The health benefits of breastfeeding for infants and mothers
Discuss about the Methodological and Conceptual Reflections.
Breastfeeding is considered as the most efficient way of feeding an infant primarily because of the health benefits that is associated with this practice. To the mother, breastfeeding promotes maternal recovery from childbirth, enhances mineralization of bones, accelerates weight loss, reduces risk of pre-menopausal breast cancer and also reduces risks of ovarian cancer (Walt et al, 2008). To the infant, breastfeeding has been associated with health benefits such as reduced illnesses, protection from respiratory infections, improved visual acuity, and high IQ scores amongst others. Breastfeeding is also a key factor in protecting the child from being overweight or becoming obese (NSW Department of Health, 2011). As such, the World Health Organization (WHO) has recommended that infants be exclusively breastfed for up to six months and thence receive safe complimentary foods as supplement to breastfeeding for up to two years (Ogbo et al, 2016).
Many countries around the world have taken up these recommendations and consequently increased their rates of breastfeeding. In Australia for example, the initiation rates of breastfeeding was estimated to be around 88% and in the state of New South Wales (NSW), 90% of all infants were found to have been breastfed. However, the sustained breastfeeding rates contradict the high initiation rates in NSW. In this case, only 16% of infants were exclusively breastfed for six months while 29% were breastfed for at least 12 months (Wen et al, 2009). Therefore, the health department of NSW has strongly advocated for the need to focus and promote exclusive breastfeeding of infants for six months as well as extend the duration for breastfeeding for at least six months.
One of the primary reason that necessitated the need to choose this policy was the importance or rather the benefits that breastfeeding has on both the mother and the infant. Furthermore, breastfeeding is an extremely important public health issue which raises concerns for the mother as well as health professionals. For instance, health professionals are encouraged to refer to the risks of not breastfeeding rather than the benefits since breastfeeding is the most natural way of feeding infants. In such cases, evidences suggest that there are a myriad number of risks that arises to the infant if they are not breastfed among them including; prevalence of a number of chronic diseases, and increased gastrointestinal illnesses as well as respiratory infections (Amir & Hector, 2007).
The importance of promoting and supporting exclusive breastfeeding for six months
The policy is also sensitive in the sense that it brings to light the poor health outcomes that are associated with poor breastfeeding practices or alternatively the use of baby formula instead of breast milk. Most importantly, these poor health outcomes have often presented huge economic and social burdens to families comprising of the infants and their parents, and also to the health care system. On this note therefore, it becomes affirmative that these poor health outcomes contributes to some of the major health problems in Australia thereby exacerbating the issue of health burden.
The policy Breastfeeding in NSW: Promotion, Protection and Support aims to outline an action plan for enhancing the promotion, protection and support of breastfeeding within the NSW health care system. In order to improve on the breastfeeding practices in NSW, these actions have particularly been stipulated for the department of health as well as local health districts (NSW Department of Health, 2011). It is also noteworthy that the policy directive has been formulated in accordance with the Australian National Breastfeeding Strategy that is led by the Australian Government and which primarily aims to increase the percentage of infants that are breastfed from birth to six months exclusively (Commonwealth of Australia, 2009).
The policy also clarifies the different roles and responsibilities in order to foster coordinated efforts among a wide group of individuals constituted in various units such as local health networks, public health system and support, ministry of health, public health units and, public hospitals amongst others. In addition, the policy has identified a number of priority areas including; monitoring and surveillance, health professionals’ education and training, breastfeeding support for priority groups, support of breastfeeding in healthcare settings, breastfeeding friendly environments and, continuity of care and support networks (NSW Department of Health, 2011). Notably, these are the key areas that must be addressed by all the involved personnel.
This policy was developed in 2011 and is considered as the first comprehensive breastfeeding policy for NSW. The policy is mainly concerned with improving breastfeeding practices as well as demonstrating the state’s commitment to the national breastfeeding strategies. In this light, the policy was premised on four main considerations/issues including; the health benefits of breastfeeding for infants and mothers, the infant feeding guidelines for health professionals, the need to improve breastfeeding rates in NSW and, the recent systematic reviews of evidence on effective interventions by health services.
