assessment

Today, the World Breastfeeding Trends Initiative (WBTi) UK Core Group published their second UK assessment report of breastfeeding and infant and young child feeding across the four UK nations. The Report’s authors present some progress since their first assessment in 2016, but many gaps remain in infant feeding policies and programmes – and the Report sets out the recommendations required to address them.

Urgent action is necessary to prioritise, protect and support breastfeeding as a public health priority; and formula-fed infants need access to affordable formula, safely prepared. The Report highlights the important public health impacts of breastfeeding on women’s health, reducing their risk of cancer, cardiovascular disease, diabetes, poor mental health, obesity and overweight. Breastfeeding reduces infants’ risk of SIDS and necrotising enterocolitis, with later impacts on diabetes, obesity and overweight, and can improve brain development, emotional development and school performance.

Launched in 2004, the WBTi assists countries to assess the status of and benchmark the progress in implementation of the Global Strategy for Infant and Young Child Feeding in a standard way. It is based on the World Health Organization (WHO) tool for national assessment of policy and programmes on infant and young child feeding. The first UK WBTi assessment was published in 2016. This latest assessment was completed to determine whether any progress had been made on breastfeeding outcomes over the last eight years.

Nations are rated against the ten parameters of policy and programmes that protect, promote and support optimal infant and young child feeding (IYCF) practices (using a 0-10 rating scale, where 0 represents the lowest or poorest rating, and 10 indicates the highest or best rating). The latest 2024 scores are listed below:

National policy, governance and funding – UK score 4/10
UNICEF UK Baby Friendly Initiative – UK score 7.5/10
Implementation of the International Code of Marketing of Breastmilk Substitutes – UK score 5/10
Maternity protection – UK score 6/10
Health care systems (in support of breastfeeding and infant and young child feeding) – UK score 6/10
Counselling services for pregnant and breastfeeding mothers – UK score 6/10
Accurate and unbiased information support – UK score 5.5/10
Infant feeding and HIV – UK score 3/10
Infant and young child feeding in emergencies – UK score 0/10
Monitoring and evaluation 5/10.

Devolved nations are in the lead

The Report also presents separate nation scorecards which show considerable variation between UK nations – with England scoring the lowest (44.5/100) and Northern Ireland scoring the highest (69.5/100) in the between nation comparisons.

The devolved nations have continued to show national leadership, with stronger policies and programmes on infant feeding, consistently scoring higher than England. Wales has been reconfiguring services, has a national action plan to 2024, and recently put a leadership team in place. Northern Ireland has put many policies in place and is the only nation to have completed updated resources on infant feeding and HIV, giving them the top score. Scotland, whose national early years team recently won the political leadership category of the Children’s Food Awards, demonstrates strong political will, joined up policies, and investment in community breastfeeding support, the UNICEF UK Baby Friendly Initiative, and the National Breastfeeding Helpline, over the longest period and has seen breastfeeding rates start to rise.

Improvements and gaps in health professional training

The UK’s UNICEF Baby Friendly Initiative (BFI) accreditation programme is recognised and recommended across all four UK nations. It supports maternity, neonatal, community and hospital-based children’s services to transform their care and works with universities to ensure that newly qualified midwives and health visitors have the strong foundation of infant feeding knowledge needed to support families.

Maternity staff in Baby Friendly (BFI)-accredited hospitals and health visitors in BFI-accredited community services have strong in-service training in the basics of breastfeeding management. Higher levels of breastfeeding education are in the preregistration training for midwives, lactation consultants (IBCLCs), breastfeeding counsellors, peer supporters and BFI-accredited health visiting programmes.

In contrast, once mothers are discharged from hospital, other health professionals such as nurses, doctors, dieticians and pharmacists may have had little or no training in infant feeding/ breastfeeding and may not know how to support breastfeeding mothers under their care (full details are presented in the report). There is no mention of infant feeding in nursing training standards; even paediatric and neonatal nurses may not have a basic knowledge of breastfeeding.

