Improving maternal and infant nutrition: a framework for action

Executive Summary

Improving the nutrition of mothers and infants cannot and must not operate in isolation, it should be seen in the broader context of improving the health and wellbeing of everyone of who lives in Scotland. This Framework is aimed at a variety of organisations with a role in improving maternal and infant nutrition. There are many partner organisations but, primarily, the NHS, local authorities, employers, the community and voluntary sector have the most opportunity to influence culture and behaviour change. The framework is aimed at policy makers within these organisations as well as frontline staff and volunteers.

We know that the diet and nutritional status of the mother before conception and during pregnancy, the feeding received by the infant in the first few months of life, the process of weaning onto solid foods and the diet and nutrition status of the growing infant all contribute significantly to the long term health of the population.

Although there has been national and international recognition of the need to promote and support breastfeeding for a number of years, resulting in positive action across many agencies, there has not always been the same focus on improving the nutrition of pregnant women, nor on the nutrition of young children beyond milk feeding. The framework stresses the importance of nutrition in the earliest years for long term health and wellbeing, but also provides case studies demonstrating some of the good practice already in place across Scotland.

The framework also highlights the vital role of significant others to the family in the choices made by parents in feeding their children. The existence of supportive environments facilitating parents to provide optimum nutrition for their family is crucial to success.

The detrimental effect of health inequalities on maternal and infant nutrition is also recognised in the framework, resulting in the recommendation of targeted support to those most in need to ensure that health outcomes for children are maximised and the gap between the most and least healthy is reduced.

It is vital that a mother's diet contains adequate nutrients and energy at each stage to allow proper foetal growth and development as well as providing the nutrients the mother needs for maintaining her own health. Poor foetal growth and development can lead to cognitive impairment and influence the development of chronic disease in later life. The impact of birth weight on long term adult health is well established. It is therefore crucial that women are given advice and support to eat healthily before, during and after pregnancy. Also, given the rise in overweight and obesity in the general population and in women of childbearing age, the number of women likely to be entering their first pregnancy and subsequent pregnancies already overweight or obese is of concern. The Framework therefore includes measures to address the needs of this population group.

The Scottish Government has adopted as policy World Health Organisation ( WHO) guidance recommending exclusive breastfeeding for the first six months of an infant's life. There exists a large and robust body of evidence demonstrating the short and long term health benefits of breastfeeding for both mothers and infants.

Women who have breastfed are at lower risk of breast and ovarian cancer and hip fracture due to osteoporosis later in life and there is evidence to suggest they are more likely to return to their pre-pregnancy weight. It is important to understand the factors which influence a mother's infant feeding decision in order to develop effective strategies to encourage more women to breastfeed.

The Scottish Government is fully committed to the principles underpinning the WHO Code on the marketing of breast milk substitutes and expects all partner organisations involved in improving infant feeding practices in Scotland to fully comply with it. In addition, the Framework emphasises the need to provide families with the information and support to safely formula feed their babies if they have chosen to do so.

Those involved in developing the Framework have established an Action Plan. Key partners, as identified in the Action Plan, will need to develop monitoring and evaluation frameworks to underpin their results plans in delivering the actions. We recognise this will take time to establish, however, by taking this approach, partners will be able to articulate their contribution to the overall aims of the framework. An Implementation Group will be established by the Scottish Government to develop a national monitoring and evaluation framework which will complement local frameworks. A Maternal and Infant Nutrition National Co-ordinator has been appointed for two years to oversee the implementation of the framework.