The UNICEF UK Baby Friendly Initiative Briefing Paper 2009

The UNICEF UK 

Baby Friendly Initiative 

Improving the health of 

the UK through breastfeeding 

Briefing Paper 2009

UNICEF 

UNICEF is the world’s leading organisation 

working for children and their rights. We 

work with families, local communities, 

partners and governments in 191 countries 

to help every child realise their full potential. 

UNICEF UK is one of 36 UNICEF National 

Committees based in industrialised 

countries. We work in the UK to champion 

children’s rights, advocate for lasting change 

and raise money for our work with children 

everywhere. 

Contact UNICEF UK to arrange a visit to a 

Baby Friendly accredited service in the UK 

Parliamentarians and civil servants 

Public Affairs Team 

breastfeeding@unicef.org.uk 

0207 375 6097 

Health professionals 

Baby Friendly Team 

bfi@unicef.org.uk 

0844 801 2414 

For more information on the UNICEF UK Baby Friendly 

Initiative please visit www.babyfriendly.org.uk 

Rights Respecting Schools 

UNICEF UK also runs the Rights Respecting Schools Award, 

which works to embed the values of the UN Convention on 

the Rights of the Child into school life. For more information 

on the Rights Respecting Schools Award please visit 

www.childwellbeing.org.uk/rrsa 

Publication Date: May 2009 

All images: UNICEF UK/Jill Jennings 

The UNICEF UK Baby Friendly Initiative Improving the health of the UK

Contents 

Executive summary 2 

Page 

Introduction 4 

Benefits of breastfeeding 5 

Why don’t more women breastfeed? 6 

The UNICEF UK Baby Friendly Initiative 9 

Breastfeeding and the NHS 12 

Focus on the four nations of the UK 13 

Recommendations 15 

Appendix 1: List of facilities with Baby Friendly accreditation 16 

Appendix 2: Map of Baby Friendly accredited facilities in the UK 17 

The UNICEF UK Baby Friendly Initiative Improving the health of the UK 

1

Executive summary 

The UNICEF UK Baby Friendly Initiative: 

Improving the health of the UK 

The aim of this paper is to give an overview of the work of the UNICEF 

UK Baby Friendly Initiative and the role that breastfeeding can play in 

addressing health inequalities in the UK. 

Having ratified the UN Convention on the Rights of the Child, the UK 

Government is obliged to do all it can to ensure that children in the UK 

enjoy the highest attainable standard of health 1 . This includes 

recognising the importance of the healthiest way to feed a baby – 

breastfeeding – in public health policy. 

The Baby Friendly Initiative 

The Baby Friendly Initiative, launched in the UK in 1994, is a 

programme of the World Health Organization and UNICEF. There are 

now more than 20,000 Baby Friendly accredited facilities in 152 

countries. Worldwide, the Baby Friendly Initiative improves the health 

of mothers and children and saves lives. 

In the UK, the Baby Friendly Initiative works with the National Health 

Service (NHS) to ensure a high standard of care for pregnant women 

and breastfeeding mothers and babies in hospitals and community 

health settings. The Baby Friendly Initiative accredits health-care 

facilities that adopt internationally recognised best practice standards 

for breastfeeding. During each stage of accreditation, the Baby Friendly 

Initiative provides support as facilities implement standards relating to 

policies and procedures, staff education, effective auditing, educating 

pregnant women and mothers, and other relevant areas. There is also a 

Baby Friendly university standards programme aimed at university 

departments responsible for midwifery and health visitor/public health 

nurse education. This ensures that newly qualified midwives and health 

visitors are equipped with the basic knowledge and skills they need to 

support breastfeeding effectively. 

Benefits of breastfeeding 

In numerous studies breastfeeding has been shown to be the 

healthiest way to feed babies. In addition to providing all the essential 

nutrients and sustenance, it greatly reduces the risk of babies 

developing health problems such as gastroenteritis, asthma, diabetes 

and obesity and helps protect women from breast and ovarian cancer 2 . 

In comparison to a formula-fed baby, a breastfed baby is five times less 

likely to be hospitalised with gastroenteritis 3 . 

However, breastfeeding rates in the UK are amongst the lowest in 

Europe. Although three-quarters of mothers initiate breastfeeding after 

giving birth, this figure falls to less than 1 in 4 by the time the baby is 

six months old 4 . 

1. Article 24 (e) of the UN Convention on the Rights of the Child 

2. Ip S, et al (2007) Breastfeeding and Maternal Health 

Outcomes in Developed Countries. AHRQ Publication No. 07- 

E007. Rockville, MD: Agency for Healthcare Research and 

Quality. 

3. Howie PW, Forsyth S, et al (1990) Protective effect of breast 

feeding against infection, British Medical Journal: 300:11-16 

4. Bolling, K., et al (2007) Infant Feeding Survey 2005, 

Department of Health, London. 

2 


5. Bartington S, Griffiths L, Tate A, Dezateux C and the 

Millennium Cohort Study Child Health Group (2006) Are 

breastfeeding rates higher among mothers delivering in Baby 

Friendly accredited maternity units in the UK? International 

Journal of Epidemiology. doi:10.1093/ije/dyl155 

6. Broadfoot M, et al (2005) The Baby Friendly Hospital Initiative 

and breastfeeding rates in Scotland. Archives of Disease in 

Childhood Fetal and Neonatal Edition: 90: F114–F116 

7. UK Department of Health (1995) Breastfeeding: Good Practice 

Guidance to the NHS. [The estimate in this report was a 

saving of £35 million per year in the treatment of 

gastroenteritis. Increasing this by 3 per cent per year (an 

average rate of inflation) for 12 years (1995 to 2007) gives the 

figure of £49.9 million.] 

