outcomes (2014)
By the end of the programme students will:
| Theme 1: Understanding breastfeeding | 2. | Appreciate the importance of breastmilk and breastfeeding on the health and well-being of mothers and babies. |
| Theme 2: Enabling mothers to breastfeed | 3. | Have an understanding of infant feeding culture within the UK and the various influences and constraints on women’s infant feeding decisions. |
| Theme 4: Managing the challenges | 11. | Draw on their knowledge and understanding of the wider social, cultural and political influences which undermine breastfeeding, to promote, support and protect breastfeeding within their sphere of practice. |
| Theme 5: Communication | 12. | Have an understanding of the principles of effective communication and current thinking around public health promotion strategies and approaches. |
Learning outcomes
By the end of this chapter you will be able to:
• identify the health benefits of breastfeeding for mother and infant;
• recognise the socio-economic characteristics of mothers who choose to breastfeed or not;
• describe the BFI best practice standards for healthcare facilities and education;
• discuss the importance of global, national and local policies and guidelines to encourage and support breastfeeding.
The benefits of breastfeeding
The World Health Organization (WHO, 2002, 2014a) recommends exclusive breastfeeding for the first six months of life and to continue for two years and beyond, because breastmilk is perfectly balanced to meet the nutritional needs of the newborn and is the only food required until six months of age. Breastmilk has the advantage of being readily available, at no cost, and delivered on demand and at the right temperature, and the infant is able to regulate the amount required at each feed. The properties of breastmilk are exclusive, cannot be replicated by formula milk (see Chapter 3) and confer many benefits on both mother and infant. Despite this, the WHO (2014a) estimates that less than 40 per cent of infants worldwide are exclusively breastfed for six months.
In 2007, Ip et al. conducted a systematic review of the evidence on the effects of breastfeeding on short- and long-term infant and maternal health in developed countries. For the infant, they suggested that breastfeeding reduces the risk of:
• diarrhoea and chest infections;
• atopic dermatitis and asthma;
• obesity and type I and II diabetes;
• childhood leukaemia;
• sudden infant death syndrome (SIDS);
• necrotising enterocolitis.
There have been a number of studies more recently that support Ip’s conclusions; the following are a few examples. In a large prospective study of 1,105 children, Silvers et al. (2012) found that breastfeeding protected against wheezing in children aged 2–6 years. A meta-analysis carried out by Amitay and Keinan-Boker in 2015 found that any breastfeeding for six months or longer was associated with lower risk of childhood leukaemia. Colaizy et al. (2016) found that if extremely low birth weight infants were not being fed breastmilk they were at increased risk of necrotising enterocolitis.
Leon-Cava et al. (2002) and Kramer et al. (2008) suggest a link between intellectual and motor development and ‘dose-related’ breastfeeding. It is thought this could be due to the long-chain polyunsaturated fatty acids in breastmilk as well as the psychosocial stimulation and bonding conferred by breastfeeding. However, WHO (Horta and Victora, 2013) commissioned an update of the 2007 systematic review (Horta et al., 2007) of the long-term impact of breastfeeding on health. The evidence from this review differed in that it could only establish a benefit in the protection against overweight or obesity and an increase in performance in intelligence tests. Evidence was inconclusive on the protection against high total cholesterol and high blood pressure, and conflicting results were found on diabetes.
The UK is facing an obesity epidemic that is predicted to increase, if current trends continue, to 48 per cent of men and 43 per cent of women by 2030 (an additional 11 million more obese adults), adding £1.9–2 billion per year in health costs associated with obesity-related diseases (Wang et al., 2011). Public Health England (PHE, 2016) also found that one third of 10- to 11- year-olds were either obese or overweight as were one fifth of 4–5-year-olds. However, van Jaarsveld and Gulliford (2015) suggest this prevalence may have stabilised. Obesity is associated with an increased risk of hypertension, type II diabetes, heart disease and some cancers. Numerous studies have found that prolonged or dose-related breastfeeding reduces the risk of obesity and that breastfed children are leaner than those who were never breastfed (Armstrong and Reilly, 2002; Yan et al., 2014). Despite this evidence the 2016 UK publication Childhood Obesity: A plan for action (HM Government, 2016) does not include breastfeeding or appropriate weaning.
Breastfeeding also confers benefits on the mother by regulating fertility (Wambach and Riordan, 2016) and reducing the risk of osteoporosis, ovarian and breast cancer in later life, as well as type II diabetes (Ip et al., 2007). Ip et al. (2007) suggest that the protective factors of breastfeeding for mothers are also dose-related; that is, the longer a mother breastfeeds the better protection she receives, particularly for breast cancer. Ip et al. (2007) also suggest that early cessation of breastfeeding o...
