This still does not take into account the costs of savings from not purchasing formula milks and teats, costs of other diseases, for example, coronary heart disease, diabetes, eczema, Crohn’s disease, or the costs of illness in the mother, for example, ovarian cancer, breast cancer and osteoporosis.
Tappin (1997) suggests that the potential savings for a minimum gain of 2% breastfeeding increase at 6 weeks based on 10 000 births in Glasgow for pre-menopausal breast cancer would save £1000 whilst a 10% increase at 6 weeks would save £4000. Costs associated with dia-betes mellitus identify that a 2% increase at 6 weeks which would save
£19 000 whilst a 10% increase at the same time would save £98 000.
Tappin (1997) also predicted the cost incurred for the potentially life-threatening condition for vulnerable premature infants neonatal necrotising enterocolitis (NEC). Tappin (1997) calculated the savings per 10 cases, finding that giving breast milk to 60% of premature babies would avert four cases of NEC, saving £20 000, and if 100% of premature babies received nothing but breast milk, eight cases would be prevented with a saving of £40 000. In England, a hundred premature lives per year are lost from this condition alone; perhaps it is time to consider offering mother’s milk or donated breast milk to all vulnerable babies.
Furthermore, the emotional costs to a family can never be measured.
Other public health questions remain about the wider costs related to infant feeding, for example, women who feed their babies formula milk will have more absence from work related to childhood illnesses than their breastfeeding counterparts, and the negative impact of long-term population health will be greater in populations of formula milk-fed infants.
Conclusion
The prevailing strong bottle-feeding culture undermines the initiation of breastfeeding in a number of ways – the feeling of difference engen-dered by being a breastfeeding mother; the lack of expertise and support amongst both formal and informal networks; the lack of confidence in breastfeeding and the well-established ‘rules’ that bottle-feeding is the
‘norm’ and the easiest way to feed a baby. Yet, mothers report that they want consistent advice and skilled support to enable them to breastfeed successfully and for longer periods of time (Hamlyn et al. 2002). It can be suggested that mothers generally want to do the best for their babies and that they are beginning to understand the immense health benefits of breastfeeding. Many do their best to give this healthy start in life to their babies, yet this commitment is often undermined by professional practice.
Supporting continued breastfeeding through implementing a mul-tifaceted approach that aims to facilitate both appropriate structural change within the healthcare system and micro-level change within the individual (Dykes 2006) may be most effective. The interven-tions needed for this approach are those demonstrated within the UNICEF Baby-Friendly hospital and community programmes, train-ing for multidisciplinary staff, subsequent policy and practice changes, culturally appropriate education and peer support programmes, com-munity media activities based on comcom-munity empowerment (Robertson
& Minkler 1994) and social marketing techniques.
If midwives are to contribute to promoting, protecting and support-ing breastfeedsupport-ing, the adoption of the UNICEF Baby-Friendly initiative provides a framework to assist them. Although implementing UNICEF standards is a challenging process, organisations that have achieved this prestigious award feel a sense of pride, which resonates through enhanced staff morale. This enhances the opportunity for women to breastfeed for longer periods of time and staff feeling that they are equipped with the right skills and knowledge to help them. Imple-menting Baby-Friendly standards demonstrates the commitment of organisations to improving the health of local population groups and to reduce health inequalities.
Key implications for midwifery practice
•
Implementing UNICEF Baby-Friendly standards leads to increased breastfeeding rates and is likely to be cost-effective.•
The UNICEF programme empowers midwives, healthcare profession-als and mothers.•
Managed, paid, peer breastfeeding support is effective in increasing and sustaining breastfeeding.•
Do you know the inequality gaps in your area of practice? Consider ways in which you may help to narrow those gaps.•
Reflect on the ways in which current hospital practices may impact upon breastfeeding initiation rates and impact upon women’s choices.•
Consider how different cultures and society affect women’s feeding choices and think of ways that the culture can be altered to accom-modate exclusive breastfeeding.References
Aarts C, Kylberg E, Hornell A, Hofvander Y, Gebre-Medhin M, Greiner T (1999) Breastfeeding patterns in relation to thumb sucking and pacifier use.
Paediatrics 104: e50.
Acheson D (1998) Independent Inquiry into Inequalities in Health Reform. London:
The Stationary Office.