8. McConnachie A et al (2004) Modelling consultation rates in 

infancy: influence of maternal and infant characteristics, 

feeding type and consultation history. Br J Gen Pract: 54: 

598–603. 

Barriers to successful breastfeeding 

Poor practice in the health service, a lack of education of health 

professionals and parents, and continued marketing and promotion of 

artificial formula are major barriers to successful breastfeeding. 

Results for child health and the NHS 

Breastfeeding initiation rates are over 10 per cent higher in hospitals 

that are Baby Friendly accredited, while mothers who give birth in a 

Baby Friendly accredited hospital are 28 per cent more likely to be still 

breastfeeding at seven days after birth 6 . 

Investment in breastfeeding leads to savings in other areas of the NHS. 

If all babies were breastfed for three months, the NHS would save £50 

million a year in the treatment of just one childhood disease – 

gastroenteritis 7 . Breastfed babies also have 15 per cent fewer General 

Practitioner (GP) consultations during their first six months of life than 

babies fed on infant formula 8 . 

Recommendations in order to increase 

breastfeeding initiation and duration rates 

1. All maternity hospitals and community health settings 

to implement best practice standards that increase 

rates of initiation of breastfeeding and extend the 

duration of breastfeeding. 

Parliamentarians can help to realise this aim by encouraging 

hospitals and community health services to work towards Baby 

Friendly accreditation and raise awareness of the Initiative within 

their constituency. 

2. All universities to provide courses in midwifery and 

public health that recognise and teach the importance of 

good breastfeeding practice. 


universities in their constituency to gain Baby Friendly accreditation 

for their midwifery and public health courses. 

3. Fully implement the World Health Organization’s 

International Code of Marketing of Breastmilk 

Substitutes. 

Parliamentarians can help to realise this aim by encouraging the 

Government to fully implement the Code and drawing attention to 

the fact that partial implementation, as represented by current UK 

legislation, is allowing companies to misinform parents and 

undermine public health. 


3

Introduction 

The Baby Friendly Initiative, launched in the UK in 1994, is a worldwide 

programme of the World Health Organization and UNICEF. In the UK, 

the Baby Friendly Initiative works with the National Health Service 

(NHS) to ensure a high standard of care for pregnant women and 

breastfeeding mothers and babies in hospitals and community health 

settings. It provides support for health-care facilities to implement best 

practice in caring for mothers and babies, and offers an assessment 

and accreditation process that recognises those that have achieved the 

required standards. 

Having ratified the UN Convention on the Rights of the Child, the UK 

Government is obliged to ensure that “all segments of society…are 

informed, have access to education and are supported in the use of 

basic knowledge of …the advantages of breastfeeding” as set out in 

Article 24 on the right of the child to the enjoyment of the highest 

attainable standard of health 9 . Further to this, in their 2008 Concluding 

Observations and Recommendations, the UN Committee on the Rights 

of the Child called on the UK Government to “implement fully the 

International Code of Marketing of Breastmilk Substitutes and further 

promote baby-friendly hospitals.” The onus is therefore on the 

Government to help ensure that breastfeeding information and support 

is available to everyone 10 . 

This paper highlights the range of factors that influence breastfeeding 

in the UK and outlines how the work of the Baby Friendly Initiative is 

helping to improve the health of the UK. 

9. Article 24 (e) of the UN Convention on the Rights of the 

Child www.unicef.org.uk/publications/pdf/uncrc.pdf 

10. UN Committee on the Rights of the Child (2008) UK 

Concluding Observations. 

www2.ohchr.org/english/bodies/crc/docs/AdvanceVersions/ 

CRC.C.GBR.CO.4.pdf 

4 


Benefits of breastfeeding 

“I cannot express enough 

how impressed and delighted 

I was by the midwives. The 

confidence and knowledge of 

the staff helped me avoid 

common problems like sore 

nipples and I am still 

breastfeeding my healthy 

baby boy 12 weeks later.” 

Mother who gave birth in January 

2009 at the UNICEF UK Baby 

Friendly accredited Royal Surrey 

Hospital in Guildford 

There is a wealth of published evidence 11 that demonstrates the 

profound health benefits for both mothers and children that 

breastfeeding provides. 

Breastfed babies are less likely to suffer from a range of conditions 

such as: 

• Gastroenteritis 

• Chest infections 

• Eczema 

• Ear infections 

• Diabetes in childhood 

• Childhood obesity 

• Childhood leukaemia 

• Sudden Infant Death Syndrome 12 

The evidence indicates that the longer a baby is breastfed the greater 

the protection from ill health they gain and the more positive the impact 

on their long-term health. In comparison to a baby fed on infant formula, 

a breastfed baby is five times less likely to be hospitalised with 

gastroenteritis 13 and on average will visit the doctor 15 per cent less 14 . 

Breastfeeding has also been shown to: 

- Increase neurological and cognitive development 

- Lower blood pressure 15 

11. See www.babyfriendlyorg.uk/research for the latest 

developments. 


Outcomes in Developed Countries. AHRQ Publication No. 

07-E007. Rockville, MD: Agency for Healthcare Research 

and Quality. 

