I join Cara Hilton in thanking Elaine Smith for bringing the debate to Parliament. The issue is very worthy of our discussion, so I want to make a few comments on it.
Earlier this week, I happened to notice on Facebook a photograph that was split into two images, the first of which was of a woman breastfeeding her child in a cafe under the disapproving glare of customers. It was accompanied by a caption that said that a shawl is a handy tool for sparing embarrassment when breastfeeding. In the second image, the shawl was draped over the disapproving customers as the woman continued to feed her child. That probably works better as a visual gag than it does from my description, but I mention it because I thought that it was rather a clever and amusing way of reminding us that if someone is embarrassed by the sight of a mother feeding her child it is their problem, and not the problem of the woman who is undertaking one of the most perfectly natural activities in the world—or, at least, that is the way that it should be.
Having congratulated Elaine Smith on securing the debate, it is also appropriate that I congratulate Emily Slough, who is referred to in the motion, on organising mass breastfeeding events to highlight problems that mothers face all too regularly. We should reflect on the fact that she was thrust into the limelight rather unwittingly because of the idiocy of someone who was passing by while she breastfed her child. Someone thought it appropriate to photograph Emily Slough surreptitiously and to post the image on the internet, captioned with the word “tramp”. It is appalling that anyone would think that doing that was appropriate or amusing. Emily Slough and others who responded defiantly to such stupidity and held mass breastfeeding events should be congratulated on their efforts.
It is important to remind ourselves of the benefits of breastfeeding. Elaine Smith did that comprehensively, but we should also remember that breastfed babies have better neurological development, better cholesterol levels and better blood pressure. Women who breastfeed benefit from a lower risk of breast cancer, ovarian cancer, hip fractures and reduced bone density. Research continues into other benefits.
Cara Hilton was right to point out the longer-term issue that relates to women breastfeeding children, but UNICEF UK has pointed out that the Health and Social Care Information Centre’s infant feeding survey indicates an improvement in the proportion of babies who are breastfed at birth, which rose by 5 percentage points between 2005 and 2010, from 76 to 81 per cent. That is positive, although the figure in Scotland was 74 per cent in 2010, which shows that we can still do better.
The challenge is that many mothers find breastfeeding in public difficult, largely because of the ignorance of others. A survey by Kamillosan camomile ointment’s manufacturers in 2011 reported that 38 per cent of breastfeeding mothers choose to breastfeed in public toilets when they are out because of unwanted attention and glares that they may receive from the public. It also reported that 12 per cent of women have been asked to stop feeding their baby in public and that 14 per cent have been reduced to having a full-scale argument with someone who objected to their feeding their baby. I say good for them for standing up for themselves, and shame on those who forced them into that.
It is important to challenge any perception that women should breastfeed in private; I hope that that will be a message from the debate. As Elaine Smith and Cara Hilton said, Parliament legislated to protect the right of mothers to feed their children. The 2005 act makes it clear that
“it is an offence deliberately to prevent or stop a person in charge of a child from feeding milk to that child in a public place or on licensed premises.”
Parliament has acted and we need to see that approach on the ground. I hope that that forms an important part of the message from the debate. I congratulate Elaine Smith again on securing the debate.
12:57
I thank Elaine Smith for securing today’s debate and for her years of campaigning to encourage and support breastfeeding in Scotland, particularly of course by bringing forward the Breastfeeding etc (Scotland) Act 2005.
I am proud that there have been a number of other progressive advances in legislation and policy over the years to support increases in breastfeeding rates. Today, most women who give birth in Scotland know about the multiple benefits that breastfeeding brings and most of them intend to breastfeed their baby. However, that good news is tempered by the fact that overall breastfeeding rates are static and by the National Childbirth Trust research that shows the high rate of mothers who stop breastfeeding or move to mixed feeding before they want to.
The policy on educating expectant parents about the benefits of breastfeeding seems to be working, but it is just one part of the story. Unless the policy is situated in a culture that actively supports, understands and enables breastfeeding, it will remain stunted in its potential to transform breastfeeding initiation rates and the length of time for which mothers breastfeed. Further progress on employment practice, childcare arrangements and effective support networks will help to bring about the change, but we also need to face up to persisting attitudes towards women’s bodies and choices.
