dr helen mcavoy

Breastfeeding on the island of

Ireland – shared challenges?

Dr Helen McAvoy MD MFPHUK

Director of Policy

Institute of Public Health in Ireland

www.publichealth.ie

1

Overview

1. Data – breastfeeding patterns

2. Data – breastfeeding experiences and contexts

3. Concluding observations

2

1. Data – breastfeeding patterns

3

Administrative data

• Recorded by service

providers

• Postnatal – linked to

engagement with

health services

Survey data

• Recorded by mothers

• Timing variable –

linked to response to

survey

Northern Ireland Ireland

At birth –

‘breastfeeding attempted’

NIMATS X pilot

underway!

On discharge from hospital CHS NPRS

First PHN visit

(within 72hrs)

X

HSE

Primary visit (10-14 days) CHS X

6 weeks CHS X

3 months CHS HSE

6 months CHS X

12 months X

1. Data – breastfeeding patterns

5

Northern Ireland Ireland

Infant Feeding Survey Last completed 2010 Once off – 2008

Longitudinal surveys of

childhood

UK Millennium Cohort Survey Growing Up in Ireland

1. Data – breastfeeding patterns

6

1. Data – breastfeeding patterns

Source: Child Health System NI 2015/2016; NPRS RoI 2015

1. Data – breastfeeding patterns

Source: Child Health System NI; NPRS RoI (Data 2006 to 2015)

0

10

20

30

40

50

60

70

80

% o

f to

tal li

ve

bir

ths

Timepoints

Breastfeeding patterns UK and Ireland

Ireland

Northern Ireland

England

Scotland

Wales

1. Data – breastfeeding patterns

Source At birth Discharge/24hr 3 days 10-14 days 6-8 weeks

0.1 1 3 10 42

Ireland NPRS & HSE 58 54

Northern Ireland NIMATS & CHS 57 46 35 27

England Public Health England. Child Health-Early Years Data-Breastfeeding Indicators 74 44

Scotland ISD Scotland. Infant Feeding Statistics 63 50 41

Wales National Community Child Health Database 59 44 36

1. Data – breastfeeding patterns

0

10

20

30

40

50

60

Under 20 20-24 25-29 30-34 35-39 40+ Total

Perc

enta

ge o

f inf

ants

(%)

Age (years)

Discharge

Primary visit (10-14 days)

6 weeks

3 months

6 months

12 months

1. Data – breastfeeding patterns Prevalence of any breastfeeding across the first year of life by maternal age (Northern

Ireland, infants born in 2014/15)

Source: Child Health System NI

Why the gap?

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Hypotheses Comment

Cultural diversity of mothers Likely, some supportive evidence

Socio-economic profile of mothers Possibly, some supportive evidence

Other socio-cultural factors Possibly, but poorly understood

Demographic profile of mothers Unlikely

System differences (antenatal, postnatal) An unknown

Policy differences –breastfeeding, maternal and child

health

Unlikely, but there are some

Operational differences in delivery of policy approach Unlikely, but there are some

1. Data – breastfeeding patterns

2. Data – breastfeeding experiences

and contexts

12

Community

Family

Mother

Baby

• Not just health services

• Not just ‘partner’

• Not just breasts!

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2. Data – breastfeeding experiences

and contexts

Source: Growing Up in Ireland; Infant Feeding Survey (2008)

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Source: UK Infant Feeding Survey (2010)

2. Data – breastfeeding experiences

and contexts

Culture eats…

• Strategy

• Infant formula

15

16

Republic of Ireland

• Healthy Ireland Survey

(2016)

• 79% ‘breastmilk meets a

baby’s nutritional needs for

the first 6 months’

• 81% ‘comfortable when

mothers breastfeed near

me in a public place’

• 52% disagree ‘infant

formula is as good as

breast milk’

Northern Ireland

• Healthy Survey Northern

Ireland 2014/2015

• 90% agree ‘breastfeeding

is good for baby’

• 92% agree ‘breastfeeding

is normal’

• 13% agree ‘breastfeeding

is embarrassing’

2. Data – breastfeeding experiences

and contexts

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44.1

27.3

11.9 9.1

4.1 3.6 0

5

10

15

20

25

30

35

40

45

50

Perc

enta

ge 1

1-16

yea

r old

s

Perception of healthiest way to feed 3 month baby

Breast and bottle feeding

Breastfeeding only

Bottle feeding only

Breast and bottle feeding andsome solids

Breastfeeding and some solids

Bottle feeding and some solids

2. Data – breastfeeding experiences

and contexts What is the healthiest way to feed a 3 month old baby? Views of 11-16yr olds in Northern

Ireland (YPBAS 2016)

Policy response to shared challenges

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3. Concluding observations

• Core issue = low initiation

• Core determinants of initiation = socio-

cultural

• Data interpretation

• What sort of data do we need to move

forward?

3. Concluding observations

19

Acknowledgements

• Dr Joanna Purdy & Dr Noelle

Cotter (IPH)

• Siobhan Hourigan (HSE)

• Julie Neill & Janet Calvert (PHA)

• Rhian Osborne (Welsh Govt)

• Growing Up in Ireland Survey

• Infant Feeding Survey 2008

• Infant Feeding Survey UK 2010

Thank you Further details in our 2017 report ‘Breastfeeding on the

island of Ireland’ available at www.publichealth.ie

Any questions?

Email : helen.mcavoy@publichealth.ie

www.twitter.com/publichealthie

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