Breastfeeding and infant feeding: strategic framework 2025-2030

2. Key Achievements on breastfeeding in Scotland

The crucial role of breastfeeding and breastmilk in reducing health inequalities continues to be recognised. Despite a welcome reduction in breastfeeding inequalities in Scotland over the past few years, breastfeeding rates continue to have a strong social gradient with babies from more deprived areas less likely to be breastfed and more likely to experience early cessation of breastfeeding compared to those living in more affluent areas.

2.1. UK and International

Scotland scored highly, compared to the overall UK score, on the World Breastfeeding Trends Initiative (WBTi) carried out in 2016^[14] and this was largely replicated in the most recent WBTi reporting for 2024^[15] .

2.2. UK

The Becoming Breastfeeding Friendly (BBF) process generates scores assessed against 54 benchmarks contained within eight gears (Advocacy, Political Will, Legislation and Policies, Funding and Resources, Training and Programme Delivery, Research and Evaluation and Coordination, Goals and Monitoring). The resulting total score indicates a country’s breastfeeding scaling-up and enabling environment (Pérez-Escamilla et al., 2018). A summary of the scores for each aspect of the 2019 BBF assessment for Scotland is shown in the Annex. Scotland was the top scoring country in the UK out of the three countries who took part, England, Wales and Scotland.

• Scotland has a strong scaling-up environment for the promotion, protection and support of breastfeeding as assessed by the BBF process;
• The BBF process is a helpful tool that led to specific recommendations that together have the potential to improve the rates and experiences of breastfeeding in Scotland;
• Scotland has a strong political commitment to breastfeeding evidenced by effective leadership, strong policies and significant investment and this needs to be sustained;
• Further co-ordination of breastfeeding activities and messages between government, health services and the third sector is needed;
• A supportive environment of breastfeeding women returning to work could be enhanced through employer guidelines and increasing women’s awareness of their rights.

Within the (2019) Becoming Breastfeeding Friendly Scotland Report (BBF), there were a number of key recommendations, across the eight themes.

• Ensuring reliable, comprehensive, explanatory and comparable data on Infant Feeding for monitoring and commissioning purposes
• Strengthening and coordinating breastfeeding messages across Scotland
• Promoting a supportive return to work environment for breastfeeding women through greater awareness and application of maternity, employment and child care provisions
• Strengthening, enforcing and monitoring legislation in Scotland that supports the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions
• Developing coordinated, consistent and evidence-based learning outcomes across education and training programmes, based on role-appropriate competency frameworks
• Ensuring families have equitable access to evidence-based infant feeding support when and how they need it through multi-component, structured models of care
• Reinforcing political will for breastfeeding among high level decision makers
• Ensuring consistent, long term government funding commitments underpin Scotland’s multi-component breastfeeding strategy

2.3. Scotland

The positive trend of increasing rates of breastfeeding, especially over the last few years is highly encouraging. We know from these most recent statistics that the rises are highest for those women historically least likely to breastfeed, such as younger women and those living in the most deprived areas.

2.3.1. National Infant Feeding Statistics

The latest national infant feeding statistics in Scotland show breastfeeding rates have notably improved in recent years, with an increase from 44% in (2002/03) to 59% (2023/24) of babies being breastfed at their health visitor first visit (10-14 days). The proportion of babies still being breastfed at 6-8 weeks has risen from 36% (2002/03) to 49% (2023/24). Breastfeeding was initiated at birth in over two thirds of babies in Scotland (68%), with 33% being exclusively breastfed since birth.

Public Health Scotland Infant Feeding Statistics Report 2023/24 states “Increases in breastfeeding over the past 10 years have been greatest among those groups with historically lower rates, such as younger women and those living in more deprived areas. This means inequalities in breastfeeding have reduced over time.”^[16]

68% of all babies receive some breastmilk from birth

2.3.2. Unicef UK Baby Friendly Initiative

A continuous commitment to embedding the foundational infrastructure and consistent standards to support infant feeding across multiple settings, including in education, has supported the overall ambition so far. Progress has continued with Achieving Sustainability (GOLD) accreditation.

