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. 1998 Nov 14;317(7169):1385.

Breast feeding: the baby friendly initiative

Unicef’s baby friendly initiative is making great progress in UK

Andrew Radford 1,2,3, Cynthia Rickitt 1,2,3, Anthony Williams 1,2,3
PMCID: PMC1114259  PMID: 9812946

Editor—We share Malik and Cutting’s enthusiasm for Unicef’s baby friendly initiative in the United Kingdom but were disappointed that they did not acknowledge the great progress made over the past year.1 It is pessimistic to state that hospitals have been slow to work with the initiative. In fact, almost all units are working towards baby friendly accreditation; 11 British maternity units have achieved the required standard and another 40 have a certificate of commitment. Although Malik and Cutting suggest that hospitals might be demoralised by unachievable targets (such as the 75% breastfeeding rate required for the global baby friendly award), we removed this requirement for the United Kingdom’s standard award in order to focus on the support and encouragement of best clinical practice.

It is also unfair to suggest that the baby friendly initiative is confined to hospitals. On 15 May we launched best practice standards for community healthcare settings, with the support of the minister for public health. This is the first step in introducing the initiative into the community and provides a framework around which clinical accreditation will be developed. The United Kingdom will probably be unique in having a primary care baby friendly award. As with the existing awards, particular emphasis is placed on support for mothers to make informed decisions about feeding their babies.

Malik and Cutting call for better coordination with existing groups that support mothers; in fact, all four national groups are fully involved with the baby friendly initiative. We were also puzzled by the statement that “government and NHS managers should recognise and encourage [the baby friendly initiative’s] development.” The Department of Health has worked in partnership with the initiative since its inception in the United Kingdom,2,3 while an increasing proportion of NHS managers see the initiative as a cost effective quality framework to achieve a high standard of care, which can be independently accredited.

We agree that much more could be done to support mothers in their choice to breast feed. Nevertheless, the healthcare system has a crucial role; it was particularly pleasing to note that the 1995 infant feeding statistics4 documented progress on relevant hospital practices.5 We are optimistic that the progress of Unicef’s baby friendly initiative in the United Kingdom can strengthen this trend.

References

  • 1.Malik ANJ, Cutting WAM. Breast feeding: the baby friendly initiative. BMJ. 1998;316:1548–1549. doi: 10.1136/bmj.316.7144.1548. . (23 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Department of Health/Unicef UK Baby Friendly Initiative. Memorandum of understanding between the National Breastfeeding Working Group and the Unicef UK Baby Friendly Initiative. London: Department of Health/Unicef UK Baby Friendly Initiative; 1993. [Google Scholar]
  • 3.National Breastfeeding Working Group. Breastfeeding: good practice guidance to the NHS. London: Department of Health; 1995. [Google Scholar]
  • 4.Foster K, Lader D, Cheesbrough S. Infant feeding 1995. London: Stationery Office; 1997. [Google Scholar]
  • 5.Williams A. Infant nutrition in Britain: where are we and where should we be going? BNF Nutr Bull. 1998;23(suppl 1):5–11. [Google Scholar]
BMJ. 1998 Nov 14;317(7169):1385.

Support must continue beyond hospital

Julie Burgess 1

Editor—Part of the problem experienced by mothers who want to breast feed their babies, which Malik and Cutting do not mention,1-1 is the lack of experience of breast feeding among nursing and medical staff—it is one thing to be told how to do it and quite another to manage it. In the past, older women in the family or community would have provided this advice from their personal experience.

Support must continue beyond the maternity hospital. Once outside the confines of the hospital, nursing mothers—especially those who need to return to work—find the outside world a hostile place. Despite assurances by the National Childbirth Trust and other interested organisations, it is difficult to combine work and breast feeding. A big step forward would be for maternity leave to extend to six months after the birth and not three or four, as generally happens at present. Not every woman would want to take so much leave, but that would be her choice. For a breast feeding woman, leaving her baby at the age of 3-4 months is fairly traumatic; the baby would probably not be naturally fully weaned until much later. Workplaces are supposed to provide somewhere for mothers to express and store milk in hygienic conditions, but do they provide the time to do this?

Generally, in modern society women who breast feed are seen as “earth mothers” with time to “waste” on such things. Until our culture changes and the mother and baby are protected as a unit from social and work pressures that threaten their time together during the first year, many women will give up. They don’t want to be seen as inefficient, unproductive, and time wasting.

Footnotes

j.burgess@uea.ac.uk

References

  • 1-1.Malik ANJ, Cutting WAM. Breast feeding: the baby friendly initiative. BMJ. 1998;316:1548–1549. doi: 10.1136/bmj.316.7144.1548. . (23 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 1998 Nov 14;317(7169):1385.

