WBTi Report shows more needs to be done to support breastfeeding in UK

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)

Get ready for National Breastfeeding Week (18-24 September 2023)

This year’s National Breastfeeding Week will be taking place from 18-24 September. The week is being promoted by the Department of Health and Social Care (DHSC) ‘Better Health Start for Life Breastfeeding’ team and builds on last year’s theme, ‘Everyone has a part to play in helping mums to breastfeed’. This will include daily themes and activities showing how families, community and health and education services all have a part to play in supporting mothers to have the feeding experience they hoped for.

The DHSC team have produced an extensive suite of free resources and campaign materials to help support any planned activity, to promote local activities and signpost your local population to their breastfeeding support tools, such as the Start for Life Breastfeeding Hub. There is still time to get involved.

The 2023 National Breastfeeding Week social media toolkit is available to help you promote the week in your area and through your social media channels. The toolkit contains:

9 x Images
Content calendar containing:
Suggested post copy
Web links
Suggested timeline for posts

Download the toolkit here and help spread the message of this year's theme 'Everyone has a part to play in helping mums to breastfeed'

To support National Breastfeeding Week at the iHV, we will have an infant feeding stand at our iHV Evidence-based Practice Conference on Thursday 21 September, with an extensive suite of free resources and campaign materials. If you are attending our conference in person, stop by and say hello to our team and Expert Adviser for infant feeding. We will be distributing free resources to support your work, including:

The ‘Off to the best start breastfeeding’ A4 leaflet and wallet card, as well as a wallet card dispenser
Empty belly posters to allow partners to add local information on breastfeeding
Editorial content for use in local publications

Follow #NationalBreastfeedingWeek on Twitter for all the latest activity.

Leading experts join iHV’s team of specialist advisers

iHV has a committed and highly regarded team, with professional expertise in numerous public health priority topics for babies, young children, and families. We also engage with practitioners and parents/ carers to support the co-production of our work and outputs through our Health Visitor Advisory Forum, regular networking events, surveys, and bespoke project and training co-production groups.

To strengthen the iHV team, we also have a growing number of Expert Adviser roles. These voluntary roles are a critical part of ensuring that the perspectives of our members are represented and that the iHV’s decisions and policy positions are rooted in current practice and evidence.

Following an open recruitment process, we have recently appointed two new iHV Expert Advisers to join our existing advisers, for the specialist topics of infant feeding and safeguarding. Our new expert advisers are health visitors and leading experts in their field and their role is to offer expert subject guidance, to support the work of the iHV.

We are absolutely delighted to announce our new iHV Expert Advisers:

Pippa Atkinson – iHV Expert Adviser for Infant Feeding

Pippa is an experienced health visitor and an International Board-Certified Lactation Consultant. She has worked as a specialist health visitor in infant nutrition. Pippa has experience of leading on the implementation of the Baby Friendly Initiative (BFI) standards for health visiting and was the clinical lead for a breastfeeding peer support service, providing specialist support to families.

Currently, Pippa is a lecturer in Health Visiting and is the BFI health visiting lead at the University of Central Lancaster (UCLan). Pippa is also a National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North West Coast (NWC) doctoral fellow, exploring how the BFI standards influence the infant feeding experiences of women from different socio-economic backgrounds.

Trish Stewart – iHV Expert Adviser for Safeguarding

Trish Stewart is the Associate Director of Safeguarding at Central London Community Healthcare NHS Trust (CLCH), managing a team of safeguarding children and adult specialist practitioners, working across 11 London boroughs and Hertfordshire.

Trish has experience in complex case management, partnership working, strategic planning and quality assurance in healthcare, including public health nursing and general practice. Trish’s interest in leadership in safeguarding led her to undertake the Elizabeth Garrett Anderson Programme with the NHS Leadership Academy, gaining a Master’s in Healthcare Leadership (MSc) and a Senior Healthcare Leadership Award in 2017.

