11th April 2025
We are delighted to share this Voices Blog by Dr Alison Spiro (retired health visitor, breastfeeding specialist and member of the WBTi UK Steering Group) who shares the ‘crucial role’ that health visitors have in supporting parents with breastfeeding and some key points from the recently published World Breastfeeding Trends Initiative (WBTi) UK Report1.
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Do parents in the UK receive the support they want to breastfeed
Health visitors are key professionals to give parents invaluable support about infant feeding. This begins with their antenatal contact, followed by the ‘new baby’ home visits and contacts throughout their child’s early years.
Most UK mothers want to breastfeed, but many feel confused. Although they know that breastfeeding is the physiological, healthy way to feed babies, many do not come from families where it is the norm. They may receive different advice, from health professionals in hospitals and family and friends. All may be well-meaning, but inadvertently undermining breastfeeding by offering advice that is not evidence-based. In this country, there are widespread attitudes that formula feeding is ‘normal’, more reliable and acceptable in public places. A listening ear from a trained health visitor can reflect on what they have been told and help them see the way forward to achieve their infant feeding goals.
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Why is health visitor support so vital?
Health visitors offer support to every mother in the UK and most are welcomed as guests to homes. They can give crucial information about how babies are breastfeeding by observing the way they latch and explaining why an effective latch is so important to achieve good milk transfer. Normal baby behaviour and frequency of feeds can be described, and how to recognise feeding cues. If parents are lacking confidence, they can be signposted to infant feeding support groups and peer support. Meeting other mothers experiencing similar concerns can help new mothers feel they are not on their own. If they have more complex problems, such as tongue-tie, there should be an integrated pathway to infant feeding leads or specialists such as International Board Certified Lactation Consultants (IBCLCs) or breastfeeding counsellors, for assessment and then to a tongue-tie clinic if treatment is needed. Health visitors are also well placed to report on breastfeeding prevalence for national data collection.
Image credit: Canva Pro
Why is it so important for health visitors and peer supporters to have breastfeeding training?
All health visitors need to receive breastfeeding training from a recognised body such as UNICEF Baby Friendly Initiative (BFI), either as a student on an accredited university course, and/or after qualification in their community. This will ensure they can offer appropriate, evidence-based support to new parents. Peer supporters should also be trained in a recognised programme such as those provided by a third sector organisation like the Breastfeeding Network, Association of Breastfeeding Mothers or NCT.
The good news is that BFI accreditation has been awarded to 21% of universities running SCPHN courses (a rise from 15% in 2016) and to 69% of health visiting services across the UK. All staff who have received this training should be able to give parents optimum support. Also, another 20% of health visiting services in the UK are working towards accreditation, and 97% and 100% of services in Scotland and Northern Ireland respectively have already achieved it. The WBTi report recommends to policymakers that all community services and universities running SCPHN courses achieve full accreditation.
What is WBTi and how are the data collected?
A WBTi assessment is a global tool for action that brings together key organisations and government agencies in a country to identify gaps and develop joint recommendations to policymakers to support and protect breastfeeding. It is a collaborative and participatory method of assessing a country’s ability to support parents and is based on the WHO Global Strategy 2003 and the Innocenti Declaration (1990, 2005)2, using a standardised approach.
The process involved leadership from a multi-sectorial Core Group of health professionals, government agencies, UNICEF and third sector organisations. The UK findings showed some improvements, but many gaps remain1. Shockingly, there are no strategies or plans for infant feeding in emergencies across all four nations of the UK.
You can see immediately how your country is doing by looking at the report cards, which appear after the main report1.
What is the UK is doing to support and protect breastfeeding?
The ten WBTi policy and programme indicators cover the key influences that impact mothers’ experiences of breastfeeding. There have been some improvements in infant feeding practices and data collection in Northern Ireland, Scotland and Wales but England lags behind them. There is a new survey in England underway now which will give us an indication of the current prevalence of breastfeeding; there was also a welcome investment in the Family Hubs programme in 50% of local authorities, which has led to more support for parents with infant feeding.
However, the UK legislation remains too narrow and does not conform with the WHO International Code on Marketing of Breastmilk Substitutes and subsequent resolutions3; this does not include the advertising of follow-on milks, bottles and teats or digital marketing. There are still some examples of conflict of interest in journals, research and health professional institutions. Some health professionals may be tempted to attend free study days run by formula companies where there may be subliminal advertising of products.
Together with policymakers, service commissioners trusts and boards, local authorities, employers and health professional organisations, we can all take action to create an enabling environment in the UK, for all parents in the UK who wish to breastfeed.
Dr Alison Spiro (retired health visitor, breastfeeding specialist and member of the WBTi UK Steering Group)
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