No surer start

“We describe formula as ‘take-away’, and breast milk as a
‘home-cooked roast dinner’. Fast food’s OK once in a while, but
would you want your child eating chicken nuggets all their

The plain speaking of specialist midwife Bella Dale makes
breastfeeding seem like the obvious choice. But if everyone knows
that “breast is best”, why does Britain have one of the lowest
breastfeeding rates in the world?

Breastfeeding protects babies against infection and allergies.
Recent evidence shows it even helps prevent the onset of childhood
obesity. For mothers, it reduces the risk of breast and ovarian

Importantly, health inequalities are also reduced by breastfeeding.
Research from Dundee has shown that breastfed children in the
lowest socio-economic group had health outcomes similar to or
better than formula fed children in the highest group.

Yet despite all the recommendations and campaigns such as last
May’s Breastfeeding Awareness Week, rates remain low and women give
up quickly. 

Experts agree that the reasons why more women choose not to
breastfeed are complex, involving social and cultural constraints,
lifestyle and working conditions.

As with many public health issues, socio-economic background and
age play their part. Mothers from manual social class groups and
those who leave school before 18 are less likely to breast feed.
Many more of those who wait to have children until they are 30

For women who need to return to work quickly or who have other
children to look after, bottle feeding can seem more convenient,
allowing more time away from the baby.

Many also feel self-conscious about breastfeeding in public. In an
attempt to break the perceived stigma around this, a new law was
passed March in Scotland in March making it an offence to stop
nursing mothers feeding their babies anywhere in public.
Campaigners are now working for a similar measure in England and

But whatever the explanation for Britain’s low rates, most experts
agree that more practical help is needed. Almost nine out of 10
women who give up breastfeeding in the first six weeks do so
reluctantly, often because they have not learned the knack of
getting the baby to latch on properly.

“Advice is very patchy and some women are left wanting,” says Jo
Bexley of Unicef’s Baby Friendly Initiative, which provides a
framework for best practice in NHS trusts. “You do have to learn
how to do it properly. Health professionals are giving out very
mixed messages.”

Sally Inch, an infant feeding specialist from Oxford’s Radcliffe
Hospital agrees that, in so far as the professional has an
influence, this should be positive and unequivocal. “Given the
powerful effect of breastfeeding to ameliorate some of the health
outcomes associated with child poverty, mothers and babies deserve
no less,” she explains.

Peer support groups have proven useful in achieving that positive
influence. Pregnant women, new mothers and those with breastfeeding
experience meet to share advice and stories, sometimes in the
presence of a health professional.

One local Sure Start programme in Tower Hamlets has boosted
breastfeeding numbers and rates are now higher in these target
areas than the rest of the east London borough. It has also cut the
number of mothers giving up early.

“We employ local women to be support workers rather than relying on
volunteers and we train them properly,” says project organiser
midwife Joy Hastings. “Whenever we advertise we have a flood of
applications, we’re spoilt for choice. We have both Bengali and
Somali speakers.

“We offer a home visit during pregnancy and continued visits
post-natally. The support groups can be more difficult – sometimes
women in the Bangladeshi community, which we deal with most, aren’t
keen on coming out. But they appreciate home visits.

“We try to involve the grandmothers and tell them about the
benefits. Sometimes they encourage bottle feeding as it means they
can be involved in child care while the daughter gets on with
something else. Family can be very influential.”

But despite the success of peer support groups, they are not
enough. The National Childbirth Trust believes a multi-faceted
approach is the only way to achieve real change, including more
training for professionals, the banning of formula advertising, and
government policy working simultaneously.

Hastings agrees that a shift in attitude is vital. “From the
government downwards, we need society to help so that no one turns
a hair when they see a woman feeding her baby.

“Breast feeding has got to be what’s normal.”

Fact file:

* More than three-quarters of mothers aged 30 or over breastfeed
their babies compared with less than half of mothers under the age
of 21.

* The Association of Breastfeeding Mothers estimates that there
are between 150 and 200 peer support groups operating across the

* The majority of men are supportive of breastfeeding, with 79
per cent of those surveyed saying that they would want their
children to be breastfed.

* Women are three times more likely to stop breastfeeding in the
first two weeks if none of their friends breastfeed.

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