Commissioning a peer-support programme for women who breastfeed

Breastfeeding rates in the UK are among the lowest in Europe. In August 2008 the Government pledged an extra £2 million to help hospitals in low-income areas increase breastfeeding rates and achieve UNICEF Baby Friendly status.The NHS Priorities and planning framework set a target to increase breastfeeding initiation rates by 2 percentage points per year, focusing on women from disadvantaged groups. Progress is monitored by measuring the prevalence of breastfeeding at 6 to 8 weeks in all primary care trusts as a key indicator of the Child health and wellbeing PSA (public service agreement) target.

Breastfeeding contributes to the health of mother and child in both the short and long terms and provides all the nutrients a baby needs. Current UK policy is to promote exclusive breastfeeding (feeding only breast milk) for the first 6 months, continuing for as long as the mother and baby wish while gradually introducing a more varied diet. The Infant feeding survey 2005 showed that 78% of women in England breastfed their babies immediately after birth but, by 6 weeks, the proportion had dropped to 50%. Only 26% of babies were breastfed at 6 months. Exclusive breastfeeding was practised by only 45% of women 1 week after birth and 21% at 6 weeks. Maternal age, educational attainment and socio-economic position have a strong impact on patterns of infant feeding. Three quarters of British mothers who stopped breastfeeding in the first 6 months (and 90% of those who stopped in the first 2 weeks) would have liked to have continued for longer. This suggests that much more could be done to support them.

Breastfeeding peer-support programmes should be commissioned only as part of a breastfeeding strategy and commissioners should be aware of all the recommendations about breastfeeding in NICE public health guidance PH11. Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households and NICE clinical guideline CG37. Postnatal care.

The guidance recommends implementing a structured programme that encourages breastfeeding using the Baby Friendly Initiative (BFI)as a minimum standard. The programme should be subject to external evaluation. The guidance also recommends the adoption of a multifaceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates. It should include:

• activities to raise awareness of the benefits of - and how to overcome the barriers to - breastfeeding
• training for health professionals
• breastfeeding peer-support programmes
• joint working between health professionals and peer supporters
• education and information for pregnant women on how to breastfeed, followed by proactive support during the postnatal period (the support may be provided by a volunteer).

Benefits

The potential benefits of robustly commissioning a peer-support programme for women who breastfeed, within a breastfeeding strategy, include:

• increasing the number of women who initiate and continue to breastfeed at 6-8 weeks
• increasing the number of women who breastfeed exclusively for the first 6 months
• reducing the number of hospital admissions for diarrhoea and respiratory infections in infants
• reducing the risk of ovarian and breast cancer in women who breastfeed
• reducing the risk of obesity in children, and lowering their risks of developing coronary heart disease and diabetes in later life
• raising public awareness of the benefits of breastfeeding
• building capacity within local communities through workforce development and employment opportunities
• reducing inequalities and improving access to breastfeeding support for women in low-income groups
• increasing choice, by providing access to a range of services across different settings
• improving performance and family-centred care by implementing the recommendations outlined in NICE public health guidance PH11 on maternal and child nutrition
• better value for money through helping commissioners to manage their commissioning budgets more effectively - this may include opportunities for clinicians to undertake local service redesign to meet local requirements in novel ways.

Key issues

Key issues in commissioning/providing an effective peer-support programme for women who breastfeed are:

• recruiting peer supporters as part of a multidisciplinary team and ensuring the team is integrated with other services for women requiring support for breastfeeding within the clinical setting and the community
• implementing the BFI Seven-point plan for communities as part of a wider breastfeeding strategy
• ensuring that women least likely to start and continue breastfeeding are actively engaged and that all pregnant women and new mothers are offered support for breastfeeding
• educating women about breastfeeding during the antenatal and postnatal periods in line with NICE public health guidance PH11 on maternal and child nutrition and NICE clinical guideline CG37 on postnatal care
• providing a quality assured service.

National priorities

National priorities and initiatives relevant to commissioning a peer support programme for women who breastfeed include:

• World class commissioning.
• The NHS in England: The operating framework for 2009/10.
• Joint planning and commissioning framework for children, young people and maternity services.
• Review of the health inequalities infant mortality PSA target.
• National service framework for children, young people and maternity services.
• Keeping children safe. The Government's response to The Victoria Climbie Inquiry report and Joint Chief Inspectors' report Safeguarding Children.
• Maternity matters: choice, access and continuity of care in a safe service.
• Commissioning framework for health and well-being.
• The UNICEF Baby Friendly Initiative.
• Updated child health promotion programme.
• Healthy weight, healthy lives.
• The Care closer to home initiative.
• Considering the impact of patient choice.
• A stronger local voice: a framework for creating a stronger local voice in the development of health and social care services.
• Implementation of NICE clinical and public health guidelines. These are currently core standards, and performance against these standards will be assessed by the Care Quality Commission in line with Standards for better health.

Although many or all of these priorities may be relevant to the services nationally, your local service redesign may address only one or two of them.