I have been thinking over the past few weeks about whether I can allow myself a sliver of optimism about a cultural shift in infant feeding in the UK. Within midwifery, mother support groups, health visiting and early years’ services there are many reasons to feel optimistic when you are out and about meeting some of the amazing, passionate and dedicated people who provide support to families every day. Speaking to people in local authorities there is a real understanding of the need for investment in the early years, and programmes to support families around health and well-being are springing up around the country. The lottery funded Better Start programmes are testing the benefit of targeted investment in family support some of the more deprived areas of England and the 1001 critical days agenda has some high profile supporters.
Sadly we may never know whether this investment is, or will, pay off in terms of increasing rates of exclusive breastfeeding, later introduction of complementary feeding and greater confidence among families about supporting good food in the early years. The loss of the UK wide infant feeding survey (IFS) that has run quinquennially since the 1970’s is a blow to everyone working in public health – and the rationale for its demise remains unclear. Despite letters, statements, emails, tweets, radio reporters sniffing around trying to find out how and why it has happened and Government committees expressing their disquiet – it seems the health departments are not for turning on this shortsighted cancellation.
This is not an expensive survey, the Department of Health admitted its contribution over the 5 year period of the study was only 480k – less than 100k per year, which when you consider this study provided baseline data on which most policy documents and ‘strategic visions’ for infant feeding services are based it sounds like a bargain. The data from the 2010 survey supports research and clinical and public health guidelines across a wide range of organisations and areas of public health: from smoking cessation to vitamin supplementation, infant feeding choices, complementary feeding and use of services.
What will replace this data in England? Apparently (so campaigners were told in a letter from Joanne Miles, Ministerial Correspondence and Public Enquiries, Department of Health) we will have data from ‘NHS England official statistics, surveys of women’s experiences of maternity services undertaken by the Care Quality Commission and the National Perinatal Epidemiology Unit at Oxford University; and from 2015, the Maternity and Children’s Dataset’.
Will these pieces of data give us the richness of data that the IFS did? Well the NHS maternity and breastfeeding statistics simply give us ‘the number and proportion of mothers’ who have initiated or not initiated breastfeeding and the number and proportion of infants who have been fully, partially or not at all breastfed at 6-8 weeks’. This may be data collected for every child in theory, but the latest report from the health and social care information centre tells us this:
In England the breastfeeding prevalence at 6-8 weeks was not published in 2013/14 due to the number children with no recorded status of 6-8 week breastfeeding prevalence being greater than 5% of all eligible children.
In 2012/13 prevalence at 6-8 weeks was 47.2%, in 2011/12 47.2% of infants due a 6-8 week check were being breastfed at 6-8 weeks.
In 2013/14 30 CCG’s failed to pass validation checks. 68 failed as the number of eligible children submitted failed to meet the -10% +20% number of expected children.
An additional 62 CCG’s failed due to more than 5% of their eligible children having no breastfeeding status recorded, among the CCG’s that failed on 95% recording coverage validation failures was NHS Richmond CCG where the 6-8 week breastfeeding status of 85.3% eligible children was not known.
Doesn’t entirely fill you with confidence – and this is just simple tick box data, with no context, no background, no explanation.
Maternal experience of services is valuable, but not related to the work many of us do in infant feeding per se, so what of the new 2015 Maternity and Children’s dataset? Looking at information on the health and social care statistics website the maternity dataset seems to have nothing of relevance to infant feeding, and the only mention of ‘breastfeeding and nutrition’ is in the new children’s dataset (CYPHS) – but it is hard to see what exactly this data will be. The site suggests that this dataset will be made up of data already collected – in Department of Health speak:
‘The CYPHS data set defines an output standard, which is to be compiled from existing clinical records to enable monthly submissions to a central data warehouse. It does not represent a definitive list of data items and values which may need to be captured for care delivery, merely a subset to which local data should be mapped for national submission and analysis purposes’
I could be wrong, but that sounds to me like it will be piecemeal data collected as areas see fit – and as very little data is currently collected in existing records, it is hard to know exactly what they think the ‘breastfeeding and nutrition’ data will look like. But I will keep digging and see if I can find any further mention – or if anyone knows more, do let me know!
So will this combination of data sources replace what we have in any way? It appears doubtful to me – we will lose the richness of the qualitative elements of the infant feeding study and all of the explanatory variables that help us understand how we can support families better and where we should be investing. Depending on what happens on May 7th we will lose this study forever I fear, or we may be presented with an opportunity to fight for it again. Perhaps we should be ready in the wings for the latter opportunity – at a cost of less than 14p per birth in England this rich data source should not be given up on.