Comprehensive Policy Analysis: Breastfeeding in NSW, Australia

This policy analysis report examines the "Breastfeeding in NSW: Promotion, Protection and Support" policy, focusing on its objectives to improve breastfeeding practices within the NSW healthcare system. The report explores the policy's rationale, highlighting the health benefits for both mothers and infants, and addresses the importance of infant feeding guidelines for health professionals. It delves into the issues addressed by the policy, including the need to increase breastfeeding rates in NSW and the evidence-based interventions that support this goal, such as professional and peer support. The analysis covers key areas like monitoring, health professional training, support for priority groups, and breastfeeding-friendly environments, offering a comprehensive overview of the policy's aims to increase exclusive breastfeeding for six months and extend breastfeeding duration, contributing to improved public health outcomes and aligning with national breastfeeding strategies. The policy aims to improve breastfeeding practices by outlining an action plan for the NSW health care system, and is based on four main considerations/issues including; the health benefits of breastfeeding for infants and mothers, the infant feeding guidelines for health professionals, the need to improve breastfeeding rates in NSW and, the recent systematic reviews of evidence on effective interventions by health services.

Running head: POLICY ANALYSIS 1
Policy Analysis
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POLICY ANALYSIS 2
Policy Analysis
Introduction
Breastfeeding is considered as the most efficient way of feeding an infant primarily
because of the health benefits that is associated with this practice. To the mother, breastfeeding
promotes maternal recovery from childbirth, enhances mineralization of bones, accelerates
weight loss, reduces risk of pre-menopausal breast cancer and also reduces risks of ovarian
cancer (Walt et al, 2008). To the infant, breastfeeding has been associated with health benefits
such as reduced illnesses, protection from respiratory infections, improved visual acuity, and
high IQ scores amongst others. Breastfeeding is also a key factor in protecting the child from
being overweight or becoming obese (NSW Department of Health, 2011). As such, the World
Health Organization (WHO) has recommended that infants be exclusively breastfed for up to six
months and thence receive safe complimentary foods as supplement to breastfeeding for up to
two years (Ogbo et al, 2016).
Many countries around the world have taken up these recommendations and
consequently increased their rates of breastfeeding. In Australia for example, the initiation rates
of breastfeeding was estimated to be around 88% and in the state of New South Wales (NSW),
90% of all infants were found to have been breastfed. However, the sustained breastfeeding rates
contradict the high initiation rates in NSW. In this case, only 16% of infants were exclusively
breastfed for six months while 29% were breastfed for at least 12 months (Wen et al, 2009).
Therefore, the health department of NSW has strongly advocated for the need to focus and
promote exclusive breastfeeding of infants for six months as well as extend the duration for
breastfeeding for at least six months.

POLICY ANALYSIS 3
Reason for choosing policy
One of the primary reason that necessitated the need to choose this policy was the
importance or rather the benefits that breastfeeding has on both the mother and the infant.
Furthermore, breastfeeding is an extremely important public health issue which raises concerns
for the mother as well as health professionals. For instance, health professionals are encouraged
to refer to the risks of not breastfeeding rather than the benefits since breastfeeding is the most
natural way of feeding infants. In such cases, evidences suggest that there are a myriad number
of risks that arises to the infant if they are not breastfed among them including; prevalence of a
number of chronic diseases, and increased gastrointestinal illnesses as well as respiratory
infections (Amir & Hector, 2007).
The policy is also sensitive in the sense that it brings to light the poor health outcomes
that are associated with poor breastfeeding practices or alternatively the use of baby formula
instead of breast milk. Most importantly, these poor health outcomes have often presented huge
economic and social burdens to families comprising of the infants and their parents, and also to
the health care system. On this note therefore, it becomes affirmative that these poor health
outcomes contributes to some of the major health problems in Australia thereby exacerbating the
issue of health burden.
Summary of policy document
The policy Breastfeeding in NSW: Promotion, Protection and Support aims to outline an
action plan for enhancing the promotion, protection and support of breastfeeding within the
NSW health care system. In order to improve on the breastfeeding practices in NSW, these

