NSW Centre for Public Health Nutrition
‘Report on breastfeeding
in NSW 2004’
Debra Hector
Karen Webb
Sharyn Lymer
Presenting Nutrition Series
Introduction for Users
o The presentations are designed to assist professionals throughout
NSW disseminate information on public health nutrition
o Each presentation is based on an existing CPHN report
o Users are requested to provide full acknowledgement of the authors,
CPHN and the Department of Health
o Notes version of the ppt gives table/figure and page numbers, for easy
reference to the report
o Further information and explanation of each slide should be sought
from the report. Visit http://www.cphn.biochem.usyd.edu.au
o Users should use Excel to prepare slides with data for their own areas,
modelled on the samples provided
o Any questions can be referred to Debra Hector, 9036 3006/9477
4351
Contents of ‘Report on breastfeeding
in NSW 2004’
• Health benefits of breastfeeding
• Defining breastfeeding and
identifying monitoring indicators
• Breastfeeding practices in NSW –
2001 data
Contents of ‘Report on breastfeeding
in NSW 2004’
• Health and economic burden associated
with poor breastfeeding practices
• Recommendations:
– for the monitoring of breastfeeding
in NSW
– objectives/outcomes for breastfeeding
promotion and support in NSW
Rationale for promoting and
supporting breastfeeding
• Breastmilk contains a range of bioactive
factors not found in formula
• Substantial health benefits to mothers
and infants
• Economic benefits, especially to health
system
• Environmental benefits
Rationale for promoting and
supporting breastfeeding
• Many of the factors associated with poor
breastfeeding practices are amenable to
intervention
• Evidence of substantial effects, to increase
the initiation and duration of breastfeeding,
from intervention strategies
Breastmilk ...
• provides all the nutrients required by infants
for at least the first six months
• changes during each feed and throughout
lactation
• contains ‘bioactive factors’ – prevent and
reduce severity of infection, help develop the
immune system
• e.g. the antibody IgA protects against ‘local’
pathogens (bacteria, viruses)
Health benefits for women
• less postpartum bleeding and more rapid
uterine involution
• earlier return to pre-pregnancy weight
• delayed resumption of ovulation, with
increased child spacing
• reduced risks of pre-menopausal (and
possibly post-menopausal) breast cancer
and ovarian cancer
• improved bone remineralization, with
reduction in postmenopausal hip fractures
Health benefits for infants
Strong evidence that breastfeeding
protects against:




gastrointestinal infection
otitis media (‘glue ear’)
lower respiratory tract infection
necrotising enterocolitis (NEC)
Health benefits for infants
• May be protective against bacteraemia,
meningitis, botulism, urinary tract
infection, SIDS
• Conflicting evidence of effects of
breastfeeding on asthma
• Reduces the incidence of chronic
diseases, such as diabetes and obesity,
in childhood and later in life
Breastfeeding may help prevent
childhood obesity
There are consistent findings from a
number of recent studies showing that
breastfeeding protects against
overweight and obesity
The precise mechanism is uncertain,
with various possible explanations
Economic costs of poor
breastfeeding practices ...