BFI-accredited university health visitor (HV) programmes have significantly more content on breastfeeding. By 2024, one fifth of HV training programmes were BFI-accredited; and WBTi’s recommendation is that all HV university programmes should achieve BFI accreditation, as well as all community services. HV services should be well staffed and integrated with a network of skilled peer supporters and a specialist pathway when needed. Health visitors have a crucial role in supporting and signposting families to other support.

“Political will is required with action and investment at all levels: local authorities, the health system, and at national levels…. We look forward to a UK that respects and supports parents’ infant feeding decisions and removes all barriers to their feeding journeys.” (WBTI 2024 REPORT).

Dr Robert Boyle, Consultant Paediatrician, Imperial College, London, said:

“There are areas of progress since the 2016 report, but the main message of this Report is that much more can be and should be done to support breastfeeding in the UK. More than half of babies born in the UK are put the breast within an hour of birth, but by age 6 weeks many babies are fully bottle-fed. These are some of the worst breastfeeding figures in the world…If we value children, their mothers and their other carers, then a step change is needed in breastfeeding support in the UK.”

Catherine Hine, The Breastfeeding Network (BfN), said:

“This Report must be a wakeup call. BfN hears time and time again from tens of thousands of women and parents we support every year, that they need the UK to step up. The overwhelming majority of women and parents want to breastfeed their children. The breastfeeding journeys of many of these families – especially those already in crisis – are heart-breakingly difficult or cut short.

“The solution is not to ignore either the voices of the overwhelming majority of women and parents, or the public health benefits of more women breastfeeding as they wish. What is needed is a robust, national strategy and long-term investment for UK families to benefit from comprehensive high-quality information and support. This must go hand in hand with government-led action to regulate marketing by a multi-billion-dollar industry, whose sustained attack on breastfeeding undermines women’s choice and mental health.”

Alison Morton, iHV CEO said:

“The iHV fully supports the WBTi Report’s recommendations, calling for better infant feeding policies, practices and support across the UK. Whilst the Report presents a mixed picture, with some improvements and areas of excellence that deserve recognition – the overall performance of the UK remains woefully poor, with unjustifiable variations in performance between the UK nations. Infant feeding support cannot be left to chance! The UK is one of the richest nations in the world, and families should expect a health and care system that is designed to achieve better outcomes. Supporting the highest standards for infant feeding is not only the right thing to do, it also makes sound economic sense.”

The WBTi Report sets out key recommendations:

National strategy – UK Government to establish a securely-funded national feeding strategy, time-bound action plan, multi-sectoral committee and national coordinator for England.
UNICEF UK Baby Friendly Initiative – UK Government to fully fund time-bound implementation and maintenance of BFI accreditation in all healthcare and community settings, as a service requirement.
UK infant formula legislation – UK government to:
- Widen the scope of the legislation to include marketing of all formula milks up to age 36 months, equipment (primarily bottles and teats) and digital marketing.
- Strengthen monitoring and enforcement of regulations.
Maternity protection – Governments to:
- Increase maternity, paternity and shared parental pay to at least the National Minimum Wage.
- Enact a statutory right to paid flexible breastfeeding breaks and suitable facilities to breastfeed, express and store milk in workplaces/education.
Health professional training – standards to include infant feeding as a mandatory pre-registration element for health workers who care for mothers, babies and young children.
Breastfeeding support services – Governments to:
- Maintain adequate maternity and health visiting staffing levels.
- All local authorities to commission integrated services meeting Baby Friendly standards: universal care from BFI-trained health professionals, a skilled peer support network and specialist services.
- Government/health departments to establish national standards for infant feeding roles.
Infant feeding in emergencies – national governments to develop and implement policies for Infant and Young Feeding during Emergencies (IYCFE) preparedness planning and responses, aligned with global guidance.

