Breastfeeding As A Public Health Issue

“Breastfeeding is beneficial to the health of both women and infants” (WHO, 2013).

In this essay I will be exploring the current ongoing public health issue that is breastfeeding and the stigma that ensues and surrounds this topic. During my exploration and analysis of this public health issue I will be using epidemiology. Using the Joint Strategic Needs Assessment (JNSA) and the Clinical Commissioning Group (CCG) I will draw conclusions as to whether they benefit breastfeeding as a public health issue or whether they cloud the awareness of the topic. Taking in to account local, national and international policies I will discuss how breastfeeding is stigmatized in certain cultures and the inequalities that women and infants face. While discussing the effects to physical and mental health that it poses and using the ladder of intervention (Nuffield, 2007) and Tannahill’s model (1985) I will debate whether current interventions help raise awareness and the effectiveness this has upon the public health issue. I will explore this public health issue and assess how the interventions have helped improve the acceptance of this issue and the thoughts and ideas that still need to be developed around this area to maintain and enhance health. I will provide current legislative documents and using the World Health Organisation 2020 framework I will discuss how they are reflected.

According to the Royal College of Paediatrics and Child Health (RCPCH, 2019) states that in Europe the UK is one of the countries with the lowest rates of breastfeeding and it decreases quite significantly in the first few weeks following birth. It also states that in a survey undertaken in 2015/2016 73.1% of women breastfed initially but that reduced to 43.2% after 6-8 weeks. (RCPCH, 2019). Another recent report published by Public Health England (2019) states that an average of 47.9% of infants are breastfed at 6-8 weeks across the UK for the first quarter of the 2019/2020 period, this has been on the increase as during the first quarter of the 2018/2019 period 44.9% of infants were breastfed at 6-8 weeks. There is limited research and findings in recent times on breastfeeding statistics due to local authorities taking over the responsibility for commissioning children’s public health in the 0-5 years’ age group from NHS England in October 2015. According to the report by Public Health England (2019) this is because not all local authorities provide their rates of breastfeeding prevalence to be analyzed and submitted in the quarterly reports. Information provided by a 2010 infant feeding survey published by the Royal College of Paediatrics and Child Health (RCPCH, 2019) explains that the rates of breastfeeding are low among younger mothers and lower socio-economic groups it shows that 46% of mothers in the lower socio-economic areas breastfed compared to 65% in the higher socio-economic areas of UK. However, it also states that this can be due to difficulties rather than willingness to breastfeed, some mothers can experience issues establishing breastfeeding, some mothers return to work more quickly than others and find it difficult to upkeep with breastfeeding and expressing. Lack in support can also lead to a decline in the number of mothers who breastfeed as well as public stigma causing mothers to feel embarrassed and uncomfortable breastfeeding in a public setting. The World Health Organisation (WHO, 2017) published that 40% of infants are exclusively breastfed in the under 6-month age range globally. Due to the impacts breastfeeding has shown to the health and survival of children across the globe the World Health Organisation (WHO, 2017)) promote breastfeeding as the most effective way to nourish and protect the health of infants. It is also stated on the World Health Organisation website (WHO, 2013) that breastfeeding is vitally important to the health of infants in the areas of high poverty as it boosts an infant’s nutrition which can help decrease the number of infant deaths caused by malnutrition. It is calculated that half of all infant deaths is due a lack of nutritional intake and this is linked with reduced numbers in breastfeeding.

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The Joint Strategic Needs Assessment (JSNA) is a program headed by the local authorities to assess the needs of that area and set in place commissioned models and reports to help develop the health and social care needs and provide better services within the local community and on a national level. The Cheshire west and Chester JSNA (2016/2017) has a strategy to promote infant feeding and nutrition in children from birth to 5 years, one of the vital aims of this is to boost the numbers of infants that are breastfed from birth and to support mothers to breastfeed preferably up until 6 months if possible. The plan set in place aims to support children by giving them the best start in life, the report states that by 2020 Cheshire west and Chester Council want to boost the number of infants being exclusively or partially breastfed from 37.5% to 43.8%. (Cheshire West and Chester JSNA, 2016/2017). The Cheshire West and Chester (2016/2017) breastfeeding council plan produces a summary report for quarterly and annual data, along with this it produces national statistics for the rest of England. This annual data shows that the percentage of breastfed babies is significantly lower in Cheshire West and Chester borough compared to the average Published for England at 34% compared to 43.2%. (Cheshire West and Chester JSNA, 2016/2017). The summary report also discusses the Clinical Commissioning Group (CCG) who are the local authority in charge of implementing the Joint Strategic Needs Assessment (JSNA) in to the local community. The clinical commissioning Group (CCG) need to take in to consideration the needs of the local community and devise a strategy to improve the public health issue within a set time period, their strategy should have set targets that they aim to meet during different time intervals. Quarterly and annual reports should be published to the success or the failings of the strategy. The infant feeding strategy summary report (2016/2017) provides the conclusion that the CCG’s were successful in boosting the percentage of babies being partially or exclusively breastfed in 5 out of 7 of the children’s centers in the borough. Showing that the Cheshire West and Chester JSNA (2016/2017) has had a positive impact upon breastfeeding as a public health issue. They were able to achieve this by being able to provide more breastfeeding support in the area in the form of Bosom buddies, one to one midwives, breastfeeding support workers and Hospital provisions. (Cheshire West and Chester JSNA, (2016/2017).

Tannahill’s model of health promotion, (1985) defines health promotion in to three overlapping categories. Health Education, Health prevention and health protection. In a journal published in 2009 Tannahill revises his health promotion model and states that he sub-categorised the key aspects of the model because health promotion as a whole subject was ‘Meaningless’ he deemed this to be because there are multiple definitions to what health promotion actually means. (Tannahill, 2009).

Health education is aimed at healthy people before they are at risk of developing disease, Health prevention is aimed at people who are at risk of developing the disease. Health protection aims to target already sick people in the hopes to slow down the disease. (Tannahill, 1985).

The baby friendly initiative is a program set up with the support of Unicef and The World Health Organisation (WHO) which aims to enhance the care that mothers, children and their families receive from maternity, neonatal, health visiting and children’s centers services, (Unicef, 2019). Any services who can show that they provide the standards of care set by The Baby Friendly initiative will receive a Baby Friendly award which has been awarded to services in the UK since 1994. (Unicef, 2019). The standards that are set in place by the Baby Friendly Initiative include, putting policies in place that help to support and guide the foundations of the intervention and putting in place up to date and advanced education for all services so they are able to provide high levels of holistic care, (Unicef, 2019). The Baby Friendly initiative also aims to achieve sustainability through four key concepts: leadership, culture, monitoring and progression to ensure that all services who are baby friendly accredited are providing a high standard of care to their service users. (Unicef, 2019). ‘The Baby Friendly Initiative is transforming healthcare for babies, their mothers and families in the UK, as part of a wider global partnership between the World Health Organization (WHO) and Unicef.’ (Unicef, 2019).