Healthy Eating - Healthy Action
Oranga Kai - Oranga Pumau

Questions and Answers about the National Breastfeeding Promotion Campaign

• Why do we need a national breastfeeding promotion campaign?
• What are the breastfeeding health targets for New Zealand?
• What are the breastfeeding rates in New Zealand?
• How will the campaign be funded?
• Why do breastfeeding rates decline after birth?
• What is the Ministry of Health using to develop the campaign?
• What is the goal of the campaign?
• Are there any other initiatives underway by the Ministry of Health to promote, support and protect breastfeeding in New Zealand?
• What international strategies and codes guide New Zealand policies and practices on breastfeeding?
• How will we measure the success of the campaign?

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Why do we need a national breastfeeding promotion campaign?

A national breastfeeding promotion campaign provides the opportunity to contribute to efforts to improve the long-term health of the population, reduce health inequalities between population groups. It is also an integral part of the response to the recommendation of the Health Select Committee to implement the Global Strategy for Infant and Young Child Feeding, and coordinate efforts towards reaching the breastfeeding indicators within Health Target Eight (refer to section on breastfeeding health targets for further information).

A national breastfeeding promotion campaign contributes to five of the thirteen health priority objectives set out in the New Zealand Health Strategy:

• improving nutrition
• reducing obesity
• reducing the incidence and impact of cancer
• reducing the incidence and impact of cardiovascular disease
• reducing the incidence and impact of diabetes.

Breastfeeding is important for nutritional and physical wellbeing from infancy right through to adulthood. Evidence indicates that breastfeeding has health benefits for the infant and the mother in both the short and long term. The short term benefits of breastfeeding include decreased incidence of otitis media, acute respiratory infections, diarrhoea and gastroenteritis, especially in less than optimal environments, urinary tract infection, and sepsis and meningitis. Breastfeeding reduces the risk of sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUDI). The long term benefits from breastfeeding include a reduction in the risk of chronic diseases such as obesity, type 2 diabetes and cardiovascular disease. Breastfeeding benefits for the mother are a reduction in risk of post-partum haemorrhaging, and breast and ovarian cancer.

Although New Zealand has breastfeeding rates at birth that are consistent with other OECD countries, rates are lower at six weeks, especially among Māori and Pacific women. Reducing inequalities between Māori and non-Māori and Pacific and non-Pacific populations is a major focus for the Ministry of Health (the Ministry).

Breastfeeding features in the Ministry’s Healthy Eating-Healthy Action (HEHA) strategy and its associated implementation plan. A key action from the HEHA strategy is to develop policies and campaigns that promote and support breastfeeding with a particular emphasis on high-need groups and Māori and Pacific peoples who have lower rates of breastfeeding than the non- Māori and non-Pacific population. The HEHA strategy is addressing health inequalities between these population groups.

What are the breastfeeding health targets for New Zealand?

The Ministry of Health set health targets for the 2007/08 year. The health targets remain in place for 2008/09. The national breastfeeding promotion campaign aligns with target eight of the ten health targets; improve nutrition, increase physical activity and reduce obesity. One of the two indicators for this target is increasing the proportion of infants exclusively and fully breastfed at:

• six weeks to 74% or greater
• three months to 57% or greater
• six months to 27% or greater.

What are the breastfeeding rates in New Zealand?

New Zealand’s breastfeeding rates for 2007 are as follows:

• At six weeks, the full and exclusive breastfeeding overall rate was 65% with a breakdown of, 58% of Māori babies, 53% of Pacific babies, 56% of Asian babies, 70% of Other babies
• At three months, the full and exclusive breastfeeding overall rate was 54% with a breakdown of 44% of Māori babies, 43% of Pacific babies, 52% of Asian babies, 59% of Other babies.
• At six months, the full and exclusive breastfeeding overall rate was 26% with, 17% of Māori, 18% of Pacific babies, 26% of Asian babies, 29% of Other babies.

Table one: A breakdown of breastfeeding rates in New Zealand based on Plunket data

How will the campaign be funded?

The Government has funded the Ministry of Health to develop a breastfeeding promotion campaign and implement the campaign as part of the Healthy Eating-Healthy Action programme.

Why do breastfeeding rates decline after birth?

There are a number of barriers that contribute to the decline in breastfeeding rates. These include:

• a lack of breastfeeding education and support
• returning to paid work
• low awareness of common problems and solutions
• many women do not have access to appropriate help for overcoming breastfeeding problems when they need it
• pain and exhaustion are common reasons for introducing formula
• supplementation of breastfeeding with formula is common at all stages and partly accounts for differences in exclusive breastfeeding rates between different population groups
• negative attitudes towards breastfeeding from the general public or family members can be a barrier to breastfeeding in public places, community or family settings.

Note: more intense and/or additional barriers are experienced by teenage parents, Māori, Pacific peoples, new migrants, and people on low income.

What is the Ministry of Health using to develop the campaign?

The Ministry of Health commissioned scoping work to determine the barriers to breastfeeding, particularly for Māori and Pacific peoples, and how to address those barriers.

There were two parts to the scoping work:

Part one: Qualitative research was undertaken to better understand public knowledge, attitudes and behaviours with regards to breastfeeding and perceived barriers to breastfeeding, particularly for high-need groups and Māori and Pacific peoples.

Part two: A comprehensive plan that considers and integrates the findings of all available information (includes a literature review and snapshot of breastfeeding services currently provided at local, regional and national levels) and includes the information obtained from undertaking qualitative research in part one. The plan will be used to inform the design and implementation of a national breastfeeding promotion campaign that will result in improved breastfeeding rates.

What is the goal of the campaign?

