Breastfeeding is a natural 'safety net' against the worst effects of poverty. Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence.  It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.
JAMES P. GRANT, EXECUTIVE DIRECTOR OF UNICEF (1980-1995)

 

Evidence shows that breastfeeding has a major role to play in public health as it promotes health and prevents disease in the mother and baby in both the short and long term[1].   Increasing the numbers of women who choose to initiate and sustain breastfeeding for their babies remains an important priority in improving health and reducing inequalities and is one of the outcomes included in the Public Health Outcomes Framework[2].  It is recommended that infants are exclusively breastfed for the first six months of life.  The importance of improving breastfeeding rates is recognised nationally and locally since it contributes to long and short term benefits to child and maternal health.
Breast feeding helps protect babies from:
  • Infectious diseases including gastro-intestinal, ear, chest and urine infections
  • Childhood diabetes
  • Eczema and asthma
  • Childhood obesity
 
Breastfeeding helps protect mothers from:
 
  • Breast and ovarian cancers
  • Osteoporosis in later life
 
The economic benefits of breast feeding are also documented and these include broader issues such as reduced absence from work because of childhood illness and the impact on the health of the population in the longer term[3].  

IMAGE 1 

Despite the overwhelming evidence of the benefits of breast feeding rates within the UK, particularly in the North East are among some of the lowest in the world.  Prevalence of breast feeding at 6 – 8 weeks is one of the indicators included in the Public Health & Clinical Commissioning Groups Outcome Frameworks.
In an attempt to facilitate an increase prevalence and reduce inequalities in breast feeding in Northumberland a breast feeding needs assessment (BFNA) was undertaken.
 
Aims:
The aims of the BFNA are to better understand the current need and provision in relation to breast feeding in Northumberland and to make recommendations to facilitate an increase and reduce inequalities in breast feeding within the county.
 
Objectives:
  • To explore the evidence base in relation to breast feeding
  • To collate and analyse epidemiological data in relation to need and demand
  • To map service provision across the county and where possible assess the outcomes and effectiveness of such provision
  • To undertake a gap analysis making clear recommendations to address any identified gaps
 
Scope:
Data has been collated and analysed in relation to:
1.Need – number of births, population demographics and evidence base
2.Demand – current and recent prevalence of breast feeding by maternal age, deprivation, ward and place of delivery (subject to data availability)
3.Supply – overview of services provided in terms of What? Where? When? Who? & How?
Due to the time and resource constraints for undertaking the BFNA it has not been possible to undertake any new consultation with women in Northumberland.  However where available reports on previous relevant consultation have been considered and included. 
 
 
[1] National Institute for Health & Clinical Excellence (2005). Promotion of breastfeeding initiation and duration – evidence into practice briefing.
[2] Department of Health (2012). Improving outcomes & supporting transparency.
[3] Ball T M, Wright A L (1999). Healthcare costs of formula – feeding in the first year of life. Paediatrics 103 (4): 870 – 876. 
NICE (2005) evidence into practice briefing presents evidence based actions for promoting the initiation and/or duration of breastfeeding among full term healthy babies.  The guidance focuses particularly on population groups where breast feeding rates are low.  The briefing highlights 8 evidence based actions that are seen to be effective in increasing initiation and/or sustaining breast feeding rates.  These are:
  1. Implementation of the UNICEF UK Baby Friendly Initiative an maternity and community settings
  2. Provision of an appropriate mix of formal and informal education and support programmes delivered by professionals and peer supporters
  3. Changing hospital and community policy & practice
  4. Abandoning specific policy and practices which are known to negatively impact on breast feeding  initiation and sustaining rates
  5. Provision of complementary telephone support
  6. Provision of targeted education and  support for women on low incomes
  7. Provision of targeted one to one needs based education and support through the first year
  8. Implementation of media programmes targeted at teenagers
 
