Running head: REPORT ON AUSTRALIAN MATERNITY SERVICE; THE

BREASTFEEDING POLICY 1

Report on Australian Maternity Service; the Breastfeeding Policy

Name

Institution

Date
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 2
Report on Australian Maternity Service; the Breastfeeding Policy

The government of Australian and some private healthcare sectors is responsible for the

formulation and implementation of public health policies. Healthcare policies are a set of

decisions, plans and actions taken to arrive at particular healthcare goals within a society

("WHO | Health policy," 2018). Such programs can be viewed as deliberations of the

government's intent outlining the vision, priorities and their establishment (Althaus, Bridgeman

& Davis, 2013). The success of a government in providing excellent healthcare services to its

population depends on the kind of the healthcare policy and its implementation. A good plan

has to factor in social, political, economic and environmental factors. Australia is a country that

posts an advanced healthcare system and so is its maternity services. Among the public health

policies that have received much attention both nationally and internationally is the maternity

services in the form of the exclusive breastfeeding (EBF) plan. EBF is a widely accepted

component of public health as the best option for infant feeding (Eidelman et al., 2012). The

World Health Organization (WHO) recommends six-month continuous breastfeeding of

newborns followed by a gradual introduction of complementary food as breastfeeding

continues up to two years or beyond (World Health Organization & UNICEF, 2003). Many

countries including Australia have incorporated the EBF into their health policies (Binns, Lee, &

Low, 2016). This paper will analyze the critical points for the implementation process of the

national breastfeeding policy in Australia and evaluate its achievements and failures thus far.

In 2001 the WHO provided guidelines for comprehensive breastfeeding as well as its

benefits (World Health Organization & UNICEF, 2003). For example, EBF is both a long-term and

short-term beneficial factor to a good relationship between the mother and the infant (Victora

et al., 2016). Also, breast milk is crucial to the initial activation of immunological and epigenetic
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 3
roles in the infant as well as controlling microbial changes of the gut (Fujita, Lo & Brindle, 2017).

Furthermore, well-breastfed children are less likely to have diarrhea (Ogbo et al., 2016),

obesity, otitis media and reduced chances of mortality (Lamberti et al., 2011). Breastfeeding

mothers lower their chances of developing breast and ovarian cancer as well as type II diabetes

when they breastfeed their infants to the recommendation duration (Victora et al., 2016). An

adequately breastfed child has a higher likelihood of developing a better intellectual functioning

(Horta, Loret de Mola & Victora, 2015). The benefits mentioned above and other documented

benefits of breastfeeding compelled the WHO member states in 2002 to adopt a global strategy

for infant and young child feeding. The comprehensive approach enhances the implementation

of national policies aimed at promoting, protecting and supporting appropriate infant and

young children feeding practices. The intention of the global strategy advocated for infant

breastfeeding from birth through four to six months which extends to two years with

appropriate weaning foods at six months. A Baby Friendly Hospital Initiative (BFHI) campaign

was launched to support the goal. The BFHI offered guidelines and recommendation to foster

maternity services that encouraged and incorporated breastfeeding support systems. Many

hospitals advanced their maternity services to acquire a BHI accreditation as the strategy

expanded to other healthcare providing facilities as well as into the community (Cai, Wardlaw &

Brown, 2012).

In Australia by 2006, there were still few facilities (19%) that were BFHI accredited

(Bartington, Griffiths, Tate & Dezateux, 2006), the government then initiated breastfeeding

research to facilitate implementation of the plan. The study came up with recommendations of

mandating the federal Department of Health and Ageing to provide finances for the Australian

College of Midwives to control BFHI efforts and be responsible for accrediting maternity

facilities (Lum, Todd & Porter, 2016). Later, a strategy requiring every State and Territory
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 4
governments to adhere to the policy was launched after the Australian Health Ministers

endorsed the "Breastfeeding strategy 2010-2015". The aims of the system were; to create

awareness for breastfeeding as a natural and socially ethical act for infant feeding, to fully

inform those involved in raising children of the breastfeeding value and increase the number of

babies that underwent complete breastfeeding. In 2001, an organization of about 1,100 women

was formed comprising of volunteers in counseling and educating other women about benefits

of breastfeeding. The organization was called Australian Breastfeeding Association (ABA), and it

instructed the community on the importance of full breastfeeding practices to both the mother

and the infants.

