What is the data telling us?

Despite the widely acknowledged benefits of breastfeeding the number of women who breastfeed their babies in the three north of Tyne Primary Care Organisations (PCO) is well below the national average of 78% for initiation.  This trend is also reflected in the sustaining rates which are also well below the national average of 50%. Under the previous government the Priorities and Planning Framework 2003/2004-2005/2006 Improvement, Expansion and Reform, identifies a specific target of an annual 2% increase in initiation rates for breastfeeding. Locally the current targets for initiation reflect the national target of a year on year 2% increase.

Targets for the next five years focus on sustaining rates, specifically the number of babies who are breastfed at 6 to 8 weeks of age and this is included in the Child Health and Wellbeing PSA indicator 12: Prevalence of breastfeeding at 6 -8 weeks after birth. The current government has not yet announced any new targets relating to improving breastfeeding rates; however it important that the focus on initiation continues in order to see an increase in sustaining rates.

Figure 1 shows both initiation and 6 -8 week data for the three Primary Care Organisations (PCOs) North of Tyne for the last two years. Initiation across all three areas is approximately 60% of all births, whilst the sustaining rates are approximately 40%. These figures are below of the national average of 78% initiation and 50% sustaining. However, data for the 2009-10 year end for Newcastle shows a sustaining rate of 40.2% which is above the target of 33.6%.

Figure 2 shows the percentage of babies for whom a breastfeeding status is known. As can be seen coverage is high with all three PCOs increasing their coverage rates to over 90% in 2009/2010.

It can be seen from Figure 3 that although initiation rates are comparable across the North of Tyne area and are gradually increasing the rates remains well below the England average.

Breastfeeding rates and deprivation

As the data in Table 2 and Figure 4 show, there is generally decreasing levels of breastfeeding with increasing levels of deprivation.  The percentage of babies being exclusively breastfeed is almost three times higher in the least deprived parts of the city compared with the most deprived.

Breastfeeding rates by GP practice

There is also wide variation across the GP practices in the city with the percentage of mothers breastfeeding (either exclusively or partially) ranging from 13.1% to 88.9%.

Breastfeeding rates by Maternal age

Newcastle data shows that the percentage of babies being breastfeed is more than three times higher amongst those born to women aged 20 and above compared to those aged less than 20 years (Table 3 and Figure 6).

                                              

What is the story behind the data?

Despite the widely acknowledged benefits of breastfeeding, the number of women who breastfeed their babies in Newcastle is well below the national average of 78% for initiation. (National Infant Survey 2005) This trend is also reflected in the sustaining rates (measured at 6-8 weeks from birth) which are also well below the national average of 50%.

Younger mothers, mothers from lower socioeconomic groups and mothers with lower educational levels appear least likely to initiate and continue breastfeeding.  Research suggests that reasons include embarrassment, lack of role models, fear of pain, misconceptions that their baby will not gain sufficient weight from breastfeeding alone and exposure to a bottle feeding culture, which promotes the use of artificial milk (Shaw et al, 2003).

Many young mothers lack access to key sources of information and advice on infant feeding such as antenatal classes, peer support programmes, friends, family and other social support networks. Although all women have access to community midwives and health visitors after discharge from hospital, young first-time mothers in particular may not ask for information or advice on issues such as breastfeeding. Social policies affecting educational attainment may also be important factors in feeding practices and breastfeeding rates may be influenced by health education specifically or by more general levels of schooling among mothers.

In Newcastle breastfeeding data is recorded at different stages throughout the first year of a baby's life. Initiation of breastfeeding is recorded by midwifery staff at the time of the birth of the baby and on discharge home from the post natal ward. Although the information is not required in accordance with existing Department of Health targets, community midwives also record method of feeding into the child's personal health record book at the point of transferring care to the designated health visitor. This is usually on day 10, but could be recorded as late as day 28 following delivery, depending on how long the community midwife chooses to visit.  Breastfeeding status is also recorded at 6-8 weeks by the GP and the health visitor. Data is recorded on to the Child Health Information System and this data is produced on a quarterly basis to meet the Department of Health reporting requirements.

What are the gaps in the data?

There has been considerable work to improve data collection and this has resulted in almost 100% data return which means that we have a more accurate picture of the number of breastfed babies.  

