Resulting “postcode lottery” to be reported in Channel 4 Dispatches documentary, Breastfeeding Uncovered, which airs 30 July at 8pm
Campaigners in over 140 council areas in England say mothers are not getting the help they need to breastfeed as local services are being reduced or shut down altogether. This represents 44% of the 326 local authority areas in the country that have experienced cuts to breastfeeding support.
The survey of campaigners and mothers was conducted by the campaign group Better Breastfeeding. “We’ve been hearing from mums who say their local breastfeeding support has been significantly reduced, or in many cases cut altogether. So far we know of 142 local authority areas in England that are affected, but these are just the ones we’ve heard about. The actual number is likely to be even higher,” said Ayala Ochert, founder and co-chair of the campaign, which is pushing for better support for mothers who want to breastfeed.
“All over the UK – and especially in England – councils and health boards are trying to save money by closing peer support and specialist breastfeeding support services, which are essential in helping mothers to continue breastfeeding. It’s a totally false economy because these services are not only very cheap, but they also save the NHS money as breastfed babies get sick less often,” she added.
On 30 July – ahead of World Breastfeeding Week – Channel 4 will broadcast a Dispatches documentary, Breastfeeding Uncovered, on the state of breastfeeding in the UK and the impact of the cuts to support services. The documentary features an interview with Professor Amy Brown, professor of child public health at Swansea University and co-chair of the Better Breastfeeding campaign, who highlights the impact of a lack of breastfeeding support on mothers’ mental health.
“This isn’t about telling mums they should breastfeed – most people already know about the benefits. Most mothers in the UK begin breastfeeding, but of those who give up in the early weeks around 80 percent of those say they would have liked to continue,” says Professor Brown. “When you consider that there are over 750,000 births each year, that means there are literally millions of women out there who have been affected by the lack of practical and societal support to breastfeed. For many women, the pain of having struggled with breastfeeding can last for decades. We hear of grandmothers breaking down in tears in breastfeeding support groups, recalling the lack of help when they were new mothers themselves.”
The Better Breastfeeding survey on the extent of the cuts gives details of the cuts experienced in each area. In some places – like Blackpool – the entire service has been closed down, while in others – such as Kent – high-quality services have been pared down, leaving some mothers without the help they need.
Previous surveys have indicated similar results. Last year, Unicef UK’s Baby Friendly Initiative asked infant feeding leads about cuts in their areas. Many of these posts have been cut but of those responding, 40% reported cuts to one-to-one breastfeeding support and 47% reported closures of breastfeeding support groups in their areas. In April 2018, the Institute of Health Visiting conducted a similar survey of its members. Of those who responded, 50% reported recent cuts to breastfeeding support groups; 54% reported cuts to breastfeeding support specialist services; and 51% reported cuts to peer support programmes.
The NCT has also reported that its Baby Cafés – groups where mothers can get skilled help from breastfeeding counsellors and peer supporters – have been closing. The numbers have nearly halved in the last three years, falling from 97 in 2014 to just 46 at the end of 2017.
Survey of mothers’ experiences
In addition to its survey on the extent of the cuts, Better Breastfeeding also teamed up with the popular website Can I Breastfeed In It? to conduct a complementary survey of mothers’ experiences of cuts to breastfeeding support. The survey, which had over 1500 responses, reveals a postcode lottery of breastfeeding support, with some mothers getting all the help they needed locally while others found themselves struggling alone.
One mum in Hartlepool said the three support groups in her area had been cut to just one and funding for peer supporters had also ended. As a result, she had to travel 50 miles to get the help she needed. Another mother in Brent wrote: “I struggled with breastfeeding in the beginning and couldn’t find support anywhere in my area. Can you imagine what it is like as a new mother with a very unhappy baby to find the courage and energy to go out to seek support, only to be told that there’s no one there to help because of short staffing?! In the end my daughter and I were admitted to hospital in another borough [Harrow] and finally got some help.”
A mother from Hampshire wrote: “Since the closure of all but about 11 children’s centres in Hampshire, where most of the breastfeeding clinics were held, there is now no longer regular and wide ranging support… The support is even more difficult to find than it was 3 years ago when I had my first child.” She praised the support that she had previously received at the clinics. “It pretty much saved me from descending into postnatal depression. If it wasn’t for me regularly attending a local breastfeeding support group (that has now had to close), my daughter would never have been diagnosed with a severe tongue tie and there is no way that I would have been able to carry on breastfeeding for as long as I did. I went almost every week, in floods of tears usually, and always received warm, friendly and dedicated support. I was, and remain, devastated that the services have been slashed so wantonly.”