The implementation of the breastfeeding policy in New South Wales (NSW) commenced

in 2002 due to an NSW Childhood Obesity Summit that recognized breastfeeding as a remedy

for obesity pandemic. Due to the policy, many midwives and nurses undertook training which

supported breastfeeding women and its practices. Further, the plan saw the establishment of

BFHI in many health facilities due to public funding for the maternity facilities (Sheehan &

Schmied, 2011). Another version of the NSW breastfeeding policy was in 2011 by the

Department of Health which outlined the integral part the midwives, children, and family health

practitioners could play to meeting the policy's objectives (Wales, 2006). In the NSW state, the

plan has been propagated by the Breastfeeding Working Group as well as the BFHI NSW

committee. One of the challenges to the success of the policy is limited funding to the policy's

initiatives since there are still very few, about eight, hospitals that have BFHI accreditation in

NSW. Also, the NSW Aboriginal Maternal and Infant Health Strategy (AMIHS) is another

initiative aimed at advancing the health of the Australian indigenous mothers during pregnancy

to reduce perinatal mortality and morbidity (Murphy & Best, 2012). The policy got funding from

the state and the NSW health department leading to the tremendous achievements. Fiscal
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 5
support has proved to be vital for the development of plan through financing research.

Moreover, the implementation of strategies that enhance policies depends on financial

empowerment as well as other factors, for example, demographic characteristics, social and

environmental factors for the breastfeeding system. All the stakeholders of public health have

to actively play a role in the establishment of the breastfeeding policy. The Australian

government through public health stakeholders established the breastfeeding system.

Implementation frameworks for the breastfeeding policy

Various government supportive interventions on the targeted population, breastfeeding

women, are critical to the progress of the procedure. After the mechanism for campaigning for

the system have been laid down, the government empowers its population for the course by

financing the facilities and the health services. For example, the Commonwealth government

realized good progress in achieving the breastfeeding policy by use of professional telephone

services. The strategy entails the exchange of system enhancing messages between the

breastfeeding mothers and the healthcare service providers. Research shows that professional

telephone support services offered before birth and through to the first month led to an

increased 60% probability for the first-time parents to breastfeed their children on their

initiative and increased the chances for full breastfeeding by 50% (Fu et al., 2014). Other

research has supported these findings by concluding that postnatal telephone interventions

substantially increase the length of breastfeeding facilitating comprehensive breastfeeding

policy for postpartum mothers (Tarrant et al., 2014). In another study, it was realized that

weekly electronic messages sent to first-time mothers for about two months improved the

breastfeeding duration (Gallegos, Russell-Bennett, Previte & Parkinson, 2014). The telephone

services prove vital in informing the socially alienated women hence a consorted efforts to
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 6
implementing the policy to achieve a healthy nation through comprehensive breastfeeding of

the infants.

The BFHI accreditation services for health facilities motivated the adoption of integrated

services for many delivery care facilities. To enhance efficiency in maternal service delivery, the

NSW adopted a continuity model whereby the pregnant women get attended to by same

professional healthcare team during pregnant up to the early postnatal period. The objective of

the continued service delivery design is to curb the challenges associated with

disconnectedness of information regarding efficient delivery care services. Therefore, the

strategy ensures that women have high rates of breastfeeding initiation (Schmied et al., 2011).

The continued design of maternal service delivery is advantageous and useful when all the

pregnant mothers have access to it. The challenge lies in its accessibility although there is an

improved access trend (Barclay et al., 2013). There are further efforts to providing woman-

centered care however it is challenging to offer the same in the post-birth environment due to

inadequate one on one engagement between the maternity services professionals and the

mothers. Again there are limited resources in many maternity facilities to support infant

feeding. In remote areas, there are additional hindrances to effective service delivery due to

inadequate resources, facilities, and constrained workforce. In implementing the breastfeeding

policy, the government has made significant advances in tailoring hospital practices to facilitate

its implementation. By training maternity services providers and improving the facilities and

their services, the NSW has managed to increase exclusive breastfeeding among newborns.