I would like to say that it is incredible that a woman such as Emily Slough can be labelled a “tramp” for breastfeeding her child in a public place, but then we live in a society that plasters boobs everywhere in a sexual context, where women’s bodies are reduced to an image that society at large can appropriate for comment and criticism, and where mothers feel exposed and judged on a daily basis. Although we are getting better at telling mothers about the benefits of breastfeeding and providing support for it, we are falling short at speaking to people more widely.
The debate is an important part of the discussion on how we tackle negative attitudes towards not just breastfeeding but women more generally. Elaine Smith’s suggestion about promoting the legislation across the country is entirely sensible, for new mothers need to know that they live in a country that supports breastfeeding not only in theory but in practice. That demands a multifaceted approach. The more people see breastfeeding in public, the more normal breastfeeding will become—and the more normal it becomes, the more people will feel that they can breastfeed in public.
While we work on changing attitudes more generally, we can work within the space that we have to get more women breastfeeding. That is precisely what is happening in Fife. We know that the women who are least likely to breastfeed are younger women and women who live in low-income areas. NHS Fife’s breastfeeding peer support project has driven up breastfeeding in deprived areas, and all Fife’s community health partnerships have just been awarded the UNICEF stage 3 award.
The team in Fife recognises that many women feel embarrassed and unsure about breastfeeding in public, even though that is unfair, so it provides a guide for new parents that lists public places in Fife that actively support breastfeeding. The more mums do it, the more it will seem like the thing to do. That will change the culture over time.
Fife knows that the only approach that works is one that puts the mother at the centre. That is why it is crucial that initiatives such as the breastfeeding peer support project continue to receive direct funding from Government.
Women who breastfeed in public should not have to cover up or apologise. A woman who breastfeeds should not be seen as a “tramp” or as a pushy middle-class mum; she should be seen as a person feeding another little person. It really is that simple.
I think that most people in Scotland recognise that it is in everyone’s interests that infants receive the nutrition that gives them the very best start in life. It is our collective responsibility to address attitudes towards breastfeeding, not just in expectant couples but in society at large.
I thank Elaine Smith for bringing the debate to the chamber. I first became aware of her passion for the issue when I was on the Health Committee a decade ago through the passage of her Breastfeeding etc (Scotland) Bill.
It is interesting to note that there were six females to three males on that committee. There was a female convener and deputy convener, and—I think—the minister here today was on the committee during the passage of the bill as well. It was interesting for us males on the committee to get the various anecdotes and stories about the issue, but the committee completely shared the ambition of the bill to confirm the rights of the child and recognise clearly the health benefits—which have been described—to the mother, the child and wider society.
The passage of the bill was a real opportunity to tackle the culture and attitudes towards breastfeeding through public debate. It generated a lot of discussion in wider society. However, my desire to speak in the debate was not just for a trip down memory lane to recall the issues. Elaine Smith will be pleased to hear that one reason why I am speaking is that the debate has, yet again, initiated interest and debate in my community.
On Monday afternoon, I was contacted with an inquiry about this debate—what it was about, what it would cover and whether the inquirers could come along. I decided to meet those people on Tuesday in Port Glasgow health centre, and I am here as a reporter of the interesting rolling debate that we had in a canteen space at the health centre. It was all women there apart from me and they contributed in between mouthfuls of their sandwiches and cups of tea. There were professional women and laypeople there who all gave a view about breastfeeding and the challenges.
Elaine Smith will be pleased that that debate was triggered by this debate and that people are genuinely interested in how we can make the ambition of her bill and, indeed, Government policy a reality. Elaine Smith might be saddened to learn—although I am sure that she is already aware—that about 80 per cent of mothers breastfeed in the affluent areas of a local authority compared to 2 per cent in the less affluent areas. That is a challenge.
The debate on Tuesday was very fluid and people were encouraged to give their views. I want to do justice to those views by getting them on the record today. Issues raised included the expectations on young mothers and the pressures that they are under these days. The choices that they have must be balanced against those pressures. The lives that they lead are very different from those of their grandmothers, but that puts pressure on them. They do not see themselves as confined by motherhood. They are anxious to get back to work for financial reasons and they want their social lives back, which they perhaps do not see as compatible with motherhood. Those are not my views, I should caution. I am reporting back on the lively debate that took place between laypeople and professionals.
