Mixed messages and social stigma at heart of UK's low breastfeeding rate, says Royal College

Social stigma is a major barrier to breastfeeding, and more must be done to support women to continue breastfeeding beyond the first few weeks according to new recommendations published today by the Royal College of Paediatrics and Child Health (RCPCH).

The new guidance, backed by midwives and health visitors, is based on the latest research and aims to give practical advice on how long women should consider breastfeeding.

It also makes the case for the health benefits of breastfeeding for both mother and child, as well as the cost savings to families and health services.

The RCPCH advises:

· Mothers should be encouraged and supported to breastfeed exclusively for up to 6 months

· Solid food should not be introduced before 4 months

· Solid food should be introduced from 6 months, ideally alongside breastfeeding to ensure the infant has adequate nutrition

· Mothers should be supported to continue breastfeeding for as long as they wish; in countries such as the UK evidence is lacking to recommend any particular duration of breastfeeding

The RCPCH also points to Unicef research that concludes even moderate increases in breastfeeding could save the NHS up to £40 million a year through fewer General Practitioner consultations and hospital admissions.

RCPCH President, Professor Neena Modi, said:

“World Breastfeeding Week is 25 years old today, but the UK has little to celebrate in terms of its record. The health benefits of breastfeeding are beyond question, from reduced likelihood of intestinal, respiratory and ear infections to hospitalisation.

“Regrettably the attitudes of a large part of society mean breastfeeding is not always encouraged; local support is patchy, advice is not always consistent and often overly dogmatic, support in the workplace not always conducive to continued breastfeeding and perhaps most worryingly breastfeeding in public is still often stigmatised. It is no wonder that for many mothers, there are too many barriers.”

The statement warns that the rate of breastfeeding in the UK is among the lowest in world and shows little sign of improving. Latest figures show that only 40% of babies are breast feeding at 6 – 8 weeks of age. To put this in context, at 6 months in Norway this figure is over 70%.

Explanations for the low prevalence of breastfeeding in the UK are complex and multiple. Women report difficulties in establishing breastfeeding, concerns about whether their baby is receiving enough milk and societal attitudes which leave them uncomfortable about breastfeeding in public or around friends and family. In addition, a lack of practical support and occasionally conflicting or overly dogmatic advice from healthcare professionals has also been cited.

The RCPCH is therefore calling for a collective, long-term plan to change the culture of breastfeeding involving educating children at school, families and the wider public.

Professor Modi said: “With the right support and guidance, the vast majority of women should be able to breastfeed. But although it’s natural, it doesn’t always come naturally. Some mothers cannot, or choose not to, breastfeed and this also needs to be respected. What society must get better at is removing the multiple barriers which can stand in the way of breastfeeding.

“Women, their families, no less children and society at large need information that is sensible and not overly dogmatic. Mums need support at the right time and place, including in the workplace from their employers, and a culture that promotes and encourages breastfeeding as a natural and positive thing to do. There must be a coordinated and determined approach across all the society if the situation is to be improved.”

The RCPCH recommendations include:

· Governments in each nation to ensure familiarity with breastfeeding is included as part of statutory personal, social and health education in schools

· UK Government to legislate for employers to support breastfeeding through parental leave, feeding breaks and facilities suitable for breastfeeding or expressing breast milk

· Local breastfeeding support to be planned and delivered to mothers in the form of evaluated, structured programmes.

· The NHS to ensure the preservation of universal midwifery services.

· UK Governments to commit to adequate resourcing to preserve universal health visiting services

· Public Health England to develop a national strategy to change negative societal attitudes to breastfeeding

· Welsh, Scottish and Northern Ireland Governments to review and evaluate their existing breastfeeding promotion plans

· The NHS in England and the Welsh Government to follow the lead of the Scottish Government and the NHS in Northern Ireland by ensuring all maternity services achieve and maintain UNICEF Baby Friendly Initiative accreditation; this requirement is currently met by all maternity units in Scotland and Northern Ireland.

· UK Government to reinstate the UK-wide Infant Feeding Survey, which was cancelled in 2015, to ensure reliable, comparable data on breastfeeding is recorded across the four nations

· All healthcare professionals should be aware of local and national support for breastfeeding mothers

The RCPCH statement marks the start of an ongoing campaign to improve breastfeeding in the UK, which it will deliver in partnerships with other organisations.