13. Howie PW, Forsyth S, et al (1990) Protective effect of breast 

feeding against infection, British Medical Journal: 300:11-16 

14. McConnachie A et al (2004) Modelling consultation rates in 

infancy: influence of maternal and infant characteristics, 

feeding type and consultation history. Br J Gen Pract: 54: 

598–603. 

15. Horta B.L. et al (2007) Evidence on the long-term effects of 

breastfeeding. WHO 

16. Strathearn L, Mamun AA, Najman JM et al (2009) Does 

breastfeeding protect against substantiated child abuse and 

neglect? A 15-year cohort study. Pediatrics Vol. 123; 483 


Outcomes in Developed Countries. AHRQ Publication No. 

07-E007. Rockville, MD: Agency for Healthcare Research 

and Quality. 

18. Department of Health (2008) Healthy Weight, Healthy Lives: 

A Cross-Government strategy for England. London: The 

Stationery Office 

www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/ 

HealthyWeight/index.htm 

19. Department of Health (2008) Health Inequalities: Progress 

and Next Steps. London: The Stationary Office 

www.dh.gov.uk/en/Publicationsandstatistics/Publications/Pub 

licationsPolicyAndGuidance/DH_085307 

20. Department of Health (2004) Breastfeeding and 

the NHS Priorities and Planning Framework 

www.dh.gov.uk/en/Healthcare/Maternity/ 

Maternalandinfantnutrition/DH_4071692 

21. HM Government (2008) PSA Delivery Agreement 12: 

Improve the health and wellbeing of children and 

young people. 

www.hm-treasury.gov.uk/d/pbr_csr07_psa12.pdf 

Furthermore, breastfeeding helps secure the bond between mother 

and child, with recent studies showing a reduced risk of maternal 

neglect amongst breastfeeding mothers 16 . 

Breastfeeding provides health benefits for mothers too, as women who 

breastfeed have a reduced risk of postnatal depression and of ovarian 

and breast cancer in later life 17 . 

Reducing health inequalities 

Evidence on the health benefits of breastfeeding has led government 

policy makers in the UK to encourage breastfeeding as the best way of 

ensuring a healthy start for children. In particular, breastfeeding has 

been recognised as playing an important role in helping to deliver 

government targets on obesity 18 and health inequalities 19 . As part of the 

Government’s commitment to reduce health inequalities, a target was 

set, through the NHS Priorities and Planning Framework 20 , to increase 

breastfeeding initiation rates by 2 per cent annually amongst mothers 

who are least likely to breastfeed. The Department of Health is 

monitoring progress towards achieving this target by measuring the 

prevalence of breastfeeding at 6 to 8 weeks in all primary care trusts 21 . 


5

Why don’t more women breastfeed? 

In the UK, 84 per cent of mothers say they are aware of the health 

benefits of breastfeeding and 9 out of 10 women who stop 

breastfeeding their child before six weeks say that they would have 

liked to have breastfed for longer. Despite this, only three-quarters of 

UK babies are breastfed at birth and just 1 in 4 still receives any 

breastmilk at six months 22 . 

Poverty and background 

Even though breastfeeding is the cheapest way to feed an infant, it is 

the poorest mothers who are least likely to breastfeed. Poor white 

women are the group least likely to breastfeed in the UK, while women 

in professional and managerial occupations, highly educated women 

and those aged 30 or over are most likely to breastfeed. At six months 

mothers aged 35 or over were more than five times as likely to be 

breastfeeding compared with mothers aged under 20 23 . Cultural 

background also plays its part. By the time their child is six months old, 

23 per cent of white mothers are still breastfeeding compared with 37 

per cent of Asian mothers and 57 per cent of black mothers 24 . 

Returning to work 

Research shows that returning to work when their child reaches six 

months is one of the reasons that women give for stopping 

breastfeeding. The number of women who stop breastfeeding because 

of returning to work decreased between 2000 and 2005, which 

indicates that extended maternity leave entitlement is having a positive 

impact on breastfeeding duration rates 25 . Whilst UNICEF UK welcomes 

this positive development, maternity leave in the UK is not meeting the 

standard set out in UNICEF’s Report Card 8 on early childhood 

education and care, which calls for parental leave of one year at 50 per 

cent of salary 26 . 

“A fair society means 

helping people to make 

healthier choices in many 

difference aspects of their 

lives. It doesn’t detract from 

personal responsibility or 

impose a nanny state…. 

Physical or mental ill health 

can remove every prospect 

of a fulfilled life. The fact that 

poorer people have the 

worse health remains an 

indictment on our society.” 

Alan Johnson, 

Secretary of State for Health, 2008 

22. Bolling, K., et al (2007) Infant Feeding Survey 2005, 

Department of Health, London. 

23. ibid. 

24. ibid. 

25. ibid. 

26. Adamson P, et al (2008) Report Card 8. UNICEF 

Innocenti Research Centre 

www.childwellbeing.org.uk/pages.asp?page=15 

6 


Lack of support 

Mothers do not breastfeed in isolation and it is known that mothers 

who have the support of their partner, family or friends are more likely 

to breastfeed for longer 27 . Unfortunately, as formula feeding has 

become the most common way 28 to feed babies, the understanding 

and experience of breastfeeding across society has been lost. This 

leaves many mothers without the support of anyone who is confident 

that they can be successful. 

Lack of knowledge 

Over the past 60 years in the UK, feeding babies and children with 

commercially manufactured formulas has become standard practice, 

which has led to a widespread lack of knowledge on how to initiate and 

sustain breastfeeding. This lack of knowledge extends to health 

professionals who are not receiving the training they need to support 

breastfeeding mothers effectively. Certain practices known to make 

breastfeeding more difficult, such as separating mothers and babies 

immediately after the birth and giving babies unnecessary formula 

supplements, therefore persist throughout the NHS. 

