How can Germany become breastfeeding-friendly? Everywhere, at any time and for any woman wishing to breastfeed? Results and recommendations from the Becoming Breastfeeding Friendly (BBF) research project were presented in Berlin on 5 June 2019. Around 170 interested parties and stakeholders from diverse areas of breastfeeding promotion attended the event to learn more about the current status of promoting breastfeeding in Germany and to discuss future activities with the research project’s experts.
There is work ahead of us
In a number of areas, there already exist enabling environments for breastfeeding, but we want to and can become even more breastfeeding-friendly. Delegates from a number of German federal ministries (the German Federal Ministry of Food and Agriculture (BMEL), German Federal Ministry of Health (BMG) and the German Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (BMFSFJ)) involved in the BBF project as well as the President of the Federal Office for Agriculture and Food (Bundesanstalt für Landwirtschaft und Ernährung (BLE)) made this very clear at the opening of the conference. Breastfeeding is about giving children a good start in life. But not all children have the opportunity to benefit from it. That is why promoting breastfeeding is also a way of contributing to equal health opportunities and should therefore be an important national concern requiring action," said Dr. Hermann Onko Aeikens (BMEL).
BBF provides evidence-based data
Professor Dr. Rafael Pérez-Escamilla from the Yale School of Public Health (USA) attended the conference. This is where the BBF method was initially developed and it is implemented in Germany in collaboration with Yale. The objective of BBF is to empower countries by providing evidence-based facts to shape policies, science and the practice of breastfeeding promotion. According to Pérez-Escamilla, by determining the status of breastfeeding promotion in the country, Germany has embarked on a dynamic process that requires further monitoring. For him, fostering breastfeeding is not just a national task but a global challenge. That is why it is so important to ensure that countries that have undertaken BBF research exchange ideas and share their findings.
Germany is moderately breastfeeding-friendly
The overall BBF score for Germany is 1.7 (on a scale from 0 "no breastfeeding promotion" to 3 "very good breastfeeding promotion"). For just under two years, the BBF Committee in Germany conducted intensive research and analysis, and formulated its recommendations. This could make breastfeeding promotion history, says Maria Flothkötter. Because for the first time ever, the current status in eight different areas of activity was systematically evaluated based on a target/actual comparison. It's worth looking into the details. Because it is only when all areas of activity work in a coordinated fashion that everything runs smoothly like the gears in clockwork. That is when breastfeeding has optimal environments which can then result in an increase in the breastfeeding rate. Maria Flothkötter, Dr. Erika Sievers, Professor Dr. Melita Grieshop, Dr. Cornelia Lange and Professor Dr. Michael Abou-Dakn presented the respective questions and methods, the most important results and the recommendations derived from them for all eight areas of activity. Legislation and Policies as well as Funding and Resources for important breastfeeding promotion measures, such as the Maternity Protection Act and parental allowances, are among the strengths of breastfeeding promotion overall, but there is still room for optimisation. However, Germany's performance is particularly weak in the areas of Promotion and Research and Evaluation. But the areas of Advocacy/public advocacy, Political Will, Training and Programme Delivery, Coordination, Goals and Monitoring also receive an average rating with room for improvement. Breastfeeding cannot be taken for granted! The speakers emphasised this greatly. Germany needs a master plan that will drive the promotion of breastfeeding. This includes the development of a national strategy for promoting breastfeeding that includes a mission statement, the reorientation of the National Breastfeeding Committee (Nationale Stillkommission (NSK)) as a strategic and political advisory body and the establishment of a permanent coordination unit for breastfeeding promotion under the auspices of the German Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft (BMEL)).
Focus on improving the promotion of breastfeeding
Breastfeeding is anything but normal in the public eye. It is a controversial topic, which is intensely sexualised and presented in an ideologically divisive manner in the social media, as Nora Imlau and Professor Dr. Matthias Hastall demonstrated. Evidence-based communication is needed to address the issue of normal/everyday breastfeeding. It is important to define the target groups and their real motivations and values, which from their point of view speak for or against breastfeeding. Imlau and Hastall recommended associating breastfeeding with positive emotions, presenting it as something natural and normal, putting an end to old wives' tales and emphasising every individual's freedom of choice. This may bolster the nerve of breastfeeding mothers and encourage expectant mothers to breastfeed.
The promotion of breastfeeding is successful if it also reaches families dealing with challenging living conditions. Mechthild Paul argued that we must understand this group’s way of life, their lifestyle, their thought and behavioural patterns. The conventional services geared towards primary prevention fail, because women in precarious circumstances hardly ever make use of them. They feel overwhelmed by them and do not see their benefit. They would rather prefer a central contact point with a regional focus and above all a respectful approach. An early and comprehensive pilot scheme and community-based networks such as Early Prevention (Frühe Hilfen) could help reach women in precarious situations. Ways to promote breastfeeding through early intervention strategies are summarised in a recent key issues paper.
Professor Dr. Stephanie Stock focused on the public health economic analyses of breastfeeding: Breastfeeding can ease some of the burden on the healthcare system. Based on international models from other countries, breastfeeding has been shown to reduce overall use of health services. Even if the costs of promoting breastfeeding are not necessarily offset, projections from the models indicate that the savings could be used to finance the promotion of breastfeeding. But the key factor to improving the cost-benefit profile in the context of breastfeeding is the extent to which vulnerable groups in particular can be reached.
Breastfeeding friendliness comes in many guises
The panel discussion was an opportunity for the conference to bridge the gap between theory and practice. Sandra Bär (Oldenburg Hospital), Nina Bott (TV presenter and breastfeeding mother), Kathrin Gräbener (RTL/n-tv), Ulrike Hauffe (Barmer Board of Directors, Federal Joint Committee), Dr. Ulrike Horacek (Health Department Recklinghausen) and Silke Raab (German Trade Union Confederation) engaged in lively discussions. One way of ensuring a systematic consultation about breastfeeding during pregnancy could be to include it in the prenatal directives. The purpose of these guidelines is to regulate the scope and timing of medical services during pregnancy and after delivery, in collaboration with midwives. Patient representatives can also submit applications to the Federal Joint Committee (Gemeinsamer Bundesausschuss (G-BA)). Clinics can create a good breastfeeding environment. The baby-friendly clinic in Oldenburg, for example, not only offers breastfeeding support around the time of delivery, but also an information evening for expectant parents and a breastfeeding hotline, which are very popular. Communities could, for example, also point out breastfeeding support programmes during welcome visits by families after the birth of the child. Breastfeeding in the workplace is a statutory right, but ongoing awareness of the issue is essential. Businesses which provide good breastfeeding enabling environments to reconcile family and work present a competitive advantage to an increasing number of working mothers.
Breastfeeding mothers are virtually absent from films and TV series. Some provocation may help attract media attention. Nina Bott wants women to breastfeed their children confidently in public as well and not let themselves be discouraged. As a breastfeeding mother, she is a self-proclaimed ambassador for breastfeeding. Her young daughter was actively involved, the five-month-old son slept through the event and hence missed the chance to be breastfed on stage.
Let's do it
Evidence-based results and recommendations are now available, as is enthusiasm and commitment to the cause. This was palpable in the lectures, discussions and conversations - whether during the plenary session or among the audience - throughout the day. In Professor Dr. Regina Ensenauer's words, the time is right to tackle the issue of promoting breastfeeding. "The BBF results are the starting point for actioning all the necessary levers, bringing the promotion of breastfeeding to the fore and making breastfeeding a matter of course," summarised Maria Flothkötter - whether at home, on a park bench, in a restaurant, at work, on the bus or at a conference like this.