Breastfeeding in Ireland; how the health system fails us.

As a public-health measure, breastfeeding is unparalleled. It is cheap, easy to understand, has no negative side effects and the method is tried and true -- as old as motherhood itself.

Yet, Ireland (and we’re not alone) fails abysmally when it comes to providing babies with mother's milk.

Things don’t even start off that well: 47per cent of Irish women breastfeed their newborn babies, according to a recent national paper by Roslyn Tarrant. However, in the weeks after birth, that rate falls off precipitously to a miserable 24%.

Every major health group, including the World Health Organization, Unicef and theoretically the HSE, recommends that babies be fed breast milk exclusively for the first six months of life, and that breastfeeding should continue as long as possible after the introduction of solid foods. The reasons for this are clear: Breast milk provides all the nutrients, growth factors and immunological factors a baby needs for optimal growth and development (physical and neurological).

Yet, 1.5 million children die every year because they are not breastfed, according to the WHO.

In Ireland, children are not dying for lack of breastfeeding, but they are missing out on tremendous benefits.

Research has shown that children who are breastfed have lower rates of pneumonia, bronchitis, colds, meningitis, urinary-tract infections, asthma, ear infections and sudden infant death syndrome. They are less likely to become overweight or obese, to develop breast cancer, allergies, diabetes, Crohn's disease and rheumatoid arthritis. Some studies even suggest breastfed babies even grow up to have higher IQs.

So, how do we explain that about 3 per cent in Ireland are meeting the minimum health standard of breastfeeding exclusively for six months?

The simple answer is that despite the seeming enthusiasm for the practice, health authorities do not promote breastfeeding, nor does our health system provide the necessary supports to moms and their newborns.

While breastfeeding is natural, it's not always easy. Proper technique -- getting the baby to latch on to the breast and suckle -- often requires some expert advice. Older mothers used to provide that knowledge but the previous generation or two lost that ability. In the postwar years, breastfeeding was actively discouraged, and by 1965, only one in four babies ever tasted mother's milk.

So the task of educating new mothers falls to health professionals. Yet, in hospitals, nurses and physicians are often too busy to help. Many hospitals have closed their breastfeeding clinics. Modern medical training does not include education about breastfeeding.

Formula makers aggressively market their products and health professionals and many Irish hospitals still provide free samples of formula -- in flagrant violation of the international code. And not everyone can afford the help of a lactation consultant, a costly event not provided by our health service. What a shortcoming.

In addition to providing services, there needs to be more education about the benefits of breastfeeding as well as the downside of formula.
The United States has shown the way with a hard-hitting public health campaign. The bold awareness program has focused on the risks of not breastfeeding. One TV ad showed a pregnant woman clutching her belly as she was thrown off a mechanical bull, and it compared the behaviour to failing to breastfeed. "You wouldn't take risks before baby's born," the ad states. "Why start after?"

The United States is also looking at labeling formula the way cigarettes are now labeled, with hard-hitting health warnings.

What public health leaders are saying is that the weight of the scientific evidence for breastfeeding is so overwhelming that it is appropriate to emphasize the risks associated with giving babies formula rather than mother's milk.

If 47 per cent of Irish women were taking up smoking within six months of giving birth, it would be a national scandal. No effort and no expense would be spared to address the issue. That 47 per cent are giving up on breastfeeding at some point during the six months is equally scandalous.

There is little justification for stocking formula in Irish hospitals, let alone distributing samples. More investments are required in breastfeeding clinics. Workplaces and public spaces need to facilitate rather than discourage breastfeeding. Education campaigns, for health professionals and the public alike, are long overdue.

"Breast is best" should not just be a catchphrase; breastfeeding should be a public health priority. Let’s start here, together.

Perinatal Statistics report – includes data from 2005 on ages, occupations, deliveries of births in relation to feeding practices in Ireland:
http://www.esri.ie/UserFiles/publications/20080725151156/SUSTAT006.pdf

Information on every birth that occurs either in hospital or at home is returned to the NPRS (National Perinatal Reporting System). The information collected includes data on pregnancy outcomes, with particular reference to perinatal mortality and important aspects of perinatal care. The period to which the information applies is from 22 weeks gestation to the first week of life. In addition, descriptive social and biological characteristics of mothers giving birth and their babies are recorded. All births are registered and notified on a standard four-part form, which is completed where the birth takes place, either at the hospital or by the attending independent midwife. The first part of the form is sent to The Registrar of Births and subsequently to the Central Statistics Office. The second part of the form goes to The Director of Community Care and Medical Officer of Health in the mother's area of residence. The NPRS dataset is compiled from the third part of this form. The fourth part of the form is retained by the hospital.
Further information on NPRS and what is collected can be found on www.nprs.ie.
 
Data on Breastfeeding in particular can be found in the following Tables and Figures; Tables 2.2, Figure 2.6, Tables 4.9 and 4.17, Figures 4.3 - 4.5, Tables G15, G16 and G19.
 
Irish student research project results:
www.breastfeedingsurvey.org