Atkins M (2008) Green and Gold the Value of Breastfeeding. Little Angels Conference. Conference Hall Blackburn.
Audit Commission (1997) First Class Delivery: Improving Maternity Services in England and Wales. London: Audit Commission.
Ball H, Ward-Platt M, Heslop E, Leech S, Brown K (2006) Infant sleep location the postnatal ward. Archives of Disease in Childhood. doi: 10.1136/adc.2006.099416.
Bailey C, Pain RH, Aarvold JE (2004) A give a go breastfeeding culture and early cessation among low income mothers. Midwifery 20 (3): 240–250, Elsevier.
Bolling K, Grant C, Hamlyn B, Thornton A (2007) Infant Feeding Survey. London:
NHS.
Broadfoot M, Britten J, Tappin DM (2005) The baby friendly hospital initiative and breastfeeding rates in Scotland. Archives of Disease in Childhood Fetal and Neonatal Edition 90: 114–116.
Broome A (1998) Managing Change. London: Macmillan Press LTD.
Calvert J (2005) Strategic planning: the Northern Ireland experience: changing health care practice to improve breastfeeding rates. UNICEF Annual Conference Notes. Bournemouth International Centre. November 2005.
CAPC/CPNP (2001) Think Tank: Factors that Contribute to Increased Breastfeeding in the CAPC/CPNP Population.
Christensson K, Cabera T, Christensson E, Uvnas-Moberg K, Winberg J (1995) Separation distress call in the neonate in the absence of maternal body contact.
Acta Paediatrica 84: 468–473.
Christensson K, Siles C, Morenol L (1992) Temperature, metabolic adaptation and crying in healthy full term newborns cared for in skin-to-skin or in a cot.
Acta Paediatrica 81: 448–493.
Dechateau P, Wiberg B (1977) Long-term effect on mother-infant behaviour of extra contact during the first hour post-partum. Acta-Paediatrica Scandinavica 66: 13–151.
Dennis CL (2002) Breastfeeding initiation and duration: a 1990–2000 literature review. Journal Obstetrics and Gynaecology Neonatal Nursing 31: 12–32.
Department of Health; National Breastfeeding Working Group (1995) Breast-feeding: Good Practice Guidance to the NHS. London: DOH.
Department of Health (1999) Saving Lives: Our Healthier Nation. London: Sta-tionary Office.
Department of Health (2000) The NHS Plan: A Plan for Investment a Plan for Reform. London: DoH.
Department of Health (2002) Improvement, Expansion and Reform-the Next Three Years. Priorities and Planning Framework. 2003–2006. London: DOH.
Department of Health (2003) Infant Feeding Recommendations. Available at www.dh.gov:uk/en/publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH4097197 (online accessed 12/07/09).
Department of Health and Social Security (DHSS) (1974) Present Day Practice in Infant Feeding. Report of a Working Party of the Panel on Child Nutrition Committee on Medical Aspects of Food Policy. London: HMSO.
Drane D (1996) The effect of teats and dummies on oro-facial development. Pre-sented at: National Conference of the Australian Lactation Consultants Association.
Hobart, Australia.
Dykes F (1995) Valuing breastfeeding in midwifery education. British Journal of Midwifery 3 (10): 544–547.
Dykes F (2002) Western marketing and medicine-construction of an insufficient milk syndrome. Health Care for Women International 23: 492–502. (Reprinted in full in Midwifery Information and Resource Service Journal (MIDIRS) (2002) 12: 527–531).
Dykes F (2003) Infant Feeding Initiative: A Report Evaluating the Breastfeeding Practice Projects 1999–2002. London: Department of Health.
Dykes F (2005) ‘‘Supply’’ and ‘‘Demand’’: breastfeeding as labour. Social Science and Medicine 60 (10): 2283–2293.
Dykes F (2006) Breastfeeding in Hospital, Cornwall: Routledge.
Dykes F, Williams C (1999) ‘‘Falling by the wayside’’: a phenomenological explo-ration of perceived breastmilk inadequacy in lactating women. Midwifery 15:
232–246.
Earle S (2002) Why some women do not breastfeed: bottle feeding and father’s role. Midwifery 16: 323–330.
Ekstr ¨om A, Widstr ¨om AM, Nissen E (2005) Process-oriented training in breast-feeding alters attitudes to breastbreast-feeding in health professionals. Scandinavian Journal of Public Health 33 (6): 424.
