Rosie Sayers’1 article is an interesting discussion on the impact of our wider culture on the acceptability of breastfeeding in public and suggests this as an important cause of low breastfeeding rates in the UK.
However, from my own personal and professional experience, I believe lack of effective support to overcome low confidence and common problems encountered when establishing breastfeeding (for example painful nipples and concerns about insufficient milk supply) is at the core of the issue.
According to UNICEF, 81% of UK mothers in 2010 initiated breastfeeding demonstrating that women are generally motivated to breastfeed, however, by 6 weeks only 17% were exclusively breastfeeding.2 Increasingly mothers are discharged from hospital shortly after giving birth and usually before breastfeeding has become established. While mothers routinely have two to three follow-up home visits from midwives and health visitors, they report that these encounters are often rushed due to over-stretched resources with little continuity and that they commonly receive conflicting information. Women with breastfeeding difficulties are directed to drop-in clinics or seek information from organisations such as the National Childbirth Trust (NCT) or Le Leche League. This fragmentation of advice and follow-up can be overwhelming to new mothers and it is understandable why formula feeding is often seen as the most reliable option. A Cochrane review of breastfeeding support3 showed that, while all forms of extra support increased the length of time women continued to breastfeed, support that is only offered if women seek help themselves is unlikely to be effective, and suggested that predictable, scheduled, ongoing visits were key to extending the time that women breastfeed.
While the UK has made real progress in increasing rates of breastfeeding initiation, the focus of attention needs to shift to providing improved support to those mothers who want to continue doing so. In addition to the wider cultural factors highlighted in Rosie Sayers’ article, focusing on issues including the nature, frequency, and continuity of long-term support as well as availability of effective information is central to tackling low breastfeeding rates in the UK.
- © British Journal of General Practice 2014