I have covered the social issues. As has been mentioned, there are fewer midwives. There is perceived to be less support now than there was, although I know that there are schemes for specific groups. Breastfeeding now competes with child protection, smoking cessation and addiction services in the job remit of people who would previously have delivered breastfeeding support. There is a difficult landscape out there. The debate is necessary because breastfeeding needs to get parity with those other issues. I say that from the point of view of the Health and Sport Committee’s focus on early years and how we transform lives in Scotland.
13:22
I congratulate Elaine Smith on securing the debate and on her excellent speech. She has a long history of championing breastfeeding, both inside and outside Parliament, and the debate is timely. When the Breastfeeding etc (Scotland) Bill was passed, back in 2004, Elaine Smith said:
“the bill is not an end, but the beginning of the Parliament pursuing practical ways to support and encourage breastfeeding.”—[Official Report, 18 November 2004; c 12118.]
That was also the year in which I first became a mum. I still remember being annoyed that I was kept in hospital for four nights after my son was born, until I could get breastfeeding established. The other mums in the ward were all formula feeding and went home the next day, but I was determined to breastfeed even though it was a lot harder than I imagined it would be. Looking back, I see that my longer stay in hospital was vital in ensuring that I could breastfeed my son, who was exclusively breastfed for the first six months—at least, that was what I thought until my mum told me later that she had given him some ice cream. I have since breastfed my other two children. Most recently, I breastfed my youngest, who was seven weeks premature and was breastfed through a tube until he was able to manage himself.
I have to confess that the idea of feeding them in public always filled me with dread. Like many mums, I would plan my day to avoid being out at feeding time, and I have to admit that I always felt slightly envious of my bottle-feeding friends, who could be out all day without any worry.
To be fair, leaving home after having a first child is always a challenge—for the first six months, I think that it was lunch time before I would get out—but it can be even more of a challenge when the person is breastfeeding. In fact, research suggests that half of United Kingdom women who have breastfed in public have had at least one negative experience.
Despite the widespread recognition that breast is best, it is virtually impossible in many places and many of our communities to feed a baby in public without people staring and without attracting both verbal and non-verbal signs of disapproval. Sadly, those negative reactions lead too many mums to stop breastfeeding altogether.
I was shocked to read about the experiences of Emily Slough, who was thrown out of Sports Direct for breastfeeding her eight-month-old baby. Worse still, she was subjected to abuse on social media, labelled a “tramp” and subjected to a host of shocking comments just for feeding her baby. One person suggested that it would be “more dignified” if she breastfed in a public toilet. Emily fought back and organised a mass breastfeeding protest. Thousands of mums came out in support of her across the UK, and many more signed an online petition that demanded that Sports Direct apologise and stop discriminating against breastfeeding mums.
Although mums here are protected by the Breastfeeding etc (Scotland) Act 2005, as Elaine Smith mentioned, many women are simply unaware that that vital protection exists. The act makes it a criminal offence to stop or to attempt to stop mums breastfeeding in public. Given the recent outcry, surely the time is now right to do more to publicise that landmark legislation, and to send out the message that mums in Scotland who want to breastfeed in public have the full protection of the law behind them. I hope that the minister will consider that, because it is absolutely vital that we do more to promote breastfeeding to mums from all backgrounds, across Scotland.
We have had many debates in the chamber about child poverty and inequality. One of the best ways to tackle health inequalities and to give children the best start in life is through breastfeeding. However, breastfeeding rates have remained largely static for the past decade. Half of mums breastfeed at 10 days and only one in four mums breastfeeds exclusively six to eight weeks later. Nine out of 10 women who stop breastfeeding before their baby is six weeks old say that they would like to have breastfed for longer.
Often, mums just need a bit more support and more information. Breastfeeding support groups are absolutely vital in that context. That is especially important for mums in more deprived areas, where breastfeeding rates are among the lowest, mums are often younger, and there is less likely to be a family history of breastfeeding. We too often hear mums being told, “Just give the wee one a bottle, so you can get a rest,” and breastfeeding mums are too often made to feel that their milk alone is not enough to sustain a large or hungry baby, when that is simply not true.
It is absolutely vital that the Scottish Government addresses that important public health issue by doing more to promote the health benefits to mums and babies, by ensuring that every mum can access the peer and professional support that they need and—perhaps most important—by promoting and celebrating breastfeeding in shops, cafes, libraries, parks and public places throughout Scotland.
