Becoming Breastfeeding Friendly Scotland: report

Theme 3: Ensuring consistent, long term government funding commitments underpin Scotland's multi-component breastfeeding strategy

Recommendation 3: To build on the advances in Scotland's breastfeeding rates and provision to date by ensuring ongoing and adequate funding is prioritised and protected for breastfeeding activities, coordination and maternity protections through core Scottish government funding structures.

Relevant BBF Scotland Gear scores: Funding and Resources: 3.0; Coordination, Goals and Monitoring: 3.0

Why is this recommendation necessary?

The Lancet series on breastfeeding emphasises the fundamental importance of framing breastfeeding as both a public health issue and consequently an issue that can only be addressed by a commitment to long-term, whole-system action^[29]. Interventions to raise the duration and exclusivity of breastfeeding are more effective when delivered as part of multi-component structured programmes across multiple settings^[30],^[31]. Led by Unicef and the WHO, the Breastfeeding Collective calls on governments to (1) Increase funding to raise breastfeeding rates from birth through two years; and (7) Strengthen monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets^[32].

Renfrew et al (2016) and Rollins et al (2016, the Lancet's Breastfeeding series) illustrate the economic imperative for strategic funded action on breastfeeding, where investing in improving breastfeeding support was associated with rapid financial return, and higher breastfeeding rates with greater savings. The WHO states that Breastfeeding is one of the best investments in global health, citing every $1 invested in breastfeeding generates $35 in economic returns, modelling the savings based on improved cognition, reduced childhood morbidity, and the environmental cost of not breastfeeding^[33]. Investment in breastfeeding has proven itself worthwhile for governments due to the potential financial return, with Cost Effectiveness and Return on Investment data being strengthened all the time, and 'investment in effective services to increase and sustain breastfeeding rates … likely to provide a return within a few years, possibly as little as one year'^[34].

Scotland has already made a sizeable financial commitment to breastfeeding with an allocation of £2.3 million under the Improving Maternal and Infant Nutrition: A Framework for Action (MINF, 2011) provided annually by Scottish Government to NHS health boards to implement a range of associated actions. Most of the NHS Boards spend a significant proportion of this allocation to support breastfeeding activities. All of the NHS Boards collaborate to fund a Scotland wide Donor Milk Bank. For the period 2018-2019, an additional £2.4 million has been allocated under a Breastfeeding Programme for Government commitment and this funds a wide range of local and national activities which support the stretch aim contained within the 'Diet and healthy weight delivery plan' to reduce the drop off in breastfeeding rates at six to eight weeks after birth by 10% by 2025. The Scottish Government also supports a National Unicef UK Baby Friendly Initiative post, Unicef accreditation costs, associated training courses and conference places; there is now national coverage in Scotland. BBF's evidence based Breastfeeding Gear Model advocates central coordination to ensure such multi-sectoral programmes remain on track through setting and monitoring goals, facilitating the flow of information across gears and providing timely feedback on actions need to improve or sustain the quality of scaled up programmes^[35]. It is critical that such long term commitment to a diversity of programme strands is maintained and coordinated at an expert level in order to sustain and enhance the positive direction of travel.

What do we want to happen?

• Ensure there is sustainable funding for protection, promotion and support for breastfeeding in Scotland.
• Strengthen monitoring systems that track funding supporting breastfeeding policy and practice.
• Ensure that multi-sectoral and multi-agency provision are both adequately resourced and monitored to ensure a clear overview and learning.
• Ensure sustained funding for expert advisory posts at Scottish government level and Unicef UK Baby Friendly initiative Scottish lead posts as critical coordinating positions.

How will this be done?

• Develop an effective and explicitly supported commitment to an implementation plan that will ensure that there is continuing improvement and effective support for breastfeeding at all levels (legislative, cultural, professional and in all settings).
• Commit to prioritising adequate and ring fenced funding for the Improving Maternal and Infant Nutrition Framework (MINF) and Breastfeeding Programme for Government implementation plans over time.
• Promote ongoing, long term support for high level breastfeeding leadership and expertise continues, through a funded strategy, permanent leadership and political commitment.
• Robust monitoring mechanisms should be integrated locally and nationally, and funded from the outset.
• Implementation and maintenance of these actions would require strategic level support from government to local level implementation.

What is the likely impact of this recommendation?

• Increase in the number of mothers who feel that they can breastfeed for as long as they want to.
• Improvements in infant and maternal mental and physical health outcomes.
• Return on Investment for public bodies through the outcomes stated above.
• Reduction in health inequalities through more consistent and wide-ranging provision.

Ensuring consistent, long term government funding commitment underpins Scotland's multi-component breastfeeding strategy

Aim: to ensure ongoing and adequate funding is prioritised and protected for breastfeeding activities, coordination and maternity protections through core Scottish government funding structures

Working with Scottish Government, this recommendation set out to deliver the following objectives

• To ensure that a multi-component breastfeeding strategy is adequately and sustainably resourced
• To maintain funding for the MINF & BPfG* implementation plans as a priority over time
• To embed costs for planning and evaluation from the outset
• To commit to prioritise funding for coordination of national and Unicef UK BFI programmes
• To embed robust funding monitoring mechanisms, integrated locally and nationally

What will success look like?

Based on best evidence, this would result in…

• More mothers are supported to breastfeed for as long as they want to
• Reduction in health inequalities via improved infant and maternal mental and physical health outcomes
• Return on Investment for public bodies funding breastfeeding support, promotion and protection