ULHG consultant’s ’10 priorities’ for elevating national breastfeeding rates to international levels

29 SEPTEMBER, 2022 | MidWest and national breastfeeding initiation rates have improved significantly in recent years. However, overall Irish breastfeeding rates are among the lowest in the world, according to a UL Hospitals Group consultant whose latest research aims to help elevate the region, and the country, to international standards in breastfeeding initiation.

Ahead of National Breastfeeding Week, which runs from this Saturday 1st October, consultant neonatologist Professor Roy K Philip, said: “In the MidWest, 61.4% of live births in 2020 initiated breastfeeding. The rate in Scandinavian countries is consistently over 90%. I’m not saying we can immediately be like Scandinavia. But achieving that rate should be our mission.”

Prof Philip was speaking following the publication in the peer-reviewed academic journal Maternal & Child Nutrition, of his research into 20 years of birth data from University Maternity Hospital Limerick (UMHL), exploring the reasons for low breastfeeding rates in the region, and proposing 10 priority national actions to increase those rates.

The collaborative research paper, entitled ‘A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement’, sees Prof Philip working with colleagues within UMHL, the School of Medicine at University of Limerick (UL) and at Dublin City University (see Editor’s Note).

Prof Philip and his colleagues explore the challenges arising from the failure of national public health awareness campaigns to achieve the targets despite the ample evidence they present of the numerous health benefits of breastfeeding for the infant, mother, society and environment.

“Around the world, the norm is when a baby is born the majority of mothers decide to feed the baby themselves. One reason for that is, it’s the most natural and species-specific feeding for a newborn infant. Of all the studies undertaken, there is no study that states formula feeding is better than breastfeeding. For the infant, breast milk reduces respiratory and gastrointestinal infections, protects the child from exaggerated weight gain, and reduces various maternal morbidities. There are innumerable benefits. And increasingly important these days, it’s also good for the environment: it’s the most ‘green’ feeding strategy available,” Prof Philip said.

The researchers detail various cultural practices and norms in Ireland that “solidify the inertia to change”, slowing the beneficial impact of public health initiatives and preventing breastfeeding from reaching the levels that are the norm in many other countries. They also refer to the pockets of deprivation still prevailing in the Mid-West, highlighted by the National Trinity Deprivation Index.

Cultural issues include the negative social perception and acceptance, and the fear of personnel embarrassment among mothers. The researchers found that these general national cultural attitudes have also negatively influenced breastfeeding among mothers of immigrant populations; for whom exclusive breastfeeding is often the norm.

Other themes identified include education and a lack of exposure to breastfeeding in child and adolescent education, as well as the lack of ‘vicarious experience’ that has shown to be an important influencer in breastfeeding initiation.

Challenges are also identified in the free availability of formula feeds in hospitals immediately after birth, as well as the lack of breastfeeding advertisements, and deficits in prenatal and antenatal educational support that contribute to lack of consistency in training, and conflicting advice.

• Prof Philip and his colleagues remain confident that change is possible, and the ‘10 priorities’ they identify to help improve the situation include:
• Publication of all WHO data on Irish national breastfeeding rates: “Even if this is low, then that should act as the impetus for improvement,” Prof Philip says.
• Extending to the WHO standard of 2 years, the entitlement to supports for all breastfeeding mothers returning to work
• Advocating for all advantages of breastfeeding
• Establishing cross-cultural peer support groups
• Implementing breastfeeding awareness and observation into primary and secondary education curriculums
• Regularising prescribing of formula milk in hospital
• Establishing a donor human milk bank in the Republic of Ireland
• Instituting a State-funded advertising campaign for breastfeeding
• Incorporating social media promotion in breastfeeding action plans
• Improving staffing levels in maternity hospitals and neonatal units to support breastfeeding, with every mother discharged to be given a breastfeeding support contact number

Prof Philip emphasises that the work already done to improve breastfeeding in the Mid-West over last two decades should not be under-estimated. “There have been significant improvements in the past 20 years. Starring at just over 40%, it is now at 63-64% of women in UMHL initiating breastfeeding. However, by the time they are discharged, and within the first few days after that, the rate is coming down. That reveals that there has been an intention to breastfeed, but the system has not done enough to support this.”

“Breastfeeding initiation rates of 90 to 95 per cent, which is our aim, can only happen when society feels that breastfeeding is the norm. The low rates in Ireland are not at all the fault of any woman. It is society’s fault that this powerful information about the benefits is not taking root. That’s what we have to work on,” he said.

“We need investment in promotion, and support is vital here. We know how successful our public health systems can be. Look at cigarette smoking. Reduction in smoking in the past two decades could not have been achieved without advertising. It could not. We have demonstrated to the whole world that we can be a pioneer. We’ve also done it with road safety, immunisation, but where are the hundreds of billboards around the country showing that breastfeeding is the best,” Prof Philip stated.

“I recall going to a conference about 20 years ago at a large Scandinavian hospital, which had at the time a breastfeeding initiation rate of over 90%. Every hour in that hospital, every display screen changed to a 30-second breastfeeding advertisement. That is what is called investing in a community. It has to be powerful, and after that, it has to be supported. We have to invest in the support systems in our maternity hospitals, in the community, in our society, if we’re really serious about bringing ourselves to the levels of international partners who are doing extremely well,” Prof Philip concluded.