The National Breastfeeding Helpline Evaluation report

1.2 Context in which the Breastfeeding Helpline operates

Page last updated: 13 February 2013

Significant attention has been given in policy, legislation and services, to support and promote breastfeeding practice in Australia. These efforts are premised on the agreed evidence and research on recommended breastfeeding practice and duration, and its importance and benefit to the community (WHO 2001; Innocenti 2005 and NHMRC 2003).

Australian National Breastfeeding Strategy 2010–15

In response to the tabling of the 2007 Parliamentary Report into the benefits of breastfeeding, Best Start, the Australian Government developed the Australian National Breastfeeding Strategy 2010–15 to protect, promote, support and monitor breastfeeding in Australia.

The Strategy defines an agreed breastfeeding continuum. This continuum, and factors associated with each of the different stages is represented in Table 1.1.

Breastfeeding Continuum

StageFactors influencing breastfeeding decisions
Pre-natalPreparatory stage for breastfeeding. Education, knowledge, commitment to breastfeeding, and development of support networks shown to impact on duration of breastfeeding.
Immediate post-natal
(0–4 days)
Breastfeeding commences. Experience in the birthing environment has a direct impact on the establishment of breastfeeding practice.
Medium post-natal
(4 days–8 weeks)
Mothers transition from health environment to home environment. Social networks, lay advice and peer support inform breastfeeding practice.
Long-term post-natal
(8 weeks–6 months)
Beyond 6 months
Breastfeeding practice during this stage is reliant on the continuation of health professional and peer support, and the extent of breastfeeding environments across different settings, including workplaces, public spaces and across the broader community.
Source: Australian National Breastfeeding Strategy 2010–15

The Strategy was formally endorsed by all levels of government in 2010, with the Department assuming a leadership role in its implementation. The implementation plan for the Strategy identifies ten key action areas that facilitate breastfeeding and emphasise the quality, accessibility and continuity of support within a continuous improvement process (see Box 1.1).

Key action areas for Implementation of the Australian National Breastfeeding Strategy 2010-15

The following action areas have been identified as key to progressing the aims of the Australian National Breastfeeding Strategy 2010-15.
  • Monitoring and surveillance
  • Health professionals’ education and training
  • Dietary guidelines and growth charts
  • Breastfeeding friendly environments
  • Support for breastfeeding in health care settings
  • Revisiting Australia’s response to the World Health Organization’s International Code of Marketing of Breast-milk Substitutes and related World Health Assembly resolutions
  • Exploring the evidence, quality assurance, cost-effectiveness and regulatory issues associated with the establishment and operation of milk banks
  • Breastfeeding support for priority groups
  • Continuity of care, referral pathways and support networks
  • Education and awareness, including antenatal education.
Source: AHMC, Communiqué 22 April 2010
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Breastfeeding in Australia

The 2010 Australian National Infant Feeding Survey provides baseline data on the practice and duration of breastfeeding and other feeding practices across the country. Key findings from the survey demonstrate near universal breastfeeding initiation for newborns, with over 90 per cent of infants being first fed with breastmilk. However rates of exclusive, predominant or complementary breastfeeding drop off significantly in the first six months of an infant’s life. The survey results indicate that by 6 months of age:
  • around 60 per cent of infants were receiving some breastmilk; but
  • only 15 per cent of infants were being exclusively breastfed.
0 presents data collected by the survey on breastfeeding rates in Australia tracked over the first six months of an infant’s life.

Breastfeeding rates in Australia


Graphical Presentation of Breastfeeding rates in Australia - see text following for more information
Exclusive breastfeeding — infant fed only breastmilk Predominant breastfeeding — breastmilk the predominant source of nourishment, with other certain liquids, drops and syrups permitted Any breastmilk — a combination of breastmilk, formula and other type of food or liquid Source: 2010 Australian National Infant Feeding Survey
These rates indicate a significant gap between breastfeeding practice in Australia and the recommendations of the National Health and Medical Research Council (NHMRC) guidelines that all infants be fed exclusively on breastmilk from birth until at least six months of age and that breastfeeding should continue in some form until the infant is at least 12 months of age.

Breastfeeding interventions

The framework of factors influencing commitment to breastfeeding adopted by the Australian National Breastfeeding Strategy identifies environmental and societal conditions that operate at individual, group and society level.
  • Individual level factors — associated with the health and capacity of the mother and infant.
  • Group level factors — associated with environment of the mother and infant, including health and hospital settings, home and work settings, and level of support available in the community.
  • Society level factors — associated with social and cultural attitudes to breastfeeding, and broader public policy approaches to health and nutrition (Hector 2005).
When considered against the breastfeeding continuum outlined in Table 1.1, this framework of factors provides a useful reference point with which to understand strategies and specific interventions designed to support breastfeeding practice.

Key findings from systematic reviews of different types and forms of interventions that cross the framework of factors described above, identify that education and support for mothers is important.
  • Education — education, particularly during the pre natal stage, maximises breastfeeding initiation. However its effectiveness in supporting breastfeeding duration is less clear, especially when delivered in isolation, particularly at four and six months of age.
  • Support — support, provided at antenatal and postnatal stages, that encompasses both services and environments. It can include support from health professionals, support staff, health service settings, social networks, and peer support.
Importantly, the literature emphasises integrated interventions, whereby a combination of professional, lay, and peer support, delivered in different settings, has shown to be most effective in improving breastfeeding duration (Amir et al 2010; Chung et al 2008; and Hector 2005).

