Imagine a world where nutritious food was freely available to all babies, thereby reducing their risk of illness and enabling them to develop into healthy adults. In fact, no imagination is required: human breast-milk is free, widely available and popular. In 2010 more than 80% of mothers surveyed for the Growing Up in New Zealand study planned to breastfeed their babies, mostly for at least six months. That’s great news, as exclusive breastfeeding for that period is the best start for babies, according to the World Health Organisation.
Higher breastfeeding rates could significantly improve our nation’s health and be good for the health budget too; a recent Unicef report estimated a moderate increase in British exclusive-breastfeeding rates could save the National Health Service about $78 million. Unfortunately, the best laid plans can go awry. Although the 2012 Growing Up in New Zealand follow-up report found 97% of New Zealand babies were exclusively breastfed on the first day of their life, four months later, after paid parental leave had ended, less than half of the babies were still exclusively breastfed. That had dropped to 28% at five months of age and 6% by six months.
The most common reason for stopping breastfeeding – given by 38% of mothers – was the perception that they didn’t have enough milk; another 32% gave it up because their baby didn’t seem satisfied by breast milk. Nineteen per cent stopped because their baby had “weaned themselves” and/or because the mothers had returned to paid work and expressing breast milk wasn’t convenient or possible.
Barriers identified by other studies include problems during the antenatal and birth period, inconsistent messages from health workers and the loss of breastfeeding as a cultural norm. Good practice by health workers could prevent many breastfeeding problems, allowing mothers to breastfeed successfully for longer, according to Julie Stufkens, executive officer of the New Zealand Breastfeeding Authority. The association is contracted by the Ministry of Health to implement the Baby Friendly Hospital Initiative, a 10-point plan to increase breastfeeding rates.
In 2001, 56% of infants were exclusively breastfed at discharge from New Zealand maternity wards. A decade, later the figure was more than 84% and nearly every New Zealand hospital had been accredited under the baby-friendly initiative. “We’ve had a major change in practice in hospitals,” says Stufkens, thanks to the association’s programme of protecting, promoting and supporting breastfeeding. Sarah-Jane Westbrooke, a paediatric dietitian at North Shore Hospital, is going a step further. Westbrooke will use the 2012 Nutritionist Development Award she recently received to gain specialist breastfeeding knowledge with the aim of becoming the first New Zealand-registered dietitian and lactation consultant.
Stufkens’s ambition is to spread the baby-friendly approach throughout the community, and to get mothers to breastfeed longer. The Baby Friendly Community Initiative, launched in 2005, gives community health service providers up-to-date information about breastfeeding so they can support mothers and help them get professional advice when necessary. “It’s their responsibility to ensure the woman is effectively feeding,” Stufkens says. Problems can arise, for instance, if a baby doesn’t attach well to the breast. Feedback from service providers and patients has been positive. “Everybody is saying the same thing – information is up to date, they’re not undermining breastfeeding by saying, ‘Oh here, take a sample of formula’, or you can’t breastfeed if you’re on a particular drug,” says Stufkens.
Mothers are getting instruction in how to position and attach their baby properly, which is reducing breastfeeding problems, and those who need more help are being told where to find it. Stufkens wants to reach more health providers. And perhaps the initiative would also be helped by an increase in paid parental leave provisions so breastfeeding mothers could continue their health-promoting work. Spend a penny, save a pound.
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