Fewtrell MS (2004) The long term benefits of having been breastfed. Current Paediatrics 14: 97–103.
Finigan V, Davies S (2004) ‘I just wanted to love, hold him forever’: women’s lived experience of skin-to-skin contact with their baby immediately after birth. The Royal College of Midwives. Evidence Based Midwifery Journal 2 (2):
59–65.
Fishbein M, Ajzen I (1975) Belief, Attitude, Intention and Behaviour: An Introduction to Theory and Research, Reading: Addison-Wesley.
Garcia J, Redshaw M, Fitzsimmons B, Keene J (1998) First Class Delivery: A National Survey of Women’s Views of Maternity Care, Oxon: Audit Commission.
Gerhardt S (2006) Why Love Matters. New York, London: Routledge.
Gregg JE (1989) Attitudes of teenagers in Liverpool to breast feeding. British Medical Journal 299 (6692): 147–148.
Gross SM, Caulfield LE, Bentley ME (1998) Counselling and motivational video tapes increase duration of breastfeeding in African American WIC partici-pants who initiate breastfeeding. Journal of the American Dietetic Association (2): 143–148.
Gwinn ML, Lee NC, Rhodes RH, Layde PM, Rubin GL (1990) Pregnancy, breastfeeding and oral contraceptives and risk of epithelial ovarian cancer.
Journal of Clinical Epidemiology 43: 559–568.
Hall Moran V, Dinwoodie K, Bramhall R, Dykes F (2000) A critical analysis of the content of tools measuring breastfeeding interactions. Midwifery 16:
260–268.
Hamlyn B, Brooker S, Oleinikova K, Wands S (2002) Infant Feeding Survey 2000, London: The Stationary Office.
Hartmann PE, Sheriff JL, Kent JC (1995) Maternal nutrition and milk synthesis.
The Proceedings of the Nutrition Society 54: 379–389.
Hauck FR, Omojokun OO, Siadaty MS (2005) Do pacifiers reduce the risks of SIDS? A meta-analysis. Pediatrics 116: 716–723.
Health Development Agency (2003) The Effectiveness of Public Health Interventions to Promote the Initiation of Breastfeeding: Evidence – Based Briefing, 1st Edition.
Geneva: Health Development Agency, NICE.
Hoddinott P, Pill R (1999) Qualitative study of decisions about infant feeding among women in east end of London. British Medical Journal 318: 30–34.
Hoddinott P, Pill R (2000) A qualitative study of women’s views about how health professionals communicate about infant feeding. Health Expectations 3: 224–233.
Horta BL, Bahl R, Martines JC, Victora CG (2007) Evidence on the Long Term Effects of Breastfeeding: Systematic Reviews and Meta Analyses. Geneva: World Health Organization.
Howard CR, Howard FM, Lanphear B, et al. (2003) Randomised clinical trial of pacifier use and bottle-feeding or cup-feeding and these effects on breast-feeding. Pediatrics 103: e33.
Howie PW, Forsyth JS, Ogston SA, Clark A, Florey C (1990) Protective effect of breastfeeding against infection. British Journal of Midwifery 300: 11–16.
Humenick S, Hill P, Spiegelberg R (1998) Breastfeeding and health professionals encouragement. Journal of Human Lactation 14: 305–310.
Kisten N, Abrahansan R, Dublin P (1994) Effects of peer counsellors on breast-feeding initiation, exclusivity and duration among low-income urban women.
Journal of Human Lactation 10: 11–15.
Kramer MS, Chalmers B, Hodnett ED, et al. (2001) Promotion of Breastfeeding Intervention Trial (PROBIT) – A randomised trial in the Republic of Belarus.
Journal of American Medical Association 285: 413–420.
Kroeger M, Smith LJ (2004) Impact of Birthing Practices on Breastfeeding, London Barb Mews: Jones and Bartlett Publishers.
Lagercrantz H, Slotkin TA (1986) The stress of being born. Scientific American April, 92–102.
Lehtonen J (1998) The effect of nursing on the brain activity of the newborn. The Journal of Pediatrics 132: 646–651.
Mahon-Daly P, Andrews GJ (2002) Liminality and breastfeeding: women nego-tiating space and two bodies. Health and Place 8: 61–76.
Marild S, Jodal U, Hanson LA (1990) Breastfeeding and urinary tract infection.