The role of peer support

Initiation of breastfeeding in Australia is high. However, as 0 demonstrates, duration of breastfeeding practice by mothers is short of NHMRC recommendations. Recent research has found there are a range of issues that impact upon sustaining breastfeeding beyond initiation, including: a disjunct between the expectation and reality of a mother’s experience of breastfeeding, difficulties encountered in breastfeeding, concerns about the adequacy of breastmilk to meet the health and wellbeing needs of the baby, the physical demands of breastfeeding, and myths and misconceptions about breastfeeding provided to mothers (HoR 2007; and Osborne et al 2009).

Peer support is cited in the literature as a particular form of intervention that can address many of these issues (HoR 2007: CCCH 2006). The National Breastfeeding Strategy identifies peer support as, ‘being provided by people who have had some experience in breastfeeding and have received a level of specific training to assist in their support role’ (AHMC 2010). This definition clearly distinguishes peer provided support from the support that is provided by health professionals and lay support provided by social and family networks.

The Australian Breastfeeding Association


The Australian Breastfeeding Association (ABA) is a voluntary, not for profit organisation that encourages and supports mothers to breastfeed, and at the same time drives greater community awareness of the importance of breastfeeding. The ABA has branches across all jurisdictions and at 30 June 2011 had over 14,000 members, over 250 ABA groups, and nearly 1,200 trained volunteer counsellors (ABA 2011).

The ABA's vision, mission and values are outlined in Box 1.2.Top of page

ABA Vision, Mission and Values


Vision

Breastfeeding is the normal way to feed and nurture infants, with babies being breastfed exclusively for 6 months and continuing to breastfeed for 2 years and beyond.

Mission

As Australia’s leading authority on breastfeeding, we:
  • educate society and support mothers, using up-to-date research findings and the practical experiences of many women; and
  • influence society to acknowledge breastfeeding as normal and important to parenting and the physical and mental health of babies, children and mothers.

Values

  • Mother-to-mother support
  • Skilled and loving parenting (in society)
  • Excellence and innovation in breastfeeding support
  • The wellbeing and diversity of our people
  • Cooperation and teamwork
  • Honest, open and respectful communication
  • Clear and transparent processes.
Source: Australian Breastfeeding Association website


Activities conducted by the ABA include the following.
  • Local ABA groups — run by volunteer counsellors and community educators who work within local networks to educate the community about breastfeeding.
  • Breastfeeding Education classes — delivered by ABA qualified counsellors and community educators providing information and support to new and expectant mothers and their families.
  • Delivery of breastfeeding training — as a Registered Training Organisation, the ABA delivers Certificate IV in Breastfeeding Education for all new counsellors.
  • Seminars — seeks to drive greater awareness of breastfeeding amongst health professionals through the delivery of a program of seminars, webinars and workshops.
  • Workplace accreditation — delivers the Breastfeeding Friendly Workplace Accreditation program, assisting workplaces to provide a breastfeeding supportive environment.
  • Breastfeeding Friendly Communities — encompasses a number of programs that support breastfeeding practice in the community and drive awareness and acceptance of breastfeeding in public.
  • National Breastfeeding Helpline — provides national access to breastfeeding counselling and support 24 hours a day, 7 days a week, through a toll free Breastfeeding Helpline number.

The National Breastfeeding Helpline


Commonwealth Government funding for a national breastfeeding helpline was committed to in the 2007 election. The funding was to allow the ABA to build the capacity and consistency of existing ABA telephone support for mothers and their families.

The establishment of the Breastfeeding Helpline constitutes a significant response to issues identified in the Best Start report, and directly relates to identified actions contained in the National Breastfeeding Strategy, specifically action on ‘continuity of care, referral pathways and support networks’ in promoting and supporting breastfeeding in Australia. The objectives of the Breastfeeding Helpline are outlined in Box 1.3.

National Breastfeeding Helpline Objectives


Objectives of the National Breastfeeding Helpline are:

  • to support breastfeeding initiation and duration for breastfeeding women through trained volunteer counsellors;
  • to improve national access and equity of access to quality factual information and advice, regardless of geographic location and with particular reference to population subgroups, including culturally and linguistically diverse communities, women with a disability, Aboriginal and Torres Strait Islander mothers, and teenage mothers; and
  • to provide a 24 hour, nationally accessible Helpline for women, partners and families seeking information and advice to support decision making in relation to breastfeeding.
Source: Department of Health and Ageing


To deliver the Breastfeeding Helpline, the ABA has entered into agreements with the Department for funding of $3,859,161 over the four-year period from 1 July 2008 to 30 June 2012. These funds include support for training and education of the volunteer Breastfeeding Counsellors working on the Helpline, establishment and maintenance of the infrastructure for an effective national telephone helpline and promotion of the Breastfeeding Helpline.

The Breastfeeding Helpline operates as a national telephone information and support service. Volunteer counsellors who staff the Breastfeeding Helpline, meet the minimum qualifications of a Certificate IV in Breastfeeding Education. Volunteers are bound by the ABA Code of Ethics and are also required to have experience of breastfeeding themselves. The ability to offer peer support to callers is a distinguishing feature of the Breastfeeding Helpline service.

The funding for the Breastfeeding Helpline is designed to facilitate access to advice and support for breastfeeding for mothers and their families including information and referral services. The ABA website is integral to the continuing education of volunteer counsellors, to communication with and between counsellors, as a source of ongoing information for mothers and their families and to the promotion of the Breastfeeding Helpline.