World Breastfeeding Trends Initiative - 2024 UK report

The World Breastfeeding Trends Initiative (WBTi), developed by the International Baby Food Action Network (IBFAN) and the Breastfeeding Promotion Network of India (BPNI), was globally launched in 2004. It includes ten indicators based on WHO’s 2003 Global Strategy for Infant and Young Child Feeding and the Innocenti Declaration (1990, updated 2005). The WBTi approach allows comparisons among countries, with 100 nations having conducted assessments to date. Countries are encouraged to reassess regularly—ideally within five years—to track progress. Results contribute to the Global Breastfeeding Collective’s (GBC) monitoring scores.

WBTi assessments are collaborative and multi-sectoral, involving healthcare bodies, government agencies, UNICEF, and third-sector organisations. The process identifies gaps and recommends actions to policymakers. Ethically, WBTi does not accept funding or sponsorship from companies producing breast milk substitutes or related products.

WBTi evaluates two main areas:

– Indicators 1-10: National policies and programs (e.g., maternity protection, healthcare support).

– Indicators 11-15: Actual infant feeding practices (e.g., early breastfeeding initiation, exclusive breastfeeding duration).

Indicators 1-10 are scored numerically out of 10, while indicators 11-15 are assessed through percentage-based color coding.

2024 findings – UK Findings

1. National Policy, Governance and Funding.

4/10

Effective national leadership is essential for protecting and supporting breastfeeding. Currently, all four UK nations align their infant feeding recommendations with WHO guidelines. However, England lacks a comprehensive national strategy or leadership for breastfeeding support, offering only limited and short-term funding through the Start for Life Family Hubs programme. In contrast, Northern Ireland, Scotland, and Wales have dedicated national strategies, action plans, and leadership structures. Scotland notably demonstrated strong political commitment early on, investing consistently in breastfeeding support, leading to increased breastfeeding rates.

2. UNICEF UK Baby Friendly Initiative (BFI).

7.5/10

The UNICEF UK Baby Friendly Initiative (BFI) promotes close, nurturing relationships through accreditation of maternity units, neonatal units, health visiting services, early years settings, and relevant university training programs. All maternity units in Scotland and Northern Ireland maintain BFI accreditation. Wales has increased accredited units but lacks dedicated national funding. England lags behind due to impacts from COVID-19, funding issues, and staffing shortages, though it aims for full accreditation in maternity and neonatal services by March 2027.

However, pre-registration medical, nursing, and health visitor training programs generally don’t reflect the success seen in service accreditation, with BFI accreditation primarily included in midwifery and health visitor university courses. Accredited health visitor training rose from 15% in 2016 to 21% in 2024.

3. Implementation of the International Code of Marketing of Breastmilk Substitutes.

5/10

The UK has not fully implemented the WHO International Code of Marketing of Breastmilk Substitutes (1981) and subsequent resolutions. Existing legislation across all four UK nations prohibits advertising only for first-stage formula but allows continued marketing of follow-on formulas, other milk products, infant foods, and feeding accessories. Companies exploit legislative loopholes, resulting in increased social media marketing and rapid price hikes amid the cost-of-living crisis. The UK government is urged to strengthen regulations, ensure clarity, and provide adequate resources for enforcement by local Trading Standards.

4. Maternity protection.

6/10

Effective maternity protection, including breastfeeding breaks and facilities, significantly improves breastfeeding rates, employee retention, and workplace productivity. In the UK, statutory maternity leave allows up to 52 weeks, but maternity pay (covering only 39 weeks) was just 46% of the National Living Wage in 2023, forcing many mothers back to work early. Statutory paternity leave remains limited to two weeks. Current UK legislation does not mandate breastfeeding breaks, workplace facilities, or accommodations for expressing breastmilk, offering only employer guidance. A notable legislative change occurred in 2023, amending the Equality Act to explicitly protect breastfeeding women from workplace discrimination. To fully align with International Labour Organisation (ILO) recommendations, the UK government needs to expand current maternity protection laws.