The role of health professionals and support networks in improving breastfeeding outcomes
There are many health benefits that have been attributed to breastfeeding which accrues to both the mother and the infant. Generally and on a global basis, breastfeeding has saved lives of infants and reduced the disease burden for infants as well as their mothers (Dieterich et al, 2014). The major long term benefit to the infant has been identified as protection against chronic diseases as revealed by studies. Moreover, evidence reveals that cognitive development is significantly improved by breastfeeding. Other notable chronic diseases that are reduced by breastfeeding include; obesity, cardiovascular diseases, hypertension, type 1 and type 2 diabetes, and hyperlipidemia (Binns, Lee & Low, 2016). Thus, the anticipation of reduction of such chronic illnesses has strongly necessitated the need to develop a directive that will ensure that more infants are increasingly being breastfed so as to benefit from the reduction of such illnesses.
Similar studies have illustrated a number of short term health benefits to the infant that are presented by breastfeeding. For instance, breastfeeding has strongly been associated with reduced incidence and duration of diarrheal illnesses. Reduced prevalence or rather occurrence of otitis media has also been attributed to exclusive and prolonged breastfeeding in infants. Breastfeeding also has an advantage of protection against bacterial infections such as bacteremia, meningitis, neonatal necrotizing enterocolitis and urinary tract infection. Unlike other forms of feeding, breastfeeding is elusive of polyunsaturated fatty acids found in milk and as such, it improves visual acuity and psychomotor development. Additionally, studies also indicate that infants who have been breastfed for lengthy periods register higher IQ scores compared to their counterparts. It is therefore critical that the infant be accorded the best path towards development and maturity which in this case can mainly be achieved through breastfeeding as compared to other methods of feeding. This policy therefore identifies this priority and has accorded emphasis on the directive in an attempt to realize the health as well as the economic benefits.
The policy also aims to adhere to the national breastfeeding strategy that was formulated in 2009 and whose objectives strongly align with the goals of this policy directive. In this case, the policy has strived to ensure that the available guidelines for breastfeeding are strongly adhered to by health professionals within NSW. Even so, the stipulated resources and training programs have focused on continuous education of health professionals comprising of nurses and midwives, to enhance their knowledge and confidence in improving breastfeeding outcomes (Holtzman & Usherwood 2018). Thus a number of infant feeding guidelines have been stipulated for health professionals and which must be followed at great lengths.
The policy directive and its alignment with the national breastfeeding strategy
For instance, it is recommended that early initiation of breastfeeding should be initiated after birth which should take approximately one hour after the child is born. Health professionals are also encouraged to room in and on a frequent basis in order to feed newborns. They should also educate and encourage mothers to breastfeed their babies for six months on an exclusive basis. They are also tasked with advising mothers on hygienically prepared foods that should be given to babies after six months (Clark & Bungum, 2003). This action should also complement their encouragement of continued breastfeeding until 12 months while complementing this feeding method with appropriate supplementary foods.
Breastfeeding intentions and behaviors vary greatly among mothers. Research reveals that most women intend to breastfeed their children after giving birth (77%). The intention however diminishes as relatively few women actually end up breastfeeding their babies within the first 24 hours after giving birth (74%). The rate further diminishes to 65% as these women do not breastfeed their children after two weeks of giving birth. The underlying factor behind these low rates was lack of support particularly from the health care system (Kervin, Kemp & Pulver, 2010). In Australia, the rates of breastfeeding have also been low over time with only 16% of infants being breastfed exclusively for the first six months and only 29% being breastfed for at least 12 months (Commonwealth of Australia, 2009; King, Hector & Webb, 2005). As studies reveal, these low rates have been prevalent despite the fact that these mothers are fully aware of the WHO recommendations on the durations within which infants should be breastfed (Ogbo et al, 2016). The need to increase these rates of breastfeeding has therefore become a critical public health concern that need to be addressed.
