Breastfeeding and infant feeding: strategic framework 2025-2030

3. Key Findings And Evidence

These Key Findings are drawn from our national learning in Scotland on interventions and approaches that support breastfeeding. We will continue to use these findings to inform and develop national ambitions and local actions.

3.1. Key Findings

Key Finding 1

Providing women with consistent support and messaging ensuring these are trauma informed, integrated into existing care pathways and the wider health and social care workforce, along with enhanced and targeted support for women and babies including those identified within ‘vulnerable’ categories e.g. neonates, women with mental health issues, diabetes and other long term conditions.

• Tackling inequalities requires local knowledge and understanding of where to invest and how interventions can be co-produced with those population groups least likely to breastfeed.

Key Finding 2

Importance of continuity of care from a skilled workforce, confident in having sensitive conversations about infant feeding during pregnancy, at birth and into the early postnatal period.

• Sustaining a workforce that is able to meet the needs of families and breastfeeding mothers, recognising the important role of the infant feeding teams, midwives, health visitors, family nurses and health care support workers in supporting women to understand the health benefits of breastfeeding.

Key Finding 3

Recognising the role of national networks and organisations such as Scottish Infant Feeding Networks (SIFN and Neo-SIFN), the Breastfeeding Leadership Team (BFLT),the Maternal and Infant Nutrition Leads (MIN) and Unicef BFI to strengthen professional and clinical expertise.

• We have multiple expert national networks across Scotland which create spaces for professional and expert clinical guidance to build collective leadership. The ongoing commitment to the Unicef UK Baby Friendly Initiative and the progressive accreditation of services across Scotland, alongside the improved accessibility of reliable data have contributed to improvement planning for breastfeeding across NHS Boards.

Key Finding 4

Recognising local need and the different models in place to support women including in-house NHS and 3rd sector peer support alongside the contribution of community-embedded support for women and families.

• Breastfeeding peer support is most effective when integrated into local systems and is part of a broader partnership approach. We have exemplar models across Scotland
• Building on the recommendations that were set out in the Maternal and Infant Nutrition Framework (2011) and gathering additional evidence in Scotland has helped shape the road map for the additional investment through Scottish Government’s Programme for Government since 2018.

Key Finding 5

Fathers and partners play a vital role in supporting early child development and there is good evidence to show how much they contribute to decisions on feeding choices.

• It is vital that breastfeeding and infant feeding more generally, is not just seen as a role for the mother. Decisions on how to feed a baby, as well as how that can be supported, should include fathers and partners as well as wider family members.

Key Finding 6

Changing the culture around breastfeeding takes a whole-of-society and whole-of Government approach to act at all levels of the system to support infant feeding choices. Senior leaders play a powerful role in driving long lasting, system change.

• Creating enabling environments to support breastfeeding, raising public awareness of their legal rights and providing visible evidence of that supportive environment are crucial to success.
• Scotland was the first country in the world to introduce bespoke legislation to enable breastfeeding in public^[17]. We have developed a whole scheme to support this. The Breastfeeding Friendly Scotland scheme^[18] was launched in 2019 to create enabling environments required to ‘normalise breastfeeding’.
• This scheme is multi-faceted and designed to introduce and integrate breastfeeding messages as early as possible.

3.2. Evidence

We have used a range of evidence to inform this framework. This includes evidence to show where breastfeeding and how young children are fed contributes to optimising population health.

Learning from the implementation of the Maternal and Infant Nutrition Framework (2011) recommendations

• Lancet Breastfeeding series (2016) and (2023)
• Scottish Maternal and Infant Nutrition Survey 2017
• Insight gathering from parents
• Becoming Breastfeeding Friendly report 2019
• Strategic use of data, local intelligence
• National learning from scaling up interventions to support breastfeeding

The evidence of the benefits of breastfeeding for babies and women is long standing and continues to grow. We are also understanding more about how early nutrition influences health in later childhood and adult life. For example, in the Obesity Action Scotland (OAS) 2023 report^[19] they set out local levers for diet and healthy weight including what was important for babies stating that:

“Improving nutrition of infants and in early childhood is key for ensuring a healthy weight as they grow into adults. This involves (i) protection, promotion, and support for breastfeeding, as well as (ii) the appropriate and timely introduction of complementary foods, and (iii) ensuring a wide and varied healthy diet throughout early childhood.”