2.3.3. Education, knowledge and skills

Responding to workforce and service need, as defined through the latest Learning and Education Needs Analysis (LNA), has led to the following:

• Securing a permanent programme lead (Senior Educator: Infant Feeding in NHS Education for Scotland (NES)
• Developed and launched Clinical Skills Workbook to strengthen the link from theory to practice
• A series of education and training webinars designed around the LNA
• Development of online modules to support implementation of the Breastfeeding Friendly Scotland Early Years Scheme

2.3.4. Data, Monitoring and Reporting

Significant improvement in the awareness and use of data to inform local action has been seen over the past few years supported by:

• Development and training on a bespoke data guide for multi-level system use
• Accessible sources of data and management information such as the Breastfeeding Report Card, Health in the Early Years (HEYS) dashboard and data to Level 2 on NSS Discovery Platform.

A quality management system has been developed, in collaboration with service providers, to improve the multi-system reporting function, oversight and impact, contributing to identification of:

• Reduction in breastfeeding inequalities over the past few years
• Increases in the number of babies being breastfed for longer
• Where and how targeted support is making a difference

2.3.5. Communications and Information

Pregnant women and new parents need a trusted, credible source of information and advice that is in line with the most current evidence. The previous stand-alone website was integrated into Scottish Government’s online information platform, which provides information to parents in a consistent, dynamic and cross topic way. This one-stop shop enables parents to access information on breastfeeding and infant feeding, alongside other key information to support their child’s development. The pages and videos on breastfeeding are some of the most frequently accessed on the Parent Club site.

• Integration of a stand-alone website for infant feeding into the core parent information platform (Parent Club).
• Bespoke parent facing material developed and maintained within Scotland’s Baby box.
• Annual Scottish Breastfeeding Week promoting, protecting and supporting breastfeeding
• Promoting access to national breastfeeding helplines, local supports and other information sources through Parent Club

2.3.6. Once for Scotland Approaches and Innovation

Continuous quality improvement is embedded into our Once for Scotland approach, enabling rich learning and insights about what is making the difference within local settings, bringing consistency and minimising duplication of effort. This is guiding the spread of innovative practice systems and settings including:

• National Breastfeeding Welcome scheme (Breastfeeding Friendly Scotland)
• Early Learning Scheme
• Schools Scheme
• Local Authority scheme (one gold award)
• Antenatal colostrum harvesting
• Kangaroo Care (skin to skin)
• Cue-Based Feeding
• Human Donor Milk in the postnatal settings
• Enhanced antenatal and postnatal support
• Reducing formula supplementation
• Breastfeeding Peer Support Core Principles

In partnership with national professional advisory groups across perinatal and infant feeding networks, a suite of resources for multiple care pathways have been produced. This includes contributions from national professional advisory infant feeding leads to publications and guidance. Some examples are listed below:

• Breastfeeding and Returning to Work NHS Workforce Policy (2024)
• Neonatal Infant Feeding Policy (2024)
• Optimal decontamination of breast pump equipment in hospital (2024)
• Managing breastmilk(Mothers own and donor)within maternity neonatal and hospital based children’s services (2025)

2.3.7. Wider system changes

Alongside the role of the NHS and third sector supporting women on their infant feeding journey, there is good evidence to show that levers which support or harm infant feeding choices and experiences, particularly breastfeeding, can only be acted upon by system leaders.

Where strong, committed senior leadership across agencies and partners is evident, we have seen some of the greatest rises in breastfeeding rates. Providing enabling environments for change and innovation to take place has resulted in inter-professional and multiagency collaborations and in the joining together of ideas and possibilities, bringing intergenerational benefits and changes to existing cultural and social norms.

For example, breastfeeding is represented in Scotland’s national Curriculum for Excellence in secondary schools and has been seen to raise awareness in school age children of the benefits of breastfeeding. Opportunities have also been taken across a number of NHS boards and Local Authorities to normalise breastfeeding by including this as a concept for some of our youngest children through the adoption of the Breastfeeding Friendly Scotland Early Learning Scheme.

Other examples include development and implementation of policies which provide assurance to pregnant and breastfeeding mothers that, as far as possible, their rights will be respected and they can be supported in their breastfeeding goals such as adopting a Breastfeeding and Returning to Work policy. This was recently developed for the NHS in Scotland and is supporting early conversations and choice.

We want to get it right for every child from birth and recognise that the actions set out in this framework should be integrated into delivery of broader child and maternal health outcomes and the services who support these.

For example, our 2025 Maternity Pathway includes reference to breastfeeding and infant feeding throughout, as does our Safer Sleep guidance and our Voice of the Infant Guidelines. It is also referenced in our National Good Food Nation Plan, with our breastfeeding stretch aim included as an indicator of progress to represent the needs of babies in these national level plans.