both in high income countries and in poorer countries (Victora et al, 2016). Breastfeeding is recognised as the optimal way to feed infants from birth and exclusive breastfeeding is recommended until about six months of age, with the introduction of complementary feeding recommended when babies are developmentally ready, usually around six months (WHO, 2003; NHS Choices, 2016). Infant formula is the only recommended alternative to breast milk during the first year of life. Breastfeeding protects against childhood infections and dental problems and is linked with an increase in intelligence and probable reductions in overweight and diabetes. For mothers, breastfeeding gives protection against pre-menopausal breast cancer, improves birth spacing, and may also protect against ovarian cancer and Type 2 diabetes (Rollins et al, 2016, Victora et al, 2016). The importance of early care practices, which breastfeeding can facilitate, on brain development and emotional attachment has also been demonstrated. A baby’s earliest relationships lay the foundation for later developmental outcomes (UNICEF UK 2016a and 2016b). Breastfeeding in South Gloucestershire: Mothers’ Early Experiences of Infant Feeding 7 The protection, promotion and support for breastfeeding is a national and local priority. Breastfeeding is a health improvement indicator within the Public Health Outcomes Framework (PHE, 2013), emphasised within the Healthy Child Programme (DH, 2009) and endorsed in public health guidance (NICE, 2014). The UNICEF Baby Friendly Initiative (BFI), a multi-faceted evidence-based intervention, supports breastfeeding and provides practice standards for organisations in service provision and care (UNICEF, 2016a). Recently, the BFI launched a ‘Call to Action for Breastfeeding in the UK, which focuses on actions to remove barriers to breastfeeding (UNICEF, 2016b). In South Gloucestershire Council, the protection, promotion and support of breastfeeding features in a range of strategies including the Health and Wellbeing Strategy 2013-16, Early Help Vision and Strategy 2015-2017, and the Healthy Weight and Obesity Strategy 2014-20. An Infant Feeding Strategy is in the early stages of development. Breastfeeding statistics are routinely available for England, the South West region and local authorities, providing breastfeeding initiation rates (percentage of all mothers who breastfeed their babies in the first 48hrs after delivery) and breastfeeding continuation rates at 6-8 weeks after birth (percentage of all infants at 6-8 weeks that are totally or partially breastfed) (PHE, 2013). Initiation of breastfeeding in South Gloucestershire has changed little in recent years. In 2014/15, it was 77.1%, similar to national and regional levels. Continuation of breastfeeding in South Gloucestershire at 6-8 weeks in 2014/15 was 47.8%, higher than the national level. Local analysis of provisional data suggests continuation rates for 2015/16 will be approximately 47.9%. These rates indicate any breastfeeding e.g. putting baby to the breast or mixed feeding and should be noted in context of national and international targets that all babies should be exclusively breastfed to six months of age. Initiation of Breastfeeding % Continuation of breastfeeding % England 74.3 43.8 South West Region 79.0 * South Gloucestershire 77.1 47.8 Table 1 Breastfeeding initiation and continuation rates 2014/15 *Data missing: earlier data suggests South Gloucestershire is consistently below the regional average Source: Public Health England (2016a) Breastfeeding continuation rates vary within South Gloucestershire (Table 1) with lower rates evident in Priority Neighbourhoods, with the exception of Filton and Staple Hill, compared to South Gloucestershire as a whole (Table 2 and 3) (Appendix B). Breastfeeding in South Gloucestershire: Mothers’ Early Experiences of Infant Feeding 8 Table 2 Breastfeeding continuation rate at 6-8 weeks by ward in South Gloucestershire (2014/15) Table 3 Breastfeeding continuation rate at 6-8 weeks by Priority Neighbourhoods in South Gloucestershire (2014/15) Within Health Visiting, breastfeeding, both initiation and duration, is recognised as an ‘early years high impact area’ (PHE, 2016b) and a number of antenatal and postnatal visits are mandated (DH, 2015). UNICEF Baby Friendly Community Accreditation (Stage 3) was achieved in South Gloucestershire in 2014. This means that Health Visiting and public health nursing services have responsibilities to provide appropriate information, choices and support for breastfeeding and that staff working in these services, and in Children’s Centres, will have received appropriate training. South Gloucestershire also commissions services (from Barnardo’s) to support breastfeeding, including seven weekly-run community based breastfeeding support groups, facilitated by trained peer supporters and a part-time Lactation Consultant for individual appointments (by referral). This is an example of community centred service design, as recommended by the South Report (2015) and NICE (2016). Breastfeeding in South Gloucestershire: Mothers’ Early Experiences of Infant Feeding 9 The South Gloucestershire Joint Strategic Needs Assessment (SGC, 2016) focuses on the current and future health needs of the local population and an important element is the integration of service user’s views in service planning and