POLICY ANALYSIS 4
actions have particularly been stipulated for the department of health as well as local health
districts (NSW Department of Health, 2011). It is also noteworthy that the policy directive has
been formulated in accordance with the Australian National Breastfeeding Strategy that is led by
the Australian Government and which primarily aims to increase the percentage of infants that
are breastfed from birth to six months exclusively (Commonwealth of Australia, 2009).
The policy also clarifies the different roles and responsibilities in order to foster
coordinated efforts among a wide group of individuals constituted in various units such as local
health networks, public health system and support, ministry of health, public health units and,
public hospitals amongst others. In addition, the policy has identified a number of priority areas
including; monitoring and surveillance, health professionals’ education and training,
breastfeeding support for priority groups, support of breastfeeding in healthcare settings,
breastfeeding friendly environments and, continuity of care and support networks (NSW
Department of Health, 2011). Notably, these are the key areas that must be addressed by all the
involved personnel.
Policy Analysis
Policy Issues
This policy was developed in 2011 and is considered as the first comprehensive
breastfeeding policy for NSW. The policy is mainly concerned with improving breastfeeding
practices as well as demonstrating the state’s commitment to the national breastfeeding
strategies. In this light, the policy was premised on four main considerations/issues including; the
health benefits of breastfeeding for infants and mothers, the infant feeding guidelines for health

POLICY ANALYSIS 5
professionals, the need to improve breastfeeding rates in NSW and, the recent systematic reviews
of evidence on effective interventions by health services.
The health benefits of breastfeeding
There are many health benefits that have been attributed to breastfeeding which accrues
to both the mother and the infant. Generally and on a global basis, breastfeeding has saved lives
of infants and reduced the disease burden for infants as well as their mothers (Dieterich et al,
2014). The major long term benefit to the infant has been identified as protection against chronic
diseases as revealed by studies. Moreover, evidence reveals that cognitive development is
significantly improved by breastfeeding. Other notable chronic diseases that are reduced by
breastfeeding include; obesity, cardiovascular diseases, hypertension, type 1 and type 2 diabetes,
and hyperlipidemia (Binns, Lee & Low, 2016). Thus, the anticipation of reduction of such
chronic illnesses has strongly necessitated the need to develop a directive that will ensure that
more infants are increasingly being breastfed so as to benefit from the reduction of such
illnesses.
Similar studies have illustrated a number of short term health benefits to the infant that
are presented by breastfeeding. For instance, breastfeeding has strongly been associated with
reduced incidence and duration of diarrheal illnesses. Reduced prevalence or rather occurrence
of otitis media has also been attributed to exclusive and prolonged breastfeeding in infants.
Breastfeeding also has an advantage of protection against bacterial infections such as bacteremia,
meningitis, neonatal necrotizing enterocolitis and urinary tract infection. Unlike other forms of
feeding, breastfeeding is elusive of polyunsaturated fatty acids found in milk and as such, it
improves visual acuity and psychomotor development. Additionally, studies also indicate that

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infants who have been breastfed for lengthy periods register higher IQ scores compared to their
counterparts. It is therefore critical that the infant be accorded the best path towards development
and maturity which in this case can mainly be achieved through breastfeeding as compared to
other methods of feeding. This policy therefore identifies this priority and has accorded emphasis
on the directive in an attempt to realize the health as well as the economic benefits.
The infant feeding guidelines for health professionals
The policy also aims to adhere to the national breastfeeding strategy that was formulated
in 2009 and whose objectives strongly align with the goals of this policy directive. In this case,
the policy has strived to ensure that the available guidelines for breastfeeding are strongly
adhered to by health professionals within NSW. Even so, the stipulated resources and training
programs have focused on continuous education of health professionals comprising of nurses and
midwives, to enhance their knowledge and confidence in improving breastfeeding outcomes
(Holtzman & Usherwood 2018). Thus a number of infant feeding guidelines have been stipulated
for health professionals and which must be followed at great lengths.
For instance, it is recommended that early initiation of breastfeeding should be initiated
after birth which should take approximately one hour after the child is born. Health professionals
are also encouraged to room in and on a frequent basis in order to feed newborns. They should
also educate and encourage mothers to breastfeed their babies for six months on an exclusive
basis. They are also tasked with advising mothers on hygienically prepared foods that should be
given to babies after six months (Clark & Bungum, 2003). This action should also complement
their encouragement of continued breastfeeding until 12 months while complementing this
feeding method with appropriate supplementary foods.

