Last updated: 10/09/2024
Achieve Baby Friendly accreditation from UNICEF
Fund and support all neonatal, maternity and health visiting services, Children’s Centres and midwifery and health visiting courses in universities to achieve accreditation from the UNICEF UK Baby Friendly Initiative
- Very low impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 0%
- Although this policy has limited impact for reducing national obesity rates, it is beneficial for other health outcomes including access to nutrition and increasing immunity
- Low evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 2/5
- High cost to governments
Cost to UK and devolved governments over 5 years
- Cost to governments over 5 years: £275m
- Benefit to governments per year: £0
What is the policy?
The UK has one of the lowest rates of exclusive breastfeeding in Europe. The UNICEF UK Baby Friendly Initiative aims to improve breastfeeding rates by accrediting healthcare facilities and universities that implement evidence-based practices to support breastfeeding and positive mother-infant relationships.
This policy proposes increased government funding and support to help all neonatal units, maternity wards/clinics, health visiting services, and Children’s Centres meet Baby Friendly accreditation standards related to breastfeeding promotion and education. It also mandates incorporating Baby Friendly curricula into all midwifery and health visitor training programmes to achieve accredited status. Continued running costs (of staff, accreditation, training and supplies) would be required annually.
Baby Friendly accreditation involves practices such as enabling skin-to-skin contact immediately after birth, allowing baby to room-in with mother, supporting exclusive breastfeeding unless medically contraindicated, and providing comprehensive staff training on effectively promoting and assisting with breastfeeding.
Recent context
As of August 2024, the percentage of services with full Baby Friendly accreditation in the UK are 44% of maternity services, 69% of health visiting services, 63% of midwifery programmes and 32% of health visiting programmes.
99% of maternity services and 89% of health visiting services who are not already accredited, are working towards accreditation. In universities, 63% of midwifery programmes and 32% of health visiting programmes are working towards the award.
In 2019, the Welsh Government published its All Wales Breastfeeding Five Year Action Plan. In 2018, Wales had one of the lowest breastfeeding rates, with rates remaining static despite investment in services and UNICEF UK Baby Friendly Initiative accreditation. This approach appears to be working, with breastfeeding rates rising from 62.1% at birth and 22.2% at six months in 2018 to 63.3% at birth and 26.2% at six months in 2022. However, these numbers are still low, progress is slow and variation across Health Boards is high.
The Scottish Government published its Improving maternal and infant nutrition: a framework for action in 2011 with outcomes tied to the UNICEF UK Baby Friendly Initiative. Scotland achieved a 100% accreditation rate at service level for the UNICEF UK Baby Friendly Initiative in 2018 according to their Becoming Breastfeeding Friendly Scotland report published in 2019. The most recent data on breastfeeding rates in Scotland show that these initiatives are working to support increased breastfeeding rates. In 2017, 43% of infants at the age of six months were receiving breast milk, compared to 32% in the 2010 infant feeding survey, an increase of 11% of all mothers.
Case studies
Effectiveness of the UNICEF UK Baby Friendly Initiative at East Lancashire Hospitals NHS Trust (ELHT)
The UNICEF UK Baby Friendly Initiative was implemented at ELHT and it was one of the first trusts to achieve the UNICEF UK Baby Friendly Initiative Gold accreditation in 2017 and then revalidation in 2018 and 2021. As outlined above, the initiative focused on embedding sustainable Baby Friendly care, promoting breastfeeding, and fostering close mother-baby relationships.
ELHT’s implementation of the Baby Friendly Initiative standards involved establishing a Baby Friendly Guardian and forming a leadership team to promote these standards. The initiative included training for management, creating a data dashboard for monitoring key metrics, and conducting staff and parent surveys to assess the culture. Key challenges included initial gaps in leadership and communication, which were addressed through targeted interventions and continuous staff engagement.
Evidence shows that the initiative significantly improved breastfeeding initiation rates from 27% to 74% over the years. Other positive outcomes included enhanced staff morale, better parent feedback, and robust monitoring systems that supported continuous improvement.