The overall goal is to increase the proportion of infants being exclusively breastfed to six months and the proportion of infants partially breastfed beyond 6 months (this is consistent with World Health Organization breastfeeding recommendations); the objectives are to:

• increase tangible support to aid mothers to breastfeed
• increase emotional support to aid mothers to breastfeed
• increase informational support to aid mothers to breastfeed.

Three settings have been identified as areas of intervention; health system, family/whānau, and communities including workplaces. Māori and Pacific peoples have been identified as the key priority groups for the campaign, although it is also envisaged that generic elements of the campaign will reach high-need groups of all ethnicities. A staged approach has been recommended beginning with the health system.

Are there any other initiatives underway by the Ministry of Health to promote, support and protect breastfeeding in New Zealand?

The Ministry of Health has a number of strategies, initiatives, and programmes that promote and support breastfeeding:

Relevant strategies are:

• The New Zealand Health Strategy
• The New Zealand Disability Strategy
• He Korowai Oranga: Māori Health Strategy
• The Pacific Health and Disability Action Plan
• The Primary Health Care Strategy
• The Healthy Eating - Healthy Action strategy and implementation plan
• The Well Child Tamariki Ora Framework.

The National Breastfeeding Advisory Committee was established in 2006 and the key role of the Committee has been to prepare a national strategic plan of action for breastfeeding, which builds on Breastfeeding: A Guide to Action (MoH 2002).

The food and nutrition guidelines background papers provide best practice guides for nutrition during pregnancy, and for feeding infants and toddlers:

• Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper.
• Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0-2): A background paper.

Protection of breastfeeding - Implementing and Monitoring the International Code of Marketing of Breast-milk Substitutes in New Zealand: The Code in New Zealand (for further information refer to the section on international strategies and codes that guide New Zealand policies and practices on breastfeeding).

Initiatives, providers and programmes include the Baby Friendly Hospital Initiative and Baby Friendly Community Initiative, maternity service providers, Well Child providers, breastfeeding advocacy and support programmes, DHB pregnancy and parenting programmes.

The Baby Friendly Hospital Initiative (BFHI) supports and promotes exclusive breastfeeding to mothers in the early stages of initiation. This initiative has been successfully implemented in maternity hospitals across the country. There are now 64 hospitals accredited as being Baby Friendly. The Baby Friendly Community Initiative (BFCI) is a continuation of support following the BFHI and provides support across the different breastfeeding stages in a child’s life. BFCI aims to protect, promote and support breastfeeding in the community. This is particularly important due to the fact that most post-natal mothers have a very short stay in hospital and this is the crucial time to provide support with the establishment of breastfeeding.

BFHI and BFCI are integral components of the work to improve the breastfeeding environment in New Zealand.

Other agencies also undertake work that contributes to the protection, promotion and support of breastfeeding and infant nutrition:

The Ministry of Justice

• Administers the Human Rights Act and the Bill of Rights.
• For further information refer to www.justice.govt.nz.

The Department of Labour

• In 2005, published “Breastfeeding in the workplace; an employer’s guide to making it work”.
• Administer the Parental Leave and Employment Protection Act 1987.
• For further information refer to www.dol.govt.nz.

The Department of Corrections

• Administer the Corrections (mothers with babies) Amendment Bill.
• For further information refer to www.corrections.govt.nz.

The Ministry of Women’s Affairs

• Assist and support lead agencies on breastfeeding to comprehensively consider women’s issues, gender issues and the human rights issues, when contributing to a range of policy and service delivery initiatives that focus on breastfeeding and infant nutrition outcomes.
• For further information refer to www.mwa.govt.nz.

What international strategies and codes guide New Zealand policies and practices on breastfeeding?

The Global Strategy for Infant and Young Child Feeding

The Global Strategy for Infant and Young Child Feeding (the Global Strategy) is a guide to action which suggests country-specific approaches to improve feeding practices though the adoption of nine operational targets . The Ministry of Health has implemented the Global Strategy through a number of strategies and initiatives. These include:

• establishing the National Breastfeeding Advisory Committee (NBAC) in 2006
• implementing the Baby Friendly Hospital Initiative, and piloting the Baby Friendly Community Initiative
• implementing and monitoring the International Code of Marketing of Breast-milk Substitutes in New Zealand
• providing policy in i) Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper; and ii) Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0-2): A background paper
• promoting and supporting breastfeeding under the Healthy Eating – Healthy Action (HEHA) strategy and implementation plan, and the national breastfeeding promotion campaign.

For further information view the Ministry of Health's Nutrition website

The International Code of Marketing of Breast-milk Substitutes

The International Code of Marketing of Breast-milk Substitutes (the International Code) (WHO 1981) was adopted by New Zealand in 1983. New Zealand, as a signatory to the International Code is committed to working towards adopting its aims. Implementing and Monitoring the International Code of Marketing of Breast-milk Substitutes in New Zealand: the Code in New Zealand (Ministry of Health 2007) represents the best position possible given New Zealand’s current legislative and commercial environment. Collectively the Code in New Zealand, the Australia New Zealand Food Standards Code (FSC 2002) and The Code for Advertising of Food (ASA 2007) cover all 11 articles of the International Code giving effect to its principles and aims.

For further information view the International Code of Marketing of Breast-milk Substitutes website

How will we measure the success of the campaign?

The main tool for measuring the success of the campaign will be through monitoring the breastfeeding rates and the effectiveness of the campaign.

The overarching campaign goal is to increase environmental support to initiate and maintain breastfeeding, especially for Māori and Pacific people. Therefore, an important part of measuring the success of the campaign will be to measure increases in the level of support.
Page last updated: 29 July 2008