“My community midwife 

quickly identified that my 

baby was not latching on 

correctly and causing me a 

huge amount of pain. She 

showed me an alternative 

way to breastfeed lying down 

which greatly eased the pain 

and enabled me to continue 

breastfeeding for the next 

three years.” 

Mother who received the 

support of a community midwife 

trained by the UNICEF UK 

Baby Friendly Initiative 

27. Dyson L, Renfrew M, et al. (2006) Promotion of breastfeeding 

initiation and duration Evidence into practice briefing. National 

Institute for Health and Clinical Excellence 

www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_ 

final_version.pdf 

28. Although three-quarters of women initiate breastfeeding less 

than 1 in 4 is still breastfeeding at all at six months. 

29. op. cit. 

Inappropriate health-care practices 

Hospitals that place importance on practices such as keeping new 

mothers with their babies, teaching mothers how to breastfeed, 

avoiding supplementation with formula and encouraging baby-led 

feeding help to create the right environment for breastfeeding. Recent 

studies have shown that hospitals have a direct impact on the 

successful outcome of a mother’s intention to breastfeed. The 2005 

Infant Feeding Survey found that mothers who had the most difficulties 

in breastfeeding were those who had used a combination of breast and 

formula (about half of all mixed-feeding mothers experienced 

problems) 29 .Those who do not receive help or advice for these 

problems after giving birth are more likely to stop breastfeeding within 

two weeks. 

Lack of training 

Health professionals such as midwives, health visitors, nurses and 

doctors can play a crucial role in helping women to initiate and sustain 

breastfeeding. Whilst recent policy developments in relation to 

breastfeeding are to be welcomed, the understaffing of maternity units 

has a negative impact on their ability to adequately support women to 

breastfeed. There has also been a historic lack of training around 

breastfeeding, meaning that most staff, if they learn skills at all (such as 

how to communicate successful breastfeeding positioning and 

attachment and how to express breastmilk), learn them on the job, 

often in an inconsistent manner. This inconsistency and lack of 

ingrained knowledge amongst staff can confuse and misinform the 

mother and mean that she feels unable to initiate and maintain 

breastfeeding. 


7

Marketing of infant formula 

Parents need accurate and impartial information about how to feed 

their babies. However, the inappropriate promotion of infant formula 

can confuse parents, implying that it is as good as breastfeeding. 

In 1995, European legislation was adopted by the UK to prevent 

companies from marketing infant formula. However, the law did not go 

far enough and still allows producers of formula milk to legally promote 

products for babies who are six months or older. The result has been 

that the companies have made the packaging of ‘follow-on formula’ 

for older babies very similar to formula for younger babies and 

newborns.‘Follow-on formula’ is then advertised on television, in 

magazines etc. in a way that is confusing and leads parents to believe 

that the advertisement applies to all infant formula. In 2005, a MORI 

poll carried out on behalf of UNICEF UK and the National Childbirth 

Trust found that 75 per cent of mothers thought they had seen an 

advertisement for infant formula, even though such advertising is 

supposed to be illegal. 

The International Code of Marketing 

of Breastmilk Substitutes 

1. Products should not be advertised or 

otherwise promoted to the public. 

2. Mothers and pregnant women and their 

families should not be given samples of 

products. 

3. Health-care providers should not be 

given free or subsidised supplies of 

products and must not promote 

products. 

4. People responsible for marketing 

products should not try to contact 

mothers or pregnant women or their 

families. 

5. The labels on products should not use 

words or pictures, including pictures of 

infants, to idealise the use of the 

products. 

6. Health workers should not be given 

gifts. 

7. Health workers should not be given 

samples of products, except for 

professional evaluation or research at 

the institution level. 

8. Material for health workers should 

contain only scientific and factual 

information and must not imply or 

create a belief that bottle-feeding is 

equivalent or superior to breastfeeding. 

9. All information and educational materials 

for pregnant women and mothers, 

including labels, should explain the 

benefits and superiority of 

breastfeeding, the social and financial 

implications of its use, and the health 

hazards of the unnecessary or improper 

use of formula. 

In 2007, the Food Standards Agency introduced guidance to strengthen 

existing legislation designed to restrict the promotion of infant formula. 

UNICEF UK welcomed this as a means of strengthening and clarifying 

the Formula and Follow-on Formula Regulations. However, we remain 

very concerned that the advertising of follow-on formula per se is still 

permitted, which means that formula feeding can still be promoted and 

there is still potential for manufacturers of infant formula to exploit 

loopholes in the law. This means that the onus remains on trading 

standards offices and non-governmental organisations to prove that an 

activity will be perceived as promoting infant formula and therefore 

undermining breastfeeding. 

Therefore UNICEF UK and other members of the Breastfeeding 

Manifesto Coalition 30 are calling on the UK Government to ensure that 

the marketing of infant formula is controlled to the standards set out in 

the World Health Organization’s International Code of Marketing of 

Breastmilk Substitutes 31 . UNICEF UK, Save the Children and the 

National Childbirth Trust published a report on this issue in 2007 32 . 

10. All products should be of a high quality 

and take account of the climate and 

storage conditions of the country where 

they are used. 

