Improving maternal and infant nutrition: a framework for action
Actions which can be taken by NHS Boards, local authorities and others to improve the nutrition of pregnant women, babies and young children.
Appendix 5: Indicators for Short, Medium and Long term Outcomes
| Short term outcome |
Potential Indicator |
Data source |
|
|---|---|---|---|
| 1 |
All those working with women prior to conception, during pregnancy & after birth have the knowledge & skills to give practical information & support on optimal nutrition effectively and/or signpost appropriately |
Quality standards for education programmes are established Under graduate and postgraduate education programmes deliver on agreed learning outcomes to required quality standards in relation to maternal and infant nutrition National occupational standards for maternal and infant nutrition are established Training programmes deliver on agreed learning outcomes based on maternal and infant nutrition core standards % of relevant workforce who have completed training in maternal and infant nutrition |
Undetermined, would need to be collected by each Higher & Further Education Institution |
| 2 |
All those working with pregnant women & parents have the knowledge, skills, confidence & attitude to give practical information & support around breastfeeding and/or signpost appropriately |
Quality standards for education programmes are established Under graduate and postgraduate education programmes deliver on agreed learning outcomes to required quality standards in relation to breastfeeding % of relevant staff who have completed 'Breastfeeding Management' course % maternity units with Baby Friendly accreditation % CHPs with Baby Friendly accreditation % Universities with Baby Friendly accreditation |
Underdetermined Baby Friendly audits UNICEF Baby Friendly Initiative |
| 3 |
All those working with families with young children have the knowledge & skills to give practical information & support on infant milk feeding, complementary feeding & establishing good eating patterns and/or signpost appropriately |
Quality standards for education programmes are established Under graduate and postgraduate education programmes deliver on agreed learning outcomes to required quality standards in relation to maternal and infant nutrition National occupational standards for maternal and infant nutrition are established Training programmes deliver on agreed learning outcomes based on maternal and infant nutrition core standards % of relevant workforce who have completed training in maternal and infant nutrition |
Undetermined, would need to be collected by each Higher & Further Education Institution Audit of training provision |
| 4 |
Services and all those working with children and families are more responsive to individual nutritional needs of children and families |
Inclusion of maternal and infant nutrition in Pathways for Maternity Care and GIRFEC pathways % of referred nutritionally vulnerable individuals accessing services Evidence that service development is influenced by feedback from vulnerable groups - link to quality outcome measure around patient experience, patient reported outcomes, patient experience of access |
Local directory of support services for maternal and infant nutrition |
| 5 |
Increased identification & engagement of nutritionally vulnerable families |
% of eligible beneficiaries who register for Healthy Start % of Healthy Start beneficiaries that obtain women's vitamins % of Healthy Start beneficiaries that obtain children's vitamins Establish a core data set for maternal and infant nutrition to be included within the local Health Plan Indicator tool % of local Health Plan Indicator tools that incorporate the core data set for maternal and infant nutrition |
Department of Work & Pensions/ SG Undetermined |
| 6 |
All relevant national & local policies support healthy maternal & child nutrition |
Existence of maternal and infant nutrition local delivery plans Inclusion of maternal and infant nutrition in other relevant local policies/strategies e.g. in Single Outcome Agreements, Children's Services Plans and/or Joint Health Improvements Plans Inclusion of maternal and infant nutrition in other relevant national policies |
Audit of Board plans Audit of local joint plans Audit of national plans |
| 7 |
Healthy food & drink is more affordable & more available to vulnerable families |
Price rise of a healthy food basket is less or more than a standard or unhealthy food basket % of eligible retailers registered with Healthy Start % of eligible retailers registered with Healthy Start within the 15% most deprived datazones based on SIMD Other indicators could be developed via Obesity Route Map |
FSA Scotland Healthy Start administrative data |
| 8 |
More parents & carers understand the impact of optimal nutrition prior to conception & during pregnancy on maternal health, and consequently on foetal & child development & health |
Maternal and infant nutrition is a core component of antenatal education which is based on principles of adult learning % of parents/carers achieving learning outcomes % of parents/carers from the six equality groups and deprived communities accessing antenatal education Relevant resources are updated taking account of equality impact assessment findings % of female respondents aged 18 - 49 yrs taking folic acid supplements because they hope to become pregnant % of pregnant respondents who started taking folic acid supplements before becoming pregnant % of pregnant respondents who have taken folic acid supplements during the first 12 weeks of pregnancy % of women who took vitamin supplements during pregnancy |
Audit of antenatal education curriculum Monitoring of local service delivery Audit of resources Scottish Health Survey - Nurse interview Infant Feeding Survey |
| 9 |
More parents and carers understand the short & long term benefits of breastfeeding on maternal health, & child development & health |
% of women who meet the required Baby Friendly standard i.e. the % of women who able to identify the health benefits of breastfeeding |
Baby Friendly audits |
| 10 |
More parents & carers understand the impact of infant milk feeding, complementary food & drinks on infant & child development & health |