Trish’s passion for safeguarding and supporting frontline practitioners is something she hopes to further champion with the iHV.

Find out more about all our Expert Advisers

COVID-19 exposes fragility of infant feeding support in the UK

With breastfeeding support under strain, service providers propose plan to tackle inequalities

This World Breastfeeding Week (1-7 August 2020), the Institute of Health Visiting joins the voice of the Breastfeeding Network who are calling on the UK government to address the fragility of breastfeeding support services.

Our organisations have seen first-hand how the COVID-19 crisis has exposed the fragility of infant feeding support available for women, parents and families.

Over the past few months, the need to support babies and families has escalated and support services have been stretched beyond anything in our experience.

Existing variations in provision for infant feeding support have increased as services have been cut, health visiting teams redeployed and provision moved online, leading to unknown outcomes on infant nutritional health, worsening maternal mental health and widening health inequalities.

Tremendous efforts from the NHS and Third Sector organisations, including many volunteers on the National Breastfeeding Helpline and other charity-run helplines, along with swift adaptation to offer online support, have provided many families with support but this is not sustainable without a longer term strategy.

Meanwhile, the need to protect infant and young child feeding in pandemic emergencies has not previously been considered and has been entirely missing from the Scientific Advisory Group for Emergencies’ reports

Investing in the health of new families, including supporting and protecting breastfeeding and supporting safe and responsive formula or mixed feeding, enables children not just to survive, but to thrive.

Rebuilding infant feeding support for communities after Covid-19 and giving important attention to the needs of mothers and children from Black, Asian and minority ethnic backgrounds will help tackle inequalities.

Infant feeding is a critical component of first 1001 Days and Early Years Health

We welcome the appointment of Andrea Leadsom MP as the Government’s Early Years Health Adviser and the announcement of a review at a time when infant feeding support services for women, parents and families have been stretched to an unprecedented degree.

Protecting breastfeeding and ensuring safe and responsive formula and mixed feeding during those first 1001 days would make a significant contribution to reducing inequalities in health. As a result, it also upholds the work of the NHS and helps build a healthier population.

While COVID-19 has undoubtedly placed a strain on support systems, it has also highlighted a huge omission in UK policy on planning for the care and feeding of infants and young children in case of emergencies, leaving our youngest members of society vulnerable.

While the benefits of breastfeeding are well-evidenced, merely stating these benefits does not ensure breastfeeding is protected or supported. At a time of global health crisis, and increasing recognition of the impact of human behaviour on the health of our planet, support for breastfeeding is also an environmental imperative.

10-point Infant Feeding Action Plan to address Inequalities

We call on the UK government to adopt the following 10-point Infant Feeding Action Plan below which has a particular focus on working to reduce inequalities:

1. For the new Government Early Years Advisor to appoint a permanent, multi-sectoral maternal, infant and young child nutrition strategy group to implement a national strategy to support good nutrition across the first 1001 days.

2. To commission and sustainably fund universal, accessible, confidential breastfeeding support delivered by specialist/lead midwives, health visitors and suitably qualified breastfeeding specialists, recognising the role of charitable organisations and community groups and their strong links with communities.

3. Ensure there are children’s centres or family hubs, disproportionately located in areas of disadvantage, offering joined-up universal services from pregnancy onwards, that include breastfeeding peer support, guidance on the introduction of solids and eating well in the early years.

4. To ensure that health visiting services are properly funded and the number of health visitors increased to ensure consistent timely nutritional support for all families to support good maternal and infant mental and physical health.

5. To integrate planning to support infant and young child feeding in emergencies into legislation, the Civil Contingencies Act, and Local Resilience Forums across the country.

6. To recognise the importance of breastmilk for preterm and vulnerable babies and the need for equitable access to donor breastmilk for these babies through the establishment of a fully funded regional donor milk banking service.

