Clare Macdonald: Primary care can play an important part in supporting breast feeding

The World Health Organization (WHO) recommends that infants should be exclusively breast fed until 6 months of age, and then to 2 years and beyond alongside complementary foods. [1] Despite this advice being supported by the Department of Health, only 1% of UK babies are exclusively breast fed at 6 months, and even at just 6 weeks of age only 23% are exclusively breast fed. [2,3]

There is well documented evidence that increasing breastfeeding rates would lead to a reduction in childhood otitis media, respiratory tract infections, gastrointestinal infections, and probably type 2 diabetes and obesity. [4] Economic modelling demonstrates that by increasing breastfeeding rates at four months to 45%, and ensuring that 75% of neonatal discharges are breast fed, there could be 53 930 fewer GP consultations each year for common childhood illnesses. [5] Despite this, there is limited funding for the provision of readily available and high quality breastfeeding support for families—with up to 85% of women stopping breast feeding before they want to. [3]

A recent survey from the National Federation of Women’s Institutes (NFWI) and NCT (National Childbirth Trust) found that 29% of women unable to see a midwife access primary care or A&E in the postpartum period, and that 64% of these women present with concerns about feeding. [6] Rightly or wrongly, families do and will contact their GP when other specialist channels fail them. So why don’t we harness these presentations to protect and promote breast feeding—safe in the knowledge that this will reduce the future workload generated by the tiny human before us.

As well as reducing infant illness, increased breastfeeding rates would lead to reduced maternal breast cancer; breast feeding is protective for triple negative breast cancers (TNBC), which are aggressive, difficult to treat, and which predominantly affect premenopausal women. [7] Our protection of, and support for, breast feeding could therefore mean that fewer of us would need to support children and families grieving the loss of a mother to TNBC.

When women stop breast feeding due to pain or physical difficulty, they are at higher risk of depression—as are those who are unable to meet their individual breastfeeding goals. Improving breastfeeding support and appropriately managing common breastfeeding problems could therefore mean less postnatal depression. [8,9]

GPs with commissioning roles should understand the value of breastfeeding support in a health economic context. We are not best placed to provide this specialist support, but we can embrace having a basic understanding of the difficulties, and we should have clear referral pathways that allow us easy access to prompt expertise for our patients—especially in the crucial early days and weeks. We can use sensitive language to support and encourage families, and can direct them to accurate and impartial information that will aid informed decision making.

Whatever method families choose to feed their babies, many will seek our guidance: “how much formula does he need?”; “could she have an allergy?”; “does he have colic?”; “can I take this medication while breast feeding?” We need to remember the trust that these potentially vulnerable mothers place in us, and give them accurate, honest, and sensitive advice.

There are moves afoot to acknowledge the crucial part that primary care can play in infant feeding. Norwich clinical commissioning group is rolling out a scheme for practices to become “breast feeding friendly,” with the provision of training and support for practices. [10] The recently formed GP Infant Feeding Network (UK) (GPIFN), established by Dr Louise Santhanam in 2016, is advocating for best practice in infant feeding among GPs and promotes collaboration between GPs and associated colleagues. Its website launched in spring 2017 and provides a comprehensive resource for GPs and other primary care clinicians on all aspects of infant feeding.

Clare Macdonald is a GP working in Leicester.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the GP Infant Feeding Network (UK) (GPIFN) executive team and co-developer of the GPIFN website with Louise Santhanam. GPIFN is a network of trained individuals, including general practitioners, who have volunteered their time to work on quality improvement in the area of infant feeding. GPIFN is not a charity and is not currently in receipt of any public funds. The time and costs of producing the website and other activities undertaken by GPIFN are voluntarily self-funded by its members.


[1] [Internet] World Health Organization; c2017. Health Topics>Breastfeeding. Available from:

[2] Department of Health; 2003. Infant Feeding Recommendation. Available from:

[3] Health and Social Care Information Centre; 2012. Infant Feeding Survey 2010. Available from:

[4] Victora C G, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475-90. Available from:

[5] Unicef UK; n.d. Preventing disease and saving resources. Available from:

[6] The National Federation of Women’s Institutes, NCT; 2017. Support overdue: Women’s experiences of maternity services. Available from:

[7] Islami F, Liu Y, Jemal A, et al. Breastfeeding and breast cancer risk by receptor status–a systematic review and meta-analysis. Ann Oncol. 2015;26:2398-407. Available from:

[8] Brown A, Rance J, Bennett P. Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. J Adv Nurs. 2015;72:273-82. Available from:

[9] Borra C, Iocovou M, Sevilla A. New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Matern Child Health J. 2015;19:897-907. Available from:

[10] Norwich Clinical Commissioning Group; c2017. Breastfeeding Friendly. Available from: