On the same page
Despite various strategies to achieve global targets for breastfeeding indicators, Australia is still struggling (Hull et al 2017, Department of Health 2010). From our national health report card, our breastfeeding initiation rate is good (92%), but dwindles rapidly so that by 6 months of age, few babies (14%) are exclusively breastfeeding (DoH 2013 Implementation Plan). The Federal Government has championed breastfeeding as a biological and societal norm (DoH 2010 Implementation Plan) and seeks to create an enduring Strategy. From the Australian National Breastfeeding Strategy: 2017 and Beyond – Report on stakeholder consultation (DoH 2017 p.21), one of the key recommendations identified was to…
“Introduce and standardise regular data collection on breastfeeding, establish a monitoring and evaluation framework, and provide funding for research to monitor progress on the Strategy and on health outcomes.”
Australia is a federation, with national public health goals and objectives monitored and evaluated by our Federal Department of Health. Responsibility would be enhanced by national governance based on a policy that embraces the WHO Global Strategy for Infant and Young Child Feeding (2003), facilitated by the standardised collection of data from all states and territories as per the WHO/UNICEF guidelines.
Sing as one voice
Without standardised and regular data collection on Infant and Young Child Feeding (IYCF), monitoring and evaluation are almost impossible. Currently, Australia is lacking a national strategy. Reviewing previous Australian National Breastfeeding Strategies (DoH) and other IYCF programmes, it is clear that collection of data is not fully standardised data and is sometimes snapshot data. WHO provide detailed guidelines on IYCF data collection that will best facilitate monitoring and evaluation in Australia, and would also facilitate evaluation against other countries. Evaluation against other countries with a similar standard of living could rapidly highlight successful strategies.
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Underpinning standardised and regular data collection are IYCF indicators. The Australian Institute of Health and Welfare (AIHW) utilises draft indicators from their 2011 National breastfeeding indicators: Workshop report. Data collected does not always adhere to these AIHW indicators at a regional or state level, thus the level of integrity of the data is compromised. Other IYCF programme reports also reveal inconsistencies in their indicators. Utilisation of the WHO/UNICEF IYCF indicators and guidelines will ensure optimal IYCF programmes, data collection, monitoring and evaluation at the regional, state or national level. Once we are all on the same page, generation of action plans, budget allocation and monitoring and evaluation will be optimised. Model policies with monitoring and evaluation tools are readily available and easily adaptable to the Australian demographic. The WHO Global Strategy for IYCF (2003) and/or the European Blueprint for Action (2008) could provide a national framework for Australia.
The Australian Health Ministers’ Advisory Council (2017 fact sheet 3) has commissioned a Literature Review to augment the stakeholder consultation feedback, both of which will inform the next Breastfeeding Strategy draft. The draft will undergo online consultation early in 2018. Progress on indicators and sustainable and regular data collection is expected.
Different verses sung to the same tune
Our current IYCF programmes maintain voluntary commitment by localities to items, eg BFHI, and creation of priority programmes by localities. While this is an excellent way to cater for priority groups, commitment to national strategies and indicators and their monitoring and evaluation should be embedded within all IYCF programmes.
In reality, IYCF indicators are not discrete entities. Induction of labour impacts on IYCF. The dairy industry impacts on IYCF. IYCF impacts on the dairy industry. A wider analysis of the influences to IYCF could reveal novel strategies and foster public engagement, for example, through realisation of the influence of markets and lack of adherence to the WHO Code.
Who pays for the songbook?
Wider and detailed analysis of the influences to IYCF may reveal gendered bias in our society. A gender-based lens on budgeting would help ensure the success of Australia’s IYCF strategies while at the same time, resolving gender inequities.
WHO (2003) Global Strategy for Infant and Young Child Feeding. Available at http://www.who.int/nutrition/topics/global_strategy/en/
Australian Health Minister’ Advisory Council 2017 Australian National Breastfeeding Strategy: 2017 and beyond – Fact Sheet 3 available from
DoH 2010 2010 Implementation Plan for the Australian National Breastfeeding Strategy 2010-2015
Australian Institute of Health and Welfare 2011 National breastfeeding indicators: workshop report. Cat. No. PHE 146. Canberra: AIHW. Available from:
Hull N, Schubert L & Smith J. (2017) Perspectives of key stakeholders and experts in infant feeding on the implementation of the Australian National Breastfeeding Strategy 2010-2015 [online]. Breastfeeding Review, Vol. 25, No.1, Mar 2017:25-34. Available from: http://search.informit.com.au/documentSummary;dn=704809215038270;res=IELHEAISSN:0729-2759. [cited 15 Nov 17].
Australian Institute of Health & Welfare (2011) 2010 Australian National Infant Feeding Survey: indicator results. Canberra: AIHW.
Department of Health (no date) 2010 Implementation Plan for the Australian National Breastfeeding Strategy 2010-2015. Available from:
European Commission, Directorate Public Health and Risk Assessment (2008) Protection, Promotion and Support of Breastfeeding in Europe: A Blueprint for Action. Available at http://www.aeped.es/sites/default/files/6-newblueprintprinter.pdf
Authors: Dawn Sheridan IBCLC and Helen Adams RN, RM, IBCLC – on behalf of Lactation Consultants of Australia and New Zealand (LCANZ)
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