30. In 2006, the Breastfeeding Manifesto was produced by a 

coalition of organisations, including UNICEF UK, in order to 

present policymakers with a clear list of objectives 

designed to improve breastfeeding rates in the UK. Since 

the introduction of the Breastfeeding Manifesto, over 300 

MPs, AMs, MSPs and MEPs have signed up to its 

objectives. www.breastfeedingmanifesto.org.uk 

31. In 1981, Member States of the World Health Organization 

adopted the International Code of Marketing of Breastmilk 

Substitutes to protect, promote and support appropriate 

infant and young child feeding practices. 

32. Faircloth C, (2007) A weak formula for legislation: how 

loopholes in the law are putting babies at risk 

www.unicef.org.uk/publications/pub_detail.asp?pub_id=140 

8 


The UNICEF UK Baby Friendly Initiative 

The Ten Steps to Successful 

Breastfeeding for maternity services 

1. Have a written breastfeeding policy that 

is routinely communicated to all healthcare 

staff. 

2. Train all health-care staff in the skills 

necessary to implement the 

breastfeeding policy. 

3. Inform all pregnant women about the 

benefits and management of 


4. Help mothers initiate breastfeeding 

soon after birth. 

5. Show mothers how to breastfeed and 

how to maintain lactation even if they 

are separated from their babies. 

6. Give newborn infants no food or drink 

other than breastmilk, unless medically 

indicated. 

7. Practice rooming-in, allowing mothers 

and infants to remain together 24-hours 

a day. 

8. Encourage breastfeeding on demand. 

9. Give no artificial teats or dummies to 

breastfeeding infants. 

10. Foster the establishment of 

breastfeeding support groups. 

33. Bartington S, Griffiths L, Tate A, Dezateux C and the 

Millennium Cohort Study Child Health Group (2006) Are 

breastfeeding rates higher among mothers delivering in 

Baby Friendly accredited maternity units in the UK? 

International Journal of Epidemiology. doi:10.1093/ije/dyl155 

The Seven Point Plan for Sustaining 

Breastfeeding in the Community 

1. Have a written breastfeeding policy that 

is routinely communicated to all healthcare 

staff. 

Almost every woman is capable of successfully breastfeeding her baby 

if she receives appropriate information and support. However, many 

women in the UK do not receive the help that they need, both before 

and after childbirth, to ensure that breastfeeding is successful. The 

Baby Friendly Initiative was established to provide health professionals 

with the necessary guidance, training and support to enable them to 

support mothers, babies and their families appropriately. 

The Baby Friendly Initiative in hospitals 

Maternity services that adopt the Ten Steps to Successful 

Breastfeeding (see side panel), can apply to be assessed and 

accredited as Baby Friendly. The Ten Steps to Successful 

Breastfeeding are evidence-based best practice standards developed 

by UNICEF and the World Health Organization. They are designed to 

enable improved practice in maternity units in order to promote, 

protect and support breastfeeding. Baby Friendly accreditation 

requires that maternity units implement all Ten Steps to Successful 

Breastfeeding and ensure that that they adhere to the International 

Code of Marketing of Breastmilk Substitutes. 

The Baby Friendly Initiative in the community 

In the UK, the majority of women give birth in a hospital and only stay 

there for a short time after the birth. Evidence shows that a Baby 

Friendly accredited hospital can improve a woman’s chances of 

initiating breastfeeding by 10 per cent 33 . However the likelihood of her 

continuing to breastfeed for as long as she wants diminishes if she 

does not receive ongoing support in the weeks and months after giving 

birth. In order to ensure parents do receive that ongoing support, 

UNICEF UK introduced the Seven Point Plan for Sustaining 

Breastfeeding in the Community for primary care trusts, community 

health care trusts, GP surgeries, locality teams, health centres and Sure 

Start Children’s Centres. The Seven Point Plan addresses the need for 

both formal health care and the less formal support that can be 

provided by breastfeeding groups and peer support programmes 

(where local mothers support new mothers to breastfeed) by setting 

standards of practice for the health service to follow. 

2. Train all staff involved in the care of 

mothers and babies in the skills 

necessary to implement the policy. 

3. Inform all pregnant women about the 

benefits and management of 


4. Support mothers to initiate and 

maintain breastfeeding. 

5. Encourage exclusive and continued 

breastfeeding, with appropriately timed 

introduction of complementary foods. 

6. Provide a welcoming atmosphere for 

breastfeeding families. 

7. Promote cooperation between healthcare 

staff, breastfeeding support groups 

and the local community. 


9

The Baby Friendly Initiative in universities 

Currently, the majority of UK health professionals who will go on to 

work in maternal health care do not receive adequate breastfeeding 

training before they qualify. In an attempt to address this training gap, 

UNICEF UK introduced an accreditation programme for university 

departments responsible for midwifery, health visitor and public health 

nurse education. The UNICEF UK Baby Friendly Initiative University 

Standards programme was developed to ensure that newly qualified 

midwives and health visitors are equipped with the basic knowledge 

and skills they need to support breastfeeding effectively. In April 2008, 

the Health Minister Dawn Primarolo MP presented the first ever 

University Standards Awards to the University of the West of Scotland 

and King’s College London. Newly qualified midwives from these two 

universities will be the first in the country to have received UNICEF 

UK’s Baby Friendly accredited training in breastfeeding. 

“There are really three things 

that need to be taught as part 

of breastfeeding training: 

knowledge, skills and 

attitude…Skills are the most 

important aspect. What Baby 

Friendly has done with its 

18 Learning Outcomes for 

universities is to encourage 

that all-important training. 