to NSW health system are
estimated as $20-40 million a year
based on 5 illnesses alone
(gastrointestinal illness, lower
respiratory infection, otitis media,
eczema and NEC)
Australian Dietary Guideline*:
‘Encourage and support breastfeeding’
* NHMRC 2003
• Early initiation of breastfeeding
• Exclusive breastfeeding until 6 months**
• Complement with appropriate food from
6 months
• Continue breastfeeding until at least 12
months of age
** this recommendation is population-based – it is recognised that some
infants will benefit from the introduction of solids before the age of 6 months
Recommendation on
Exclusive Breastfeeding
• Increasing evidence that exclusive
breastfeeding to 6 months is particularly
beneficial to health
• Australia’s infant feeding guidelines
(NHMRC 2003) now recommend exclusive
breastfeeding for the first 6 months
(previous recommendation ‘4 to 6 months’)
Types of breastfeeding
Complementary
Breastfeeding
Full
Exclusively
Predominately
Describing breastfeeding practices
in NSW
• Recommendations for national set of
breastfeeding indicators (AFNMU, 2001)
• Data from the NSW Child Health Survey
2001 were used to report on an interim set
of breastfeeding indicators possible with the
data
• First state-based population survey of
breastfeeding practices in NSW
NSW Child Health Survey 2001
• First state-based population survey of
health of children (0-12 years) in NSW
• CATI survey (computer assisted telephone
survey)
• Infant feeding practices based on a subset
of respondents – mothers or fathers of
children 0-23 months
• Responses based on recall
• N = 1,489 (87.7% mothers)
Percentage of infants 'ever breastfed'
(Indicator 1) by AHS
100
98.7
93.4
% infants
95
93.7
91.7
90
86.9
88.4
90.8
90.2
Illa
NSW
87
82.6
85
80
75
70
CS
NS
SES
SWS
WS
CC
Went Hunt
Area Health Service
Percentage of infants 'ever breastfed'
(Indicator 1) by AHS
98.4
100
% infants
95
93.6
94.5
93.5
90.2
89
90
85.7
85
84.6
82.2
80
75
70
NR
MNC
NE
Mac
FW
MW
Area Health Service
GM
S
NSW
Percentage of infants 'ever breastfed'
(Indicator 1) for different maternal subgroups
AGE
EDUCATION
100
96.1
% infants
95
90.4
90
86.8
85
84.5
80
75
< 25 yrs
>25 yrs
<Tert.
Tertiary
% infants ever breastfed
Percentage of infants ever breastfed
(Indicator 1), by maternal disadvantage
100
95.5
95
92.4
89.8
90
87.3
86.2
85
80
1st - Least
2nd
3rd
4th
Quintile of disadvantage
5th - most
Duration of any breastfeeding (Indicator 2)
100
90
80
% infants
70
60
50
40
30
20
10
0
ever
1
2
3
4
5
6
7
8
Completed months
9
10
11
12
% infants
Prevalence of any breastfeeding to 4, 6
and12 months (Indicator 2) for
Northern Sydney AHS
100
90
80
70
60
50
40
30
20
10
0
NS
NSW
66.6
54.2
56.6
42.5
32.2
18.1
4 months
6 months
12 months
Prevalence of breastfeeding at 4, 6 and 12
months (Indicator 2) by maternal country
of birth
100
Aust.
90
O'seas
80
% infants
70
60
50
53.3
56.2
41.8
44.7
40
24.6
30
16.2
20
10
0
4 months
6 months
12 months
Median duration of breastfeeding among
'ever breastfed' infants (Indicator 6), by AHS
12
Completed months
10
10
8
6
6
6
6
6
6
6
6
Ill
NSW
5
4
4
2
0
CS
NS
SES SWS
WS
CC
Went Hunt
Median duration of breastfeeding among
'ever breastfed' infants (Indicator 6), by AHS
12
Completed Months
10
10
8
8
7
7
6
6
6
FW
MW
7
6
6
4
2
0
NR
MNC
NE
Macq
GM
South TOTAL
NSW
Median duration of any breastfeeding among
'ever breastfed' infants (Indicator 6),
by maternal age and education
Completed Months
12
10
9
8
6
6
4
5
3
2
0
< 25 yrs
Age
>25 yrs
<Tert.
