Commissioning & Public Health

By Dr Louise Santhanam, General Practitioner

Mothers’ reasons for not initiating breastfeeding are complex and varied, with a number of societal and cultural factors shaping their decision. We know that eight in ten women stop breastfeeding before they want to, saying they feel unsupported to do so or that they feel uncomfortable breastfeeding in public. Evidence shows that breastfeeding support at the right time and in the right place is effective in promoting successful breastfeeding. For some families that may be community based peer or group support whilst others may need more specialist hospital based support.

Professor Kevin Fenton, Public Health England National Director for Health and Wellbeing, from Public Health England: Commissioning Infant Feeding Services- A Toolkit for Local Authorities (June 2016)

Commissioning Infant Feeding Services

Two recent research series have demonstrated clearly the health impacts of increasing and sustaining breastfeeding in both the developed world and developing world1, 2.  The responsibility for commissioning of children’s public health services in England is now that of the Local Authority, and includes the provision of Health Visiting Services and Breastfeeding Support services.  The Mandated Health Visitor review at 6-8 weeks of life currently includes breastfeeding support and data collection. In 2016 Public Health England published Infant Feeding: Commissioning Services, a report highlighting the benefits of a comprehensive commissioning approach to infant feeding, including measures to maximise the health of babies who are not breastfed3:

  • Reduction of costs to local public services
    • The cost to the NHS every year of treating just 5 illnesses linked to babies not being breastfed is at least £48 million (infant chest infections, ear infections, gastroenteritis, NEC and breast cancer)4
    • Fewer GP consultations
    • Fewer hospital admissions
  • Increase in children’s life chances
    • Reduction in SIDS
    • Reduction in respiratory, gastrointestinal and ear infections
    • Reduction in tooth decay
  • Reduction in childhood obesity
    • Longer breastfeeding duration has been associated with a reduction in the likelihood of overweight/obesity prevalence and incidence of type 2 diabetes.
  • Reduction of health inequalities for disadvantaged families
    • Women from low income groups are les likely to breastfeed and more likely to have a preterm baby. Breastfeeding is protective of preterm health.
  • Improvement in mother-infant relationships and wellbeing
    • Investing in breastfeeding support and relationship building can protect maternal mental health.
  • Benefits to families who are not breastfeeding
    • Parents feeling supported and understanding how to formula feed safely
    • Parents knowing how to responsively feed their babies

If half those mothers who currently do not breastfeed were to breastfeed for up to 18 months in their lifetime, for each annual cohort of around 313,000 first-time mothers there could be4:

  • 865 fewer breast cancer cases with cost savings to the health service of over £21 million.
  • 512 breast cancer-related quality adjusted life years (QALYs) would be gained, equating to a value of over £10 million.

The potential benefits to Commissioners of investing in infant feeding strategies are therefore considerable. See also our webpage on ‘The Role of the GP‘. 

Infographic shared with thanks to Helen Calvert of the #hospitalbreastfeeding campaign

Importance of Monitoring Breastfeeding Statistics

UK data on infant feeding was collected via the national Infant Feeding Survey up until 2010 when the survey was decommissioned. Accurate breastfeeding statistics are important to inform public health strategy and commission services and to ‘encourage the continued prioritisation of breastfeeding support locally’5.

UK Infant Feeding Survey 2010 (Summary Version)

UK Infant Feeding Survey 2010 (Full Version)

Statistics for England

In England breastfeeding initiation data collection is now the responsibility of individual maternity units working towards Baby Friendly Accreditation.  Local Authorities are now responsible for collecting 6-8 week prevalence data. Public Health England is currently collecting the data.  

Public Health England Child Health Profiles Includes data on a number of child health outcome measures by area, including breastfeeding initiation and rates at 6-8 weeks.

In the longer term (post June 2016) it is planned that 6-8 week breastfeeding statistics will reported by the Children and Young People’s Health Services Dataset. However it will be some time before reliable data can be reported from this source5.

Public Health England: Monitoring Infant Feeding Data Support Pack  June 2016- Materials to support Local Authorities, but which also explain the importance of data collection in informing and supporting commissioning.

Statistics for Northern Ireland

HSC Public Health Agency: Statistical Profile of Children’s Health in Northern Ireland Links to a report from 2014-15 which includes breastfeeding rates at discharge post-birth and 12 months of age.

Statistics for Scotland

ISD Scotland Child Health: Infant Feeding- Breastfeeding Statistics Statistics at 10 days and 6-8 weeks are published annually.

Statistics for Wales

Statistics for Wales: Births in Wales 2005-2015 Data from the National Community Child Health Database Includes data on breastfeeding rates at birth, 10 days and 6-8 weeks.

Further Information 

Public Health England: Infant Feeding- Commissioning Services June 2016

Public Health England: Health Matters- Giving Every Child the Best Start in Life May 2016- Report on the importance of investing in early years health promotion and protection.

Public Health England: Childhood Obesity- Applying all Our Health 2015

Unicef UK: Preventing Disease and Saving Resources- The Potential Contribution of Increasing Breastfeeding Rates in the UK 2012


  1. The Lancet Breastfeeding Series January 2016
  2. Acta Paediatrica Special Issue: Impact of Breastfeeding on Maternal and Child Health November 2015
  3. Public Health England: Infant Feeding- Commissioning Services July 2016
  4. Unicef UK: Preventing Disease and Saving Resources- The Potential Contribution of Increasing Breastfeeding Rates in the UK  October 2012
  5. Public Health England: Monitoring Infant Feeding Data Support Pack June 2016

Published April 2017