We now include far more 

skills training for student 

midwives than I ever 

got myself.” 

Midwifery Admissions Lecturer, 

King’s College London 

Endorsement of the Baby Friendly Initiative 

In 2006, the National Institute for Health and Clinical Excellence (NICE) 

made implementing the UNICEF Baby Friendly Initiative in both hospital 

and community health-care settings one of six key recommendations in 

its Clinical Postnatal Care Guidelines. This followed on from substantial 

evidence which demonstrated that the Baby Friendly Initiative is both a 

clinically sound and cost-effective intervention to improve health care 34 . 

Two years later, a second NICE guideline concerning the nutrition of 

pregnant women, mothers and babies recommended the 

implementation of the Baby Friendly Initiative 35 . 

34. National Institute for Health and Clinical Excellence (2006) 

Routine postnatal care of women and their babies: NICE 

Clinical Care Guideline 37. 

www.nice.org.uk/nicemedia/pdf/CG37NICEguideline.pdf 

35. National Institute for Health and Clinical Excellence (2008) 

Improving the nutrition of pregnant and breastfeeding 

women and children in low income households: NICE 

Public Health Guidance 11. 

www.nice.org.uk/nicemedia/pdf/PH011guidance.pdf 

36. Scientific Advisory Committee on Nutrition (2008) Infant 

Feeding Survey 2005: A commentary on infant feeding 

practices in the UK. London: The Stationery Office 

www.tsoshop.co.uk/bookstore.asp?Action=Book&ProductI 

d=9780112431183 

In 2008, in response to the latest analysis of breastfeeding rates across 

the UK, the Government’s Scientific Advisory Committee on Nutrition 

recommended the implementation of the Baby Friendly standards by all 

health-care providers 36 . 

Following on from these recommendations, Government policy 

increasingly endorses the Baby Friendly Initiative. However, despite the 

progress made in recent years, less than half of all maternity hospitals 

in England (45 per cent) have made efforts to achieve Baby Friendly 

status. Twenty-five maternity hospitals, or a little over 10 per cent of 

the total, have gone on to become fully accredited. 

10 


Staged approach to Baby Friendly accreditation 

In order to support hospitals and community-based health-care facilities 

to achieve Baby Friendly status, UNICEF UK provides a staged 

approach towards full Baby Friendly accreditation. 

“You can know all you like, 

but when you are on the 

postnatal ward with a 

mother in tears, knowing 

what is in colostrum is not 

useful. You need the skills to 

know where to put your 

hands, how to position the 

baby. Without this, your 

training is lacking.” 

Midwifery Admissions Lecturer, 

King’s College London 


11

Breastfeeding and the NHS 

Cost savings for the NHS 

There are a number of cost savings across several areas of health care 

resulting from increased breastfeeding rates. More research is required 

to ascertain the true potential cost savings to the NHS if all mothers 

breastfed their baby for the first six months of life. However, given the 

range of infections and conditions that non-breastfed babies are prone to, 

even conservative estimates indicate very substantial savings to the NHS. 

If more women breastfed for longer, which research indicates is their 

preference, the potential cost savings to the NHS far outweigh the 

initial costs of Baby Friendly accreditation. Breastfed babies and their 

mothers are at lower risk of a range of illnesses. It is estimated that the 

NHS spends £50 million per year in England and Wales in treating 

gastroenteritis in bottle-fed infants 37 . Therefore, a 1 per cent increase in 

breastfeeding among babies at 13 weeks will save approximately 

£672,000 per year in treating this illness alone. 

Facilities being assessed for Baby Friendly accreditation are charged 

£7,350 (2009) for all three stages of the assessment and accreditation 

process, which can be spread across up to five years. UNICEF UK 

makes every effort to keep charges low and does not include any 

element of profit in its charges to the NHS. Included in this charge are 

the fees of the assessment team members (nine days of staff time in 

total), the review of policies, curricula, information leaflets and other 

materials, detailed reports on the findings from each of the three 

assessments, support from the Baby Friendly Initiative staff and 

advisers in the run-up to the assessments, the right to use the Baby 

Friendly accreditation mark on appropriate documents and a Baby 

Friendly Award plaque. Optional training and materials to support 

health-care facilities to achieve Baby Friendly accreditation are also 

available using a similar not-for-profit charging structure. 

A costing report from NICE in 2006 showed that just three years after 

becoming Baby Friendly, increased breastfeeding rates mean that a 

maternity unit will start to save money due to significantly reduced 

occurrences of certain childhood illnesses. 

“My breastfeeding training 

was brilliant as a student. 

There was a lot of detail so 

when I went into practice I 

really felt that I could help 

women right from the start.” 

One of the first midwifery 

students to graduate from the 

Baby Friendly accredited course at 

King’s College London. 

37. UK Department of Health (1995) Breastfeeding: Good 

Practice Guidance to the NHS. [The estimate in this report 

was a saving of £35 million per year in the treatment of 

gastroenteritis. Increasing this by 3 per cent per year (an 

average rate of inflation) for 12 years (1995 to 2007) gives 

the figure of £49.9 million.} 

12 


Focus on the four nations of the UK 

The Royal Oldham Hospital serves a 

deprived area and nearly 30 per cent of its 

patients are made up of non-English 

speakers. Breastfeeding initiation rates rose 

from 29 per cent in 1994 to 55 per cent on 

accreditation in 1999. A further increase to 

62 per cent was achieved by the time of 

re-assessment in 2004. The breastfeeding 

initiation rate rose again to 66 per cent in 2008. 

