This year, ‘Dietitians’ Week’ coincides with ‘Breastfeeding Awareness Week’ so what better topic for a blog!
So let’s consider the evidence. Firstly breastfeeding protects the infant, child and adult from a vast range of illnesses including infection, diabetes, asthma, heart disease and obesity, as well as sudden infant death syndrome. It also protects mothers from breast and ovarian cancers and heart disease and, supports the mother-baby relationship and their mental wellbeing. We also know breastfeeding contributes to significant savings to the NHS with initial investments paying off within just a few years including tens of thousands of fewer hospital admissions and GP consultations.[1]
The first ‘Baby Friendly’ hospital to be accredited n Scotland was in Perth Royal Infirmary in 1998. It was over a decade later, in 2011, that Scottish Government fully supported UNICEF Baby Friendly. The UNICEF Baby Friendly Initiative is an evidence-based and staged accreditation programme supporting maternity, neonatal, health visiting and children’s centre services to transform their care. Breastfeeding rates are not great but the 2017 Scottish Maternal and Infant Nutrition Survey highlights the positive impact that UNICEF Baby Friendly practices are having on infant feeding in Scotland.[2] Key findings include:
- At 6 months – 43% of infants were receiving any breast milk, compared to 32% in the 2010
- At 6 weeks – 55% of infants were receiving any breast milk, compared to 50% in the 2010
There is still a long way to go but then breastfeeding is a highly emotive subject. Why? Well because so many families have not breastfed, or have experienced the ordeal 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 is hurtful. It is time to stop laying the blame for our low breastfeeding rates at the door of individual women and instead, acknowledge that this is a public health issue for which we all share responsibility – including dietitians.
Now at this point I fully expect all my dietetic colleagues to be in full agreement with what I have said so far. But let’s reflect. As a public health dietitian, breastfeeding sits within my remit but I am no authority on this specialist subject and so I am very fortunate to have a team of breastfeeding experts working with me. I am also very relieved because whilst I may understand the evidence on how breastfeeding improves health, saves lives and reduces costs, I am afraid my professional skills are non-existent! Now I am not suggesting dietitians suddenly become experts in the skills of supporting breastfeeding (although I think it would be a very good thing if some did), what I am suggesting, is we can support a more breastfeeding friendly culture in other ways and we can stop doing things which may be offsetting this aspiration. For example, UNICEF’s call for action includes protecting the public from harmful commercial interests by adopting, in full, the World Health Organisation’s International Code of Marketing of Breastmilk Substitutes and subsequent resolutions (the Code), 1981. The Code is a voluntary international health policy framework which regulates the marketing of breastmilk substitutes in order to protect breastfeeding. So what does it mean for practice? It means:
- No advertising for infant feeding products anywhere within public services
- No contact between company personnel and pregnant women or mothers.
- No items bearing company logos on public service premises nor used by its staff. Examples include mugs, stationery, diary covers, key fobs, lanyards, pens, tourniquets, gestational / age-in-weeks calculators, weight conversion charts, post-it note pads.
- No free samples to health professionals or mothers.
- Only scientific and factual information, free from commercial bias, used in the care of babies and their parents.
Compliance to the Code is part of all NHS Scotland Boards’ Infant Feeding Policies and required compliance by all NHS Scotland personnel working with pregnant women and new mothers. Do we all comply?
Contributed by:
Joyce Thompson (@JoyceeThompson)
Dietetic Consultant in Public health Nutrition
NHS Tayside
23 May 2019
References
[1] https://www.unicef.org.uk/babyfriendly/about/preventing-disease-and-saving-resources/
[2] https://www.gov.scot/publications/scottish-maternal-infant-nutrition-survey-2017/
AHPs across health and social care. 
Thought provoking piece- what changes can AHPs make in everyday environments that encourage people to achieve and thrive? Whether its in the information we make available, or the everyday spaces we meet people in – to make sure that our ‘messaging’ matches that of the Public Health 6 priorities? and supports people with their wellbeing?
Good questions! How about:
1 Work with colleagues to create a ‘healthy office’ or ‘healthy department’ culture
2 Consider how the practice environment can promote healthier living
3 move away from ‘advice giving’ towards motivational interviewing to support health behaviour change