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]

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


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.

As a result RCOG Information for pregnant women is updated:

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:

  1. 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.
  2. 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.

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.

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.

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.

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.

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.

An article on Tongue-tie services in the UK has just been published in the June edition of MIDIRS Digest .

This paper reviews the evidence surrounding tongue-tie division (frenotomy) and reports on the findings of a national survey to map the provision of UK NHS tongue-tie services.  The findings emphasise the variability of service provision across NHS Trusts, and the limitations within the evidence base relating to assessment tools and intervention. There is a need for equitable access to skilled assessment and services to prevent both under- and over-diagnosis, and a need for all women to receive appropriate and timely breastfeeding support.

As a parents’ charity, to help address the variability and improve care for families, NCT recommends:

  1. All Trusts/boards have an infant feeding coordinator/team and are working towards achieving or maintaining Baby Friendly status, to provide at least the minimum level of skilled support with breastfeeding.
  2. Identifying priorities and securing funding for further research on tongue-tie, including longer term follow up, research into women’s experiences and identifying standardised diagnostic criteria and assessment tools.
  3. Development of evidence-based good practice protocols by NICE or as part of the Baby Friendly Initiative to include
  • commissioning of services, skilled assessment of feeding and clear criteria for referral for possible division,
  • skilled support with feeding immediately after division, follow up, with ongoing support readily available, regular audit and reviewing the training process.
  1. Easy access for all parents to a tongue-tie service, if needed, preferably provided by the local NHS Trust/board but, if not, with a clear referral route to a neighbouring Trust/board.
  2. Services to have sufficient capacity, in order to minimise waiting times.
  3. Recognition that mothers may have painful and upsetting experiences of tongue-tie and should have their concerns taken seriously.

An open letter on the crisis in breastfeeding in the UK has been issued today, signed by midwives, health visitors, paediatricians, lactation consultants, breastfeeding counsellors, peer supporters, university researchers and others who work for professional organisations and charities that support families – including the Institute of Health Visiting (iHV).

The letter follows the recent series in The Lancet on breastfeeding – the most comprehensive review of all the evidence on breastfeeding to date.

The open letter states: “The breastfeeding crisis in the UK is in fact a crisis of lack of support for those mothers who choose to breastfeed.” It highlights the recent cuts to breastfeeding support services and the infant feeding specialist posts, which are driven by cuts to public health, which amount to £200 million in total in England.

Cheryll Adams, Executive Director, Institute of Health Visiting, said:

“The uptake of breastfeeding is a major public health issue and the UK must address its very disappointing figures, laid bare by the Lancet, as a first step in also addressing many other health issues improved by breastfeeding, including the challenging year on year increase in childhood obesity which breastfeeding can protect against. A reduction in childhood obesity is a priority for the government so breastfeeding must now also be given priority status with mothers given access to the professional and voluntary support they need to breastfeed for as long as they wish.”

The open letter will be sent to all four governments of the UK and in particular to: Jane Ellison (Minister for Public Health), Ben Gummer (Minister for Care Quality), Duncan Selbie (Chief Executive, Public Health England) and Simon Stevens (Chief Executive of NHS England).