7. To implement the Unicef UK Baby Friendly Initiative across community, hospital and neonatal services, building on the recommendation for all maternity services to be accredited in the NHS Long Term Plan.

8. To make it a statutory right of working mothers to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.

9. To support the commitment to re-instate the quintennial Infant Feeding Survey which builds on data previously collected every five years since 1975, most recently in 2010.

10. To protect babies from harmful commercial interests by bringing, as a minimum, the full World Health Organisation International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.

For enquiries, please email [email protected]

Infant feeding guidance and pregnancy guidance during COVID-19 outbreak

Many parents are very concerned about how to feed their babies during the COVID-19 outbreak. Here, we share the latest statement on best practice from Unicef UK Baby Friendly Initiative – who also suggest that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) as these could change as more information becomes available.

The Unicef statement (on the link below) includes:

Public Health England (PHE) guidance – If you are breastfeeding while infected
Accessing infant formula – information from First Steps Nutrition Trust

Go to Unicef website - Infant feeding during the COVID-19 outbreak

Download pdf version of Unicef UK - Infant feeding during the COVID-19 outbreak

In addition, the Royal College of Obstetricians and Gynaecologists (RCOG) has updated their guidance on Coronavirus (COVID-19) infection and pregnancy (published today 18 March) to reflect the announcement on Monday evening (16 March) that pregnant women have been placed in a ‘vulnerable group’. Check the summary of updates on pages 3-5 to see all the changes.

Go to RCOG updated guidance

As a result RCOG Information for pregnant women is updated:

Go to RCOG Information for pregnant women and their families

iHV welcomes SACN ‘Feeding in the first year of life’ report

The Scientific Advisory Committee on Nutrition (SACN) has published its report on ‘Feeding in the first year of life’, providing recommendations on infant feeding from birth up to 12 months of age.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“We welcome the SACN ‘Feeding in the first year of life’ report and having timely access to the latest advice and recommendations on infant feeding, especially reinforcing the existing guidance on breastfeeding and the introduction of solids.

“I would like to advise all health visitors to read the report and its recommendations and ensure that they use it to inform all nutritional advice they give to parents.”

SACN recommends babies are exclusively breastfed until around 6 months of age and continue to be breastfed for at least the first year of life. Additionally, solid foods should not be introduced until around 6 months to benefit the child’s overall health. This represents no change to current government recommendations.

SACN recommends that a wide variety of solids foods, including iron-containing foods should be introduced in an age appropriate form from around 6 months of age.

SACN recommends that advice on complementary feeding should state that foods containing peanut and hen’s egg can be introduced from around 6 months of age and need not be differentiated from other solid foods. The deliberate exclusion of peanut or hen’s egg beyond 6 to 12 months of age may increase the risk of allergy to the same foods.

Other recommendations include:

Breast milk, infant formula and water should be the only drinks offered between 6 and 12 months of age. Cows’ milk should not be given as a main drink, as this is associated with lower iron status.
A wide range of solid foods, including foods containing iron, should be introduced from around six months of age, alongside breastfeeding. These foods should have different textures and flavours and may need to be tried several times before the infant accepts them, particularly as they get older.

Breastfed infants up to 12 months should receive a daily supplement containing 8.5 to 10µg of vitamin D (340-400 IU/d). Formula-fed infants do not need a supplement unless consuming less than 500ml of infant formula a day.

Go to Feeding in the first year of life: SACN report

APPG inquiry infant formula costs – Important opportunity to provide HV experience of impact

Health visitors at the frontline can provide feedback into this All-Party Parliamentary Group (APPG) Inquiry into infant formula costs.

The All-Party Parliamentary Group (APPG) on Infant Feeding has launched an inquiry on the costs of infant formula to families in the UK and the impact that the choice of infant formula, and the purchase of infant formula, is having on the health, well-being and financial situation of families.

