I thought it might be of interest to some of you to see how breastfeeding
rates are monitored here in England.  (This varies in the other 3
countries of the UK). Every Primary Care Trust -- body responsible for the
local health economy -- in England (there are 152) has a set of 'vital
signs' which it is required to report on to the Department of Health
quarterly.  Since April 2008, one of the vital signs has been on
breastfeeding rates at 6-8 weeks.

This target is divided into two parts: coverage (for how many babies at
6-8 weeks do we know the feeding status) and prevalence (rate of partial
or full breastfeeding).

We have national targets for coverage (90% for the current year, which
ends on 31 March 2010) and 95% for 2010-11.  Every PCT is set local
targets for the prevalence, reflecting the picture in their area.

The results are published on the DH website regularly, so you can see the
picture regionally and locally (by PCT).

I have been employed for just over a year now, in the public health
department of a PCT, and the impetus for having an infant feeding person
in the department came directly from having the vital sign -- PCTs are
judged by their overall performance on these vital signs.  This vital sign
sits directly under the programme of work in the locality around healthy
weight (halting the rise of obesity).

Within my PCT I am responsible for monitoring all aspects of the sign --
from ensuring the data meets quality standards to getting programmes on
the ground to improve rates and meet our prevalence targets.  (and in my
spare time I am responsible for introduciton of solid foods and programmes
around them too, and for implementing the UK 'Healthy Start' vitamin
supplements for babies).  OBVIOUSLY I work with a lot of teams (e.g
informatics on the data) to do this, I don't have to calculate myself!!

I am not sure what the equivilent is in other countries, or if the UK is
alone in having had a quiet revolution taking place where experts in
breastfeeding have moved into these more strategic roles over the last few
years.  (My role is entirely strategic, I have no clinical
responsibilities -- in many PCTs there is a dual function for the job with
some strategy and some clinical -- typically a special problems clinic or
tongue-tie division clinic).  In some places there is someone with quite a
large clinical role, some strategy role and the rest of the strategy will
be looked after by someone with a more general strategic or commissioning
role around women and children.

Anyway, if you are at all interested, you can look at the reports and all
the technical information on how we have to report and what we are
actually measuring on the Department of Health website:
http://www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/Breastfeedinginfantfeeding/DH_085657

It might also be of interest to you to know that I am not the only person
from a voluntary organisation background in this type of role -- there are
a scattering across the country, and the two National Infant Feeding Best
Practice Advisors currently in post come from the voluntary organisations
rather than from a midwifery or health visiting background.

Magda Sachs
Public Health Manager (Infant Feeding)
NHS Salford

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