Lancet 336: 942.
Mathur GP, Mathur S, Khanduja GS (1990) Non nutritive suckling and use of pacifiers. Indian Pediatrics 27: 1187–1189.
Mattos-Graner RO, de Moraes AB, Rontani RM (2001) Relation of oral yeast infection in Brazilian infants and use of pacifier. ASDC Journal of Dentistry for Children 68 (1): 33–36.
McFadden A, Renfrew MJ, Dykes F, Burt S (2006) Addressing the learning needs for breastfeeding: Setting the scene. Maternal and Child Nutrition 2: 196–203.
Minchin M (1998) Artificial Feeding: Risky for any Baby. Nottingham: La Leche League Books.
Montagu A (1986) Touching: The Human Significance of the Skin, 3rd Edition.
New York: Harper Row.
Murray SF (1994) Baby Friendly Mother Friendly, London: Mosby.
National Case Control Study Group (1993) Breastfeeding and the Risk of breast cancer in young women. United Kingdom National Case Control Study Group. British Medical Journal 307: 17–20.
National Institute for Clinical Excellence (2005) The Effectiveness of Public Health Interventions to Promote the Duration of Breastfeeding [Systematic review] 1st Edition. London: National Institute for Clinical Excellence.
National Institute for Clinical Excellence (2006a) Routine Postnatal Care of Women and Their Babies. Nice Clinical Guideline 37. www.nice.org.uk/
CG037.
National Institute for Clinical Excellence (2006b) Full Guideline 2nd Draft for Consultation Routine Postnatal Care of Women and their Babies. National Collab-orating Centre for Primary Care.
National Institute for Clinical Excellence (2006c) Effective Action Briefing on the Initiation and Duration of Breastfeeding. Public Health Collaborating Centre for Maternal and Child Nutrition: Evidence and Guidance. Revised version.
National Institute for Clinical Excellence (2008) Improving the Nutrition of Preg-nant and Breastfeeding Mothers and Children in Low-income Households. NICE Public Health Guidance 11. London: National Institute for Clinical Excellence.
Newcombe PA, Storer BE, Longneckr MP (1994) Lactation and a reduced risk of premenopausal breast cancer. The New England Journal of Medicine 330:
81–87.
Nicoll A, Thayaparan B, Newell M, Rundall P (2002) Breast feeding policy, promotion and practice in Europe. Results of a survey with non-governmental organizations. Journal of Nutritional and Environmental Medicine 12 (3): 255–264.
North West Framework for Action (2008) Addressing Health Inequalities A North West Breastfeeding Framework for Action, Manchester: North West Regional Public Health Group.
Odent M (2003) Birth and Breastfeeding, Sussex: Clairview Books.
Palmer G (2003) It’s the belief that’s important. Practising Midwife 6 (10): 20–22.
Paronen J, Knip M, Savilahti E (2000) Effect of cow’s milk exposure and maternal type 1 diabetes on cellular and humoral immunization to dietary insulin in infants at genetic risk for type 1 diabetes. Finnish trial to reduce IDDM in the Genetically at Risk Study. Diabetes 49: 1657–1665.
Penrose–Arlotti J, Hanson-Cottrell B, Hughes-Lee S, Curtin JJ (1998) Breast-feeding among low income women with and without peer support. Journal of Community Health Nursing 15 (3): 163–178.
Perez-Escamillia R, Pollitt E, Lonnerdal B, Dewey KG (1994) Infant feeding policies in maternity wards and their effect on breastfedding success: an analytical overview. American Journal of Public Health 84(1): 89–97.
Pettitt DJ, Bennett PH, Saad MF, Charles MD (1997) Abnormal glucose tolerance during pregnancy in Pima Indian Women: Long term effects on offspring.
Lancet 350 (9072): 166–168.
Philipp BL, Malone KL, Cimo S, Merewood A (2003) Sustained breastfeeding rates at a US Baby-Friendly Hospital. Pediatrics 112: e234–e236.
Porteous RM, Kaufman K, Rush J (2000) The effect of individualised professional support on duration of breastfeeding: a randomised control trial. Journal of Human Lactation 16 (4): 303–308.
Renfrew MJ, Dyson L, Wallace L, D’Souza L, McCormick FM, Spiby H (2005) The Effectiveness of Health Interventions to Promote the Duration of Breastfeed-ing; Systematic Review, London: National Institute for Health and Clinical Excellence.
