House Standing Committee on Health and Ageing
The Best Start
Report on the inquiry into the health benefits of breastfeeding
August 2007
Canberra
© Commonwealth of Australia 2006
ISBN 978-0-642-78982-2 (printed version)
ISBN 978-0-642-78983-9 (HTML version)
Contents
Foreword
Membership of the Committee
Terms of reference
List of abbreviations
List of recommendations
Chapter 1
Introduction
Chapter 2 Breastfeeding in Australia
Chapter 3
The health and economic benefits of breastfeeding
Chapter 4
Breastfeeding Management
Chapter 5
Breastfeeding challenges
Chapter 6
The health system
Chapter 7
Regional, remote and Indigenous communities
Chapter 8
The impact of breast milk substitutes
Appendix A – Submissions
Appendix B – Exhibits
Appendix C – Public Hearings and Site Inspections
Foreword
Australia is currently experiencing a ‘baby boom’ with the number of births in
2006 being at its highest level since 1971, and the second-highest since 1911.1
During the last ‘baby-boom’ breastfeeding rates were at their lowest. However,
since that time, due to the work of groups such as the Australian Breastfeeding
Association, breastfeeding rates have increased and more evidence has been found
about the health benefits of breastfeeding for the baby and mother.
Breastfeeding is the normal way to feed a baby. The majority of Australian
women intend to breastfeed their baby and most initiate breastfeeding after the
birth. However, after several weeks or months many women have stopped
breastfeeding and are feeding their baby infant formula.
There is a level of concern from government, the community and individuals that
when babies are not being breastfed to the recommended six months, they are
missing out on the scientifically proven short and long-term health benefits. It is
the responsibility of the entire community to ensure the best possible nutrition
and health is available to all of its members, beginning with its youngest.
The issues around the low rates of breastfeeding are complex. When a woman
makes the decision to breastfeed, what her partner thinks and what the
community around her thinks are three of the factors that can influence this
decision. Additionally the effect of the interactions with health professionals and
provision of breastfeeding support have an effect on the duration of breastfeeding.
The effect of having to return to work is also important on breastfeeding duration.
The committee was initially surprised by the level of interest in the inquiry,
particularly from members of the community. Much of the evidence obtained was
from individuals who wanted to share their own experience and the depth of
feeling in these submissions was unmistakable.
However, this is not a simple ‘breast versus bottle’ argument. The passionate
advocates of breastfeeding through those who had an incredibly difficult
breastfeeding experience or chose not to breastfeed all have a voice in this inquiry.
The committee observed that most mothers are at some point along this spectrum
and it is vital that all mothers are supported. The amount of guilt and emotion
that surrounds a mother's decision of how to feed her baby was a recurrent theme
in the inquiry and one that the committee recognises. The marketing and
availability of infant formula was considered by some in the community to be a
critical factor in breastfeeding rates. Although there are certainly views in the
community that infant formula is ‘as good as’ breastmilk, the committee contends
that most mothers revert to infant formula because they experience significant
difficulties with breastfeeding.
The committee considers many of the issues affecting breastfeeding initiation and
duration could be addressed by ensuring that all expectant and new mothers have
availability to consistent, accurate and timely support for breastfeeding from the
health system and the community at large.
Further research into breastfeeding in Australia is also required to develop
successful strategies to increase the rate of exclusive breastfeeding to six months.
For example, Margaret Barnes of the University of the Sunshine Coast was
recently awarded a research grant to investigate the link between breastfeeding
problems and assisted conception treatments. She also hopes to develop a
midwifery intervention program to educate mothers who have difficulty
breastfeeding. This and other research programs will undoubtedly assist efforts to
increase breastfeeding duration in Australia.
The committee received 479 submissions, held 10 public hearings and made 3 site
inspections. I would like to thank those who put in so much time and effort into
their submissions and travelled to appear at public hearings and assist the
committee.
It was pleasing to receive submissions and hear evidence from the governments of
Queensland, South Australia, New South Wales, Western Australia, Tasmania and
the Northern Territory. The committee thanks the remote communities of
Pormpuraaw and Kowanyama, on the Gulf of Carpentaria in far north
Queensland for hosting a site inspection as part of this inquiry. The committee
appreciated the communities' candour.
Finally, I would like to especially thank the Deputy Chair, Steve Georganas MP,
the previous Deputy Chair, Jill Hall MP and all the members of the committee.
The committee's focus on fully comprehending the issues that arose from this
inquiry is to be commended.
