Breastfeeding can be a healthy and fulfilling way of feeding your baby if you want to do it. Sadly, only a fraction of UK women who currently set out to breastfeed manage to continue until six months. We agree, something has got to change, but that does not mean that we have to jump feet first into the nearest and quickest so-called solution, the Baby Friendly Hospital Initiative (BFHI). There are a number of issues with the BFHI guidelines, which we outlined in our response to the recent public consultation on the revised BFHI guidelines.
Underpinning the BFHI is the claim that breastfeeding will save over 800,000 lives, reduce the burden on our (amazing) National Health Service and boost the economy. However, as with any data at all we need to be cautious. The UK was not one of the seventy-five low to middle income countries used as the basis for these calculations and these countries may not be representative of the UK situation, so the extent to which these numbers are relevant to the UK remains unclear. Furthermore, if we’re talking about cost to the NHS then we also must consider costs related to service provision, accreditation, treatment for breastfeeding related difficulties and infant readmission for feeding related morbidities.
So what do we want from an infant feeding support initiative?
In the first instance we need to know that any health focused intervention works. The BFHI has struggled to prove itself as an effective means of improving breastfeeding rates. A study published in JAMA showed no consistent evidence of an association between system-level feeding interventions and breastfeeding rates up to 16 weeks’ postpartum. In Ireland funding for BFHI was recently paused as it had not shown itself to be effective at improving breastfeeding rates. Becoming an accredited hospital is a costly investment and that’s not just in taxpayer money, it’s in women’s time and effort. We need to know that it’s worth it or whether a different approach would be more effective.
We also need to be sure that an intervention is based on sound science. A recent review process carried out by the WHO and UNICEF into the BFHI allowed us the opportunity to raise several areas we feel are of concern, one of which is a lack of robust evidence supporting several elements of the initiative. For example, there is no evidence to suggest that dummies, which have a protective effect over SIDS, should be avoided. While this was acknowledged by BFHI during the review process, this step remained within the BFHI guidelines regardless. Another point could be supplementation where emerging evidence is pointing towards the idea that supplementing earlier, before problems begin to arise, leads to better breastfeeding rates at six months and beyond.
We need to seek assurances that an intervention is safe. The BFHI advice to supplement with formula only when ‘medically necessary’ is concerning as the harms of underfeeding may already have been done by the time formula is deemed a necessity. Indeed in Norway, often held up as shining examplar due to their breastfeeding rates, the BFHI guidelines have been implemented in such a way as to allow judicial supplementation and around 70% of babies receive early supplementation. To ensure safety, we also need to be able to accurately assess the outcomes of any given intervention. At present data on associated outcomes of infant feeding such as rates of readmission for breastfeeding complications (e.g. mastitis and breast abscess), postnatal depression, hypernatremia, hyperbilirubinemia and hypoglycaemia etc. are not consistently collected and considered so we have no way of knowing exactly just how safe the current initiative is.
Finally, at Infant Feeding Support UK, we believe that any infant feeding support initiative must also be inclusive. In a letter template provided by Unicef urging MP’s to support the Baby Friendly Hospital Initiative (BFHI) it states;
“…breastfeeding is a highly emotive subject because so many families have not breastfed, or have experienced the trauma of trying very hard to breastfeed and not succeeding. The pain felt by so many parents at any implication that they have not done the best for their child can close down conversation. Whilst no parent should have to feel such pain, the UK context has become so fraught that those who advocate for breastfeeding risk being vilified by the public and in the media.”
This statement could be paraphrased as a good old fashioned ‘calm down dear’, an attempt to silence parents by painting them as traumatised and overly emotional. We believe that it has no place in this discussion because it’s lazy, sexist and, if progress is to be made, cannot be tolerated. The voices and experiences of all parents, but especially these families, are essential if we are to improve infant feeding services in the UK.
The Infant feeding Survey 2010, which is the last time such a survey was carried out, tells us that only 4% of new parents access the breastfeeding support services currently available. Many report feelings of moral judgement, stigma and dissatisfaction around their infant feeding decisions. It is not clear how the current BFHI guidelines will help this situation as it offers somewhat contradictory advice on how to ensure that parents who use infant formula receive the same level of care and respect as their breastfeeding counterparts. This is clearly something that is already falling short and needs to be addressed urgently to ensure every family and every baby gets the best possible start.
Let’s commit to listen to the experiences of all families, including those who nourish their babies using infant formula, so that the UK can lead the way in safe, supportive and science-based infant feeding support.