Health inequalities and IMR
I was interested to read your letter/article in the Journal of Epidemiology and Community Health, and your conclusion that there were significant reductions in IMR. You wondered whether this might have been due to interventions such as Sure Start and the Health in Pregnancy grant. I would be surprised if the latter played any significant part, as it came far too late in pregnancy to do anything significant and, anecdotally at least, was often spent on items that would not contribute to health outcomes. As a midwife and health visitor, it seemed the most ill-thought- out piece of spending the government put in place, spending that could so easily have been better used earlier in pregnancy, if directed more specifically - maybe to provide maternal folic acid and Vitamin D freely to all pregnant women.
If we are seeing an improvement in inequalities in IMR, I would submit that higher breastfeeding initiation and continuation rates, and the investment that the government of the time put into supporting breastfeeding (largely withdrawn now), could well be a significant contributing factor. Recent DH data comparing admissions and breastfeeding rates show a significant reduction in admissions of infants to hospital for conditions such as chest infections, bronchiolitis and gastroenteritis in areas where breastfeeding rates are high, even where deprivation levels are also high. Modelling by Bartick and Reinhold (2010) in the US showed that, if 90% women followed the recommendations to breastfeeding exclusively for 6 months, over 900 excess infant deaths would be prevented each year, as well as $13 billion annually. I believe that similar modelling is being undertaken in the UK, and I would imagine it might well show similar results, even if on a smaller scale.
Conflict of Interest:
I am Infant Feeding Coordinator for a London borough, tasked with leading the borough to UNICEF Baby Friendly accreditation, to ensure that all mothers, however they choose to feed their babies, receive the information and support they need to do that appropriately and successfully.