Hon Alex Somlyay MP
Chair
Membership of the Committee
Chair |
Hon Alex Somlyay MP |
Deputy Chair |
Mr Steve Georganas MP (from 06/12/06)
Ms Jill Hall MP (until 06/12/06) |
Members |
Hon Alan Cadman MP |
|
Mrs Justine Elliot MP |
|
Mrs Kay Elson MP |
|
Hon Warren Entsch MP |
|
Mr Michael Johnson MP |
|
Ms Catherine King MP |
|
Mr Ross Vasta MP |
Committee Secretariat
Secretary |
Mr James Catchpole |
Inquiry Secretary |
Ms Pauline Brown |
Research Officer |
Ms Meg Byrne (22/05/07 to 17/08/07) |
Administrative Officer |
Ms Lauren Walker |
Terms of Reference
The House of Representatives Standing Committee on Health and Ageing has
reviewed the 2005-2006 annual report of the Department of Health and Ageing
and resolved to conduct an inquiry.
“The Committee shall inquire into and report on how the Commonwealth
government can take a lead role to improve the health of the Australian
population through support for breastfeeding.
The Committee shall give particular consideration to:
- the extent of the health benefits of breastfeeding;
- evaluate the impact of marketing of breast milk substitutes on
breastfeeding rates and, in particular, in disadvantaged, Indigenous and
remote communities;
- the potential short and long term impact on the health of Australians of increasing the rate of breastfeeding;
- initiatives to encourage breastfeeding;
- examine the effectiveness of current measures to promote breastfeeding;
and
- the impact of breastfeeding on the long term sustainability of Australia's
health system.”
(29 November 2006)
List of abbreviations
| ABA |
Australian Breastfeeding Association |
| ABS |
Australian Bureau of Statistics |
| AIDS |
Acquired Immune Deficiency Syndrome |
| AIHW |
Australian Institute of Health and Welfare |
| ALCA |
Australian Lactation Consultants Association |
| AMIHS |
Aboriginal Maternal and Infant Health Strategy |
| APMAIF |
Advisory Panel on the Marketing in Australia of Infant Formula |
| ART |
Assisted Reproductive Technology |
| BFHI |
Baby Friendly Hospital Initiative |
| BFWA |
Breastfeeding Friendly Workplace Accreditation |
| CATI |
Computer Assisted Telephone Interview |
| CDC |
Centers for Disease Control (US) |
| DHA |
Department of Health and Ageing |
| FAO |
Food and Agriculture Organisation (UN) |
| FSANZ |
Food Standards Australia New Zealand |
| GAA |
Growth Assessment and Action |
| GDP |
Gross Domestic Product |
| GP |
General Practitioner |
| GST |
Goods and Services Tax |
| HIV |
Human Immunodeficiency Virus |
| IBCLC |
International Board Certified Lactation Consultant |
| IBFAN |
International Baby Food Action Network |
| ICDC |
International Code Documentation Centre |
| IFMAA |
Infant Formula Manufacturers Association of Australia |
| IVF |
In Vitro Fertilisation |
| JIM |
Justice and International Mission (Unit of the Uniting Church in Australia) |
| LBW |
Low Birth Weight |
| LCPUFA |
Long Chain Polyunsaturated Fatty Acid |
| MAIF |
Marketing in Australia of Infant Formula |
| MCHN |
Maternal and Child Health Nurse |
| MGRS |
Multicentre Growth Reference Study |
| MMB |
Mothers Milk Bank |
NATSINS
AP
|
National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan |
| NCHS |
National Centre for Health Statistics (US) |
| NCSMC |
National Council of Single Mothers and their Children |
| NEC |
Neonatal Necrotising Enterocolitis |
| NHANES |
National Health and Nutrition Examination Survey (US) |
| NHMRC |
National Health and Medical Research Council |
| NHS |
National Health Survey |
| PANDA |
Post and Antenatal Depression Association |
| PATS |
Patient Assisted Travel Scheme |
| PND |
Postnatal Depression |
| PROBIT |
Promotion of Breastfeeding Intervention Trial |
| RACP |
Royal Australasian College of Physicians |
| RFDS |
Royal Flying Doctor Service |
| SIDS |
Sudden Infant Death Syndrome |
| UNICEF |
United Nations Children’s Fund |
| WHA |
World Health Assembly |
| WHO |
World Health Organisation |
List of recommendations
2. Breastfeeding in Australia
Recommendation 1
That the Department of Health and Ageing coordinate and oversee the
implementation of a national strategy to promote and support
breastfeeding in Australia, including providing leadership in the area of
monitoring, surveillance and evaluation of breastfeeding data.