Breastfeeding initiation at Queen’s Park 

Hospital, Blackburn increased from 

27 per cent in 1991 to 61 per cent on 

accreditation in 1998. In 2006, their 

breastfeeding rates had risen even further 

to 68 per cent. 

With just over 2,000 births a year at 

Calderdale Royal Hospital, Halifax, 

breastfeeding initiation rose from an initial 

level of 54 per cent to 68 per cent at time of 

accreditation. This had continued to increase 

to 76 per cent by 2008. 

“I cannot thank you enough 

for all the help and support 

you gave to my baby and I 

during our stay in hospital. 

Your patience and 

understanding is a credit to 

your profession. My 

daughter is breastfeeding 

really well and gaining 

weight. I am so glad that I 

persevered with the 

breastfeeding – with your 

help. Thanks once again – 

you are worth your weight 

in gold!” 

England 

Number of hospitals with full Baby Friendly accreditation: 25 

Number of hospitals with other stages of Baby Friendly accreditation: 79 

Percentage of births in Baby Friendly Hospitals: 10.8 per cent 

The latest available data shows that the breastfeeding initiation rate for 

England is 78 per cent but two-thirds of those who initially breastfeed 

have stopped by the time their child is six months old. Mothers in the 

north-east and north-west regions of England have the lowest levels of 

exclusive breastfeeding at birth, whilst mothers in the south-west (78 

per cent) and the south-east coast (78 per cent) regions have the 

highest levels. 

The Department of Health is working towards ensuring that all relevant 

hospital and community settings adopt the principles of the UNICEF 

Baby Friendly Initiative. To help achieve this, the Department of Health 

is investing £6 million between 2008 and 2010 to promote the Baby 

Friendly Initiative in areas with the lowest rates of breastfeeding or the 

capacity to achieve the greatest increase in breastfeeding rates. 

Wales 




The 2005 UK Infant Feeding Survey provided breastfeeding rates for 

Wales for the first time. This survey showed that two-thirds of mothers 

initiated breastfeeding but by six weeks only 37 per cent of mothers 

were still breastfeeding and this number had fallen to 18 per cent by 

six months of age. In order to improve breastfeeding duration rates in 

Wales, the Minister for Health and Social Services for Wales launched a 

national breastfeeding promotion programme in February 2008. The 

same year, the Welsh Assembly began funding a full time Baby 

Friendly Initiative Professional Officer post to help improve 

breastfeeding rates in Wales. 

Mother who gave birth at the 

Baby Friendly accredited 

Prince Charles Hospital in 

Merthyr Tydfil, Wales 


13

Scotland 




Scotland has the highest level of participation in the UNICEF UK Baby 

Friendly Initiative of any UK nation with more than 40 per cent of 

Scottish maternity units having achieved the UNICEF award. Half of all 

Scottish babies are born in a UNICEF Baby Friendly accredited 

maternity unit, which has led 70 per cent of new mothers in Scotland 

to start breastfeeding their baby. Data on all babies born between 1995 

and 2002 in Scottish maternity units with more than 50 births per year, 

shows that babies born in Baby Friendly hospitals are 28 per cent more 

likely to be exclusively breastfed at seven days postnatal age than 

babies born in other hospitals. 

Support for breastfeeding is a key strand of the Scottish Government’s 

early years work. NHS Boards in Scotland have been set a 

performance target to increase the number of babies who are 

exclusively breastfed at 6-8 weeks by 25 per cent by the year 2010/11. 

In September 2008, the Scottish Government provided NHS Boards 

with £19 million over three years to improve the nutrition of women of 

childbearing age, pregnant women and children under the age of five 

living in areas of deprivation. It is expected a proportion of this 

allocation will be used by NHS Boards to assist in achieving the health 

improvement target on breastfeeding. Furthermore, the Scottish 

Government is funding a Baby Friendly Initiative Professional Officer 

post for Scotland for the next two years. 

Northern Ireland 




Approximately 28 per cent of births in Northern Ireland take place in 

Baby Friendly hospitals. A breastfeeding strategy was introduced in 

1999 and Northern Ireland was the first of the UK nations to fund a 

Baby Friendly Initiative Professional Officer post to help improve 

breastfeeding rates. Northern Ireland’s Department of Health Social 

Services and Public Safety (DHSSPS) funded a public information 

campaign on breastfeeding in 2004, 2005, 2007 and 2009. 

"It has boosted staff morale, 

when hearing positive 

comments that women have 

made regarding our 

breastfeeding support." 

Midwife, Vale of Leven 

Hospital, Scotland 

Breastfeeding initiation at Altnagelvin 

Area Hospital and Foyle HSS Trusts, 

Londonderry rose from 33 per cent in 1996, 

to 44 per cent on accreditation in 2001. 

It increased a further 7 per cent by 

re-assessment in 2003. 

Anniesland, Bearsden & Milngavie Local 

Health Care Cooperative, Glasgow reported 

its breastfeeding initiation rate rising from 75 

per cent to 83 per cent in the 12 months prior 

to accreditation in 2003. 

14 


Recommendations in order to increase 

breastfeeding initiation and duration rates 

UNICEF UK welcomes the efforts made 

to improve the profile of breastfeeding in 

policies relating to childcare, maternity and 

public health. It is essential that policies on 

breastfeeding continue to be positioned 

within the context of child and public 

health to help establish practices that 

support women to both initiate and 

continue breastfeeding. 

