NSW Centre for Public Health Nutrition

‘Report on breastfeeding

in NSW 2004’

Debra Hector Karen WebbSharyn Lymer

Presenting Nutrition SeriesIntroduction for Users

o The presentations are designed to assist professionals throughout NSW disseminate information on public health nutrition

o Each presentation is based on an existing CPHN report

o Users are requested to provide full acknowledgement of the authors, CPHN and the Department of Health

o Notes version of the ppt gives table/figure and page numbers, for easy reference to the report

o Further information and explanation of each slide should be sought from the report. Visit http://www.cphn.biochem.usyd.edu.au

o Users should use Excel to prepare slides with data for their own areas, modelled on the samples provided

o Any questions can be referred to Debra Hector, 9036 3006/9477 4351

Contents of ‘Report on breastfeeding in NSW 2004’

•Health benefits of breastfeeding

•Defining breastfeeding and identifying monitoring indicators

•Breastfeeding practices in NSW – 2001 data

Contents of ‘Report on breastfeeding in NSW 2004’

• Health and economic burden associated with poor breastfeeding practices

• Recommendations:– for the monitoring of breastfeeding

in NSW– objectives/outcomes for breastfeeding promotion and support in NSW

Rationale for promoting and supporting breastfeeding

• Breastmilk contains a range of bioactive factors not found in formula

• Substantial health benefits to mothers and infants

• Economic benefits, especially to health system

• Environmental benefits

Rationale for promoting and supporting breastfeeding

• Many of the factors associated with poor breastfeeding practices are amenable to intervention

• Evidence of substantial effects, to increase the initiation and duration of breastfeeding, from intervention strategies

Breastmilk ...

• provides all the nutrients required by infants for at least the first six months

• changes during each feed and throughout lactation

• contains ‘bioactive factors’ – prevent and reduce severity of infection, help develop the immune system

• e.g. the antibody IgA protects against ‘local’ pathogens (bacteria, viruses)

Health benefits for women• less postpartum bleeding and more rapid

uterine involution• earlier return to pre-pregnancy weight • delayed resumption of ovulation, with

increased child spacing• reduced risks of pre-menopausal (and

possibly post-menopausal) breast cancer and ovarian cancer

• improved bone remineralization, with reduction in postmenopausal hip fractures

Health benefits for infants

Strong evidence that breastfeeding protects against:

gastrointestinal infection otitis media (‘glue ear’) lower respiratory tract infection necrotising enterocolitis (NEC)

Health benefits for infants• May be protective against bacteraemia,

meningitis, botulism, urinary tract infection, SIDS

• Conflicting evidence of effects of breastfeeding on asthma

• Reduces the incidence of chronic diseases, such as diabetes and obesity, in childhood and later in life

Breastfeeding may help prevent childhood obesity

There are consistent findings from a number of recent studies showing that breastfeeding protects against overweight and obesity

The precise mechanism is uncertain, with various possible explanations

Economic costs of poor breastfeeding practices ...

to NSW health system are estimated as $20-40 million a year

based on 5 illnesses alone (gastrointestinal illness, lower

respiratory infection, otitis media, eczema and NEC) 

Australian Dietary Guideline*: ‘Encourage and support breastfeeding’

• Early initiation of breastfeeding

• Exclusive breastfeeding until 6 months**

• Complement with appropriate food from 6 months

• Continue breastfeeding until at least 12 months of age 

* NHMRC 2003

** this recommendation is population-based – it is recognised that some infants will benefit from the introduction of solids before the age of 6

months

Recommendation on Exclusive Breastfeeding

• Increasing evidence that exclusive breastfeeding to 6 months is particularly beneficial to health

• Australia’s infant feeding guidelines (NHMRC 2003) now recommend exclusive breastfeeding for the first 6 months (previous recommendation ‘4 to 6 months’)

