Breastfeeding programmes "should be targeted"

doi:10.1136/bmj.321.7259.467/a

BMJ 2000;321:467 ( 19 August )

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Breastfeeding programmes "should be targeted"

Zosia Kmietowicz, London

Breastfeeding programmes should target women who are most likely to give their babies bottled milk, said a report from theNHS Centre for Reviews andDissemination.

Women from disadvantaged groups and ethnic minorities are least likely to breast feed, and these women could benefit mostfrom involvement in small, informal discussions on the meritsand practicalities of breast feeding; this method of encouragementwas shown to have the greatest impact on uptake (Effective HealthCare 2000;6:2). Despite huge efforts to encourage breast feeding,the level in the United Kingdom has remained static for the past20 years, with a strong disparity between the socialclasses.

Just half of new mothers from the poorest social class (class V) make attempts to breast feed compared with 90% of those fromthe highest social class (class I). In 1995, 62% of women in Englandand Wales started to breast feed, compared with 48% in Scotlandand 41% in Northern Ireland. In a review of all the evidence availableon promoting breast feeding the researchers from York Universityfound that simply giving women leaflets on the benefits of breastfeeding was of little value. Inviting women to participate insmall discussion groups and one to one advice sessions achievedthe best results $---$ in some cases tripling the rate of breastfeeding.

Also effective were peer support programmes offered by trained and experienced peers, such as those offered by the NationalChildbirth Trust. Bottle feeding is fast being accepted as normalpractice in the United Kingdom, most of western Europe, and theUnited States, except for women from higher incomegroups.

More data on the impact of initiatives and breast feeding are needed. In 1997 only eight out of 13 trusts visited by the AuditCommission could provide information on the number of new mothersbreast feeding when they were discharged fromhospital.

© BMJ 2000

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