5. Health Care Systems (in support of breastfeeding and IYCF).

6/10

Healthcare professionals are crucial for supporting optimal breastfeeding and infant feeding practices, requiring appropriate training both pre-registration and through ongoing professional development. Currently, UK professional bodies like the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) set high-level standards, but significant training gaps were identified against WHO recommendations in the UK’s WBTi reports. UNICEF Baby Friendly Initiative (BFI) accreditation remains the primary provider of post-registration training, especially regarding the International Code of Marketing of Breastmilk Substitutes, though limited mainly to maternity and health visiting services. Additionally, standard UK practice typically ensures mothers and babies stay together in maternity units, but Scotland uniquely provides national guidance on mother-baby togetherness across other hospital departments.

6. Counselling Services for Pregnant and Breastfeeding Mothers.

6/10

The definition and evaluation criteria for counselling services for pregnant and breastfeeding mothers have evolved since the 2016 UK WBTi report, now aligning closely with WHO’s broader definition that includes advice, practical support, listening, specialist breastfeeding knowledge, and skills.

Statutory services vary across the UK, providing between 5 and 11 mandatory health visitor contacts, but workforce shortages, particularly severe in England, have worsened significantly since 2016. BFI-accredited services are expected to deliver enhanced support, including peer support, specialist services, and tongue-tie services, but local variations persist.

No comprehensive national data exist on access to breastfeeding counselling; thus, BFI-accredited maternity and health visiting services are used as indicators. Scotland and Northern Ireland maintain full marks, while England and Wales have lower scores due to stricter evaluation standards. Third-sector organisations contribute substantially, with more qualified breastfeeding counsellors and IBCLCs available than in 2016. The National Breastfeeding Helpline has provided round-the-clock support since March 2024, funded by UK and Scottish governments.

7. Accurate and Unbiased Information Support.

5.5/10

Accurate and unbiased information is essential for helping parents make informed infant feeding decisions. While UK government and NHS information sources have expanded and align with global recommendations, national Information, Education, and Communication (IEC) strategies remain inconsistent: Northern Ireland and Scotland have dedicated IEC strategies, while England does not, and Wales includes IEC within its broader breastfeeding action plan. Despite available guidance, unsafe infant formula preparation practices remain widespread.

8. Infant feeding and HIV.

3/10

In the UK, HIV screening is offered universally to pregnant women (with over 95% uptake), alongside free antiretroviral therapy (ART). Recent data indicates no HIV transmission through breastfeeding when mothers maintain undetectable viral loads and adhere to ART. Although the British HIV Association (BHIVA) updated guidelines in 2020 to support breastfeeding women living with HIV, the official recommendation continues to promote formula feeding. Misinformation remains common among health professionals and the public regarding HIV and breastfeeding, and many health workers lack awareness of the updated guidelines. England and Wales have not yet nationally adopted the latest BHIVA guidance, resulting in lower assessment scores compared to 2016 due to stricter scoring criteria.

9. Infant and Young Child Feeding during Emergencies (IYCFE).

0/10

Infants and young children remain highly vulnerable during emergencies, yet no UK nation has implemented national strategies or response plans specifically addressing infant and young child feeding in emergencies (IYCFE). Though Northern Ireland and Scotland have appointed coordinators, there are no comprehensive plans or dedicated resources. Lessons from COVID-19 responses have strengthened readiness for future emergencies, yet gaps persist. Additionally, food insecurity continues as an ongoing crisis for many families; existing support programs like Healthy Start remain insufficient, leaving many families unsupported.

10. Monitoring and Evaluation.

5/10

Effective monitoring and evaluation require regular, robust data collection aligned with WHO/UNICEF indicators. However, UK nations currently do not fully align their data collection with these international standards, leading to lower scores in the 2024 assessment compared to 2016. Routine data collection varies significantly across the four UK nations, with England collecting limited infant feeding data at birth and 6-8 weeks, often incomplete. England is conducting its first national infant feeding survey since 2010. In contrast, the devolved nations (Northern Ireland, Scotland, and Wales) collect data at various intervals up to 23 months. Notably, Scotland has recorded faster increases in breastfeeding rates among younger and more disadvantaged mothers.

11-15. Infant and Young Child Feeding Practices.

Breastfeeding initiation rates vary from 62 to 72% between the four nations. About half of all babies start breastfeeding within an hour of birth. There is still a steep drop-off and by 6 weeks fewer than 50% of babies are receiving any breast milk at all. There is a concern that many start solids before the recommended age of 6 months.

If you’d like to read the full report, you can access it here.