Tertiary
Education
Median duration of any breastfeeding among
'ever breastfed' infants (Indicator 6),
by socioeconomic disadvantage
Completed Months
12
10
9
8
7
6
6
6
5
4
2
0
1st - Least
2nd
3rd
4th
SEIFA quintile of disadvantage
5th - most
Percentage of infants regularly given solid foods
before 4 and before 6 months (Indicator 3),
by AHS
100
60
40
20
4 m onths
6 m onths
All NSW
S
GM
MW
FW
Mac
NE
MNC
NS
Illa
Hunt
Went
CC
WS
SWS
SES
NS
0
CS
% infants
80
Percentage of infants given solids
before 4 and 6 months (Indicator 3) for
Northern Sydney AHS
80
70
NS
68.7
NSW
69.8
% infants
60
50
40
30
20
10.3
12.6
10
0
4 months
6 months
Percentage of infants regularly given solds
before 4 and 6 months (Indicator 3),
by maternal age
90
80
79.3
<25 yrs
>=25 yrs
71.8
% infants
70
60
50
40
30
20
22.6
12.2
10
0
4 months
6 months
Percentage of infants regularly given solids
before 4 and 6 months (Indicator 3), by
maternal education
80
70
<tertiary
tertiary
71.2
67.4
% infants
60
50
40
30
20
10
16.3
5.9
0
4 months
6 months
Percentage of infants regularly given solids
before 4 and 6 months (Indicator 3), by
maternal background
90
80
79.6
ESB
NESB
72.5
% infants
70
60
50
40
30
20
10
14.0
7.3
0
4 months
6 months
Percentage of infants regularly given breastmilk
substitutes before 4 and 6 months
(Indicator 4) by AHS
100
4 months
6 months
% infants
80
60
40
20
0
CS
NS
SES SWS
WS
CC
Went Hunt
Illa
NSW
Percentage of infants regularly given breastmilk
substitutes before 4 and 6 months
(Indicator 4) by AHS
100
4 months
6 months
% infants
80
60
40
20
0
NR
MNC
NE
Mac
FW
MW
GM
S
NSW
Percentage of infants given breastmilk
substitutes before 4 and 6 months
(Indicator 4), for Northern Sydney AHS
100
90
4 months
6 months
80
% infants
70
59.6
60
45.9
50
40
46.5
36.8
30
20
10
0
NS
NSW
Percentage of infants given breastmilk
substitutes regularly before 4 and 6 months
(Indicator 4) by maternal subgroup
100
90
ESB
NESB
% infants
80
70
60
50
68.3
57.2
50.5
45.4
40
30
20
10
0
4 months
6 months
Percentage of infants given breastmilk
substitutes before 4 and 6 months
(Indicator 4) by maternal subgroup
100
90
<25 yrs
>=25 yrs
80
% Infants
70
69.1
61.1
58.3
60
50
43.9
40
30
20
10
0
4 months
6 months
Population rates of infants fully breastfed to 3, 4
and 6 months (Indicator 5A) by AHS
70
60
% infants
50
40
30
20
10
0
CS
NS
3 months
SES
SWS
4 months
WS
6 months
CC
Went
Hunt
Ill
NSW
Population rates of infants fully breastfed
to 3, 4 and 6 months (Indicator 5A) by AHS
60
% infants
50
40
30
20
10
0
NR
MNC
3 months
NE
Macq
4 months
FW
6 months
MW
GM
South TOTAL
NSW
Population rates of infants fully breastfed to 3,
4 and 6 months (Indicator 5A) for
Northern Sydney AHS
100
NS
90
TOTAL NSW
% infants
80
70
60
50
58.4
48.4
40
31.8
24.6
30
20
5.2
10
4.6
0
3 months
4 months
6 months
Determinants of Breastfeeding
* amenable to intervention
Socio-cultural,
economic and
environmental
factors*
Sociodemographic
characteristics of
mother and family
Breastfeeding
practices
- initiation
- exclusivity
- duration
Structural and
Social
support*
Health
service
organisation,
practices and
interventions
*
Health status
of mother and
infant
Mother’s
knowledge,
attitude, skills *
Specific
aspects of
feeding
practices*
Recommendations for focus of
breastfeeding interventions:
• the decline in breastfeeding that occurs in the
first few months
• continued breastfeeding for at least 12 months
• exclusive breastfeeding to 6 months
• high-risk groups:
– young mothers, less-educated mothers: short
duration and low intensity of breastfeeding
– ATSI mothers: initiation and intensity of
breastfeeding