How breastfeeding trends in Ireland can be improved

Opinion: Ireland performs poorly when it comes to breastfeeding rates and there is significant work to be done to translate policy into practice

By Liz O'Sullivan, TU Dublin and Sarah Brennan, NUI Galway

Ireland’s first World Breastfeeding Trends Initiative report, which is published today, describes how well Ireland is doing in terms of breastfeeding policies, programmes and practices. This report involves scoring a set list of indicators and producing a final score out of 100. Ireland is the 99th country to produce one of these reports, allowing us to benchmark ourselves on the global stage. While a score of 56 out of 100 places us 10th of the 19 European countries and 57th of the 99 countries globally with a completed report, our middle-of-the-road score should not be perceived as cause to celebrate.

The report indicates that we are doing well in some areas; we have a national breastfeeding action plan, and we have clear governance outlining how this plan is to be delivered. In addition, our legislation for maternity leave is quite strong, with a recent addition that sees breastfeeding mothers entitled to breastfeeding breaks of one hour per day up to their child’s second birthday.

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From RTÉ Radio 1's Today with Claire Byrne in 2021, Aoibhinn Ni Shuilleabhain, member of the Baby Feeding Law Group Ireland and the mother rep on the National Maternity Hospital Infant Feeding Steering Committee, discusses breastfeeding rates in Ireland

But when it comes to breastfeeding rates, Ireland performs poorly compared to other countries. We don't routinely track breastfeeding rates beyond three months postpartum, there have been only very modest increases in breastfeeding rates over the last number of years and the targets set out in the breastfeeding action plan are not being met. This suggests that there is significant work to be done in terms of translating policy into practice.

This disconnect between policy and practice is evident from the findings of recent studies conducted among mothers. The government-funded National Maternity Experience Survey (2020) highlighted that areas for improvement identified by mothers included staffing levels, communication, and issues relating to feeding their babies. In this survey, 15% said they did not get adequate support and encouragement from healthcare professionals with feeding their baby.

These findings are echoed by an independent study carried out by TU Dublin and Bainne Beatha, a parent-led breastfeeding advocacy group. Although many respondents described positive experiences, more described instances of poor breastfeeding support in the hospital and the community.

From RTÉ Radio 1's Drivetime, Dr Liz O'Sullivan discusses the breastfeeding support study

A deep-dive into the experiences of mothers while in the maternity unit indicated that many women felt let down. Breastfeeding was promoted while they were pregnant. but formula was often the solution offered if they experienced any challenges after the baby was born. Such experiences, as well as the World Breastfeeding Trends Initiative findings, suggest that simply having policies in place is going to be ineffective at increasing our breastfeeding rates if these policies are not optimally implemented.

The most obvious challenge to policy implementation is staffing. Midwifery staffing, in particular, is repeatedly highlighted as a major problem by journalists, and by those in management positions. Not only does recruitment require attention, we also need to consider staff retention, which was highlighted as a significant issue by the Irish Nurses and Midwives Organisation in response to Budget 2024.

It’s no surprise that Ireland’s breastfeeding rates are so low if there are not enough midwifery posts and it's a struggle to retain the midwives who are employed. Not only is this a problem for mothers and babies, but it is also no doubt a challenge for midwives, who likely don’t have the time to deliver the breastfeeding-related care and support they’ve been trained to provide.

From RTÉ Radio 1's Drivetime, discussion on breastfeeding support survey with Dr Liz O'Sullivan and Petrina O'Halloran, mother of two who had two contrasting experiences of breastfeeding support

Within this environment, where hands-on support for breastfeeding is sub-optimal, families are bombarded with marketing for formula milk, at point-of-sale, on the radio and television, and through multiple online fora. We know, from landmark reports published by the World Health Organization in 2022 and The Lancet in 2023, that the marketing of formula is often aggressive, manipulative and exploitative.

This affects our unconscious mind driving our behaviours towards formula feeding and undermines parents’ confidence in breastfeeding. We need stricter legislation in Ireland, that is monitored and enforced, to ensure that families only receive information about infant feeding that is evidence based and free from commercial influence.

Full legislative inclusion of the International Code of Marketing of Breast milk Substitutes would achieve this end. The Online Safety and Media Regulation Act, which was signed into law in 2022, begins to move towards enactment of this. Under this act, Coimisiún na Meán, will oversee the regulation and restriction of a broad range of marketing deemed harmful to children, including the advertisement of infant formula and follow-on formula on diverse media platforms and online. With these new regulations, Ireland can meaningfully protect our families, healthcare professionals, and government from this aggressive and pervasive marketing, thus protecting breastfeeding.

READ: What's Ireland's plan for feeding babies in a national emergency?

Ireland has more to do to ensure that mothers and families receive the consistent, timely, evidence-based breastfeeding support and care they want and deserve. An obvious place to start is developing a new breastfeeding action plan as the current plan expires next month and there is no sign of a new plan to replace it.

To achieve our envisioned increase in breastfeeding rates, we need to monitor current prevalence of exclusive breastfeeding to six months of age and breastfeeding duration to two years and beyond, (in line with WHO guidance), set realistic targets, and fund measures to achieve those targets. However, developing plans and setting targets, and introducing education and training initiatives will all be pointless endeavours with continuing healthcare staff shortages.

The Government needs to step up and prioritise infant and young child health through investing in the protection, promotion, and support of breastfeeding. The future of our small, yet highly influential country, depends on the health and wellbeing of its youngest and most vulnerable citizens. Optimised breastfeeding, the most impactful and equitable intervention, can ensure the health and wellbeing of the nation.

Dr Liz O'Sullivan is a Lecturer in Nutrition at the School of Biological, Health and Sports Sciences at TU Dublin. Dr Sarah Brennan is a lecturer in NUI Galway's Donegal Medical Academy.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ

READ: What's Ireland's plan for feeding babies in a national emergency?

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