1. All maternity hospitals and community health 

settings to implement best practice standards that 

increase rates of initiation of breastfeeding and 

extend the duration of breastfeeding. 


hospitals and community health services to work towards Baby 

Friendly accreditation and raise awareness of the Initiative within 

their constituency. 

2. All universities to provide courses in midwifery and 

public health that recognise and teach the 

importance of good breastfeeding practice. 


universities in their constituencies to gain Baby Friendly 

accreditation for their midwifery and public health courses. 

3. Fully implement the World Health Organization’s 

International Code of Marketing of Breastmilk 

Substitutes. 

Parliamentarians can help to realise this aim by encouraging the 

Government to fully implement the Code and drawing attention to 

the fact that partial implementation as represented by current UK 

legislation is allowing companies to misinform parents and 

undermine public health. 


15

List of health-care facilities that have achieved 

full UNICEF UK Baby Friendly accreditation 

Name Town Region Unit Type 

Northern Health and Social Care Trust Ballymena Northern Ireland Community 

Down Lisburn Community Trust Ballynahinch Northern Ireland Community 

Foyle HSS Trust Londonderry Northern Ireland Community 

Colin Neighbourhood Sure Start Belfast Northern Ireland Community 

Anniesland, Bearsden & Milngavie LHCC Glasgow Scotland Community 

Bridgeton Health Centre Glasgow Scotland Community 

Coatbridge LHCC Coatbridge Scotland Community 

Sure Start Pinehurst and Penhill, Swindon Swindon South West Community 

Castleford and Normanton District Hospital Castleford Yorkshire and the Humber Community 

Princess Elizabeth Hospital Guernsey Channel Islands Maternity 

Chesterfield & North Derbyshire Royal Hospital Chesterfield East Midlands Maternity 

Darley Maternity Unit Matlock East Midlands Maternity 

Derby City General Hospital Derby East Midlands Maternity 

University Hospital of North Tees Stockton-on-Tees North East Maternity 

James Cook University Hospital Middlesbrough North East Maternity 

University Hospital of Hartlepool Hartlepool North East Maternity 

Salford Royal Maternity Hospital Salford North West Maternity 

North Manchester General Hospital Manchester North West Maternity 

Royal Blackburn Hospital Blackburn North West Maternity 

Royal Oldham Hospital Oldham North West Maternity 

West Cumberland Hospital Whitehaven North West Maternity 

Altnagelvin Area Hospital Londonderry Northern Ireland Maternity 

Antrim Hospital Antrim Northern Ireland Maternity 

Ulster Hospital Belfast Northern Ireland Maternity 

Lagan Valley Hospital Lisburn Northern Ireland Maternity 

Royal Naval Hospital Gibraltar Other Maternity 

Arbroath Maternity Unit Arbroath Scotland Maternity 

Ayrshire Maternity Unit Kilmarnock Scotland Maternity 

Princess Royal Maternity Hospital Glasgow Scotland Maternity 

Montrose Royal Infirmary Montrose Scotland Maternity 

Perth Royal Infirmary Perth Scotland Maternity 

The Queen Mother’s Hospital Glasgow Scotland Maternity 

Rankin Maternity Unit Greenock Scotland Maternity 

Royal Alexandra Hospital Paisley Scotland Maternity 

Simpson Centre for Reproductive Health Edinburgh Scotland Maternity 

Gilbert Bain Hospital Lerwick Scotland Maternity 

Southern General Glasgow Scotland Maternity 

Forth Park Hospital Kirkcaldy Scotland Maternity 

Chipping Norton Community Hospital Chipping Norton South Central Maternity 

Royal Surrey County Hospital Guildford South Central Maternity 

St Richard’s Hospital Chichester South Central Maternity 

Wallingford Community Hospital Wallingford South Central Maternity 

Southmead Hospital Bristol South West Maternity 

St Michael’s Hospital Bristol South West Maternity 

Stroud Maternity Unit Stroud South West Maternity 

Shepton Mallet Community Hospital Shepton Mallet South West Maternity 

Royal Glamorgan Hospital Pontypridd Wales Maternity 

Llandough Hospital Llandough Wales Maternity 

Neath Port Talbot Hospital Port Talbot Wales Maternity 

Nevill Hall Hospital Abergavenny Wales Maternity 

Princess of Wales Hospital Bridgend Wales Maternity 

Royal Gwent Hospital Newport Wales Maternity 

Prince Charles Hospital Merthyr Tydfil Wales Maternity 

Tair Afon Midwifery Unit Aberdare Wales Maternity 

Caerphilly Birth Centre Caerphilly Wales Maternity 

Walsall Manor Maternity Hospital Walsall West Midlands Maternity 

University Hospital of North Staffordshire Stoke-on-Trent West Midlands Maternity 

Russell Hall Hospital Dudley West Midlands Maternity 

Bradford Royal Infirmary Bradford Yorkshire and the Humber Maternity 

Calderdale Royal Hospital Halifax Yorkshire and the Humber Maternity 

Harrogate District Hospital Harrogate Yorkshire and the Humber Maternity 

University of Nottingham Nottingham East Midlands Training 

King’s College London London London Training 

University of the West of Scotland Paisley Scotland Training 

16 The UNICEF UK Baby Friendly Initiative Improving the health of the UK

Shetland 

Maternity 

Community 

Training 


17

UNICEF UK 

30a Great Sutton Street 

London EC1V 0DU 

www.babyfriendly.org.uk 

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The UNICEF UK Baby Friendly Initiative Briefing Paper 2009

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