Breastfeeding and infant feeding: strategic framework 2025-2030

1. Introduction

This is Scotland’s Breastfeeding and Infant Feeding Strategic Framework for 2025-2030. Its purpose is to set out key strategic actions to support the infant feeding journey during pregnancy, in the days and weeks after birth, in the first year of life and beyond as part of a continuum.

It builds on a number of important documents that have supported breastfeeding and infant feeding in Scotland over the past decade or so, such as the Maternal and Infant Nutrition Framework (2011) and the Becoming Breastfeeding Friendly Report (2019).

Our high level commitments to breastfeeding and infant feeding in Scotland are:

• To publish an overarching framework setting out the blue print for breastfeeding and infant feeding actions in Scotland up to 2030 (this document)
• To set out key deliverables which we know will support implementation at national level, that can be adapted to local level through our quality improvement and evidence based approach, taking us towards 2030
• To set out how we will further implement recommendations from the 2019 Becoming Breastfeeding Friendly report, and integrate them into broader action including responding to the World Breastfeeding Trends Initiative (2024) report card for Scotland.
• To make clear our ongoing commitment to the Unicef UK Baby Friendly Initiative (BFI)^[1] and our journey to Achieving Sustainability (Gold) accreditation across maternity, neonatal and community settings
• To continue to align action with the most recent national^[2] and international^[3] evidence, and to build on key findings from our work to date about what works in Scotland
• To continue our commitment to supporting high quality infant feeding education and training across the maternity, heath visiting, neonatal and wider workforce
• To set out the importance of connecting how babies are fed – and the importance of breastfeeding – for early child development and population health recognising its contribution to ambitions set out within the National Performance Framework^[4]

It also forms part of the core ambition for babies and young children in Scotland in their early years, to support all children to receive the nurturing and responsive care they need to develop their full potential. What and how babies are fed, from birth, is a core component of this work set out in the Nurturing Care Framework^[5] , which underpins Scotland’s ambitions for getting it right for every child. Breastfeeding and responsive feeding provide a firm foundation for early child development as fundamental components of nurturing care^[6] , not only in maximising nutritional needs for babies, but in optimising opportunities for early learning and their developing brain.

The role of nutrition and diet in the early years is a cornerstone of providing nurturing care. Therefore, we need to work collectively and collaboratively across government, with local and third sector partners, within communities with staff and parents to ensure that we can deliver on our high level commitments to give every child in Scotland the best start in life. This framework sets out our national ambitions to achieve that.

“How babies are fed should be considered as a fundamental part of an overarching system that supports health and wellbeing throughout the life course, that begins in early childhood^[7] . Ensuring that all babies are fed safely and responsively, is a vital contribution towards achieving nurturing care^[8] .”

1.1. Why is protecting, promoting and supporting breastfeeding important?

“Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women’s work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly^[9] .”

The United Nations highlight that “women have the right to accurate, unbiased information in order to make an informed choice about breastfeeding”^[10]

The World Health Organisation (WHO) recommends that all ‘infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health’^[11] . The intrinsic value of breastfeeding is further recognised by the World Bank stating that breastfeeding is ‘a foundational investment in human capital’^[12] .

A range of factors will determine a women’s feeding choices. On a personal level, although most women do, not every woman wants to, or can breastfeed, they may be exposed to information that is misleading or discouraging of breastfeeding, or they may live in communities where they have never seen a baby being breastfed. Therefore, it is important that pregnant women and new mothers are provided with the advice and support they need, where they need it and how they need it, that is evidence based, free from bias and supports their choices, including for formula feeding. Equally important is ensuring that mothers who show a desire to breastfeed are fully supported to achieve their breastfeeding goals and any external factors which could undermine maternal confidence and self-efficacy are addressed.

The need to ensure that the nutrition that babies and young children receive is safe and appropriate is crucial to their growth and development. There are commitments embedded within the United Nations Convention on the Rights of the Child, now embedded in law in Scotland, that set strategic direction for countries on early nutrition and breastfeeding. The most recent concluding observations by the United Nations Committee in 2023 set out actions for the UK Government and devolved nations to continue its efforts to promote breastfeeding, including by:

(i) strengthening support for mothers, including through flexible working arrangements;

(ii) fully implementing the International Code of Marketing of Breast-milk Substitutes^[13] and strengthening relevant legislation; and

(iii) raising awareness of the importance of breastfeeding among families and the general public

The International Code of Marketing of Breast-milk Substitutes (The Code) and its resolutions are designed to ensure that all families, regardless of feeding choices, are protected from exploitation. The Code protects babies who are fed infant formula by controlling the marketing of unnecessary and potentially harmful products, preventing misuse of claims and underpins standards developed by Unicef UK Baby Friendly that apply to NHS hospital and community based settings.