The Best Start — Report on the Inquiry into the Health Benefits of BreastfeedingThe Best Start inquiry was a significant catalyst for the Australian National Breastfeeding Strategy. This 2007 House of Representatives Standing Committee on Health and Ageing inquiry examined how the Australian Government could take a lead role in improving the health of the Australian population through support for breastfeeding (HoR 2007). The inquiry noted that there is significant government and non-government support for breastfeeding, but little coordination and limited evidence about what works in practice. Twenty two recommendations were made in the inquiry report. The development of an Australian National Breastfeeding Strategy was a key element of the Australian Government’s response to the inquiry (2008).
The Report of the Maternity Services ReviewImproving Maternity Services in Australia: The Report of the Maternity Services Review (2009) highlighted the complex nature of maternity services, which involve a mix of federal, state and territory and private arrangements. The maternity services review made a number of recommendations that focused on the need to improve the maternal and perinatal outcomes for Indigenous and rural Australians, improve choices available to pregnant women, increase access to high quality maternity services, and provide support for the maternity services workforce.
In relation to breastfeeding, the review recommended:
That in order to lengthen the duration of breastfeeding, further evaluation be undertaken to identify the health care or community settings in which breastfeeding information and support are most effectively received, with a particular priority on consulting and supporting women from diverse cultural and socioeconomic backgrounds (DoHA 2009).
The Australian Government has responded to the report with a $120.5 million maternity services reform package to provide access for midwives to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme, and a Government supported professional indemnity insurance scheme for eligible midwives. These arrangements will be available to appropriately qualified and experienced midwives working in collaboration with obstetricians and health facilities. New national guidance for health professionals to support collaborative models of maternity care will be developed.
The Australian Government is committed to building on the maternity services reform package by working with the states and territories and key stakeholders to develop a National Maternity Services Plan to ensure co-ordination of maternity services across Australia.
The Paid Parental Leave: Support for Parents with Newborn Children InquiryThis inquiry was undertaken to assess the economic, productivity, and social costs and benefits of providing paid maternity, paternity and parental leave. The Productivity Commission’s analysis suggested that 18 weeks of parental leave in conjunction with other complementary policies would encourage employed women to breastfeed exclusively for longer. The report outlined the health benefits to mothers and children when parental leave from work is available to support the care of young children. It included a detailed examination of the evidence for the health benefits of breastfeeding, the effectiveness of interventions to promote and support breastfeeding, and the impact on breastfeeding of returning to paid work (PC 2009).
The Productivity Commission’s report did not make an official recommendation about breastfeeding support, on the basis that work on the Australian National Breastfeeding Strategy was already underway. However, the report did note that further research on breastfeeding support in the first month after birth and beyond, as well as supportive environments such as breastfeeding friendly workplaces, would be worthwhile. It also noted that the Australian National Breastfeeding Strategy and the National Maternity Services Plan could address the need to improve coordination and continuity of care between antenatal, birthing and postnatal support services to encourage breastfeeding continuation rates (PC 2009).
Following the completion of the Productivity Commission inquiry, the Australian Government announced in May 2009 that it will fund a paid parental leave scheme, providing 18 weeks pay on the minimum wage, commencing on 1 January 2011.
Council of Australian Governments early childhood initiativesEarly childhood is a high priority for Australian governments. A number of recent Council of Australian Governments (COAG) initiatives seek to improve the health and wellbeing of Australia’s children.
- Investing in the Early Years - A National Early Childhood Development Strategy - aims to improve the health, safety, early learning and wellbeing of all children and better support disadvantaged children to reduce inequalities. Its vision is that all children have the best start in life to create a better future for themselves and the nation (COAG 2009). The framework recognises that the Australian National Breastfeeding Strategy can contribute to this vision.
- The National Partnership Agreement on Preventive Health provides $325.5 million over four years, commencing in 2011-12, for the Healthy Children initiative to deliver programs that promote physical activity and healthy eating in a range of settings. This initiative recognises the need for breastfeeding support interventions (COAG 2008).
- COAG aims to halve the gap in mortality rates between Indigenous and non-Indigenous children under the age of five within a decade. The Indigenous Early Childhood Development National Partnership will contribute to meeting this target. The partnership agreement comprises $564 million of joint funding over six years (2009-2014) to address the needs of Indigenous children in their early years. This National Partnership has three priority areas:
- integration of early childhood services through the establishment of thirty five Children and Family Centres;
- increased access to antenatal care, pre-pregnancy and teenage sexual and reproductive health; and
- increased access to, and use of, maternal and child health services by Indigenous families.
Social InclusionThe Government’s social inclusion agenda seeks to ensure that all Australians have the resources, opportunities and capabilities they need to learn, work, engage with their community and have a voice to influence decisions that affect them. Social inclusion principles give high priority to early intervention and sustainability, development of tailored services and using an evidence-based approach. The Australian National Breastfeeding Strategy is consistent with the social inclusion agenda and focuses on targeting disadvantaged groups, community approaches and generating long-term health gains through improved breastfeeding rates.
Health ReformThe broader health reform agenda is relevant to the Australian National Breastfeeding Strategy. This agenda is being informed by the following key documents and accompanied by an extensive consultation with the state and territory governments and the Australian community:
- Building a 21st Century Primary Health Care System – A Draft of Australia’s First National Primary Health Care Strategy (2009) is aimed at addressing the delivery of care to ensure that families can get the health care they need, in an appropriate place and at the right time. It has a focus on priority direction for change including improving access and reducing inequity, better management of chronic conditions, increased focus on prevention and improving the quality, safety, performance and accountability of services.
- Australia: The Healthiest Country by 2020 - National Preventative Health Strategy - the roadmap for action (2009) from the Preventative Health Taskforce provides a blueprint for tackling the burden of chronic disease and includes as an action item: support the development and implementation of a National Breastfeeding Strategy in collaboration with the state and territory governments.
- A Healthier Future for all Australians, the final report of the National Health and Hospitals Reform Commission (NHHRC) tackles performance benchmarks and practical reforms to the Australian health system which could be implemented in both the short and long term, to address the challenges of access to services, the growing burden of chronic disease, population ageing, costs and inefficiencies, and the escalating costs of new health technologies. The NHHRC has provided a long term, comprehensive view and options about health care reform. This report also recognises the importance of breastfeeding in the context of disease prevention with a particular focus on providing a healthy start to life for priority groups.