In 1994 the Committee on Medical Aspects of Food Policy recommended that mothers should be encouraged and supported to breast feed for at least four months.1 This has been adopted as policy in Scotland, and a target was set by the Scottish Office in 1994: “50% still breastfeeding at 6 weeks postnatal age by 2005.”2 Breastfeeding rates in Scotland reported for 1990-1 used information gathered on inborn errors screening (Guthrie) cards at 7 days' postnatal age and covered 99.8% of babies.3 This paper considers the increase in breastfeeding rates over an eight year period in Scotland to 1997-8, with correction for demographic changes in maternal age, as older women are more likely to choose to breast feed.4
Methods and results
Information on breast feeding, hospital of birth, and health board has been collected on Guthrie cards in Scotland since the National Inborn Errors Screening Programme was established in 1964. All information is transferred to a computer database in one Glasgow laboratory. Postcode information has been available since 1990 and maternal age since 1995. Since 1990, breastfeeding rates have been reported to maternity units and health boards throughout Scotland.
During 1990-1, 131 759 babies were born in Scotland,3 and 118 055 babies were born in 1997-8 (total births 118 647 (Information and Statistics Division Scotland, Common Services Agency, Edinburgh)). The number of infants who were breast fed and the number who were bottle fed were determined for each postcode area (table). Confidence intervals were calculated for the difference in the proportion of breastfed babies between the two periods.
In Scotland, breast feeding at 7 days of age has increased by 6.4% (95% confidence interval 6.0 to 6.8) from 35.6% in 1990-1 to 42.0% in 1997-8. The largest increase (11.5%) was seen in Edinburgh and the largest decrease (5.5%) in Aberdeen.
Because maternal age has increased, from a mean of 26 in 1990 to 29 in 1998,5 we corrected for this variable. Breastfeeding rates were calculated in one year steps of maternal age for 1997-8. The maternal age distribution for 1990-1 was taken from the annual report of the registrar general, and breastfeeding rates for maternal age for 1997-8 were substituted into the maternal age distribution for 1990-1. The breastfeeding rate for Scotland would have been 39.4% in 1997-8 if the maternal age distribution had been the same as in 1990-1. Therefore, 2.6% of the observed 6.4% rise in breast feeding can be explained by increase in maternal age.
Comment
In the eight years from 1990-1 to 1997-8, the breastfeeding rate in Scotland has increased by 6.4% from 35.6% to 42.0% at 7 days of age. Some of this increase (estimate 2.6%) may be due to an increase in maternal age. Maternity units and health boards should be congratulated on their achievements and encouraged to increase support for breast feeding. Some areas had a large increase, and two areas—Aberdeen and Shetland—showed a decrease. A more detailed analysis by maternity unit, documenting attempts to promote breast feeding, such as participation in the Baby Friendly Hospital Initiative, may allow the effectiveness of health promotion campaigns to be assessed.
The target of 50% breast feeding at 6 weeks of age by 2005 will not be met unless further health promotion measures are implemented quickly.2 The breastfeeding rate dropped by 10% between 7 days and 6 weeks of age in Scotland in 1995,4 and it seems unlikely that the breastfeeding rate at 7 days will reach 50% in the eight years from 1998 to the end of 2005; at its present rate of change, without further change in maternal age, it will reach only 45.8% (42.0% + (6.4% – 2.6%)).
Table.
Numbers (percentages) of babies born in each postcode area of Scotland in 1990-1 and 1997-8 who were breast fed, taken from information recorded on Guthrie cards
| Postcode area | Breast fed/total 1990-91 | Breast fed/total 1997-98 | Percentage difference (95% CI) |
|---|---|---|---|
| EH (Edinburgh*) | 8751/22 381 (39.1) | 9557/18 905 (50.6) | 11.5 (10 to 12) |
| KW (Kirkwall, Orkney) | 456/1044 (43.7) | 544/1010 (53.9) | 10.2 (5.9 to 14) |
| PH (Perth*) | 1657/3486 (47.5) | 1883/3270 (57.6) | 10.1 (7.7 to 12) |
| KA (Kilmarnock, Ayrshire) | 2911/10 028 (29.0) | 3192/8510 (37.5) | 8.5 (7.1 to 9.9) |
| G (Glasgow*) | 8852/32 476 (27.3) | 10 291/28 937 (35.6) | 8.3 (7.6 to 9.0) |
| FK (Falkirk*) | 1951/6425 (30.4) | 2249/5996 (37.5) | 7.1 (5.4 to 8.8) |
| PA (Paisley, Renfrewshire) | 2994/9096 (32.9) | 2966/7461 (39.8) | 6.9 (5.4 to 8.4) |
| ML (Motherwell, Lanarkshire) | 1836/8719 (21.1) | 2371/8797 (27.0) | 5.9 (4.6 to 7.2) |
| TD (Galashiels, Selkirkshire) | 864/1900 (45.5) | 951/1873 (50.8) | 5.3 (1.1 to 8.5) |
| DD (Dundee*) | 2698/6920 (39.0) | 2754/6264 (44.0) | 5.0 (3.3 to 6.7) |
| IV (Inverness*) | 2660/5456 (48.8) | 2656/5029 (52.8) | 4.0 (2.1 to 5.9) |
| DG (Dumfries*) | 1396/3482 (40.1) | 1369/3180 (43.1) | 3.0 (0.6 to 5.4) |
| KY (Kirkcaldy, Fife) | 3681/8654 (42.5) | 3496/7697 (45.4) | 2.9 (1.4 to 4.4) |
| ZE (Lerwick, Shetland) | 376/636 (59.1) | 301/553 (54.4) | −4.7 (−10.3 to 0.9) |
| AB (Aberdeen*) | 5866/11 056 (53.1) | 5035/10 573 (47.6) | −5.5 (−6.8 to −4.2) |
| All Scotland | 46 949/131 759 (35.6) | 49 615/118 055 (42.0) | 6.4 (6.0 to 6.8) |
Includes surrounding areas.
Footnotes
Funding: None.
Competing interests: None declared.
References
- 1.Working Group on the Weaning Diet of the Committee on Medical Aspects of Food Policy. Weaning and the weaning diet. London: HMSO; 1994. p. 49. [Google Scholar]
- 2.Management Executive. Local breastfeeding targets. Edinburgh: Scottish Office; 1994. p. 1. . (MEL (1994) 110.) [Google Scholar]
- 3.Ferguson AE, Tappin DM, Girdwood RWA, Kennedy R, Cockburn F. Breast feeding in Scotland. BMJ. 1994;308:824–825. doi: 10.1136/bmj.308.6932.824. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Foster K, Lader D, Cheesbrough S. Infant feeding 1995. Results from a survey carried out by the Social Survey Division of ONS on behalf of the UK health departments. London: Stationery Office; 1997. [Google Scholar]
- 5.Registrar General for Scotland. Live births and age of mother. Edinburgh: Scottish Office; 1998. . (Annual report.) [Google Scholar]