Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694819455462.pdf (Australia)
The Parliament of the Commonwealth of Australia The Best Start Report on the inquiry into the health benefits of breastfeeding House of Representatives Standing Committee on Health and Ageing August 2007 Canberra © Commonwealth of Australia 2007 ISBN 978-0-642-78982-2 (printed version) 978-0-642-78983-9 (HTML version) Printed by CanPrint Communications Pty Ltd, Canberra.

Cover design by Lisa McDonald, Department of the House of Representatives, Printing and Publishing Office, Canberra.
Cover photographs of Mother kissing yawning baby and Mother breastfeeding baby are courtesy of Jupiterimages Contents 1 Introduction ...........................................................................................................1 Overview .................................................................................................................................... 1 Setting the context.................................................................................................................... 2 Conduct of the inquiry.............................................................................................................. 4 Scope and structure of the report ........................................................................................... 5 2 Breastfeeding in Australia....................................................................................9 Overview .................................................................................................................................... 9 NHMRC’s Dietary Guidelines.................................................................................................... 10 The national perspective ........................................................................................................ 11 The Australian Breastfeeding Association................................................................................. 13 Breastfeeding rates in Australia ............................................................................................ 14 Monitoring breastfeeding ....................................................................................................... 15 Research................................................................................................................................... 18 Factors affecting breastfeeding............................................................................................. 21 Individual factors that influence breastfeeding
 .......................................................................... 23 Group and social factors that influence breastfeeding .............................................................. 24 Partners .................................................................................................................................... 24 Successful strategies to encourage breastfeeding ............................................................. 26 Breastfeeding education ........................................................................................................... 28 Peer support or counselling programs ...................................................................................... 30 Breastfeeding - a community responsibility......................................................................... 32 iv 3 The health and economic benefits of breastfeeding .......................................37 Overview .................................................................................................................................. 37 Health benefits for the baby ................................................................................................... 38 Obesity, early nutrition and chronic disease risk ................................................................ 40 Health benefits for the mother ............................................................................................... 42 Emotional benefits to the mother and baby.......................................................................... 43 The unique properties of breast milk .................................................................................... 44 Promoting the health benefits of breastfeeding................................................................... 45 ‘The gift of human milk’.......................................................................................................... 46 Milk banks in Australia
 .............................................................................................................. 48 Barriers to milk banking............................................................................................................. 49 The future of milk banks in Australia ......................................................................................... 51 The economic benefits of breastfeeding............................................................................... 52 The economic value of breast milk and breastfeeding .............................................................. 53 Cost savings to the health system............................................................................................. 54 4 Breastfeeding Management ...............................................................................59 Overview .................................................................................................................................. 59 The science of supply............................................................................................................. 60 Initiation – the early days ....................................................................................................... 61 Duration of breastfeeding....................................................................................................... 66 Low supply and perceived low supply ....................................................................................... 67 Demand feeding and routines ................................................................................................... 68 Myths and misconceptions........................................................................................................ 69 Sleep......................................................................................................................................... 71 Infant
71 Infant weight.............................................................................................................................. 72 Extended breastfeeding ............................................................................................................ 72 5 Breastfeeding challenges...................................................................................75 Overview .................................................................................................................................. 75 Returning to work ................................................................................................................... 77 Breastfeeding and work ............................................................................................................ 79 Breastfeeding-Friendly Workplace Accreditation (BFWA) Program .......................................... 80 Breastfeeding equipment .......................................................................................................... 82 v Family Law................................................................................................................................ 82 People with compounding issues .............................................................................................. 83 When breastfeeding does not work out ................................................................................ 87 Guilt and anger.......................................................................................................................... 89 6 The health system...............................................................................................93 Overview .................................................................................................................................. 93 The birth................................................................................................................................... 94 Increasing medicalisation of birth
 .............................................................................................. 95 Baby Friendly Hospital Initiative............................................................................................ 96 History....................................................................................................................................... 96 BFHI in Australia ....................................................................................................................... 97 The health professional advice merry go round ................................................................ 100 General Practitioners .............................................................................................................. 102 Infant weight and growth charts .......................................................................................... 103 Development of Growth Charts............................................................................................... 104 Development of new growth charts ......................................................................................... 105 Australian use ......................................................................................................................... 106 Issues...................................................................................................................................... 107 Continuity of care.................................................................................................................. 109 Lactation Consultants .......................................................................................................... 110 7 Regional, remote and Indigenous communities ............................................111 Overview ................................................................................................................................ 111 Factors influencing
 breastfeeding....................................................................................... 112 Regional and remote communities...................................................................................... 113 Staff workforce and workplace issues ................................................................................ 115 Advice ..................................................................................................................................... 115 Indigenous health status...................................................................................................... 116 Breastfeeding rates in Indigenous populations........................................................................ 116 The critical importance of breastfeeding ................................................................................. 118 Barriers to breastfeeding......................................................................................................... 118 The marketing of infant formula............................................................................................... 119 Education ................................................................................................................................ 120 vi Cultural factors........................................................................................................................ 120 Housing................................................................................................................................... 121 Travel ...................................................................................................................................... 121 Low birth weight – compounding issues.................................................................................. 122 Successful strategies to encourage breastfeeding in Indigenous communities....................... 124 8 The impact of breast milk
 substitutes.............................................................127 Overview ................................................................................................................................ 127 What is infant formula?
........................................................................................................ 127 Infant formula information ....................................................................................................... 130 WHO Code ............................................................................................................................. 131 The Marketing in Australia of Infant Formulas: Manufacturers and Importers (MAIF) Agreement ............................................................................................................................. 133 The WHO Code and MAIF - differences ................................................................................. 134 Advisory Panel on the Marketing in Australia of Infant Formula (APMAIF) ..................... 135 Review of MAIF and APMAIF................................................................................................ 137 The Australian context ......................................................................................................... 139 Implementation of the WHO Code .......................................................................................... 142 Breastfeeding information – other sources.............................................................................. 143 Appendix A – Submissions .....................................................................................147 Appendix B – Exhibits .............................................................................................159 Appendix C – Public Hearings and Inspections....................................................163 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 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 viii 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.
ix 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 xi 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: (a) the extent of the health benefits of breastfeeding; (b) evaluate the impact of marketing of breast milk substitutes on breastfeeding rates and, in particular, in disadvantaged, Indigenous and remote communities; (c) the potential short and long term impact on the health of Australians of increasing the rate of breastfeeding; (d) initiatives to encourage breastfeeding; (e) examine the effectiveness of current measures to promote breastfeeding; and (f) 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 xiv GP GST HIV General Practitioner Goods and Services Tax 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 JIM In Vitro Fertilisation 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 xv 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 xvi 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.
xviii 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.
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.
xix 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.
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.
xx 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.

xxi