Furthermore, the global strategy for breastfeeding led to the BFHI guidelines that will

promote a conducive breastfeeding environment in the maternity wards. The BFHI is so

effective in boosting breastfeeding initiation efforts (Hector, Hebden, Innes-Hughes & King,
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 7
2013). By aiming at establishing BFHI guidelines provided by the WHO the Australian

government has made improved advances in achieving the breastfeeding policy objectives as

more facilities obtain BFHI accreditation. However, in the Australian perspective the

implementation of BFHI is challenging due to inadequate resources to make changes to a

management team, inconsistent dissemination of policy particulars and resource demanding

education of staff (Schmied et al., 2011). It proves impossible to successively employ the policy

if the team does not undergo comprehensive training. Also, the BFHI strategy is only relevant so

long as the mother is in the hospital environment (Escamilla, Martinez & Segura-Perez, 2016)

exposing the limited applicability of the policy. Sometimes breastfeeding issues arise when the

mother has already left the maternity facility (Fu et al., 2014) which may lead to breastfeeding

cessation. The solution to this problem is the Universal Health Home Visitation initiative that

follows on the progress of the infant and the mother after being released from the hospital.

However, this demands more resources. Maternal guidance after the hospital is helpful in

facilitating child breastfeeding exclusively. The Australian government has put more resources

into this strategy by financing groups and organizations that offer home maternity services. So

far it has proven a suitable method of facilitating continued adherence to the breastfeeding

policy. Therefore, the BFHI so far has realized success as indicated by the increased number of

BFHI accredited facilities.

Another critical component to implementing the policy is the breastfeeding education

for midwives and nurses. The midwives interact more often with mothers, and through them,

the crucial policy information is made available to the targeted women in the prenatal, during

birth and post-natal periods. The efficiency of this form of implementing the policy relies on the

effectiveness of the communication strategy. There have been communication barriers

especially when nurses are handling aboriginal women limiting the information flow. The
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 8
government should channel more resources to enlightening midwives on the breastfeeding

policy to ensure all children are offered exclusive breastfeeding. Although, there is a need for

research to ascertain the most appropriate professional intervention (Schmied et al., 2011). The

government has utilized the training of midwives as a way of reaching to the aboriginal mothers

who have a less tendency of seeking professional maternal services due to low socio-economic

status (Lording, 2009). Research has shown that the number of indigenous infants that are

exclusively breastfed after leaving the hospital is small as compared to non-indigenous

(Australian Institute of Health, & Welfare, 2012) indicating the need for breastfeeding policy

informed midwives.

The Australian government has to a greater extent eliminated the mother-to-mother

support service for breastfeeding that has existed in previous years. The traditional way of

offering breastfeeding services to lactating mothers has now evolved to usher in an era of

skilled lactation consultants. For one to provide breastfeeding pieces of advice, he or she must

be registered after undergoing the required training and obtained credentials. One of the

reasons for the increasing number of lactation consultants in Australia is due to the admittance

of women, that breastfeeding is technically impossible without professional help (Barclay et al.,

2013). One disadvantage of professionalizing breastfeeding is that it devalues midwives and

family health nurses that do not merit as breastfeeding consultants although they have

essential information through exposure and experience which is vital to implementing the

policy. Non-skilled midwives don't have to face total elimination from the breastfeeding plan

but rather be offered professional training to supplement their knowledge. They are essential in

the event the professional consultancy is inaccessible or unavailable. In this aspect, the

government has enhanced the implementation of the breastfeeding policy through the
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 9
recognition of family nurses and midwives. However, it should improve on offering formal

education to midwives.

The government offered to support women that do not breastfeed for understandable

reasons. The countrywide acceptance of optimal breastfeeding has led to the social isolation of

some women who either consciously defy feeding their children or have problems

breastfeeding them (Schmied & Lupton, 2001). Social alienation from such mothers can lead to

a feeling of being unfair mothers which discourages them from adequately providing for their

infants (Lee, 2014). These women feel judged therefore developing a negative attitude towards

breastfeeding so sometimes they turn to infant formula as a supplement or substitute for

breast milk. There is need to recognize the needs of such women. Healthcare policies have

documented the need to support such women hence future reforms about of the system

should incorporate a way of encouraging them. There have been campaigns against the use of

infant formula, but it can be an excellent supplement to lactating women with breastfeeding

stigma necessitating the need to educate them about the appropriate way to use it.

Furthermore, the acceptance of such women will have a positive societal effect by preventing

stigmatization.

