Becoming Breastfeeding Friendly Scotland: report

Background: Breastfeeding and the provision of human milk is the most accessible and cost-effective activity available to public health, which is known to prevent a range of infectious and non-communicable diseases (NCDs), specifically gastro-enteritis, childhood obesity, diabetes type 2 and maternal breast cancer[1],[2]. However, global efforts to further improve exclusive breastfeeding rates have had limited success, in part because effective scaling‐up frameworks and roadmaps have not been developed[3]. Breastfeeding rates in Scotland have improved in recent years, with an increase from 44% (2001/2002) to 51% (2017/2018) of babies reportedly receiving 'any breastfeeding' at first health visitor visit at 10-14 days, and the proportion of babies being breastfed at 6-8 weeks rising from 36% of babies (born in 2001/02) to 42% of babies (born in 2017/18)[4] However, the figures remain relatively low and drop off rates high when compared to other countries and recommended targets, with breastfeeding rates lower among women in areas of higher deprivation, exacerbating health inequalities.

BBF: The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University and has been piloted in Mexico and Ghana. In the short term, it provides an evidence-based tool to guide countries in assessing their breastfeeding status and their readiness to scale up. In the long term, it supports countries to identify the concrete measures they can take to sustainably increase breastfeeding rates, based on data-driven recommendations. The BBF Gear Model is made up of eight simultaneous conditions which sustain breastfeeding: the gears. This conceptual model illustrates how each gear must be sufficiently mobilised to turn the next, whilst the central Coordination gear gathers and delivers timely feedback.

Using the BBF framework, the BBF Scotland committee has prioritised a set of eight recommendation themes to take forward in order to scale up the protection, promotion and support of breastfeeding in Scotland.