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The need to improve breastfeeding rates in NSW
Breastfeeding intentions and behaviors vary greatly among mothers. Research reveals
that most women intend to breastfeed their children after giving birth (77%). The intention
however diminishes as relatively few women actually end up breastfeeding their babies within
the first 24 hours after giving birth (74%). The rate further diminishes to 65% as these women do
not breastfeed their children after two weeks of giving birth. The underlying factor behind these
low rates was lack of support particularly from the health care system (Kervin, Kemp & Pulver,
2010). In Australia, the rates of breastfeeding have also been low over time with only 16% of
infants being breastfed exclusively for the first six months and only 29% being breastfed for at
least 12 months (Commonwealth of Australia, 2009; King, Hector & Webb, 2005). As studies
reveal, these low rates have been prevalent despite the fact that these mothers are fully aware of
the WHO recommendations on the durations within which infants should be breastfed (Ogbo et
al, 2016). The need to increase these rates of breastfeeding has therefore become a critical public
health concern that need to be addressed.
Similar studies have identified have identified a number of other factors that may
influence the decision of mothers to breastfeed or use formula and consequently impact on the
rates of breastfeeding. For instance, marital status, education, age, culture and confidence have
all been identified as significant reasons that may influence a mother’s choice on whether to
breastfeed their children or not. Nonetheless, maternal benefits, knowledge about feeding, infant
nutritional benefits, socio-economic status and most importantly, personal as well as professional
support have been the chief reasons that impact on mothers’ intentions to breastfeed their
children (Radzyminski & Callister, 2016; Amir & Donath, 2008). Additionally, studies indicate
that the combination of feeding methods such as breast and formula feeding methods has

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strongly been favored by mothers thereby decreasing their willingness to exclusively breastfeed
their children for six months (Lum, Todd, & Porter, 2016). Therefore, to strongly support
breastfeeding as a health promotion strategy, NSW has identified the concern of increasing
breastfeeding rates as one of the primary steps that should be taken within the policy.
Evidence on effective interventions
Personal and professional support have been found to be some of the most effective and
efficient interventions to improve breastfeeding rates among mothers. Studies suggest that health
care institutions should look to prioritize multicomponent intervention as a primary strategy for
intervening in breastfeeding practices. Also, baby friendly hospital initiative interventions within
hospitals have also yielded better breastfeeding outcomes among mothers. Nonetheless, to ensure
the success of such initiatives, there is need to increase provider training especially when
intervention are conducted between pre and post-natal periods (Kim et al, 2018; Sinha et al,
2015). Such practices will prove critical in encouraging mothers to improve their breastfeeding
practices although they haven’t been full constituted within the policy.
Another study also identified peer support interventions as another considerable
intervention to improve breastfeeding practices. In a systematic review conducted by Kaunonen,
Hannula and Tarkka (2012), it was realized that although individual support and education was
commonly used during pregnancy, hospitalization and postnatal period, peer support was also
commonly favored by many mothers. Furthermore, the combination of professional and peer
support from well-trained and experienced peer supporters was pivotal in ensuring the
continuation of breastfeeding (Kaunonen, Hannula & Tarkka, 2012) The policy has similarly
strived to encourage and support breastfeeding during pregnancy and during the postnatal period

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thereby indicating that it has acknowledged this form of intervention as effective way to improve
breastfeeding outcomes (NSW department of health, 2011). However, for the policy directive to
be a success there is need to ensure that continuous breastfeeding support is maintained during
the different phases of motherhood.
Evidence of Critical Discussion and Analysis
Objectives and goals
One of the main goals of the policy is to increase breastfeeding rates in NSW. As
aforementioned, Australia has high rates of breastfeeding initiation but the rates gradually
decline within the first weeks of postpartum as the trend continues throughout the first year of
birth (Cramer et al, 2017). This is contrary to WHO recommendations which stipulate that
infants should exclusively be breastfed for the first six months and afterwards be supplemented
with nutritious and safe foods for at least two years after birth (Thompson et al, 2014). In this
regard therefore, the directive has mandated that collaborative efforts need to be established so
that the rates of infants who are breastfed for the first six months exclusively be increased and
also, the number of babies who are breastfed for at least one year should be increased.
Although there are many factors that significantly influences mothers’ decisions to
breastfeed their babies, this policy still aimed to at least maintain the current breastfeeding rates
among infants. Even though this is so, the directive is still aiming to increase the number or
rather proportion of infants who are exclusively being breastfed for at least six months in
addition to increasing the duration of breastfeeding (The Royal Hospital for Women, 2016).
These goals would ideally be achieved by disseminating the recommendations regarding
exclusive and lengthy breastfeeding among different infant populations.

