Havering Breastfeeding Friendly Scheme

Themes this local practice example relates to:

  • Early Years
  • General resources

Basic details

Organisation submitting example

London Borough of Havering / NHS Havering

Local authority/local area:

London Borough of Havering / NHS Havering

The context and rationale

The Havering Breastfeeding Friendly Scheme was set up to help increase breastfeeding continuation rates, by allowing mothers to feel more confident about breastfeeding in public. This was done through local businesses signing up to the scheme which identified them as breastfeeding friendly venues, where mothers could feel comfortable about breastfeeding in public. 

Rates of breastfeeding in Havering are lower than the national average, and the lowest of all London boroughs. Because of this, Havering Children’s Trust adopted ‘increasing breastfeeding initiation and continuation rates’ as a priority in its Children and Young People’s Plan. Designing and launching the Havering Breastfeeding Friendly Scheme was one of the first actions undertaken as part of this. The aim of the scheme is to help mums identify places that welcome breastfeeding, in the hope that this will support them to feel confident to breastfeed when outside the home, and therefore continue breastfeeding for as long as they wish. The scheme also linked in with a social marketing campaign to raise the profile of breastfeeding across the borough, aiming to drive a cultural change in normalising breastfeeding. 

The idea was selected as something which would be fairly simple to implement, would involve minimal disruption for those involved (i.e., local businesses), whilst having a big impact on mothers continuing breastfeeding. 

Knowledge base
Mothers felt that the lack of public places to breastfeed confidently was a barrier to them choosing to breastfeed their children. Although the idea of adopting a set of common standards among public settings had been tried in other parts of the country, it was felt that a local scheme could be developed which met local needs and really helped mothers.


The aims of the scheme were:
• to help increase breastfeeding continuation rates amongst Havering mums 
• to encourage a range of local businesses and service locations to sign up to the scheme, offering mums a wide variety of places to breastfeed when out in public 
• to make it easier for mums to breastfeed their babies when outside the home and thus encourage mums to breastfeed for longer, thereby ensuring mothers and babies get the wide range of health benefits from doing so.

The practice

The first step in launching the scheme was to design a brand and image, and identify the requirements of mums for breastfeeding when in public. The former was done with the involvement of a design agency, which produced a range of brand suggestions for the scheme, with the final design being selected after consultation with local mothers. To identify the requirements for businesses signing up to the scheme, local mothers were questioned about what they would want in a venue that actively welcomed breastfeeding, and a list of criteria was selected. Local mothers felt that the most important thing a business could do would be to actively welcome mums to breastfeed, and not ask them to leave even if another member of the public complained. All other requirements included in the scheme were either optional or very easy to achieve, to ensure minimal or no disruption for the business signing up. 

The Breastfeeding Friendly scheme pack features the following information pages:
• Information for businesses - an information page detailing background information on breastfeeding and why the scheme has been developed.
• How can I join? – outlining what businesses need to do to join.
• Policy Information and checklist - setting out what the venues are agreeing to by signing up to the scheme.
• Information for staff – all staff working at the venue should read this to ensure they are aware of the scheme.
• Checklist agreement - to be signed and returned once the manager has read and is happy with all the information.

The checklist sets out the requirements businesses are agreeing to on signing up for the scheme, which include:
- The business must welcome breastfeeding in any area of their premises open to the public.
- A mother breastfeeding on the premises must not be asked to move or stop breastfeeding by any member of staff, even if another customer has complained about it.
- All staff employed at the business must have read and understood the information for staff, and be clear on the requirements of the scheme. 
- Clear signs must be displayed that inform the public that theirs is a breastfeeding friendly premises.
- Hand washing and baby changing facilities to be provided, if possible. 
Once businesses have agreed to the scheme, they are sent a certificate of accreditation and their name is added to the scheme’s webpage: www.havering.gov.uk/breastfeeding.

The scheme was launched during National Breastfeeding Awareness Week 2011. A wide range of venues was approached, including GP surgeries, Children’s Centres and public libraries, as well as local cafes and restaurants. In most cases, the managers or owners were approached directly, using contacts provided by the Business Development Officer at Havering council. Venues were approached via both telephone and face-to-face visits. Clear information was provided about the scheme and its benefits, and those businesses/settings interested in joining were then asked to submit an application form to the scheme administrator. When approved, the administrator sent a certificate and window sticker to the accredited venue, to be displayed in clear view of the public. The public are encouraged to report any businesses not abiding by the rules of the scheme to the scheme administrator. 
The scheme involves a range of partners, including:
• London Borough of Havering – Communications team, Business Development Officer Performance and Policy team in Social Care and Learning
• NHS Havering – Public Health lead
• Havering Children’s Centres
• Two local Councillors who are our local ‘Breastfeeding Ambassadors’ and who supported us from the outset.