The inquiry wants to hear stories from families themselves, from those that care and support pregnant women and families with infants and children, those who work with food redistribution or food banking projects, with faith groups supporting communities and anyone else who has information to share on how families choose a brand of infant formula and manage the costs of formula feeding.

Health visitors at the frontline will have seen and heard how this is impacting on families – and can provide feedback into the APPG Inquiry.

The inquiry wants to collect stories and information from the recent past that may be lived experience, reported by others to you or which has been collected as part of other work. The focus is on infant formula costs, choice of infant formula and the impact of this on the health, well-being and finances of formula feeding families.

The deadline for submissions is 26 June 2018.

Go to the APPG inquiry on infant formula costs

Please do use this opportunity to provide your feedback to this inquiry – as it is an important opportunity to feed in HV experience of impact.

Please note:

The APPGIFI strongly believes that breastfeeding should be protected and promoted in the UK and that all women who wish to breastfeed should receive support to do so (as long as there is no medical reason to advise against it). This inquiry however focuses on UK families who use and purchase infant formula in the first year of their infant’s life, many of whom may exclusively formula feed for the majority of that time.

Infant Feeding e-learning programme now live

A new e-learning programme to support education around the implementation of Baby Friendly standards in healthcare and public healthcare settings has been developed.

The programme is for healthcare professionals who have contact with pregnant women and new mothers. It aims to provide information about the importance of building close and loving relationships with baby during pregnancy and following birth, as well as information around breast and bottle feeding.

Topics covered by the session include:

Challenges and Culture
Importance of Breastfeeding
Importance of Love
Formula Feeding
Providing Unbiased Information.

This programme is not intended to replace existing training. Instead it is intended to complement training for those in facilities which are implementing Baby Friendly standards.

It has been developed by Health Education England, e-Learning for Healthcare (e-LfH) and the National Infant Feeding Network (Yorkshire and Humber). Unicef Baby Friendly Initiative has also given their
support to the programme.

For more information about the Infant Feeding e-learning programme and for details of how to access the programme visit: https://www.e-lfh.org.uk/programmes/infant-feeding/

The e-learning programme is available via the e-LfH Hub and the Electronic Staff Record.

PHE – Open consultation Feeding in the first year of life

The Scientific Advisory Committee on Nutrition (SACN) consultation on its draft report ‘Feeding in the first year of Life’ is open for comment.

Health visitors are invited to submit comments relating to the scientific content of the draft SACN report ‘Feeding in the First Year of Life’. You are also invited to draw the committee’s attention to any evidence that it may have missed.

By The original uploader was Ellywa at Dutch Wikipedia – Transferred from nl.wikipedia to Commons., Public Domain, https://commons.wikimedia.org/w/index.php?curid=7113434

Please ensure that any evidence you bring to SACN’s attention satisfies the inclusion and exclusion criteria summarised in the ‘consultation invitation’, see link below.

Please send your responses to [email protected] by 5pm on 13 September 2017.

All responses will be published following the conclusion of the consultation.

Go to PHE consultation on Feeding in the First Year of Life

Launch of Commissioning Guidance for Infant Feeding

PHE and Unicef UK are delighted to announce the launch of “Commissioning Infant Feeding Services: A toolkit for Local Authorities”.

This publication provides guidance to help local commissioners protect, promote and support breastfeeding. The document is jointly branded by Public Health England and Unicef UK and includes endorsements from:

Sally Davis, Chief Medical Officer
Viv Bennett, Chief Nurse
Kevin Fenton, Director, Public Health England

The document has several parts:

Summary: highlights key messages and themes.
Part 1, Infographics: these colourful, easy to use slides give a concise and accessible overview. Please feel free to use these in your own presentations.
Part 2, Toolkit: details what success would look like for a commissioner working within their local authority to promote, protect and support breastfeeding.
Part 3, Data: sets out guidance on effective data collection, monitoring and reporting.

Commissioning Infant Feeding Services: A toolkit for Local Authorities