12:53
We have had a very interesting debate and, as others have done, I thank Elaine Smith for bringing such an important subject to Parliament for debate. I am glad that we waited to welcome the mums—and the staff—to the gallery.
We know about the various media articles on the public shaming that is meted out to mothers who choose to breastfeed their babies in public. The case of Emily Slough has been highlighted. Her fight-back campaign is inspiring to others, but the fact that breastfeeding mothers still receive such treatment shows that we still have a fair way to go to bring about a shift in public attitudes and make breastfeeding the norm.
The Breastfeeding etc (Scotland) Act 2005 protects the right of any person to feed a child when required and in the most appropriate place for them without the fear of interruption or criticism. Cara Hilton, Elaine Smith and Elaine Murray asked about the promotion of that legislation and the leaflet on it. I can inform members that the leaflet is being updated to coincide with the 10th anniversary of the passing of the 2005 act in 2015. That will provide an opportunity to again promote the benefits of the legislation and the rights that it provides. We will keep people informed of that.
Richard Simpson raised a number of issues. It would probably be best for me to write to him, or to arrange for Michael Matheson to write to him, with answers.
Mention has been made of the “Infant Feeding Survey 2010”, which is the most recent infant feeding survey. It reports more positively on the experiences of women in Scotland than it does on those of women in other areas of the UK, but it highlights the challenges that breastfeeding in public brings.
As many members have said, good nutrition from the earliest days of life will contribute significantly to the long-term health of Scotland’s population. In 2011 we published “Improving Maternal and Infant Nutrition: A Framework for Action”, which outlined the measures that all organisations should take in working with families to ensure that every parent is supported to give their baby the very best nutritional start in life.
We all know about the short-term and long-term health benefits of breastfeeding both for mothers and for infants, so why have breastfeeding rates remained steady, with approximately 36.5 per cent of babies being breastfed at their six to eight-week review in 2012-13?
I think that the answer is that so many factors influence a mother’s infant feeding decision. Family and peer pressure, culture, public attitudes and support from professionals are just a few factors among many. Effective strategies to encourage and enable more women to initiate and maintain breastfeeding cannot be delivered by health professionals, policy development or legislation alone; we need a supportive and collaborative approach.
We want to ensure that parents understand that, for however long a mother chooses to breastfeed, breast milk will contribute to a baby’s future health and ensure that they feel supported and encouraged from the earliest days. There are important messages about the benefits for mums themselves, which members have spoken about today.
Research has made clear that the greatest benefits for mother and baby are gained through exclusive breastfeeding for the first six months. As has been said, it is the natural way to feed babies and infants. Breast milk provides the most comprehensive source of nutrition for the first six months of a baby’s life and contains a range of immunological substances that cannot be manufactured for formula milk.
We want to strengthen the NHS contribution by improving access to NHS care during the antenatal period for those women who are least likely to consider breastfeeding and who are most in need of encouragement and support. Building good relationships with health professionals in the antenatal period will help to support mothers to start breastfeeding and to maintain it in the earliest weeks of their babies’ lives. To help in achieving that aim, the Scottish Government provides funding of approximately £2.5 million per year to health boards to implement the framework’s action plan, including a range of breastfeeding support activities and interventions.
We recognise the contribution that the UNICEF baby-friendly initiative makes to improving the care of mothers and babies. Every single NHS board in Scotland is working towards achieving and maintaining BFI status in hospital and community settings. The Scottish Government is demonstrating its commitment to the initiative by funding a full-time professional officer for Scotland for four years, and is providing financial support to help all NHS boards to achieve that prestigious award. Progress is being made nationally, with 84 per cent of births in Scotland taking place in a BFI-accredited hospital, which compares very well with the situation elsewhere.
As well as supporting women in making the important decision on how to feed their baby, support and advice must be readily available postnatally. Peer support is a key way of providing encouragement to families and their communities. It enables women to share similar experiences with newly breastfeeding mums and to offer emotional and practical support to complement the support that is offered by professionals. It can be mutually beneficial to the peer supporter and the supported mother.
The provision of breastfeeding peer support must be fully integrated in local service planning and delivery to enable the recruitment, training and on-going supervision of the peer supporter. To support that work, NHS Scotland’s breastfeeding peer support guidance was published in November last year.