The importance of peer support programmes for women who breast feed is well documented and NICE (2008)[1] have produced a guide to support the commissioning of such services.  The guidance highlights the importance of commissioning peer support programmes as part of a broader strategy and highlights the cost effectiveness of peer support programmes. The key components of a peer support programme for women who breast feed are defined as:
  • Engaging communities and recruiting peer supporters – peer supporters need to be recruited from and reflect the diversity of the community in which they live.
  • Training and supervision – in line with NICE & BFI standards health professionals need to be competent to provide information & advice to breastfeeding mothers and peer supporters. A whole team approach is recommeneded where all staff including recptionists and ancillary staff are made fully aware of the importance of breast feeding and help to facilitate a supportive environment.
  • Developing a high quality peer support programme -  specifically these need to be local, easily accessible and part of a multidisciplinary team
UNICEF UK Baby Friendly Initiative
The worldwide programme was established in 1992 to encourage maternity units to implement ten steps to successful breastfeeding . the programme was launched in the UK in 1994 and its principles were extended to cover work in community settings in 1997. The initiative works to ensure a high standard of care in relation to infant feeding for pregnant women, mothers and babies.

IMAGE 2

 
 
[1] National Institute for health & Clinical Excellence (2008). A peer support programme for women who breastfeed. 

Breastfeeding data definitions

The Department of Health provide the following definition the mother is defined as having initiated breastfeeding if, within the first 48 hours of birth, either she puts the baby to the breast or the baby is given any of the mothers breast milk (Department of Health 2005).

Data Sources
Data was collated from a varity of sources including:
  • Child Health Information System hosted at Northumbria Healthcare NHS FT (2012-13 data)
    • Breast feeding at birth (initiation), 10 days and 6-8 weeks
    • Age of mother
    • Residence of mother (ward/lsoa level data –ability to assign deprivation quintiles)
    • Registered GP practice (ability to compare 4 CCG areas)
    • Place of delivery
  • Child and Maternal Health Intelligence Network (2011-12 data quoted in CMO report)
  • Locally developed proforma (See Appendix 1) was used to map existing provision and professional views.
 
In 2012 there were 3,151 births amongst Northumberland women. This is slightly higher than the number in 2011 whene there were 2,975 births.  Figure 1 shows the maternal age distribution for births during 2012/13 financial year.



Figure 1:  Number of births by maternal age for Northumberland 2012/2013[5]
 
[5] Data source: Child Health Informatics, Northumbria Healthcare NHS FT

CHART

Teenage pregnancy rates are high in most North East Local Authorities compared to the rest of England and Northumberland is in the highest quintile (Figure 2).  Within Northumberland there is also variation in rates of teenage conceptions and mothers with higher rates clusterd in areas of high deprivation, particularly in the South East and Central areas of the county.

Figure 2: Teenage mothers (age under 18 years at time of conception) – 2011/12

The association with maternal age and deprivation presents as  increased rates of teenage mothers living in the most deprived areas of Northumberland.  Figure 3 shows the number of births by age group and deprivation quintile with 1 being the most deprived areas of Northumberland and 5 being the least deprived.

Figure3:  Number of births by deprivation quintile for Northumberland 2012/20135

2.4 Place of delivery
Mothers acorss Northumberland deliver predominantly at theWansbeck General Hospital (WGH) and the Royal Victoria Infirmary (RVI) in Newcastle .  Although mothers can choose where to deliver, many women in the more deprived areas of Northumberland (particularly in the Central Locality) are unable to travel to Newcastle due to poor and unaffordable transport links.

Figure 4: Place of delivery for births during 2012/13[1]

Due to the demographics of the local population around Wansbeck General Hospital, women who deliver there are significantly younger than the group of women deliverin at the RVI.  Over 60% of mothers delivery at Wansbeck General hospital were under 30 years in 2012/13 (Figure 5).
 

Figure 5: Maternal age by place of delivery for births during 2012/136

2.5 Breast Feeding Rates - Department of Health Data
 
The North East region has the lowest rates of breast feeding in England and this has been relatively stable since 2009/10 with approximately 60% of mothers initiating breast feeding and only about a 30% continuing until 6-8 weeks (Figures 6 & 7).  Northumberland has performed similarly to the other North East areas and in the 2013 CMO report (2011/12 DH data) there were 63.6% of mothers who had initiated breast feeding and 36.5% of infants were still being breast fed at their 6-8 week review.

Figure 6: Percentage of Mothers Initiating Breast Feeding by PCT Boundaries – 2012/13 Q4

Figure 7: Percentage of Mothers Breast Feeding at 6-8 weeks by PCT Boundaries – 2012/13 Q4

2.6          Detailed Northumberland Child Health Information System Data 2012/13

 
To better understand breast feeding rates within Northumberland, we used child level data provided by the Child Health Information System located in Northumbria Healthcare (NHC) for the financial year 2012/13.  The results from these data for initiation will be different from what is reported nationally through Department of Health (DH) and Chi Mat as they report breast feeding rates by number of maternities rather than by number of babies.  This does not adjust for multiple births.
 
To be consistent, we use the number of babies / infants as the denominator for reporting breast feeding rates at each time period – initiation, 10 days and 6-8 weeks.  Differences in Northumberland wide data are presented in the table below.

TABLE

2.6.1      Breast Feeding Prevalence by place of delivery
The RVI reported significantly higher rates of breast feeding at all assessment times as seen in the figure below.  There is also a greater fall off for mothers delivering at Wansbeck which is most noticeable in the first 10 days (RVI reduces by 7% and Wansbeck  by 11%).   Demographic data tell us that mothers deliviering at WGH are younger and come from more deprived areas so there are greater challenges for promoting breast feeding that require a well trained and motivated frontline workforce within midwifery.
The fall off between 10 days and 6-8 weeks is 12% for mothers who have delievered at either the RVI or WGH,  indicating that the services provided in the community are appropriately targeted to meet  the needs of all mothers who are breast feeding.

Figure 8: Percentage of Babies Breast Fed by Place of Delivery – 2012/13[1]

2.6.2      Breast Feeding Prevalence by the CCG Locality Areas

Given the variation in demographics and health needs across Northumberland, the CCG is divided into 4 distinct localities – Blythe Valley, Central, North and West  presented in the map below.

INSERT MAP

There are about 50% more births for mothers registered with GPs  in the Blyth Vally and Central CCG areas compared to those registered with GPs in North and West Northumberland areas (Figure 9).

Figure 9:  Number of births by CCG Locality for Northumberland 2012/2013[1]

As deprivation is clustered in the Blyth Valley and Central CCG areas, these areas also have higher numbers of morthers under 19 years (Figure 10). 

Figure 10:  Number of births to teenage mothers by CCG Locality for Northumberland 2012/20138

Blyth Valley and Central are dominted by more deprived wards compared to the North and in stark contrast to the West (Figure 11, Note: Q1=most deprived  and Q5=least deprived).

Figure 11:  Number of births by deprivation quintiels across CCG Localities 2012/20138

Women from the West locality are also more ikley to deliver at the RVI than at Wansbeck during the 2012/13 period  when we compared deliveries from the two main maternity units serving Northumberland (Figure 12).  However, it should be noted that there were also 120 deliveries at Hexham during this period and that Hexham Hospital is part of Northumbria Healthcare NHS FT.

Figure 12:  Number of births by CCG Locality and Place of Delivery 2012/2013[1]
 
Breast feeding rates are signifcalty better in the West Locality at all times (Figure 13) and can be partly explained by the older and more affluent demographics of mothers.  However, breast feeding is may also be influenced by a more accepting culture within the West community and differences in breast feeding support offered by maternity service during the antenatal period and at the time of delivey  provided at the RVI compared to Wnasbeck Hospital. 

Figure 13:  Breast Feeding Rates by CCG Localities 2012/20139

 
2.6.3      Breast Feeding Prevalence by Connected Northumberland target Wards for Fulfilling Lives: A Better Start big Lottery application
Connected Northumberland big lottery application focuses on 11 of the most deprived wards in Northumberland, all located within the Central CCG locality and includes:
 
Ashington Central
Bedlington East
Choppington
College
Haydon
Hirst
Lynenouth
Newbiggin Central and East
Seaton with Newbiggin West
Sleekburn
Stakeford

As reported previously, maternal age less than 25 and deprivation are associated with lower breasting feeding rates for both initiation and continuing for at least 6-8 weeks.  Mothers are younger in the Target Wards with almost 40% of them under the age of 25 compared to 25% of mothers across the rest of Northumberland (Figure 14). 

Figure 14. Maternal age comparing Target Wards to the Rest of Northumberland, 2012/13

 Mothers in the Target Wards are also more likely to live in the more deprived areas with 65% of them living in the most deprived areas compared to only 20% of mother from the Rest of Northumberland (Figure 15).

Figure 15. Maternal deprivation comparing Target Wards to the Rest of Northumberland, 2012/13

Figure 16 shows breasting feeding rates at initiation, 10 days and then 6-8 weeks comparing babies born in the Target Wards to the rest of Northumberland.  In the Target Wards, rates of initiation are 13% lower than the Rest of Northumberland (43% vs. 56%).
The percentage drop off at 10 days and 6-8 weeks is similar for the Target Wards and the Rest of Northmberland indicating that services in the post-natal period are being targeted appropriately so that there is not a higher drop off in the Target Wards where mothers face the greatest barriers in terms of younger mothers with complex social needs combined with a low cultural acceptance of breast feeding as the norm.

Figure 16. Breast feeding rates comparing the Target Wards to the Rest of Northumberland



 
 
[1] Data source: Child Health Informatics, Northumbria Healthcare NHS FT


[1] Data source: Child Health Informatics, Northumbria Healthcare NHS FT
 
 
[1] Data source: Child Health Informatics, Northumbria Healthcare NHS FT
 
[1] Data source: Child Health Informatics, Northumbria Healthcare NHS FT



 
In order to understand existing service provision in relation to breast feeding advice and support across the county a proforam was developed (See Appendix I). This was widely distributed to a range of statutary , community and voluntary organisations. An analysis of the responses is set out below.

Responses:
17 questionnaires were completed electronically and returned.  All respondents had completed most of the questions.  Responses were returned from a variety of services  including maternity and health visiting services, infant feeding teams & coordinators, Sure Start and Children’s centres and teenage parents support staff. There was a good torsgeographical spread from across the county.  
Breast feeding promoting activities:
All services provided written information leaflets on breast feeding and the majority (94%) promoted   breast feeding  support websites.

Breast feeding education activities:
82% of services offered one to one  breast feeding education and 76% provided education in group situations.  Peer support was offered face to face by 82% of services and 76% reported offering peer support by telephone. 71% offered one to one support from a professional.

Breast feeding support:
12% of services encouraged rooming in for all mothers after the birth and 18% facilitated baby led breast feeding immediately after birth. Whilst these figures appear low analysis suggests they are appropriate as the majority of responses were from services whose remit did not include support to women immediately after delivery.  82% of services showed women how to hand express milk  and also offered a referral to breast feeding support groups.

Service advertising:
Services are being advertised and promoted to women using a varity of mediums including face to face awareness raising by professionals, posters and leaflets and via electronic media such as Twitter and websites.

Service standards:
13 of the 17 services that responded reported having achieved full UNICEF baby Friendly Accreditation. The remaining four were however working towards this with two having achieved stage 1 and two stage 2. Whilst 16 of the 17 services that responded reported having a breast feeding policy in place only four reported knowing the review date for the policy. Services were most likely to monitor performance in relation to breast feeding rates at intiation, 10 days and/or 6 – 8 weeks.  Only 29% of services reported monitoring of outcomes in relation to priority groups.  65% of services reported undertaking consultation work with pregnant/new mothers within the last 24 months. A review of the information collated suggested this related to feedback on peer support services rather than comprehensive consultation on their experiences of breast feeding support across the maternity and early years pathway. 

Key points raised by provider questionnaires:
Data was also obtained via free text comments on the provider survey returned by the 18 providers of support across maternal & children’s services using midwives and health visitors working with the infant feeding coordinators and peer supporters. 
These comments reflected their views on level of need within the communities, their ability to provide a service for mothers that could be targeted for those most in need and the significant challenges and barriers that exist in Northumberland. 
Common themes identified as barriers included:
  • Cultural norm to bottle feed (intergenerational trend)
  • Confidence of young mothers and concerns about how they will be perceived
  • Lack of fully trained staff and peer support volunteers
  • Often inconsistent messages and/or support being given
  • Limited services provided outside of usual office hours with exception of peer supporters who would also provide telephone support
  • Peer supporters currently unable to support mothers in immediate postnatal period while still in hospital and limited antenatal support
  • Post-natal midwifery checks are now mostly in clinics rather than at home
Findings reported in section 2 and 3 have been discussed with stakeholders at various forums across Northumberland including meetings with CCG commissioners and leads for the provider services delivered through Northumbria Healthcare NHS FT (NHC) and Northumberland Children’s Centres.  This has included:
  • FACT Board meeting on 3 December 2013 (report to FACT attached as Appendix II)
  • Connected Northumberland Community Partnership meeting on 26 November 2013 and discussions with parents from the target wards at the stakeholder and strategy day events
  • Meeting with Janice McNichol, Head of Midwifery, NHC 29 Nov 2013 and 13 Mar 2014
  • Meeting with Janet Leigh, Health Visitor Manager, NHC and Gill Physick, Ashington Children’s Centre lead to discuss community engagement events
  • Breast Feeding Strategy Group meeting, 17 December 2013
Recommendations were formulated with input from a wide range of commissioners, providers and mothers.  This needs assessment has also benefited from the community engagement work conducted as part of the Connected Northumberland application to Big Lottery.  Specifically, this has directed our thinking about peer support across the whole pathway with increased input during the antenatal period and at the time of delivery.
  • Breast feeding rates continue to be a concern particularly for
    • Younger mothers (under 25) and those living in the most deprived areas
  • Percentage drop off after 10 days to 6-8 weeks is the same for all groups
    • Indicates community services are being appropriately targeted
  • Higher initiation rates at Royal Victoria Infirmary than Wansbeck Hospital
    • Wansbeck mothers significantly younger and from more deprived areas
    • Greater percentage drop off between initiation and 10 days for mothers who deliver at Wansbeck (11%) compared to the RVI (7%)
  • Community services have obtained stage 3 UNICEF Baby Friendly and in December 2013 had an outsatning re-accreditation inspection
  • Wansbeck Hospital failed stage 2 UNICEF Baby Friendly in December 2013 and is due a re-inspection by the UNICEF team during th week beginning 19 May 2014
    • Only 57% of staff interviewed gave an adequate explanation of how they would determine that a baby was receiving enough breastmilk.
    • Although 100% Staff interviewed reported that they teach mothers how to express milk manually only 71% of staff interviewed were able to demonstrate/describe an acceptable technique for expressing milk manually.
  • Currently limited provision of antenatal support and no immediate post-natal support from peer supporters at Wansbeck Hospital
  • Northumberland mothers report that given the importance of breast feeding they would like to have clearer information and more accessible support throughout the maternity pathway.  Many mothers state they prefer support from ‘someone like them or any other mum, living in their area and who has been through it themselves’.
  • Northumberland has a Breast Feeding Strategy group with wide representation
 