The arts and the media can help

O O Ejidokun 1, J Norton 1, Sam Ramaiah 1

Editor—Malik and Cutting’s editorial drew attention to the potential in the imaginative use of the media in promoting breast feeding, especially among mothers in their teens and 20s.2-1 In Walsall we are working towards achieving the 10 steps to successful breast feeding2-2 and developing a card informing mothers where they can feed their babies while shopping locally.

We also have a multiagency working group promoting breast feeding within the hospital and in the community. This group, in collaboration with the health authority, wrote to five producers of the leading soap operas based in the United Kingdom and shown during prime viewing time, asking them to help us in our efforts to promote breast feeding. We received only three responses, varying from a total lack of interest in our campaign to one of great enthusiasm. The BBC production EastEnders has not only commissioned research on breast feeding but also made positive references to breast feeding in its story line.

Increasingly, the arts and media are being recognised as effective means of providing health education messages to people and obtaining feedback from service users. Walsall Health Authority has commissioned a theatre company to research women’s choices for childbirth, and the company has delivered workshops for health professionals on the issues of informed choice and breast feeding.2-3

All these initiatives are likely to have a cumulative effect on women in Walsall, and we expect that the number of mothers who take up breast feeding will increase.

References

  • 2-1.Malik ANJ, Cutting WAM. Breast feeding: the baby friendly initiative. BMJ. 1998;316:1548–1549. doi: 10.1136/bmj.316.7144.1548. . (23 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-2.Vallenas C, Savage-King F. Evidence for the ten steps to successful breast feeding. Geneva: WHO Child Health and Development Unit; 1997. [Google Scholar]
  • 2-3.Norton J, Connolly J, Belbin A, Patel B. Changing childbirth: what choices for Walsall women? A research project. Walsall: Walsall Health Authority; 1997. [Google Scholar]
BMJ. 1998 Nov 14;317(7169):1385.

In Sri Lanka only quarter of babies under 4 months are exclusively breast fed

D P Gunasekera 1,2, P C Gunasekera 1,2

Editor—Promotion of breast feeding in Sri Lanka is not confined to the hospitals of the baby friendly initiative3-1 but is carried out island wide, through the mass media and posters in hospitals and maternal and child health clinics. In Sri Lanka, advertising and promoting formula milk as a substitute for breast feeding is prohibited. Tins of artificial milk must carry the slogan “Breast milk is best for your baby.” To promote breast feeding, obstetricians, paediatricians, and family doctors must be competent to advise mothers. A national survey showed, however, that most obstetricians and paediatricians were dissatisfied with the training they received on breast feeding. Furthermore, there was no consensus regarding certain baby friendly initiative practices that are being promoted (D P Gunasekera et al, paper presented at the annual scientific congress of the Sri Lanka College of Paediatricians, 16-20 July 1997, Colombo, Sri Lanka). A consensus on current breast feeding policies is imperative so that mothers are not confused by contradictory advice.

In Sri Lanka mothers receive full pay maternity leave for three months. Hence early supplementation is started so that they can return to work. Although legislation exists that allows mothers to take time off to breast feed once they return to work, many are unaware of their rights.

Traditional herbal supplements and water are often recommended by elderly relatives, and this advice is often accepted by the new mother. Only 24% of babies aged under 4 months are exclusively breast fed, while 41% of babies aged under 2 months are given supplementation with water.3-2 Promotion of breast feeding should be continued in the community once the mother returns home, but only seven tenths of women receive postnatal care by the public health midwife at least once within the first 10 days of delivery.3-3

The importance of updating those who give maternity and infant health care about breast feeding, both in hospitals and in the community, must be emphasised. Promotion of breast feeding in the mass media, legislative control of promotion of artificial feeds, and the leave entitlements and working hours of mothers who breast feed would also help promote the baby friendly initiative.

References

  • 3-1.Malik ANJ, Cutting WAM. Breast feeding: the baby friendly initiative. BMJ. 1998;316:1548–1549. doi: 10.1136/bmj.316.7144.1548. . (23 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3-2.Department of Census and Statistics, Ministry of Finance, Planning, Ethnic Affairs and National Integration in collaboration with Ministry of Health, Highways and Social Services. Feeding patterns and nutritional status of children. Sri Lanka demographic and health survey 1993. Colombo: DCS; 1995. p. 133. [Google Scholar]
  • 3-3.Evaluation Unit, Family Health Bureau. Annual report on family health—Sri Lanka 1995. Colombo: Colombo; 1997. [Google Scholar]

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