A more regulatory mechanism of the Trade Practices Act 1974 was agreed upon

between the manufacturers and importers of the infant formulation and the Commonwealth

government to adhere to the international WHO's ethics for marketing breast milk substitutes.

The agreement (MAIF) is a voluntarily regulation that aims at the elimination infant milk

substitutes from hospitals by preventing its marketing and physical availability. To this course,

the government formed an advisory team to monitor the adherence of manufactures to the

agreement (Sheehan & Schmied, 2011). Non-compliance from any company could be tabled in
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 10
parliament, and the violators could face severe consequences for the sixth step of the ten steps

program advises against food or drinks other than the mother's milk, unless medically

endorsed. Therefore, the

NSW government has ensured no advertisement or marketing about mother's milk substitute is
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 11

done to mothers in hospitals (Forde & Miller, 2010). The signed agreement has gone a long way

in reducing the use of breast milk supplements on infants, and the government should maintain

its stance even as pressure may arise from the business community.

The successive implementation of the breastfeeding policy is dependent on some other

factors besides appropriate strategies. The factors play a role in enabling or acting as barriers to

the implementation of the plan. Therefore, it's crucial that they are analyzed and if they hinder

the success of the policy, a way around it should be strategized. One of the factors is the

intention of the mothers to breastfeed. The decision whether to breastfeed or not is mostly

made independently by the mothers early before an encounter with healthcare professionals

(Brown, Raynor & Lee, 2011). There are preconceived ideas that women have about

breastfeeding. Such notions can predict whether a woman will initiate and give exclusive

breastfeeding to her infant or otherwise. For example, there is a widespread belief that the

mother's milk is the best and most natural way of taking care of an infant (Faircloth & Hoffman,

2013). The success of the breastfeeding policy can be attributed to the use of the already

existing attitudes to breastfeeding among mothers. The initial stage of the strategy focuses on

spreading breastfeeding promotion messages creating awareness. If the current intention to

breastfeed is against the policy, that fact forms the bases for setting off the plan. The rate of

breastfeeding initiation has raised among Australians to 96% in 2010 form 87% in 2001 showing

that the intention to feed has received the required attention as a factor affecting the success

of the breastfeeding policy.

Another breastfeeding determinant factor is self-efficacy which is defined as the belief in

one's ability to affect activities that take place in someone's life (Bandura, 2006). Issues that

affect self-efficacy are worth for consideration when formulating and implementing the policy.
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 12

Self-efficacy for women can be influenced by factors such as exposure to breastfeeding,

previous experiences and the mental status of the mother (Forde & Miller, 2010). Available

evidence depicts that peer support initiatives facilitate mother's self-efficacy for breastfeeding

(Hector, Hebden, Innes-Hughes & King, 2013). A self-efficacy scale for breastfeeding was

designed to enhance the evaluation of behaviors and perceptions which can build confidence

for mothers to initiate breastfeeding. The developed range is crucial for the policy since it helps

with the facilitation of self-breastfeeding efficacy among women.

The social environment for breastfeeding mothers such as her partner, family, and allies

play a role in forming a positive attitude towards initiating and sustaining the policy (York &

Hoban, 2013). The experiences other women relatives have undergone through while

breastfeeding their infants are significant in influencing breastfeeding behaviors of other

mothers especially the new mothers (Rollins et al., 2016). Grandmothers in specific have been

found to be vital in shaping young mothers to perform exclusive breastfeeding (Negin, Coffman,

Vizintin & Raynes-Greenow, 2016). The social network is essential to the implementation and

success of the policy.

In conclusion, Australia has made great strides regarding supporting the international

target of exclusive breastfeeding for all infants. The achievements made so far are as a result of

good implementations strategies and the consideration of the enhancing and hindrance factors

of the policy. The breastfeeding initiation rates in Australia have increased, however, sustaining

it to six months experiences little success (Brodribb, Kruske & Miller, 2013). There is a need for

creating a more policy enhancing environment by enacting labor laws that allow for enough

maternity leave as well as focusing on the post-birth care to ensure exclusive breastfeeding

(Hansen, 2016). Moreover, the aboriginal, and young women form a vital target group for
 REPORT ON AUSTRALIAN MATERNITY SERVICE; THE BREASTFEEDING POLICY 13

implementing the policy hence requiring considerable attention. From the above, it is clear that

there is space for improvements for the full realization of the breastfeeding goals in Australia.

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