The future health of mothers and babies is being put at risk by hospitals’ continued failure to implement minimum standards of care around breastfeeding, UNICEF UK said today.

Nearly four out of ten maternity hospitals in England (38%) have made no efforts to put in place best practice around breastfeeding, despite this being a key recommendation in the Nice (National Institute for Clinical Excellence) Postnatal Care Guidelines published one year ago.

This means that many women are still being denied a real choice in how to feed their baby as skilled help is often not available to support a mother to follow through her decision.

Implementing evidence-based best practice has been proven to raise breastfeeding rates, which has a direct impact on the health of our nation, as breastfeeding has positive effects on the health of mothers and babies – whether rich or poor – therefore counteracting health inequalities in the population.

Northern Ireland is the best performing UK country in terms of improving support for mothers wanting to breastfeed, with only one out of 10 maternity units failing to show progress, while Wales and Scotland still perform better than England with 23% and 21% respectively.

Baby Friendly Hospitals

The figures were released by UNICEF UK in order to mark the one-year anniversary of the Nice postnatal care guidelines, which recommended that every maternity unit should implement the Baby Friendly Initiative – a global programme of UNICEF and the World Health Organisation – as independent research has shown it to be the only programme to systematically improve breastfeeding rates.

Hospitals are given the coveted Baby Friendly Award only after they have passed a rigorous assessment by UNICEF staff, which ensures that policies to promote breastfeeding are in place, and that all staff have been trained in how to help women breastfeed.

Sue Eardley, Strategy Manager at the Healthcare Commission – which is responsible for monitoring hospitals’ implementation of guidelines – said: "Increasing breastfeeding rates has been shown to have significant benefits for babies and mothers and the Baby Friendly Initiative provides a mechanism for ensuring staff are trained and provide a consistent message to women and their families.”

The Healthcare Commission is currently conducting a review of maternity services in England and will be publishing its findings in early 2008. Sue Eardley added: “Our review will gather and publish absolute and comparative data on implementation of the Baby Friendly Initiative as well as other aspects of the NICE Postnatal Care guidance, including training and competency of staff in this important aspect of healthcare."

Cost savings

With budgets being slashed across the NHS some health professionals argue that they cannot afford the costs of going Baby Friendly (which are mainly the costs of training staff).

But another document issued by Nice alongside the postnatal guidelines one year ago showed that working towards Baby Friendly status would start to show cost savings for the NHS after only three years because of reduced childhood illnesses due to the projected increase in breastfeeding levels.

UNICEF UK Baby Friendly Initiative Director Sue Ashmore said: “It should be of grave concern to us all that in England four out of ten maternity hospitals have failed to take any action to implement standards recommended by Nice that, not only would have huge health benefits for mothers and babies, but that also would save them money within three years.”

Lack of support

Many new mothers who want to breastfeed give up in the early days, long before they want to, because of problems such as pain or poor milk supply which could have been prevented if they had received skilled help from health professionals.

Unfortunately, many midwives and health visitors have had little or no training in how to breastfeed, and so problems of “latching on” (how the baby positions its mouth over the nipple) and failure to feed on demand (whenever the baby wants to feed) are common, leading to mastitis, cracked or bleeding nipples, and an inadequate supply of milk.

But given the right advice and help from the start by trained health professionals breastfeeding should be a mostly painless experience, and problems of milk supply should rarely occur.

Baby Friendly Hospitals

Once a unit is accredited, breastfeeding levels increase significantly. Hospitals starting with low breastfeeding rates can double them when they become Baby Friendly, and even hospitals starting with very high rates show at least a 10% rise.

In order to ensure that women are not made to feel pressurised, the Baby Friendly Initiative adopts a no-blame approach to breastfeeding promotion. Whilst ensuring women are provided with evidence-based information of the many health benefits of breastfeeding, it is stressed that mothers should not be discriminated against whatever their method of feeding.

If they choose to artificially feed, mothers should be shown how to safely make up a bottle of formula. And the Baby Friendly Initiative advocates other measures that benefit all mothers and babies whatever their chosen method of feeding – extended skin-to-skin contact after birth, 24-hour rooming-in, and demand feeding.

Yet most mothers still do not get the basic care or information that they need to feed their babies as only a small minority of English maternity units have reached full Baby Friendly status. Apart from the four out of ten which have taken no action, most of the remainder have either registered their intent to implement best practice or have obtained a Certificate of Commitment - both of which are intermediary stages in the process of achieving the full award.

This means that in England only 10% of women give birth in fully accredited Baby Friendly hospitals, while Scotland has the highest proportion of fully accredited units with 58% of women giving birth in hospitals with the Baby Friendly award. In Wales the figure is 46% and in Northern Ireland is it 39%.

Sue Ashmore added: “We would urge all units – particularly those in England where the figures are so low - to implement Baby Friendly practice in full, as only then will we start to see an end to the pain and guilt so often experienced by mothers when breastfeeding fails.”

Call to action

UNICEF UK has this week written to all hospital Chief Executives this week, drawing attention to the Nice guidelines, which require all healthcare providers to “implement an externally evaluated structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum.”

Parents and other interested parties are being called on to write to the Chief Executive of their local hospital urging them to adhere to the Nice recommendation to implement the Baby Friendly Initiative in full.

Members of the public can find out the status of their local hospital by visiting www.babyfriendly.org.uk/htables. There is also a standard letter which can be sent to Chief Executives, with the postal address.

Risk Assessment

In one recent case, concerned members of the public wrote to the Chair of their Strategic Health Authority demanding that a full risk assessment be carried out in a PCT where the Nice recommendation on breastfeeding had not been acted upon.

As a result of carrying out the risk assessment the SHA has made funding available for the maternity unit to work towards Baby Friendly over the next three years.

Notes to editors:

Breastfeeding protects babies and their mothers against a wide range of illnesses.
It saves the NHS millions of pounds per year. Bottle feeding increases the risk of babies falling ill. It also causes significant environmental damage. Despite this, breastfeeding rates in the UK are among the lowest in Europe.
Artificially-fed babies are at greater risk of: gastro-intestinal infection, respiratory infections, necrotising enterocolitis, urinary tract infections, ear infections, allergic disease (eczema, asthma and wheezing), insulin-dependent diabetes mellitus
Women who breastfed are at lower risk of: breast cancer, ovarian cancer, hip fractures and bone density.
For further information please contact Sarah Vincent in the UNICEF UK press office on 07814 447935 or 0207 430 0162 or email sarahv@unicef.org.uk