The findings from the “Growing Up in Scotland” longitudinal study that was published in April 2014 show an increased understanding of the importance of breastfeeding and its long-term benefits. Breastfeeding rates in the most deprived areas of Scotland have increased in the past decade, which is a good thing. The overall breastfeeding rates at the first visit have increased from 24.3 per cent in 2001-02 to 30.7 per cent in 2012-13.
I will certainly take that suggestion forward. It may be more appropriate for Michael Matheson to progress, but I will certainly take it up with him.
The increase in the overall breastfeeding rates in the most deprived areas is due mainly to an increase in the percentage of mums who are mixed-feeding their child, which indicates that more mothers in those areas are initiating breastfeeding and continue to give their babies some breast milk in the early weeks of life.
We have to handle that quite carefully because we want mums to give their babies at least some breast milk while of course promoting the clear message that exclusive breastfeeding is best but any breastfeeding is better than none. Those are the careful but sometimes difficult messages that professionals must wrestle with giving.
I think that we would all agree that Scotland should celebrate and support women who make the choice to breastfeed, regardless of where or for how long they choose to do so, and that we all have a part to play in making that happen. I will certainly take forward many of the issues and suggestions that have been made during the debate and will discuss with Michael Matheson how best to take them forward.
13:35 Meeting suspended.
I am pleased to be able to lead a debate today on the important issue of breastfeeding, which is not discussed enough in society or in Parliament. According to the Scottish Parliament information centre, it has never been the principal subject of a Government-led debate in the Scottish Parliament. That is concerning because low breastfeeding rates cost money and lives, as is proved in the UNICEF UK-commissioned report of last year, “Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK”.
I will expand on that later, but first I want to welcome health workers, mums and babies from my constituency and other parts of Scotland to the gallery. I extend a particularly warm welcome to Jenny Warren, who was our national breastfeeding adviser until 2005. Unfortunately, that post no longer exists, which is a bit of a problem, since the World Health Organization’s strategy spells out the need to appoint a national breastfeeding co-ordinator. We do not seem to have an infant feeding adviser in post, either.
A breastfeeding-friendly Scotland needs commitment and understanding from our young people, so I am delighted that members of Coatbridge and Chryston youth forum are here today and are taking an interest in the issue.
The abuse on Facebook of breastfeeding mum Emily Slough shows us that appalling misogynistic insults are still being aimed at mothers for normal and nurturing maternal behaviour. I want to congratulate Emily and the thousands of people across the UK who supported her, on their protesting against such atrocious attitudes. I do not have time to go into the sexual politics, but others will do so. I just want to say that it is crazy that it is okay for breasts to be ogled on page 3, but cannot be seen in public feeding hungry babies.
During the passage of my member’s bill, the Breastfeeding etc (Scotland) Bill, I detailed the advantages of mother’s milk, so I will leave it to others to mention the undisputed health benefits of this unique designer food. Today, I want to concentrate my limited time on other aspects of our low breastfeeding rates and the effects on our nation’s health.
In “The Politics of Breastfeeding”, Gabrielle Palmer tells us that every 30 seconds, a baby dies from infection due to lack of breastfeeding, through use of bottles, artificial milks and other risky products. She goes on to say:
“If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers’ needs, the very announcement of their find would send their shares rocketing to the top of the stock market.”
However, of course, instead of women who produce this miraculous substance being celebrated, supported and encouraged to feed their designer food to their babies, big corporations profit from selling an inferior substitute. So, how did that happen?
In the late 1800s, improvements in dairy production led to a whey surplus that needed a market outlet: that became the basis for artificial baby milk. It was used not because research had proved it to be the most suitable food, but because it was there and it was cheap. Big business found an outlet for a by-product of the milk industry, then aggressively marketed that inferior product to women who paid for it, rather than using the fabulous, exclusive and free product that they produce themselves. It is, frankly, unbelievable.
In the “Global Strategy for Infant and Young Child Feeding”, the WHO and UNICEF said:
“lack of breastfeeding—and especially lack of exclusive breastfeeding during the first half-year of life—are important risk factors for infant and childhood morbidity and mortality”.
In other words, not breastfeeding can be very bad for children’s health. As a society, we shy away from putting it in those terms, perhaps in case we offend those who have chosen to feed artificially or those who simply cannot breastfeed. The latter are a tiny minority—less than 1 per cent—and there are, of course, other options including milk banks, which is an issue that needs further discussion.
