Australian National Breastfeeding Strategy 2010-2015

5.4 Monitoring

Page last updated: 15 July 2010

Monitoring, research and evaluation are important to provide further insight into breastfeeding initiation and duration rates, as well as a better understanding of ways in which breastfeeding can be protected, promoted and supported. Research, monitoring and evaluation are required at all stages of the breastfeeding continuum.

Most states and territories monitor breastfeeding rates and duration. However, there is a lack of consistency on what data are collected and what indicators are reported. Several states use Computer Assisted Telephone Interviewing (CATI) to collate data on breastfeeding, including Queensland, Victoria, Western and South Australia. South Australia also uses CATI to ask questions about community perceptions of breastfeeding and evaluate social marketing campaigns.

At a national level, breastfeeding data have been collected through the National Health Surveys and the National Aboriginal and Torres Strait Islander Health Surveys. The most recent national data are from the Longitudinal Study of Australian Children.

The measurement of breastfeeding is a complex matter. In 2001, as part of a broader food and nutrition monitoring and surveillance project, Webb et al. proposed a set of breastfeeding indicators for Australia. Considerations included the need to ensure they were relevant to the Australian policy environment, consistency with WHO indicators, feasibility with a nationally representative sample and relevance for priority groups. The recommendations in the 2001 Webb report have not been implemented.

In 2006, 19 Headline Indicators for priority areas for children’s health, development and wellbeing were endorsed by the Australian Health Ministers’ Conference, the Community and Disability Services Ministers’ Conference, and the Australian Education Systems Officials Committee. These Headline Indicators are designed to focus government policy attention on identified priorities for children’s health, development, and wellbeing (DHS 2006). One of the indicators is the proportion of infants exclusively breastfed at four months of age. This indicator is for four, rather than six, months because exclusive breastfeeding at six months is not a stable indicator as solid foods are often introduced at this time.

The Australian Institute of Health and Welfare report, A Picture of Australia’s Children 2009 presents data on those National Children’s Headline Indicators for which data are currently available. The report includes a summary of the available national and state/territory breastfeeding data. However, no data are currently available on the indicator of exclusive breastfeeding at four months, either at national or state and territory levels (AIHW 2009).

The Child Health and Wellbeing Subcommittee is responsible for overseeing the Headline Indicators work program which includes two streams of work: data development and data reporting. This work program will facilitate comparison of state and territory data, and data from sub populations of children, including Aboriginal and Torres Strait Islander children, children living in remote and disadvantaged areas, and children from culturally and linguistically diverse backgrounds.

In 2007, the Core Maternity Indicators Project recommended a set of ten core maternity indicators for benchmarking the quality and safety of maternity care. One of the recommendations from the report concerns the achievement and maintenance of Baby Friendly Hospital Initiative accreditation or the number of WHO Ten Steps to Successful Breastfeeding (see Figure 3.1) that have been implemented in each facility (WHA 2007). The core maternity indicators are under consideration by the Maternity Services Inter-Jurisdictional Committee.

Further work on breastfeeding indicators was commissioned by the Australian Government Department of Health and Ageing and conducted by Hector in 2008. A key finding was the need for stakeholders to collaborate and agree on a specific way forward for breastfeeding indicators.

The Department of Health and Ageing is currently working with the Australian Institute of Health and Welfare to progress this breastfeeding indicators work in the context of developing a National Infant Feeding Survey. It is noted that breastfeeding practices performance indicators contained within the Aboriginal and Torres Strait Islander Health Performance Framework are relevant to the Indigenous Early Childhood Development National Partnership Agreement (COAG 2009).

Monitoring breastfeeding amongst other priority groups such as young mothers, mothers from a low socio-economic status and mothers from culturally and linguistically diverse backgrounds is not undertaken in Australia in a standardised or regular manner. In general, research and data collection for each of these priority groups is the subject of individual research projects and survey methodologies rather than a consistent national agenda. This is a deficiency of the current monitoring system that could be addressed through a monitoring framework to support the Australian National Breastfeeding Strategy.