Evidence and evaluation - making a difference to children, young people and families

There is no formal monitoring of businesses once they have signed up to the scheme. However, mums are able, and encouraged, to provide feedback on venues and any venues found not to be complying with the ethos of the scheme will be deregistered. Currently, over 100 venues are signed up to the scheme. 
In terms of monitoring the impact of the scheme, a one-page social marketing questionnaire was designed to assess the overall impact of the work undertaken (which includes both the Breastfeeding Friendly scheme as well as a series of poster campaigns). The questionnaire was aimed at members of the public – including expectant and new mothers, their partners and family and also lay members of the public. It was distributed through local children’s centres and libraries in June 2011, at the time of the launch of the breastfeeding friendly scheme, but prior to any poster campaign. A second questionnaire was then distributed in February 2012, by which time the scheme had been active for over six months, and the first poster campaign was run (where locally designed posters were displayed for two weeks on 92 boards across Havering). A comparison of the results can be seen below:

Have you seen, heard or read any local adverts, publicity or any other types of information in the last 2-3 months which focused on breastfeeding? 
June 2011 - Yes = 65.3%, 
February 2012 - Yes = 75.5%.

Do you agree of disagree with the statement ‘I think it is a good idea for mums to breastfeed their baby’
June 2011 - Agree = 69.3%,
February 2012 - Agree = 73.8%.

Do you agree of disagree with the statement ‘I do not mind if mums breastfeeds in public’
June 2011 - Agree = 80%,
February 2012 - Agree =83%.

Do you agree of disagree with the statement ‘I do not think a woman should breastfeed in public’
June 2011 - Agree = 7.6%, 
February 2012 - Agree = 4%.

Public awareness of the campaign increased, and a greater percentage of respondents reported they were aware of the benefits of breastfeeding and agreed with the statement ‘I do not mind if mums breastfeed in public’. The percentage of respondents opposed to mothers breastfeeding in public had decreased.

In addition, during the planning phase of the scheme, a number of focus groups were conducted with local mums to gain an understanding of whether they thought such a scheme would be beneficial. Comments from these focus groups include:

- The only places you can really go to feed your baby are the toilets – would you eat your meal in there?
- Even places like Mothercare don’t provide very nice facilities to breastfeed, the local one is really bad, it’s just a windowless room. 

- I think it’s a good idea for places to display a sign that says they welcome mums to breastfeed, that way you won’t be as worried about other people complaining. 

- It would encourage me to breastfeed when out and about if I saw other people doing it as well; if I didn’t see no one else doing it then I wouldn’t.

At the launch of the scheme we also conducted interviews with café owners, who were also very positive about the scheme:

‘Our café is all about being welcoming and feeling like a home away from home so we want mums to feel comfortable breastfeeding in public. It’s completely natural and healthy.’

No specific quantitative follow-up has yet been undertaken, however the local NHS collects figures on breastfeeding prevalence at 6-8 weeks, as per government requirements. The prevalence of breastfeeding at 6-8 weeks for 2010-11 and 2011-12 can be seen below. 

Breastfeeding prevalence @ 6-8 weeks:

Q1 – 39.9%
Q2 – 39.9%
Q3 – 34.9%
Q4 – 34.9%

Q1 – 44.7%
Q2 – 38.7%
Q3 – 38.7%
Q4 – 41.5%

There has been an increase in the percentage of mothers continuing to breastfeed when their child is between the age of 6 and 8 weeks. Whilst the Breastfeeding Friendly scheme, along with the social marketing campaign, may have helped contribute to this rise, we are unable to prove this directly from this data. We must also note a substantial amount of additional work had been undertaken during the year, both to improve the quality of data collection and to increase support for breastfeeding by hospital/community staff (e.g. midwives and health visitors). 

Since the launch of the scheme, we have developed business cards showing the scheme logo and providing mums with the website address where all accredited venues are listed. These cards were distributed to a range of health professionals, including health visitors and midwives, who give these to mothers on both ante- and post-natal contacts, to promote the scheme to all. The fact that this is now part of routine service will again help to normalise breastfeeding amongst mothers. 

Feedback: Local mums were consulted about the scheme during its development, and asked them to suggest venues they would like to see signed up to the scheme. Mothers questioned were really positive about having somewhere they knew would welcome them to breastfeed and which actively promoted this.

Helping others to replicate your practice

Sustaining practice
Now the scheme is set up, it requires little involvement from PCT/council staff. The mums regulate the programme and nominate venues they would like to see accredited. 

Initial set-up costs were mainly for design of a logo and identity for the scheme. The cost of this was £800. In addition to this, there are the ongoing costs of printing programme packs, certificates and window clings. This cost is roughly £300 for 100 packs (this can vary depending upon paper used, size of material, etc.). No money was spent on publicity, as the scheme has been promoted by working in partnership with the council communications team. 

The success of the scheme was largely due to the partnership approach taken between the local council and NHS and the involvement of the communications team was critical. Involvement of the Business Development Officer in the council, who was able to provide the contact name for all local businesses, was also key, as this saved a lot of time in contacting them to promote the scheme. 

The main challenges encountered were in contacting the correct person at the venues, as often the manager was not available and messages had to be left with assistants. Having the names of all owners from the business development team helped. Assistance from colleagues who worked with certain groups was also essential, for example working with a colleague in the early years team to promote the scheme and coordinate applications as part of their routine contact with their early years settings.

It would be relatively simple for other areas to replicate this scheme and this has been considered in neighbouring boroughs. The area would need to modify the scheme pack and branding to fit with any local area branding already in place. 

Golden threads: 
• Know your communities
• Together with children, parents and families – involve service users
• It takes a community to raise a child – see the bigger picture


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