Types of breastfeeding

ComplementaryBreastfeeding

Full

ExclusivelyPredominately

Describing breastfeeding practices

in NSW• Recommendations for national set of

breastfeeding indicators (AFNMU, 2001)

• Data from the NSW Child Health Survey 2001 were used to report on an interim set of breastfeeding indicators possible with the data

• First state-based population survey of breastfeeding practices in NSW

NSW Child Health Survey 2001

• First state-based population survey of health of children (0-12 years) in NSW

• CATI survey (computer assisted telephone survey)

• Infant feeding practices based on a subset of respondents – mothers or fathers of children 0-23 months

• Responses based on recall

• N = 1,489 (87.7% mothers)

Percentage of infants 'ever breastfed' (Indicator 1) by AHS

98.7

93.491.7

82.6

86.988.4

87

93.790.8 90.2

70

75

80

85

90

95

100

CS NS SES SWS WS CC Went Hunt Illa NSW

Area Health Service

%

infa

nts

Percentage of infants 'ever breastfed' (Indicator 1) by AHS

93.6

98.4

93.5

85.7

82.284.6

89

94.5

90.2

70

75

80

85

90

95

100

NR MNC NE Mac FW MW GM S NSW

Area Health Service

% in

fan

ts

Percentage of infants 'ever breastfed' (Indicator 1) for different maternal subgroups

84.5

86.8

90.4

96.1

75

80

85

90

95

100

< 25 yrs >25 yrs <Tert. Tertiary

AGE EDUCATION

% in

fant

s

Percentage of infants ever breastfed (Indicator 1), by maternal disadvantage

95.5

89.8

87.3

92.4

86.2

80

85

90

95

100

1st - Least 2nd 3rd 4th 5th - most

Quintile of disadvantage

% in

fant

s e

ver

bre

ast

fed

Duration of any breastfeeding (Indicator 2)

0

10

20

30

40

50

60

70

80

90

100

ever 1 2 3 4 5 6 7 8 9 10 11 12

Completed months

% in

fan

ts

Prevalence of any breastfeeding to 4, 6 and12 months (Indicator 2) for

Northern Sydney AHS

66.6

56.6

32.2

54.2

42.5

18.1

0

1020

3040

50

6070

8090

100

4 months 6 months 12 months

% in

fant

s

NS NSW

Prevalence of breastfeeding at 4, 6 and 12 months (Indicator 2) by maternal country

of birth

53.3

41.8

16.2

56.2

44.7

24.6

0

10

20

30

40

50

60

70

80

90

100

4 months 6 months 12 months

% in

fant

s

Aust. O'seas

Median duration of breastfeeding among 'ever breastfed' infants (Indicator 6), by AHS

6

4

6

10

6 6 6 6 65

0

2

4

6

8

10

12

CS NS SES SWS WS CC Went Hunt Ill NSW

Co

mp

lete

d m

ont

hs

Median duration of breastfeeding among 'ever breastfed' infants (Indicator 6), by AHS

7

10

6

8

6 67 7

6

0

2

4

6

8

10

12

NR MNC NE Macq FW MW GM South TOTALNSW

Co

mp

lete

d M

on

ths

Median duration of any breastfeeding among 'ever breastfed' infants (Indicator 6),

by maternal age and education

3

56

9

0

2

4

6

8

10

12

< 25 yrs >25 yrs <Tert. Tertiary

Co

mp

lete

d M

on

ths

Age Education

Median duration of any breastfeeding among 'ever breastfed' infants (Indicator 6),

by socioeconomic disadvantage

9

76

56

0

2

4

6

8

10

12

1st - Least 2nd 3rd 4th 5th - most

SEIFA quintile of disadvantage

Co

mp

lete

d M

on

ths

Percentage of infants regularly given solid foods before 4 and before 6 months (Indicator 3),

by AHS

0

20

40

60

80

100C

S

NS

SES

SW

S

WS

CC

Wen

t

Hun

t

Illa NS

MN

C

NE

Mac FW MW GM S

All

NS

W

% in

fant

s

4 months 6 months

Percentage of infants given solids before 4 and 6 months (Indicator 3) for

Northern Sydney AHS

68.7

12.6

69.8

10.3

0

10

20

30

40

50

60

70

80

4 months 6 months

% in

fan

ts

NS NSW

Percentage of infants regularly given solds before 4 and 6 months (Indicator 3),

by maternal age

22.6

79.3

12.2

71.8

0

10

20

30

40

50

60

70

80

90

4 months 6 months

% in

fant

s

<25 yrs >=25 yrs

Percentage of infants regularly given solids before 4 and 6 months (Indicator 3), by

maternal education

16.3

71.2

5.9

67.4

0

10

20

30

40

50

60

70

80

4 months 6 months

% in

fant

s

<tertiary tertiary

Percentage of infants regularly given solids before 4 and 6 months (Indicator 3), by

maternal background

72.5

7.3

79.6

14.0

0

10

20

30

40

50

60

70

80

90

4 months 6 months

% in

fant

s

ESB NESB

Percentage of infants regularly given breastmilk substitutes before 4 and 6 months

(Indicator 4) by AHS

0

20

40

60

80

100

CS NS SES SWS WS CC Went Hunt Illa NSW

% in

fant

s

4 months 6 months

0

20

40

60

80

100

NR MNC NE Mac FW MW GM S NSW

% in

fan

ts

4 months 6 months

Percentage of infants regularly given breastmilk substitutes before 4 and 6 months

(Indicator 4) by AHS

Percentage of infants given breastmilk substitutes before 4 and 6 months

(Indicator 4), for Northern Sydney AHS

46.5

36.8

45.9

59.6

0

10

20

30

40

50

60

70

80

90

100

NS NSW

% in

fant

s

4 months 6 months

Percentage of infants given breastmilk substitutes regularly before 4 and 6 months

(Indicator 4) by maternal subgroup

50.5

68.3

45.4

57.2

0

10

20

30

40

50

60

70

80

90

100

4 months 6 months

% in

fant

s

ESB NESB

Percentage of infants given breastmilk substitutes before 4 and 6 months(Indicator 4) by maternal subgroup

61.169.1

43.9

58.3

0

10

20

30

40

50

60

70

80

90

100

4 months 6 months

% In

fant

s

<25 yrs >=25 yrs

Population rates of infants fully breastfed to 3, 4 and 6 months (Indicator 5A) by AHS

0

10

20

30

40

50

60

70

CS NS SES SWS WS CC Went Hunt Ill NSW

% in

fant

s

3 months 4 months 6 months

Population rates of infants fully breastfed to 3, 4 and 6 months (Indicator 5A) by AHS

0

10

20

30

40

50

60

NR MNC NE Macq FW MW GM South TOTALNSW

% in

fant

s

3 months 4 months 6 months

Population rates of infants fully breastfed to 3, 4 and 6 months (Indicator 5A) for

Northern Sydney AHS

58.4

31.8

5.2

48.4

24.6

4.6

0

10

20

30

40

50

60

70

80

90

100

3 months 4 months 6 months

% in

fant

s

NS TOTAL NSW

Breastfeeding practices- initiation

- exclusivity- duration

Sociodemographic characteristics of mother and family

Socio-cultural, economic and environmental factors*

Structural and Social support*

Specific aspects of feeding practices*

Health status of mother and infant

Health service organisation, practices and interventions* 

Mother’s knowledge, attitude, skills *

Determinants of Breastfeeding

* amenable to intervention

Recommendations for focus of breastfeeding interventions:

• the decline in breastfeeding that occurs in the first few months

• continued breastfeeding for at least 12 months• exclusive breastfeeding to 6 months• high-risk groups:

– young mothers, less-educated mothers: short duration and low intensity of breastfeeding

– ATSI mothers: initiation and intensity of breastfeeding