Considerations for implementation
Ongoing adequate funding is crucial, as achieving and maintaining accreditation across numerous facilities and universities demands substantial investment in staff training, curricula integration, facility upgrades, and ongoing monitoring (see Table 2 for an estimate of costs). Extensive workforce training is necessary to ensure all healthcare professionals and university faculty members are proficient in the latest Baby Friendly skills and practices. Meanwhile, facilities may require renovations to accommodate rooming-in and create conducive spaces, along with procurement of necessary equipment. University programmes must undergo thorough curriculum reviews to integrate Baby Friendly education standards effectively.
Estimating the population impact
The result of a meta-analysis, using a random effects model, indicated a small but significant reduction in BMI in children associated with breastfeeding promotion interventions [pooled effect: z score mean difference: 0.06 (95% confidence interval: 0.12;0.00)]. The effects on zBMI occurred in low- [-0.11 (0.20; 0.02)] and high-income [-0.18 (0.31; 0.04)] countries only, with no significant impact on BMI in middle-income countries.
However, the reduced BMI levels were observed in the first two years of birth. The meta-analysis did not find a significant effect of breastfeeding on the BMI of children in the age group 5–18 years, which is the age group relevant for our modelling. To our knowledge there is a lack of evidence for the impact of breastfeeding on BMI scores of children aged five years and over. Therefore, we’ve taken the effect size as zero.
Estimating the per-person impact
We estimated that this policy would have approximately no effect on the body weight of children aged 5–18 years
If we had identified a relevant effect size to include in our analytical model, we would have assumed rates of breastfeeding in the population to be 48%, to estimate how many children might have been exposed to this policy.
Estimating the population reach
If we had identified a relevant effect size, we would have applied this to children living with overweight or obesity, that is children aged 5–17 with a BMI percentile of greater than or equal to 85.
Changes in the prevalence of people living with obesity
As a result of the effect sizes identified in the literature, our modelling suggests this policy would have no impact on the proportion of children living with obesity.
This policy is beneficial for other outcomes, such as access to a more nutritious diet and increased infant immunity, which is beneficial for health.
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| n/a | 0% | n/a | 0% |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £275 million over five years
We estimated the total costs to governments to be approximately £275 million, which includes costs for NHS trusts, universities and community health visitors. Table 2 presents a summary of the costs. Please see cost calculations appendix for more details.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £50.3m | One-off | First year cost for counties to implement Baby Friendly initiatives across NHS trusts |
| Government | £165m | Annual (4 years) | Total annual cost for counties to implement Baby Friendly initiatives after the first year, across NHS trusts |
| Government | £2.6m | One-off | Cost for maternity units to implement Baby Friendly initiatives (includes accreditation, training, supplies) |
| Government | £56m | One-off | Cost for community health visitors implement Baby Friendly initiatives (includes accreditation, training, supplies) |
| Government | £1.4m | One-off | Cost for a university to implement Baby Friendly initiatives (includes accreditation, training, supplies) |
Total annual benefit
We estimated that this policy would have an annual benefit (cost savings accrued via obesity reduction) of approximately £0
Based on our analysis, and using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would not lead to monetary benefit for the governments through a reduction in obesity prevalence. However there is evidence that other health benefits of breastfeeding (unrelated to obesity prevalence) would lead to cost-saving health benefits. It was beyond the scope of this project to review and estimate these.
Impact on disease incidence
Based on our analysis and analysis conducted by HealthLumen, there is no evidence that this policy would impact disease incidence avoided (as a consequence of changes in obesity prevalence). It is possible that other health benefits (for example increased infant immunity) may impact disease incidence, but it was beyond the scope of this project to review and estimate these.
Behind the averages: impact on inequalities
This issue holds significant importance in the UK, where infant mortality rates are more than twice as high in the lowest compared with the highest socioeconomic groups. A study in the US found that breastfeeding initiation is significantly associated with reduced odds of post-perinatal infant deaths due to infection. Given this evidence, breastfeeding support is crucial for narrowing health inequalities through prevention of infection and infant mortality. There is no evidence however that this policy would reduce childhood obesity in the lowest socioeconomic groups.
A recent survey by Public Health England confirmed that socioeconomic factors significantly influence women’s awareness of the health benefits of breastfeeding and their ability to access support. By standardising high-quality breastfeeding education and assistance across all care settings through the UNICEF UK Baby Friendly Initiative accreditation, this policy would ensure that mothers from all socioeconomic backgrounds receive consistent expert guidance, bridging the support gap that currently exists along sociodemographic lines.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated this policy as having a Limited evidence base.
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