Mothers’ mental health
Breastfeeding rates in the UK are among the lowest in the world, with just 1% of mothers exclusively breastfeeding for six months. Around 80% of mothers begin breastfeeding, but by 6 weeks half of them have stopped breastfeeding. Around 8 out of 10 of these mothers say they stopped breastfeeding before they wanted to. Many cite lack of support as their reason for stopping or problems such as sore nipples, which can almost always be solved with skilled breastfeeding support. A report last year from the NCT on women’s experiences of maternity care, Support Overdue, found that two thirds of mothers said their midwife was too busy to help them with feeding their baby.
“We’re sleepwalking our way from a crisis to a total disaster with the present cuts to breastfeeding support. There had been steady gains in breastfeeding rates in recent decades, but these are about to start falling back down again. And that translates into hundreds of thousands of mothers every year being let down,” Professor Brown warned.
When women plan to breastfeed but it doesn’t work out, their risk of postnatal depression doubles, according to research from Cambridge University. “Antenatal education is very important, but it’s not enough to just tell women about the benefits of breastfeeding. They need practical, one-to-one, skilled help once their baby is born so that they can actually do it. Many people are surprised to discover that it’s not always completely straightforward. Mothers also need to hear when things are going well and their baby is feeding normally, especially those who don’t have any family and friends who have breastfed,” said Ayala Ochert.
Government guidance being ignored
Guidance from NICE (National Institute for Health and Care Excellence) and from Public Health England (PHE) says that local authorities should ensure that all mothers have access “local, easily accessible breastfeeding peer support programmes” and that peer supporters should be part of a multidisciplinary team, including midwives, health visitors and others. It also says all new mothers should be contacted directly by peer supporters within 48 hours of their transfer home from hospital (or within 48 hours of a home birth). The guidance also says that when there are more complex breastfeeding problems – for example, if the baby has a tongue tie that is affecting their ability to suck – mothers should be seen by a specialist, such as a lactation consultant. Only a small handful of places in the country now remain where all these NICE guidelines on breastfeeding support are followed.
Last year, Chief Medical Officer, Professor Dame Sally Davies, wrote to local authorities about the importance of breastfeeding: “Improving breastfeeding rates is not the responsibility of individual women struggling alone in a culture that can be hostile towards breastfeeding – rather this is a public health challenge for which we all share responsibility. We must find a way to meet this challenge; failure to invest in breastfeeding leads to poorer health outcomes for children and women today and for generations to come.”
She singled out peer support as a success story, but local authorities appear to be ignoring her advice. A study from Cardiff University in 2017 reported that mothers have access to peer support in just 56% of the UK. (The actual number is now even lower, following cuts since the study was conducted.) Many councils wrongly assume that breastfeeding support can be provided by midwives and health visitors alone, but this goes against PHE and NICE guidance. In practice, most midwives and health visitors will have far less training on how to support breastfeeding mothers – typically just two days’ worth of training compared with two years for breastfeeding counsellors and even longer for lactation consultants.
NHS England’s new Maternity Transformation Programme, which is currently being implemented across the country, includes the aim of increasing breastfeeding rates. Baroness Cumberlege wrote in her report Better Births: “Women told us that [breastfeeding] care was poor. There needs to be much better support for breastfeeding focused on practical help that supports and empowers women.” Yet very few Local Maternity Systems have plans in place to improve breastfeeding rates – instead, breastfeeding support is being cut.
The government has been criticised for failing to include breastfeeding as part of its Childhood Obesity Strategy, despite evidence that breastfeeding could reduce obesity in later life by as much as 13%.
In 2016, over 30 organisations, including medical royal colleges and charities supporting new families, wrote an open letter on the crisis in breastfeeding support. They wrote: “The breastfeeding crisis in the UK is in fact a crisis of lack of support for those mothers who choose to breastfeed.”
Better Breastfeeding’s campaign co-chair Ayala Ochert concluded: “Just at the time when we should be investing in breastfeeding support as a matter of urgency, local councils and health boards across the UK are disinvesting. It makes no sense, and parents across the country are demanding that skilled breastfeeding support is available to all who need it. This must be made a national priority that gets translated into real support locally.”
The campaign’s petition against the cuts gained has over 18,500 signatures.