% of parents/carers who prepare infant formula according to guidelines % of parents/carers who report accessing information on complementary feeding % of participants from the six equality groups and deprived communities accessing support for complementary feeding Relevant resources are updated taking account of equality impact assessment findings % of infants weaned at around six months |
Infant Feeding Survey Evaluation of weaning sessions Audit of resources Infant Feeding Survey |
| 11 |
More parents & carers have the confidence & skills to implement good feeding and eating patterns |
% of parents/carers who prepare infant formula according to guidelines % of parents/carers who report they have increased confidence after accessing support for complementary feeding % of children who receive vitamin supplements Other indicators could be developed from the National Diet & Nutrition Survey ( NDNS) of Infants & Young Children (to be published 2012) |
Infant Feeding Survey Evaluation of local service Infant Feeding Survey NDNS of Infants & Young Children (2012) |
| 12 |
More parents & carers understand the impact of under/overweight prior to pregnancy & returning to a healthy weight after birth on the mother's future health |
% of women whose height and weight is recorded at booking to allow calculation of Body Mass Index % of women who report being given information on impact of weight on health Inclusion of an intervention within the Pathways for Maternity Care for women whose BMI is outwith the normal range |
ISD Scotland data Undetermined Review of Pathways |
| Medium Term Outcome |
Potential Indicator |
Data Source |
|
| 13 |
More children are breastfed and for longer |
% of infants breastfed at birth, 10 days, 6-8 weeks and 6 months |
ISD Scotland Infant Feeding Survey |
| 14 |
More parents & carers choose healthy food & drinks for themselves & their children |
% of infants who receive an "ideal" first food at weaning (fruits, vegetables, baby rice) % of eligible beneficiaries who register for Healthy Start % of respondents who have tried to eat more healthily in the last year to improve their health % of respondents who have maintained a healthier eating pattern in the last year % of women taking vitamin supplements while breastfeeding Other indicators could be developed from NDNS survey on infants and young children (to be published 2012) |
Infant Feeding Survey Healthy Start Management Information Scottish Health Survey - Knowledge, attitudes and motivation module Undetermined NDNS survey on infants and young children (2012) |
| 15 |
Increased acceptability of breastfeeding in Scottish society in general & in disadvantaged groups |
% of women who have been stopped from or made to feel uncomfortable about breastfeeding in a public place % of respondents in the general population who tend to agree or strongly agree that women should only breastfed their babies at home or in private % of respondents in lower socioeconomic groups who tend to agree or strongly agree that women should only breastfed their babies at home or in private |
Infant Feeding Survey Scottish Health Survey - Knowledge, attitudes and motivation module |
| 16 |
Increased awareness in the general population of the short & long term benefits of breastfeeding on maternal & child development & health |
% of respondents who are able to identify at least one health benefit of breastfeeding for infants % of respondents who are able to identify at least one health benefit of breastfeeding for mothers % of respondents who state that bottle fed babies are less healthy and less immune to infection than breast fed babies |
Undetermined |
| 17 |
Increased awareness in the general population of the impact of nutrition on foetal & child development & health |
% of general population who identify folic acid supplementation as important for pregnant women % of general population who are able to identify the recommended daily intake of fruit and vegetables for children |
Undetermined |
| Medium/Long term Outcome |
Potential Indicator |
Data Source |
|
| 18 |
society values & prioritises maternal & child nutrition |
% household expenditure on fruit and vegetables % household expenditure on soft drinks % household expenditure on confectionery % of respondents in the general population who tend to agree or strongly agree that women should only breastfeed their babies at home or in private |
Family Food Survey Scottish Health Survey - Knowledge, attitudes and motivation module |
| 19 |
breastfeeding is increasingly seen as the norm |
% of respondents who if a close friend or relative was having a baby would encourage them to breastfeed |
Undetermined |
| 20 |
the social & physical environment supports healthy nutrition for young children |
% of early years establishments assessed who provide fruit, milk and water daily % of early years establishments assessed who have a healthy eating policy |
Care Commission inspections |
| Long term Outcome |
Potential Indicator |
Data Source |
|
| 21 |
reduced childhood obesity |
% of children with a BMI on or above 85 th centile and on or above 95 th centile at the Primary 1 assessment |
ISD Scotland |
| 22 |
improved child nutrition-related health & wellbeing |
% of infants breastfed at birth, 10 days, 6-8 weeks and 6 months % of infants weaned at around 6 months % of children with a BMI on or above 85 th centile and on or above 95 th centile at the Primary 1 assessment % of Primary 1 children with decayed, missing or filled teeth |
ISD Scotland Infant Feeding Survey ISD Scotland Scottish Dental Inspection Programme |
| 23 |
reduced inequalities in child nutrition-related health & wellbeing |
Reduction in gap across all quintiles of rates of 21 & 22 above |
As 21 & 22 above |
| 24 |
reduced maternal obesity |
% of overweight and obese women aged 16 - 44 yrs % of overweight and obesity in pregnant women at first booking appointment % overweight and obese women following birth (at a point in time yet to be determined) |
Scottish Health Survey ISD Scotland Undetermined |
| 25 |
improved maternal nutrition-related health & wellbeing |
% of women taking folic acid supplements prior to and during pregnancy % of women taking vitamin D supplements during pregnancy and while breastfeeding % of pregnant women with a BMI < 18.5 at first booking appointment |
Scottish Health Survey - Nurse interview Undetermined ISD Scotland |
| 26 |
reduced inequalities in maternal nutrition-related health & wellbeing |
Reduction in gap across all quintiles of rates of 24 & 25 above |
As 24 & 25 above |
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