Breastfeeding Policies & Programs: Australia’s Performance on the World Stage

“What if governments had a proven, cost-effective way to save babies’ lives, reduce rates of malnutrition, support children’s health, increase educational attainment and grow productivity? They do: It’s called breastfeeding. And it is one of the best investments nations can make in the lives and futures of their youngest members – and in the long-term strength of their societies.”

Anthony Lake, UNICEF Executive Director

We know that research has unequivocally shown breastfeeding to be important for optimal health and economic outcomes. But how is a country’s performance measured in relation to breastfeeding support, promotion, and protection? 

A recent editorial published in the Lancet (July 2017) entitled ‘Breastfeeding: a missed opportunity for global health’ highlighted the work of the Global Breastfeeding Collective and focused on a Global Breastfeeding Scorecard. The Collective, a partnership led by UNICEF and WHO, drew on data collected through 20 international agencies and non-government organisations (NGOs) to score the performance of 194 countries (WHO UNICEF, 2017). A key element of evaluation was the World Breastfeeding Trends Initiative (WBTI).

They found that Australia and high-income countries lag behind when it comes to implementing breastfeeding support at a cultural level. In fact, research has shown that although breastfeeding's positive health outcomes are well reported in developed countries, breastfeeding is more common in developing countries.  

You may be surprised to learn that Australia scores lower than Afghanistan on the scorecard. And of the six countries that achieved the minimum standard on more than half of the indicators — Armenia, Cuba, The Gambia, Guatemala, Nepal and Vietnam — all were low-income countries.

How were countries evaluated?

Countries were assessed against the following indicators to establish whether they had an enabling environment and what level of reporting they are carrying out in relation to breastfeeding.

An enabling environment is indicated by:

  • Amount of (donor) funding available for breastfeeding
  • Status of WHO code implementation in legislation
  • Status of paid maternity leave
  • Status of Ten steps to successful breastfeeding (BFHI-accredited facilities)
  • Percent of primary health care facilities offering individual IYCF (infant and young child feeding) counselling
  • Percent of districts offering community breastfeeding programs.

Reporting tools consisted of:

  • Assessment of the overall breastfeeding program (WBTi)
  • Exclusive breastfeeding rates.

Why did Australia score lower than Afghanistan?

  • Australia has not fully implemented the WHO code and relies on a voluntary agreement with formula manufacturers known as the MAIF Agreement.
  • There is a lack of recent data (within the last 5 years) on national breastfeeding rates, particularly exclusive breastfeeding rates.
  • There is a lack of data and lack of monitoring of factors which protect, promote and support breastfeeding.
  • Australia has not had a World Breastfeeding Trends Initiative (WBTi) assessment undertaken.

Australia is not alone in having poor data on breastfeeding practices. UNICEF attribute this deficiency in data to a lack of value placed on breastfeeding in developed countries. 

WBTi – The key to reporting

WBTi takes a big picture view of a country’s status as a breastfeeding nation. This assessment of overall breastfeeding programs in a country is crucial to obtaining a good score on the Global Breastfeeding Scorecard.  To date, 84 countries have been assessed against the WBTi framework, including the USA and UK.

The initiative was developed by International Baby Food Action Network (IBFAN) Asia to assess individual countries on their practices, policies and programs in relation to breastfeeding. It also identifies gaps and makes recommendations for improvements.

The WBTi assesses 15 indicators in two stages as outlined:

Part 1

  • National Policy, Programme and Coordination
  • Baby Friendly Hospital Initiative (Ten steps to successful breastfeeding)
  • Implementation of the International Code of Marketing of Breastmilk Substitutes
  • Maternity Protection
  • Health and Nutrition Care Systems (in support of breastfeeding & IYCF)
  • Mother Support and Community Outreach
  • Information Support
  • Infant Feeding and HIV
  • Infant Feeding during Emergencies
  • Mechanisms of Monitoring and Evaluation System

Part 2 

  • Early Initiation of Breastfeeding
  • Exclusive breastfeeding
  • Median duration of breastfeeding
  • Bottle feeding
  • Complementary feeding

Each indicator used for assessment has the following components:

  • The key question that needs to be investigated.
  • Background on why the practice, policy or program component is important.
  • A list of key criteria as a subset of questions to be considered in identifying achievements and areas needing improvement, with guidelines for scoring, colour-rating, and ranking how well the country is doing.

When will Australia be measured against the WBTi assessment?

The WBTi assessment is now underway thanks to the work of breastfeeding advocates who met with IBFAN Asia and UNICEF/WHO representatives in 2017. The group of individuals and advocacy groups agreed to conduct the assessment of Australia’s policies and programs on breastfeeding and infant and young child feeding.

You are making a difference

By creating a society where combining breastfeeding and work is accessible to women, you are removing a barrier to natural weaning which in turn has the potential to increase the average age of breastfeeding. You are also playing a vital role in providing support to breastfeeding families. As an accredited Breastfeeding Friendly Workplace you are in the unique position of improving Australia’s standing against this global measuring tool. 

Further reading

Explore the full WBTi tool and participating countries

Read the UNICEF report  

Based on an article written in September 2017 by Dr Susan Tawia, the Australian Breastfeeding Association’s Manager of Breastfeeding Information and Research.