As part of National Breastfeeding Week (01-07 October) in the Republic of Ireland, IPH launched a report on breastfeeding on the island of Ireland. The report presents up to date figures on breastfeeding patterns and on attitudes, perceptions and experiences of breastfeeding.
Dr Helen McAvoy is co-author on the report and in these 2 blog posts reflects on findings and potential implications for public health policy and practice.
The posts focus on two inter-related themes – Part 1: ‘starting to breastfeed’ and Part 2: ‘infant feeding culture’ on the island of Ireland.
Starting to breastfeed
There is good news. More women are starting to breastfeed in both jurisdictions. Rates of breastfeeding on discharge from hospital in the Republic of Ireland improved by 9% over the most recent decade, while rates in the North improved by 5%. This is the first analysis that I am aware of that recognises a small but significant North South gap in breastfeeding rates on the island of Ireland- a gap that may be widening over time. This is significant as we want all babies on the island to receive the benefits of breastmilk.
While progress has been made, a concern is that low breastfeeding rates remain a shared challenge for both jurisdictions. It is often cited that Ireland or indeed the UK have the lowest breastfeeding rates in Europe - this is referenced primarily from OECD data for the period 2005-2008. I could not source a more up to date comparison that included Ireland and Northern Ireland – so I do wonder whether Ireland can indeed claim this dubious honour of worst in Europe! Different countries measure breastfeeding in different ways and at different time points so that comparisons are really very challenging. However, Wales recently recorded that 60% of mothers attempt breastfeeding at birth which would seem to be not that far off the 58% of mothers in Ireland breastfeeding at the point of discharge from hospital. Is Ireland catching up with rates in Wales and Scotland where 49% of mothers were breastfeeding at 10-14 days after the birth? The North-South gap is not unique to Ireland, nor is it unique to breastfeeding. While there is indeed a North South gap in breastfeeding on the island of Ireland, this appears to mirror to a smaller extent the North South gap evident within England and indeed across Great Britain.
Moving the focus closer to home a key question is why has this pattern emerged on the island? We do not have the answer to that question, but there is some supportive evidence that an enhanced rate of improvement in the South was partially driven by changes in the cultural background of mothers. A higher proportion of immigrant mothers, who brought with them the high breastfeeding rates of their country of origin, may well have caused the rates in the South to progress faster than the North. However, we do need to better understand whether differences in maternal age and socio-economic status between jurisdictions may be a factor. Rather than further surmising, I would recommend that further detailed analysis of the factors underlying the trends in both jurisdictions would be valuable. This could aid understanding of the differing policy and programme effects as well as the wider social factors creating the context for infant feeding decisions in both jurisdictions.
Although Northern Ireland may be achieving progress slightly more slowly in terms of increasing breastfeeding rates, the policies and the ambition are not lacking. They have set a robust long-term policy goal that 70% of babies in 2025 would be breastfed on discharge from hospital. Well-developed information systems measuring breastfeeding in maternity hospitals and throughout the first year of life will be a real asset to the North in moving forward where the Republic of Ireland information systems are currently engaged in a bit of a catch up. Northern Ireland’s score on the World Breastfeeding Trends Initiative seems to indicate that better progress is being made on policies and programmes in Northern Ireland than in many other areas of the UK. I hope that we will see improvements across the island and a narrowing of the gap in coming years.
Dr Helen McAvoy
Director of Policy
Institute of Public Health in Ireland
For local and reliable support and advice on breastfeeding:
Northern Ireland: www.breastfedbabies.org
Republic of Ireland: www.breastfeeding.ie
Resources mentioned in this blog:
Breastfeeding on the island of Ireland – all sources mentioned in terms of the Republic of Ireland and Northern Ireland are cited within this report