Recommendation 2
The Department of Health and Ageing implement the recommendations
in the Towards a national system for monitoring breastfeeding in Australia
document commissioned by the Commonwealth Government in 2001.
Recommendation 3
That the Department of Health and Ageing fund research into:
- the long-term health benefits of breastfeeding for the mother and
infant; and
- the evaluation of strategies to increase the rates of exclusive
breastfeeding to six months.
Recommendation 4
That the Department of Health and Ageing fund research into best
practice in programs that encourage breastfeeding, including education
programs, and the coordination of these programs.
Recommendation 5
That the Department of Health and Ageing fund the Australian
Breastfeeding Association to expand its current breastfeeding helpline to
become a toll-free national breastfeeding helpline.
Recommendation 6
That the Department of Health and Ageing fund a national education campaign to highlight:
- the health benefits of breastfeeding to mothers and babies;
- that breastfeeding is the normal way to feed a baby;
- that the use of breast milk is preferable to the use of infant formula;
and
- the supportive role that the community can play with
breastfeeding.
Recommendation 7
That the Department of Health and Ageing fund an awards program,
which provides recognition for workplaces, public areas and shopping
centres that have exemplary breastfeeding facilities.
3. The health and economic benefits of breastfeeding
Recommendation 8
That the Department of Health and Ageing fund a feasibility study for a
network of milk banks in Australia including the development of a
national regulatory and quality framework within which a network of
milk banks in Australia could operate. The feasibility study should
include funding pilot programs at the Mothers Milk Bank at the John
Flynn Private Hospital, Gold Coast and the King Edward Memorial
Hospital milk bank in Perth.
Recommendation 9
That the Department of Health and Ageing commission a study into the
economic benefits of breastfeeding.
5. Breastfeeding challenges
Recommendation 10
That the Speaker of the House of Representatives and the President of the
Senate take the appropriate measures to enable the formal accreditation
by the Australian Breastfeeding Association of Parliament House as a
Breastfeeding Friendly Workplace.
Recommendation 11
That the Department of Health and Ageing provide additional funding
for the Australian Breastfeeding Association to expand the Breastfeeding-
Friendly Workplace Accreditation (BFWA) Program nationally to enable
the accreditation of more workplaces.
Recommendation 12
That the Treasurer move to exempt lactation aids such as breast-pumps,
nipple shields and supply lines from the Goods and Services Tax.
Recommendation 13
That the Attorney General investigate whether breastfeeding is given
suitable consideration in the implementation of shared custody
arrangements and also provide advice to the Family Law Court and
Family Relationships Centres on the importance of breastfeeding.
6. The health system
Recommendation 14
That the Department of Health and Ageing fund the Australian College
of Midwives to run the Baby Friendly Hospital Initiative in Australia, to
facilitate the accreditation of all maternity hospitals.
Recommendation 15
That the Department of Health and Ageing work with the Australian
Council on Healthcare Standards (and/or equivalent accreditation
organisation) towards including Baby Friendly Hospital status as part of
the accreditation process.
Recommendation 16
That the Commonwealth Government, when negotiating future
Australian Health Care Agreements, require state and territory
governments to report on the number of maternity wards in public
hospitals that have been accredited under the Baby Friendly Hospital
Initiative.
Recommendation 17
That the Minister for Health and Ageing, in consultation with state and
territory health ministers, decide on a standard infant growth chart to be
used in all states and territories.
Recommendation 18
That the Minister for Health and Ageing provide Medicare
provider/registration numbers to International Board Certified Lactation
Consultants (IBCLC) as allied health professionals.
7. Regional, remote and Indigenous communities
Recommendation 19
That the Department of Health and Ageing provide leadership in the area
of monitoring, surveillance and evaluation of breastfeeding rates and
practices in Indigenous populations in both remote and other areas.
Recommendation 20
That the Commonwealth Government promote breastfeeding within
Indigenous Australian communities as a major preventative health
measure.
8. The impact of breast milk substitutes
Recommendation 21
That Food Standards Australia New Zealand change the labelling
requirements for foods for infants under Standard 2.9.2 of the Food
Standards Code to align with the NHMRC Dietary Guidelines
recommendation that a baby should be exclusively breastfed for the first
six months.
Recommendation 22
That the Department of Health and Ageing adopt the World Health
Organisation's International Code of Marketing of Breast-milk
Substitutes and subsequent World Health Assembly resolutions.
Footnotes
| 1 |
Australian Bureau of Statistics media release ‘New ABS population estimates show births second highest and deaths highest on record’ June 5, 2007; 63/2007 Back |
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