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Similar study by Shakya et al (2017) reveal that community-based peer support for mothers is
effective in increasing the period or duration within which an infant is breastfed exclusively after
birth. In this study, it was revealed that infants aged between 3 and 6 months were the most
affected by this initiative (Shakya et al, 2017).
Contradicting studies have however identified educational programs as the most
significant forms of intervention in breastfeeding. For instance, Guise et al (2003) found out that
primary care based interventions are critical in enhancing mothers’ willingness to breastfeed.
Particularly, the evidence indicated that one woman in every three women attending
breastfeeding educational programs would breastfeed their child exclusively for at least 3 or 5
months (Guise et al, 2003). This study therefore becomes essential for the policy since there is
need to translate the findings of this study into the policy’s widespread practice in the diverse
care settings across NSW.
The decision parameters
Resources
In order to improve breastfeeding practices and outcomes, evidence suggests that there is
need to develop effective professional support strategies that are accessible to a wide range of
mothers. These support interventions constitute the primary resources that should be delivered in
the immediate post-natal and antenatal period (Kervin, Kemp & Pulver, 2010). Even though such
professional support has highly been advocated for, studies reveal that health professional’s
effort to provide breastfeeding support has been negatively impacted by the lack of willingness
of mothers to attend community-based support programs. To ensure the success of such support
interventions, there is need to build strong partnerships with the target populations and

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understand the timing and the technicalities that will be involved in offering interventions for the
maximum benefits to the mothers and their babies (Cramer et al, 2017).
In order to increase breastfeeding rates and consequently enhance health promotion,
studies reveal that there is need to develop and implement education programs that are aimed at
changing or rather improving the breastfeeding practices. Such an initiative has further been
touted as one of the most efficient ways in improving hospital-based breastfeeding rates since
mothers are likely to continue breastfeeding after being discharged from the hospital, and they
also become well-prepared for breastfeeding after giving birth and afterwards become satisfied
during the post-natal period (Barnes et al, 2010).
Similarly, health professional’s education and training has been identified as one of the
priority areas within the policy. Furthermore, the directive emphasizes on the need for enhancing
antenatal education. Precisely, health professionals have been entrusted with the critical task of
providing education as well as exploring all the available antenatal and postnatal breastfeeding
educational materials (NSW Department of Health, 2011). Such initiatives therefore indicate the
acknowledgement and prioritization of education that is given by the policy in a bid to improve
breastfeeding outcomes from a collective effort of both healthcare professionals and mothers.
Timeframes
It was initially anticipated that the deadline for implementation of the policy would be
June, 2016. This completion would comprise the fulfillment of all the seven areas that are
stipulated under the third section of the policy. The mid-term review process was set to be
around mid-2013. This review would ideally comprise a full report given by the Directors of
population health services, departmental branch managers and chief executives of local health

POLICY ANALYSIS 12
districts. A further progress report was scheduled to be availed by the same parties as of
September, 2013 The released implementation plan would entail a clearly stipulated roles,
responsibilities, and timeframes for strategies and actions (NSW Department of Health, 2011)..
In addition, the policy directive was intended to be read in conjunction with the NSW health
fundraising policy directive and NSW health sponsorships policy directives.
Conclusion
The policy directive to promote, protect and support breastfeeding is critically important
because of the health benefits that are associated with this practice which accrue to the mother
and the infant. There are a myriad long term benefits that are associated with breastfeeding and
which enhances the well-being of the infant. For instance and as revealed by studies,
breastfeeding has been widely associated with the reduction of chronic diseases such as obesity
and diabetes, and it also bolsters cognitive development among infants. Mothers also stand to
benefit from breastfeeding health wise given that they are likely not to develop obesity and also
realize an improvement in their general health.
However, despite such overwhelming evidences, the breastfeeding rates in Australia have
continued to decline especially after the first weeks of birth. The policy directive developed by
the NSW health department therefore becomes essential in increasing this rate particularly
because it aims at increasing the duration of breastfeeding and increasing the proportion of
infants who are breastfed exclusively for six months. The policy has therefore developed a
number of interventions including education and training, individual and professional support
and, enhancing the adherence to breastfeeding guidelines for health professionals. Nonetheless,
peer support could also prove to be critical for the long term success of the policy especially