NSW Centre for Public Health Nutrition ‘ Report on breastfeeding in NSW 2004’

1. Debra HectorKaren Webb • Sharyn Lymer NSW Centre for Public Health Nutrition ‘Report on breastfeeding in NSW 2004’

2. Presenting Nutrition SeriesIntroduction for Users The presentations are designed to assist professionals throughout NSW disseminate information on public health nutrition Each presentation is based on an existing CPHN report Users are requested to provide full acknowledgement of the authors, CPHN and the Department of Health Notes version of the ppt gives table/figure and page numbers, for easy reference to the report Further information and explanation of each slide should be sought from the report. Visit http://www.cphn.biochem.usyd.edu.au Users should use Excel to prepare slides with data for their own areas, modelled on the samples provided Any questions can be referred to Debra Hector, 9036 3006/9477 4351

3. Contents of ‘Report on breastfeeding in NSW 2004’ Health benefits of breastfeeding Defining breastfeeding and identifying monitoring indicators Breastfeeding practices in NSW – 2001 data

4. 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

5. 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

6. 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

7. 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)

8. 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

9. Health benefits for infants Strong evidence that breastfeeding protects against: gastrointestinal infection otitis media (‘glue ear’) lower respiratory tract infection necrotising enterocolitis (NEC)

10. 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

11. 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

12. Economic costs of poor breastfeeding practices ... to NSW health systemare estimated as $20-40 million a year based on 5 illnesses alone (gastrointestinal illness, lower respiratory infection, otitis media, eczema and NEC)

13. Australian Dietary Guideline*: ‘Encourage and support breastfeeding’ *NHMRC 2003 • Early initiation of breastfeeding • Exclusive breastfeeding until 6 months** • Complement with appropriate food from 6 months • Continuebreastfeeding until at least 12 months of age  ** this recommendation is population-based – it is recognised that some infants will benefit from the introduction of solids before the age of 6 months

14. Recommendation on Exclusive Breastfeeding Increasing evidence thatexclusivebreastfeeding 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’)

15. Types of breastfeeding Complementary Breastfeeding Full Exclusively Predominately

16. 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

17. 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)

27. Age Education

42. Determinants of Breastfeeding * amenable to intervention Sociodemographic characteristics of mother and family Socio-cultural, economic and environmentalfactors* Breastfeeding practices - initiation - exclusivity - duration Structural and Social support* Health status of mother and infant Health service organisation, practices and interventions* Specific aspects of feeding practices* Mother’s knowledge, attitude, skills *

43. 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