Righard L, Alade MO (1990) The time has come to reassess delivery ward routines. Lancet 336: 1105–1107.
Riordan J (2005) Breastfeeding and Human Lactation, 3rd Edition. Library of Congress Cataloguing-in-Publication Sudbury, MA: Jones & Bartlett Pub-lishers.
Robertson A, Minkler M (1994) New Health Promotion Movement: a critical examination. Health Education Quarterly 21 (3): 295–312.
Rogers C (1961) On Becoming a Person, Boston: Houghton Miltin.
Rossenblatt KA, Thomas DB (1993) WHO collaborative study of neoplasia and steroid contraceptives. International Journal of Epidemiology 22: 192–197.
Scott JA, Binns CW (1999) Factors associated with the initiation and duration of breastfeeding. Breastfeeding Review 71: 15–16.
Shore C, Burrs S, Elliot K, Harper M, Jones S, McMahon J, Owen K, Radford A, Williams A (1998) Breastfeeding in Paediatric Units; Guidance for Good Practice.
London: RCN.
Short RV (1994) What the breast does for the baby, and what the baby does for the breast. Aust NZ Journal Obstet Gynaecol 34 (3): 262–264.
Simmons V (2003) Inconsistent advice and practice:part 3. British Journal of Midwifery 11: 564–567.
Sirkoski J, Renfrew MJ (1999) Support for breastfeeding mothers (Cochrane Review).
In The Cochrane Library, Issue 2, Oxford Update Software.
Smale M, Renfrew MJ, Marshall JL, Spiby H (2006) Turning policy into practice;
more difficult than it seems. The case of breastfeeding education. Maternal and Child Nutrition 2: 103–113.
Tappin D (1997) Health Service potential cost savings with increased breast-feeding rates. Greater Glasgow Health Board Breastbreast-feeding Strategy, Yorkhill:
Peach Unit
Tarkka MT, Paunonen M, Laippala P (1998) What contributes to breastfeeding success after childbirth in a maternity ward in Finland? Birth 25: 175–181.
UK National Case Control Study Group (1993) Breastfeeding and the risks of breast cancer in young women. British Medical Journal 307: 17–20.
UNICEF (1991) State of Worlds Children, Oxford: Oxford University Press.
UNICEF (2007) http://www.babyfriendly.org.uk/.
UNICEF (2008) Infant Feeding Survey 2005: Findings Related to the Baby Friendly Initiative. http://ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/infant-feeding/infant-feeding-survey-2005.
UNICEF UK BFI (1998) A Seven Point Plan for the Protection; Promotion and Support of Breastfeeding in Community Health Care Settings. London: UNICEF.
http://www.babyfriendly.org.uk/.
UNICEF UK BFI (2005) Baby Friendly Initiative Teaching Packs. Avail-able at: http://www.babyfriendly.org.uk/teaching-packs.asp (accessed 11/11/2008).
Valdes V, Pugin E, Miriam H, et al. (1995) The effects on professional practice of a three day course on breastfeeding. Journal of Human Lactation 11: 185–190.
Vogel AM, Mitchell EA (1998) The establishment and duration of breastfeeding, part 1: hospital influences. Breastfeeding Review 6: 5–9.
Whelan A, Lupton P (1998) Promoting successful breastfeeding among women of low income. Midwifery 14: 94–100.
Wiberg B, Humble K, de Chateau P (1989) Long-term effect on mother-infant behaviour of extra contact during the first hour postpartum: follow-up at three years. Scandinavian Journal of Social Medicine 17: 181–191.
Wilson AC, Forsyth JS, Greene SA, Irvine L, Hay C, Howie EW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. British Medical Journal 316: 21–25.
Woolridge M (1994) The baby friendly hospital initiative UK. Modern Midwife 4 (50): 29–30.
World Health Organisation (1981) International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO.
World Health Organisation (1998) Evidence for the Ten Steps To Successful Breast-feeding, Geneva: WHO.
World Health Organisation (2007) Evidence on the Long-Term Effects of Breastfeed-ing: Systematic Reviews and Meta-analyses. Geneva: Department of Child and Adolescent Health and Development (CAH), World Health Organization.
Wright S (1998) Politicisation of ‘‘culture.’’ Anthropology in Action 5: 3–10.