Read the World Breastfeeding Trends Initiative: Full UK Report, Summary and Nation Scorecards here

Members of the WBTi Core Group include:

Association of Breastfeeding Mothers (ABM)
Baby Milk Action
Baby Feeding Law Group
Breastfeeding Alliance
Breastfeeding Network (BfN)
First Steps Nutrition Trust (FSNT)
GP Infant Feeding Network (GPIFN)
Hospital Infant Feeding Network (HIFN)
Institute of Health Visiting (iHV)
Lactation Consultants of Great Britain (LCGB)
La Leche League GB (LLLGB)
L Leicester Mammas
Maternity Action
NCT
Royal College of Midwives (RCM)
UNICEF UK Baby Friendly Initiative (BFI)
University of Central Lancashire (UCLAN)

Researchers at the NIHR Children Policy Research Unit have published their latest paper “What do parents, professionals and policy colleagues want from a universal assessment of child development in the early years? A qualitative study in England” in the BMJ Open.

Launching the paper on social media, the researchers summarised the findings stating, “Parents and health visiting professionals in England want a measure of child development at 2-2½ years to be a springboard for a ‘warm conversation about what’s going on – covering child, sibling and parent wellbeing. Not just ‘tick, tick, tick’”.

Objective: Every child in England should be offered a health and development review at age 2-2½ years by the health visiting service, part of which includes an assessment of child development. To inform policy and practice, the study gathered the views and experiences of parents and health visiting professionals on key priorities for, and barriers to, a universal assessment of early child development at age 2-2½ years.

Design, setting, participants: Data were collected through 15 focus groups with 29 parents, 24 health visitors and nursery nurses, five service managers and five policy colleagues in England. Participants were asked to reflect on their experiences of, and priorities for, measuring child development at the 2-2½ year universal review.

Analysis: The research team analysed data using Reflexive Thematic Analysis.

Results: Two overarching themes were identified in the data:

The first theme, ‘just a part of the puzzle’: a useful tool in a holistic review, reflected a consistent priority – across all focus groups – for a measure of child development that was well embedded in the wider review, that facilitated conversations about the child and family system and allowed negotiation of parent and professional judgement of the child’s development, and had a clear stated purpose.
The second theme, ‘they need to know why they’re doing it: a need for clarification’, reflected the need for a clear purpose for, and less variable delivery of, the tool, including a need for clarification on its intended purpose to provide population-level data.

Conclusions: Parents and practitioners wanted a tool that facilitated a holistic conversation about development, wellbeing and health across the family system, with direct observation of the child by the professional. Used skilfully, the Ages and Stages developmental assessment tool can constitute an intervention in itself, as it helps scaffold a conversation about how parents can support their child’s optimal growth and development. Consideration should be given to the experience of and support available to the practitioner using the tool within the health and developmental review.

Responding to the publication, Alison Morton, iHV CEO said:

“The findings from this important research paper are no surprise – but it’s important to have them validated through research. When parents and health visiting practitioners were asked what they want from child development reviews, they both agreed – put the child in the centre, observe how they are developing and interacting with the world around them – listen to parents and work together to gain an understanding of the child as a unique person.

“And, above all, be focused on the purpose of the review and stop ‘ticking the box and missing the point’.

“The universal health visiting service in England only reviews all children at four mandated reviews between birth and school entry (the number of reviews, and programme of health visiting support, is much higher in the other UK nations) – at the very least, we owe it to our babies, children and families, to get this right.

“I hope that this research will act as a powerful catalyst for change and a shift back to more personalised care. Any tool that is used to support the assessment of child development and wellbeing must be used as part of a holistic assessment to support professional’s observation, parental report and clinical decision-making – not to replace it.”

iHV would like to extend thanks to the research team (Joanna L Lysons, Rocio Mendez Pineda, Maria Raisa Jessica Aquino, Hannah Cann, Pasco Fearon, Sally Kendall, Jennifer Kirman and Jenny Woodman) for this important research which brings out what parents and health visiting practitioners want from child development reviews.

Read the paper here