Promoting breastfeeding: A view of the current position and a proposed agenda for action in Scotland

The prevalence of breastfeeding in Scotland is the second lowest in Europe. There is good evidence that breastfeeding results in decreased gastrointestinal, and to a lesser extent respiratory infections, in the first year of life, and reduced serious infections in low-birthweight babies. Published evidence for the effectiveness of interventions which seek to promote successful breastfeeding within populations is scanty and of poor quality, although numerous studies have highlighted hospital practices which discourage and undermine breastfeeding. Changing these poor practices has been shown to be achievable and can lead to improved breastfeeding rates. Experience in other industrialized countries such as Canada, Australia and Norway has shown that substantial increases in breastfeeding are achievable through combined government and health service action over a period of one or two decades. We recommend a combination of government and health service action to promote breastfeeding in Scotland including: implementation of the international Code on Marketing of Breastmilk Substitutes: reviews of health professional basic and in-service training in breastfeeding management, maternity leave and allowances, and workplace facilities for breastfeeding mothers; promotion of the 'Baby Friendly Initiative'; development of community support for breastfeeding mothers; routine collection of breastfeeding data to support annual monitoring of breastfeeding rates: and support for research on the effectiveness of strategies which seek to promote breastfeeding.