Editor—The report from the NHS Centre for Reviews and Dissemination highlights many of the reasons why the work of the Unicef UK baby friendly initiative is a crucial component of any strategy to promote and support breast feeding.1
Although breastfeeding rates in the United Kingdom have remained static since 1980,2 a survey of 21 baby friendly hospitals has found an increase of more than 10% in breastfeeding initiation. The percentage of babies who are breast fed rose from 60% two years before the units received their baby friendly award to 70.6% a year after their accreditation (table). Some of the largest increases were in hospitals serving inner city or deprived areas, which traditionally have low rates. For example, breastfeeding initiation at the Ulster Hospital in Belfast has increased from 29% in 1995 to 55% now. Some hospitals in areas with traditionally strong breastfeeding rates have also shown increases with the Royal Surrey Hospital, Guildford, showing a rise from 74% in 1995 to 86% today.
Compounding the problem of the low uptake of breastfeeding is the rapid decline in prevalence. Each year, 75 000 mothers stop breast feeding in the first postnatal week, but only 1% say that this is how long they had intended to breast feed for. The reasons most give for stopping relate to problems that could be avoided or solved if they were better supported.3 The principle behind the baby friendly initiative is that best practice standards should be adopted so that health professionals are able to support mothers in their chosen feeding method. Healthcare facilities which implement best practice—the 10 steps to successful breastfeeding for the maternity services4 or the seven point plan for the protection, promotion, and support of breast feeding in community healthcare settings5—can be assessed and accredited as baby friendly. The standards combine the foundations of good practice (policy, training, information) with changes to practice (skin to skin contact, rooming in, exclusive breast feeding) and good cooperation between the different parts of the health service and the voluntary sector.
Thirty one maternity units in the United Kingdom have a full baby friendly award, and another 68 have a certificate of commitment, which rewards the development of a detailed action plan. We hope that the latest report will accelerate progress among the remaining units.
Table.
Birth rates and incidence of breast feeding in 21 hospitals according to timing of accreditation by Unicef UK baby friendly initiative
| Accreditation | No of births | No (%) of babies breast fed |
|---|---|---|
| Two years before | 34 538 | 20 719 (60.0) |
| One year before | 34 122 | 21 563 (63.2) |
| During | 33 861 | 22 365 (66.1) |
| One year after* | 22 552 | 15 930 (70.6) |
Includes figures for part of year for hospitals accredited during 1999.
References
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- 3.Unicef UK Baby Friendly Initiative. Baby friendly hospitals show strong increase in breastfeeding rates. Baby Friendly News No 6, July 2000
- 4.WHO/Unicef. Protecting, promoting and supporting breastfeeding: the special role of maternity services. A Joint WHO/Unicef Statement. Geneva: WHO; 1989. [Google Scholar]
- 5.Unicef UK Baby Friendly Initiative. The baby friendly initiative in the community—an implementation guide. London: Unicef UK Baby Friendly Initiative; 1999. [Google Scholar]