A breastfeeding strategy for Northern Ireland.

The word "breastfeeding" is not listed in the index ofthe UlsterMedical Journal. The majority of the province's medical students and postgraduate trainees in obstetrics, paediatrics and general practice receive no training in the practical management of breastfeeding.' These omissions both reflect and contribute to public attitudes to breastfeeding in Northern Ireland. Only 45% of infants born in Northern Ireland receive any breast milk and within eight weeks half of these will be fully artificially fed;2 we share with the Republic of Ireland the lowest breastfeeding rate in the world.' The recently published Breastfeeding Strategy for Northern Ireland from the Department ofHealth and Social Services analyses this situation and offers many practical recommendations. Artificial infant feeding causes substantial morbidity, some mortality and increased health care costs, even in affluent countries.3 Infants who receive little or no breast milk are subject to more infections, including gastro-enteritis, respiratory and urinary infections, and acute, recurrent and chronic otitis media,3 and in later childhood are more likely to be overweight,4 atopic5 and diabetic.3 Preterm infants and those born small for gestational age (SGA) benefit from breast milk in the prevention of necrotising enterocolitis;3 SGA infants show better catch-up growth (including growth of the head circumference) iffed breast milk.6 Standard infant formula does not support brain development as well as breast milk, in both preterm and term infants; preterm formulas now include compensatory amounts of long-chain polyunsaturated fatty acids, but the problem remains in other formulas.3 Mothers who breastfeed experience both short-and long-term health benefits,3 including efficient weight loss following delivery and some protection against ovarian and endometrial cancer. The lactational amenorrhoea method of contraception is as effective as barrier methods. Epidemiological evidence suggests that bottle-feeders are more likely than breast-feeders to sustain osteoporotic hip fractures in old age. The benefits of breastfeeding for mother and infant are dose-related; many only follow several months of exclusive breastfeeding.3 For this reason, the DHSS recommends exclusive breastfeeding for four to six months, with continued breastfeeding throughout the first year.3 In Northern Ireland, only 5% of infants are still receiving breast milk at the age of nine months.2 Why has Northern Ireland such exceptionally poor levels of breastbeeding? Mothers say they initially choose artificial feeding because they would like other people to help with feeding, because they dislike the idea of breastfeeding, or because of previous infant feeding experiences; the commonest reasons given for early abandonment of breastfeeding are …