Similar studies have identified have identified a number of other factors that may influence the decision of mothers to breastfeed or use formula and consequently impact on the rates of breastfeeding. For instance, marital status, education, age, culture and confidence have all been identified as significant reasons that may influence a mother’s choice on whether to breastfeed their children or not. Nonetheless, maternal benefits, knowledge about feeding, infant nutritional benefits, socio-economic status and most importantly, personal as well as professional support have been the chief reasons that impact on mothers’ intentions to breastfeed their children (Radzyminski & Callister, 2016; Amir & Donath, 2008). Additionally, studies indicate that the combination of feeding methods such as breast and formula feeding methods has strongly been favored by mothers thereby decreasing their willingness to exclusively breastfeed their children for six months (Lum, Todd, & Porter, 2016). Therefore, to strongly support breastfeeding as a health promotion strategy, NSW has identified the concern of increasing breastfeeding rates as one of the primary steps that should be taken within the policy.
Priority areas identified for improving breastfeeding practices
Personal and professional support have been found to be some of the most effective and efficient interventions to improve breastfeeding rates among mothers. Studies suggest that health care institutions should look to prioritize multicomponent intervention as a primary strategy for intervening in breastfeeding practices. Also, baby friendly hospital initiative interventions within hospitals have also yielded better breastfeeding outcomes among mothers. Nonetheless, to ensure the success of such initiatives, there is need to increase provider training especially when intervention are conducted between pre and post-natal periods (Kim et al, 2018; Sinha et al, 2015). Such practices will prove critical in encouraging mothers to improve their breastfeeding practices although they haven’t been full constituted within the policy.
Another study also identified peer support interventions as another considerable intervention to improve breastfeeding practices. In a systematic review conducted by Kaunonen, Hannula and Tarkka (2012), it was realized that although individual support and education was commonly used during pregnancy, hospitalization and postnatal period, peer support was also commonly favored by many mothers. Furthermore, the combination of professional and peer support from well-trained and experienced peer supporters was pivotal in ensuring the continuation of breastfeeding (Kaunonen, Hannula & Tarkka, 2012) The policy has similarly strived to encourage and support breastfeeding during pregnancy and during the postnatal period thereby indicating that it has acknowledged this form of intervention as effective way to improve breastfeeding outcomes (NSW department of health, 2011). However, for the policy directive to be a success there is need to ensure that continuous breastfeeding support is maintained during the different phases of motherhood.
One of the main goals of the policy is to increase breastfeeding rates in NSW. As aforementioned, Australia has high rates of breastfeeding initiation but the rates gradually decline within the first weeks of postpartum as the trend continues throughout the first year of birth (Cramer et al, 2017). This is contrary to WHO recommendations which stipulate that infants should exclusively be breastfed for the first six months and afterwards be supplemented with nutritious and safe foods for at least two years after birth (Thompson et al, 2014). In this regard therefore, the directive has mandated that collaborative efforts need to be established so that the rates of infants who are breastfed for the first six months exclusively be increased and also, the number of babies who are breastfed for at least one year should be increased.
Although there are many factors that significantly influences mothers’ decisions to breastfeed their babies, this policy still aimed to at least maintain the current breastfeeding rates among infants. Even though this is so, the directive is still aiming to increase the number or rather proportion of infants who are exclusively being breastfed for at least six months in addition to increasing the duration of breastfeeding (The Royal Hospital for Women, 2016). These goals would ideally be achieved by disseminating the recommendations regarding exclusive and lengthy breastfeeding among different infant populations.
The challenges and factors that influence breastfeeding rates
Similar study by Shakya et al (2017) reveal that community-based peer support for mothers is effective in increasing the period or duration within which an infant is breastfed exclusively after birth. In this study, it was revealed that infants aged between 3 and 6 months were the most affected by this initiative (Shakya et al, 2017).
Contradicting studies have however identified educational programs as the most significant forms of intervention in breastfeeding. For instance, Guise et al (2003) found out that primary care based interventions are critical in enhancing mothers’ willingness to breastfeed. Particularly, the evidence indicated that one woman in every three women attending breastfeeding educational programs would breastfeed their child exclusively for at least 3 or 5 months (Guise et al, 2003). This study therefore becomes essential for the policy since there is need to translate the findings of this study into the policy’s widespread practice in the diverse care settings across NSW.
In order to improve breastfeeding practices and outcomes, evidence suggests that there is need to develop effective professional support strategies that are accessible to a wide range of mothers. These support interventions constitute the primary resources that should be delivered in the immediate post-natal and antenatal period (Kervin, Kemp & Pulver, 2010). Even though such professional support has highly been advocated for, studies reveal that health professional’s effort to provide breastfeeding support has been negatively impacted by the lack of willingness of mothers to attend community-based support programs. To ensure the success of such support interventions, there is need to build strong partnerships with the target populations and understand the timing and the technicalities that will be involved in offering interventions for the maximum benefits to the mothers and their babies (Cramer et al, 2017).
In order to increase breastfeeding rates and consequently enhance health promotion, studies reveal that there is need to develop and implement education programs that are aimed at changing or rather improving the breastfeeding practices. Such an initiative has further been touted as one of the most efficient ways in improving hospital-based breastfeeding rates since mothers are likely to continue breastfeeding after being discharged from the hospital, and they also become well-prepared for breastfeeding after giving birth and afterwards become satisfied during the post-natal period (Barnes et al, 2010).
Similarly, health professional’s education and training has been identified as one of the priority areas within the policy. Furthermore, the directive emphasizes on the need for enhancing antenatal education. Precisely, health professionals have been entrusted with the critical task of providing education as well as exploring all the available antenatal and postnatal breastfeeding educational materials (NSW Department of Health, 2011). Such initiatives therefore indicate the acknowledgement and prioritization of education that is given by the policy in a bid to improve breastfeeding outcomes from a collective effort of both healthcare professionals and mothers.
Short-term and long-term health benefits associated with breastfeeding
It was initially anticipated that the deadline for implementation of the policy would be June, 2016. This completion would comprise the fulfillment of all the seven areas that are stipulated under the third section of the policy. The mid-term review process was set to be around mid-2013. This review would ideally comprise a full report given by the Directors of population health services, departmental branch managers and chief executives of local health districts. A further progress report was scheduled to be availed by the same parties as of September, 2013 The released implementation plan would entail a clearly stipulated roles, responsibilities, and timeframes for strategies and actions (NSW Department of Health, 2011).. In addition, the policy directive was intended to be read in conjunction with the NSW health fundraising policy directive and NSW health sponsorships policy directives.
Conclusion
The policy directive to promote, protect and support breastfeeding is critically important because of the health benefits that are associated with this practice which accrue to the mother and the infant. There are a myriad long term benefits that are associated with breastfeeding and which enhances the well-being of the infant. For instance and as revealed by studies, breastfeeding has been widely associated with the reduction of chronic diseases such as obesity and diabetes, and it also bolsters cognitive development among infants. Mothers also stand to benefit from breastfeeding health wise given that they are likely not to develop obesity and also realize an improvement in their general health.
However, despite such overwhelming evidences, the breastfeeding rates in Australia have continued to decline especially after the first weeks of birth. The policy directive developed by the NSW health department therefore becomes essential in increasing this rate particularly because it aims at increasing the duration of breastfeeding and increasing the proportion of infants who are breastfed exclusively for six months. The policy has therefore developed a number of interventions including education and training, individual and professional support and, enhancing the adherence to breastfeeding guidelines for health professionals. Nonetheless, peer support could also prove to be critical for the long term success of the policy especially since studies reveal that such an initiative has been associated with lengthy breastfeeding periods.
References
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The economic and social burdens of not breastfeeding
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