Community Services in Northumberland based in Northumberia Healthcare NHS FT have achieved UNICEF BFI Stage 3 and have recently been given an outstanding review for their re-accreditation assessment.  Midwifery services within Wansbeck Hospital, Northumbria Healthcare NHS FT have not achieved UNICEF BFI Stage 2.  This highlights a service gap that needs to be urgently addressed over the next 6 months so that they can reach this milestone and progress to improving the quality of support for Breast Feeding to achieve BFI Stage 3 in the following 12 months. 
Northumberland has a Breast Feeding Strategy group with representation and collaboration from a wide range of stakeholders.  This group is currently taking forward an action plan to address the key recommendations from the needs assessment.
Key recommendations from the Breast Feeding Needs Assessment
  • Breast Feeding Strategy group to lead on action plan
  • Increase capacity of peer support in antenatal and immediate post-natal period 
  • Midwifery Services, Wansbeck Hospital to achieve Stage 3 UNICEF baby friendly and actively support the action plan of the Breast Feeding Strategy group
  • Continue to raise awareness and promote use of breast feeding support services available in children’s centres and other community locations
  • Work within the community to support mothers to breast feed and promote championing breast feeding more widely across intergenerational groups, including schools and key public services across Northumberland
  • Recognise the benefits of developing the peer support network for breast feeding not only in terms of increasing breast feeding rates but also for developing skills and knowledge of this group of volunteers. 
The Breast Feeding Needs Assessment was presented at the Family and Child Trust (FACT) Board meeting in December 2013 and the recommendations endorsed by the board including the following points noted of what the wider partners present from outside of health could action:
 
Points to note:
 
All public buildings should provide facilities and support for breastfeeding mothers returning to work, including an environment that enables mothers to express milk, and store expressed milk, so they can continue to feed their baby with breast milk. Provisions to support breastfeeding/expression of milk should be considered in any new buildings or refurbishment works to public buildings.
 
Reception staff in public buildings should be trained to confidently and appropriately respond to requests to breastfeed. No woman should be prevented from breastfeeding in public areas, however if a woman requests privacy, a room should be available where they can breastfeed.
 
The benefits of breastfeeding should be included in school curricula in order to change cultures, making breastfeeding the norm. This would require commitment from schools to include promotion of breastfeeding within Personal, Social, Health & Economic education (PSHE).
 
Partners and wider family can have a substantial influence on initiation and maintenance of breastfeeding
insert table
FACT BOARD REPORT - 3 December 2013
Report Title: Public Health Breast Feeding Needs Assessment
1. PURPOSE
The breast feeding needs assessment (BFNA) was undertaken in Northumberland to increase our understanding of the need for support, demand on current services and the gap between need and demand that require improvement.  The findings of the BFNA identified groups of mother and times during the maternal pathway that we need to focus on to improve breast feeding rates. This is essential for us to understand how we can work towards reducing inequalities in breast feeding rates across Northumberland. 
 
2. IMPLICATIONS
Key findings from the BFNA:
  • Breast feeding rates continue to be a concern, particularly in younger mothers (under 25) and those living in the most deprived areas of our county – particularly evidenced by analysis of the Big Lottery wards in comparison to the rest of Northumberland
  • Support in the community during post-natal period has been targeted to these groups and it can be seen that maintaining breast feeding at 10 days and 6 weeks is similar for these groups when compared to the mothers aged 25 and older and those from less deprived areas (that is, the percentage drop off at 10 days and 6-8 weeks is the same for all groups).  This highlights how important it is to improve initiation rates in these groups to increase 6-8 week prevalence.
  • There is a significant difference in initiation rates between mothers delivering at the Royal Victoria Infirmary and Wansbeck Hospital but it needs to be acknowledged that mothers delivering at Wansbeck Hospital are significantly younger and from more deprived areas
  • Community services have obtained stage 3 UNICEF Baby Friendly (recognised international highest standard of service) and are currently undergoing re-accreditation
  • Midwifery services at Wansbeck Hospital are currently seeking stage 2 UNICEF Baby Friendly
  • There is currently limited provision of antenatal breast feeding support services and peer supporters are not available in the immediate postnatal period when mothers are still in Wansbeck Hospital
  • Northumberland has a Breast Feeding Strategy group with wide representation
 