However, in worrying about offending some parents, we put lives at risk, we fail to take important steps to challenge our ill health and obesity, and we spend vast sums dealing with the consequences.
We need to ensure that society is well educated about the wonders of breast milk and the dangers of artificial milk, so that families can make real informed choices instead of just following social norms with no idea of the risks. Most parents want what is best for their children, but I do not believe that the majority know what formula milk is and why it is different from breast milk. It is understandable, then, that so many choose to use it.
The UNICEF UK-commissioned report not only tells us that low breastfeeding rates lead to increased incidence of illness, with a significant cost to the national health service, but supports that fact with hard figures—probably for the first time—showing that moderate increases in breastfeeding translate into huge cost savings. For example, if only half the mothers who do not breastfeed were to do so for up to 18 months, there would be 865 fewer cases of breast cancer, meaning a saving of £21 million and improved quality of life equating to more than £10 million for each annual cohort of first-time mothers. If 45 per cent of babies were exclusively breastfed for four months, and if 75 per cent of babies in neonatal units were breastfed at discharge, more than 3,000 fewer babies would be hospitalised with gastroenteritis, nearly 6,000 fewer babies would be hospitalised with respiratory illness, and there would be more than 300 fewer cases of the potentially fatal disease necrotising enterocolitis. Together, those things would save more than £16.3 million.
Those are all in the first category of savings for which it is possible to provide quantitative economic models based on strong evidence. There are another three categories, in which the benefits include an increase in IQ, fewer cases of sudden infant death syndrome and reductions in childhood obesity. Those other categories need a wee bit more research. The report shows conclusively that breastfeeding is a major public health issue and that low breastfeeding rates cost the NHS millions each year.
So, what should we do? I propose better support in communities, the inclusion of breastfeeding education in school curriculums and the provision to parents of proper information about the risks of not breastfeeding. We also need regular reports to Parliament on the progress of the Scottish Government’s framework and the specific steps that are being taken to increase breastfeeding rates, in order that we can sustain breastfeeding and change societal attitudes. The report tells us that we need breastfeeding to be a priority for all NHS boards, and that we need effective implementation of standards on baby-friendly initiatives, access to well-trained health professionals who understand the benefits of breastfeeding, and further research and funding.
The report also tells us that we need to strengthen and use existing legislation such as the Breastfeeding etc (Scotland) Act 2005. As far as I am aware, that act has been used only once, resulting in a slap-on-the-wrist letter to a company that verbally abused a mother and baby before it threw them out on to Sauchiehall Street. I hope that women report any attempts to stop their breastfeeding in public to the police, because it is illegal, and I hope that proper action can be taken. Perhaps the cabinet secretary can tell us why the promotional leaflet for the Breastfeeding etc (Scotland) Act 2005 has not been reprinted, although that information is important.
It is worrying that many people talk about discreet breastfeeding, including on the Government’s own website. We need to see it and talk about it if we are to fundamentally change social attitudes and encourage others to breastfeed. On Monday, blogger Mama Bean made the point that breastfeeding should not be
“a secret art form preserved for private rooms & hushed conversations”.
We need increased Government commitment to ensuring that the barriers for mothers are removed, and we need society to recognise that breastfeeding is normal and should be seen in public. The reward for that will be a much healthier population, less illness among babies and massive savings for the NHS.
Celebrating and supporting breastfeeding is good for mums and babies, good for society and good for the public purse. Breast is, indeed, best.
12:48
I congratulate Elaine Smith not only on securing the debate but on her unswerving commitment in Parliament over the past 15 years to promoting breastfeeding—in particular, breastfeeding in public. I do not think that anybody has done more than she has to promote it since the Parliament began. That work includes her member’s bill in 2004, which protected mothers who wish to breastfeed in public, and motions that she has lodged since then.
Promoting breastfeeding in public is more controversial than promoting breastfeeding per se, and Elaine Smith has had the courage over the years to take on that controversy. She made the important point today that milk substitute is a by-product of the dairy industry and is not designed to suit young human beings. Biochemically, it is nothing like human milk.
