The goal of public health work is to promote health and to mitigate the effects of social inequalities in the population. Health surveillance is a necessary part of this work to allow prioritisation and targeted interventions (1). According to current law, municipalities must monitor their population’s health and the factors affecting it, as well as facilitate research. Ever since they were established, child health centres and the school health services have collected data of relevance to health surveillance and epidemiological research, but this information has largely been recorded as free text. For reporting, collation and analysis of data, more structured information is required (2).
Since 2008, Bergen municipality has collaborated with researchers at the Norwegian Medical Birth Registry, University of Bergen, Department of Paediatrics, Haukeland University Hospital, Bergen University College and Uni Research Health to develop the medical records system «Health Profile 0 – 20 years» (or «Health Profile»). Within this system, basic health information in electronic patient records from child health centres and the school health services, including height, weight, breastfeeding, nutrition, dental health, sleep, development/behaviour, social interaction/bonding and language, is used for statutory health surveillance and research. «Health Profile» can provide information on service provision, quality and professional development as well as the effects of interventions, and can form the basis for studies of living conditions. The system meets stringent requirements with regard to privacy and data security and was adopted in Bergen in January 2010.
Research shows that breastfeeding has health benefits for mother and child, both in the short and long term (3, 4). Exclusive breastfeeding until six months of age, as opposed to exclusive breastfeeding for 3 – 4 months followed by partial breastfeeding, can lead to fewer intestinal infections for the infant and weight loss and lactational amenorrhoea in the mother. Exclusive breastfeeding is defined as breastmilk alone during the last 24 hours, without any other liquids or solids (3). In low-income countries, it is particularly important that all infants are exclusively breastfed for six months and that breastfeeding is maintained until the infant is at least one year of age (3) – (5).
There is no evidence that exclusive breastfeeding has long-term protective effects with regard to allergy development, growth, obesity, dental health, cognitive skills or behaviour in children. In Norway, there was a goal to increase the proportion of infants exclusively breastfed at six months of age from 7 % to 20 % over the course of 2007 – 11 (6).
Recent studies suggest that children in countries such as Norway may experience health benefits from being introduced to solid foods before they are six months old, such as protection against anaemia, allergies and coeliac disease (7, 8), but this is still uncertain (9). Because breastmilk provides immunological protection, it is recommended that breastfeeding be continued after the introduction of solid foods (4, 10). The Nordic Nutrition Recommendations from 2012 advise that breastmilk should be part of the diet until 12 months of age, with partial breastfeeding thereafter for as long as suits mother and infant (9). According to the World Health Organization (WHO), breastmilk continues to be an important energy and nutrient source for children aged 6 – 23 months (5).
Previous Norwegian and Swedish studies have shown that the proportion of mothers who breastfeed is highest among those with higher education who are over 24 years of age, married/cohabiting, and who already have children. The proportion is lower among smokers and mothers of infants with low birth weight (11) – (13). The duration of maternity ward stays has decreased in recent times, and women often return home two or three days after giving birth, before breastfeeding is well established.
All forms of additional support, whether from health professionals or others (fathers, friends and parents), increase the proportion of mothers who breastfeed and the duration of breastfeeding (14). The National Competence Centre for breastfeeding at Oslo University Hospital has, in collaboration with the Norwegian Nurses Association, drawn up a set of best practices for breastfeeding guidance (15), and child health centres that work in accordance with best practice are certified as specialist breastfeeding centres.
The purpose of this study was to use «Health Profile» in combination with the Medical Birth Registry to survey breastfeeding and the factors affecting it in the infant’s first six months, including maternal age and smoking habits as well as infant birth weight. We have not come across any studies that examine potential advantages of specialist breastfeeding centres, and therefore wished to compare the course of breastfeeding in mothers attending standard health centres and those attending specialist centres.