Unknown breastfeeding rates among Traveller women in Ireland: a systems failure to collect, record and report

Abstract

Dear Editor, National breastfeeding data are recorded annually through the National Perinatal Reporting System in Ireland. It is now 35 years since the first national perinatal report was published which recorded that 30.20% of women breastfed in 1984 [1]. There has been a very gradual increase in breastfeeding in Ireland in the intervening years. The most recent Perinatal Statistics Annual Report recorded that 50% of women exclusively breastfed, while 60% reported any breastfeeding which included breast or combined feeding on hospital discharge in 2016 [2]. When compared with international figures, Ireland has one of the lowest breastfeeding initiation rates in the world [3]. Furthermore, younger women, women from lower socioeconomic groups and Traveller women have even lower breastfeeding rates than the low national average in Ireland [3]. Although the National Perinatal Reporting system provides detailed information on infant feeding type by age of mother for singleton and multiple pregnancies, county of residence, mother’s socio-economic group and nationality, mother’s ethnicity is not included. The Healthcare Pricing Office highlights ‘the importance of having an accurate and complete perinatal reporting system at national level’ (p. 2) [2]. Arguably, the current system is incomplete as it fails to collect, record and report breastfeeding data for Traveller women in Ireland. The Traveller community, which makes up 0.7% of the population [4], was acknowledged as being a distinct ethnic group in Ireland on 1 March 2017 in Dáil Éireann [5]. The National Traveller and Roma Inclusion Strategy 2017–2021 calls for ‘a phased, incremental implementation of a standardised ethnic identifier across all health administrative systems to monitor access, participation and outcomes of all groups’ (p. 33) [5]. Given that infant mortality is greater among Traveller infants than infants in the general population [6], it is appropriate that a standardised ethnic identifier begins with perinatal data. There are arguments in favour of and against using ethnic identifiers in data systems [6]. However, without ethnic identifiers, it is impossible to evaluate any action to address the problem. The Traveller community has a lower life expectancy and poorer general health than the population in Ireland [5]. The evidence is overwhelming that breastfeeding confers health benefits during infancy and beyond for mother and infant [7]. Therefore, it is essential that women in the Travelling community are supported to breastfeed. However, Traveller women face challenges to breastfeeding that are unique to their ethnic group [8]. Yet, it is impossible to comprehensively evaluate breastfeeding support without reliable data. Monitoring efforts to improve breast feeding rates amongst Traveller women in Ireland requires data collection. The Health Service Breastfeeding Action Plan 2016–2021 highlights the need to identify and address barriers to breastfeeding for Traveller women [3]. It is clear that lack of reliable data is currently one of the many barriers. The most recent data were recorded nearly 10 years ago by the All Ireland Traveller Health Study, when it reported that an extremely low 2.2% of Traveller women had breastfed [9]. It is unknown what percentage of Traveller women breastfeed today. In conclusion, it is imperative that the National Perinatal Reporting System makes the necessary changes to collect, record and report breastfeeding data for Traveller women. These unknown data conceal the gravity of the situation and undervalue the importance of breastfeeding for this ethnic group. If these changes were implemented, they would have far-reaching effects into all aspects of maternal and infant health not least infant feeding, for the Travelling community in Ireland. * Anne Fallon [email protected]