3. RECOMMENDATIONS
  • Breast Feeding Strategy group to lead on action plan going forward and ensure that support is equitably provided across the whole pathway and that action plans are monitored and reviewed at least quarterly
  • Increase breast feeding peer support in the antenatal and immediate post-natal period with collaborative working between community services and midwifery staff at Wansbeck Hospital
  • Midwifery within Wansbeck Hospital to achieve Stage 3 UNICEF baby friendly and learn from good practice within community
  • Continue to raise awareness and promote use of breast feeding support services available in children’s centres and other community locations
  • Identify opportunities to work within the community to support mothers to breast feed and promote championing breast feeding more widely across intergenerational groups, including schools and key public services across Northumberland
  • Recognise the benefits of developing the peer support network for breast feeding not only in terms of increasing breast feeding rates but also for developing skills and knowledge of this group of volunteers.  Identify opportunities for supporting these volunteers to develop further educational skills and employment opportunities.
 
Public Health will fund an additional breast feeding peer support coordinator who will help to develop additional support for the antenatal and immediate post-natal period. The aim of this is to improve the continuity of support across the whole pathway.
 
More importantly this work highlights the important role that all organisations represented at FACT have to play in making Northumberland a ‘baby friendly’ county for all mothers to feel supported to breast feed their babies at home, work or in any public environment.
 
The FACT Board is asked to:
  1. Note the content of the Breast Feeding Needs Assessment, November 2013.
  2. Consider what contribution the FACT Board Partners can make to supporting the recommendations from this needs assessment for wider promotion and support of breast feeding across Northumberland
 
4. BACKGROUND
Evidence shows that breastfeeding has a major role to play in public health as it promotes health and prevents disease in the mother and baby in both the short and long term.   Increasing the numbers of women who choose to initiate and sustain breastfeeding for their babies remains an important priority in improving health and reducing inequalities and is one of the outcomes included in the Public Health Outcomes Framework.  It is recommended that infants are exclusively breastfed for the first six months of life but breast feeding for any period of time is beneficial.  Therefore mothers should be supported to reach goals that are realistic and achievable for them. The importance of improving breastfeeding rates is recognised nationally and locally since it contributes to long and short term benefits to child and maternal health.
Breast feeding rates across all of the North East counties are the lowest in England and have shown only modest signs of improvement over the past 4 years with concerns that they may be reducing in some areas.  This is despite significant input into raising awareness and supporting mothers across a wide range of health, social care and voluntary sector agencies.
The UNICEF Baby Friendly Initiative (BFI) is an internationally accepted programme that provides a staged approach to developing a wide range of evidence-based services to achieve better breast feeding outcomes.  National Institute of Health and Social Care Excellence (NICE) guidance links directly to the BFI evidence and recommendations for accreditation.
                Public Health has been investing in BFI over a number of years but has not seen the tangible outcomes that we would have expected.  However, we now see an opportunity for improvement in outcomes by investing in initiatives overseen by the Breast Feeding Strategy Group and championed by all partners as part of the wider Connected Northumberland agenda.
 
5. BACKGROUND PAPERS
NICE Promotion of breastfeeding initiation & duration; evidence into practice briefing.
http://www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_final_version.pdf
NICE Commissioning Guidance for Breast Feeding Peer Support
http://www.nice.org.uk/usingguidance/commissioningguides/breastfeed/breastfeed.jsp
UNICEF Baby Friendly Initiative
http://www.unicef.org.uk/BabyFriendly/
Department of Health Breast Feeding Statistics
https://www.gov.uk/government/statistical-data-sets/breastfeeding-statistics-q4-2012-to-2013
NICE Promotion of breastfeeding initiation & duration; evidence into practice briefing.
http://www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_final_version.pdf
 
NICE Commissioning Guidance for Breast Feeding Peer Support
http://www.nice.org.uk/usingguidance/commissioningguides/breastfeed/breastfeed.jsp
 
NICE Quality Standard for Postnatal Care (QS37)
http://guidance.nice.org.uk/QS37
 
 
UNICEF Baby Friendly Initiative
http://www.unicef.org.uk/BabyFriendly/
 
Department of Health Breast Feeding Statistics
https://www.gov.uk/government/statistical-data-sets/breastfeeding-statistics-q4-2012-to-2013