At present the acute hospitals are not able to provide patient level data on breastfeeding initiation.  This prevents an analysis of initiation rates by geographical area or level of deprivation which is essential if we are to effectively monitor and address health inequalities.

Recent work has focused on trying to identify the drop off rate for breastfeeding between discharge from hospital and the first contact in the community by the health visitor. This is because we know that a lot of women will be breastfeeding when they leave hospital but by the time the health visitor visits at 10 days of age, they have stopped. The reason for collecting this data is so that we can try to find the best way to support women to continue to breastfeed.

There is no easily available data regarding support programmes including peer Support referrals and attendance rates at the cities three breastfeeding Baby Cafes.  Current work involves an evaluation of the different support groups across the city, in order to identify what women value and also to gain the views of the health care professionals who are often the main referrer of women to peer support and support groups.

What are the national and local drivers?

The importance of increasing breastfeeding rates for the benefit of the population is reflected in the following local, regional and national documents.

• NHS North of Tyne Strategic Plan 2010-2014.
• Our Vision, Our Future Our North East NHS: A Strategic Vision for Transforming Health and Healthcare Services within the North East of England.
• North East Breastfeeding Framework 2010.
• North East Infant Feeding, Weaning and Nutrition Guidelines: for Babies and Children under 5 years.
• Healthy Lives, Brighter Futures: The Strategy for Children and Young People's Health.
• Healthy Weight Healthy Lives: A Cross-Government Strategy for England.
• NICE Clinical Guideline No 37: Postnatal Care: Routine Postnatal Care for Women and their Babies.
• NICE Public Health Guidance 11: Improving the Nutrition of Pregnant and Breastfeeding Mothers and Children in low-income households.
• Tackling Health Inequalities: A Program for Action.
• Every Child Matters.
• Maternity Matters.
• Standards of Maternity Care: Report of a Working Party.
• Delivering Choosing Health.
• The NHS in England: the Operating Framework for 2009/10.
• Review of the Health Inequalities Infant Mortality PSA target.

Breastfeeding is also identified as a priority for partners in the local authorities and, in addition to the JSNA, is included in the following:

• Comprehensive Citywide Breastfeeding Strategy 2006 -2011 (Link)
• The Citywide Breastfeeding Strategy Action Plan (Link)

What is currently working here or elsewhere?

In 2006 NICE guidance Routine postnatal care of women and their babies (www.nice.org.uk) made a recommendation that all maternity providers should implement an externally evaluated structured programme such as the Baby Friendly Initiative (www.babyfriendly.org.uk ) to encourage and support breastfeeding. This was reinforced in further guidance published in 2008 Maternal and Child Nutrition. Work has since been focused on achieving Baby Friendly accreditation. Improving staff knowledge and skills and providing peer support has been shown to help women to breastfeed for longer.

All women are offered breastfeeding information, advice and guidance in the routine care offered by midwives and health visitors. This is provided through one to one consultations and through infant feeding workshops which are provided in the antenatal period.  Further support is offered in the postnatal period by health visiting teams and children's centres.

Newcastle has been training peer supporters for several years now and there are number of breastfeeding support groups which provide information, advice and support for breastfeeding women across the city.

What should we be doing next?

The main focus of the work is to achieve UNICEF Baby Friendly accreditation across community, hospital and children's services. Two infant feeding coordinators have been appointed to project manage the work required to achieve UNICEF baby friendly accreditation.

• Training: Deliver training so that all midwives and health visitors are trained to UNICEF BFI standars.
• Training: All early years' staff trained to UNICEF standards to support and signpost women to services to support breastfeeding.
• Information and support:  Relevant information on breastfeeding for women in the ante and postnatal period. This must be cognisant of the need to provide translated literature to women where English is not their first language.
• Publicity: More positive publicity for breastfeeding building on social marketing work. Encourage the provision of adequate breastfeeding facilities in both the work place and in public places.
• Funding: NHS North of Tyne have commissioned Newcastle Hospitals and the PCT to progress the work towards baby friendly accreditation. A business plan has been submitted to secure funding past March 2011 in order to ensure that this work is able to progress.
• Improvement of data collection: The work to improve data collection must continue to enable effective and accurate monitoring as well as evaluation of the ongoing effort to increase breastfeeding rates in Newcastle.