Encouraging breastfeeding in public is important for similar reasons to those for discouraging smoking in public places. We discourage smoking in public places for public health reasons and because seeing people smoking normalises it. If children continually see people smoking, it will seem to them to be normal behaviour and they will do it. Similarly, seeing mothers breastfeeding in public normalises breastfeeding, so even if children and young people have not seen a young member of their family being breastfed, it will still be part of normal and expected maternal behaviour.
Statistics that were published last year showed that more than 47 per cent of babies were breastfed at 10 days, which fell to 36 per cent at six to eight weeks and, of them, 25 per cent were exclusively breastfed. Unfortunately, those rates are similar to the rates 10 years ago. We seem to be no nearer hitting the target of 50 per cent being breastfed at six weeks, despite the passage of Elaine Smith’s act. Like others, I believe that more needs to be done to promote the advantages of breastfeeding, and to use and publicise the legislation.
We need to dispel some of the negative information that deters too many women from even considering breastfeeding. One factor is the perception that breastfeeding is bound to be very difficult and sore. It can be for some women and, as Elaine Smith said, a small proportion of women are unable to breastfeed at all. That should be understood, but most women can breastfeed and some find it easy and straightforward. I was one of them. I have three children and breastfed them all until they decided that they wanted to give up. I have absolutely no recollection of finding it difficult, although I have to say that birth was another matter.
Having the opportunity to breastfeed on demand was another matter. My children are now 28, 26 and 24, and in the days when I was breastfeeding, doing it in public places was pretty difficult unless you were wearing a suitably encompassing and camouflaging garment. I returned to work full time when my eldest child was four months old. My son’s childminder was supportive and had breastfed all five of her children, but I had to express milk for my son in the toilet at work. I have never prepared anybody else’s meal in a toilet—not even a dog’s meal.
I want to draw attention to the weight charts that indicate that children should double or triple their weight by certain times. Those do not work for breastfed children, because they do not put on weight so quickly. That ought to be understood, so that breastfeeding mothers do not feel that they are somehow not giving their children enough nutrition.
Breastfeeding has a whole load of advantages. The most important is for the child’s health, as members have said. My youngest son was born during a norovirus epidemic, which was pretty worrying in relation to newborns. All five of my family managed to get it, but my six-week old baby was the least ill of all of us because he was protected by my antibodies. Other children of that age are not so protected.
Night feeding was easy. There was no messing around with heating up bottles to the right temperature and all that nonsense. I could almost literally do it in my sleep—not that I would necessarily recommend that. Obviously, partners cannot be much help with the feeding, but they can assist with other night-time jobs such as changing nappies.
Another advantage is weight loss: I went back to my pre-pregnancy weight fairly quickly after giving birth. All my children were born during the Christmas and new year period and I was able to have all the Christmas goodies—the chocolate, the cheese, the Christmas cake and everything else—and still lose weight. Happy days! They never came back, unfortunately.
Breastfeeding is great for babies and for their mothers. More needs to be done to enable more mums to breastfeed, and to portray breastfeeding as a positive choice so that people choose the most natural way of nourishing their babies.
13:02
I absolutely do—I could not agree more. Quite often, it is about freeing up a bed in hospital. I do not expect mothers to have to stay in for four days, as Cara Hilton did; they could be given help and support at home. I whole-heartedly agree that support is vital.
It is interesting to note that older mothers are more likely to breastfeed than young mothers. In 2012-13 in Scotland, I was surprised to see that only 5 per cent of mothers aged under 20 breastfed their babies at six to eight weeks compared with 34 per cent of mothers aged 40 and over. The main statistic to note is that 41 per cent of mothers in the least deprived areas were exclusively breastfeeding at six to eight weeks, a figure that is three times greater than that for mothers in the most deprived areas. When we consider the cost of infant formula, that is undoubtedly an area in which, as Elaine Smith said, more support, awareness and help could be given.
Scotland still compares favourably with Wales and Northern Ireland on breastfeeding, and we are only 2 per cent behind England in the figures for exclusive breastfeeding at six weeks. However, we can do better.
I commend Elaine Smith for bringing the debate to Parliament and for helping us all to raise awareness of breastfeeding. There is no doubt of the health benefits to baby and mother. It should also not be lost that there are savings to the public purse and families, particularly those from the most deprived backgrounds.
More can be done to encourage and support more women to breastfeed and to make breastfeeding in public the social norm, as Jayne Baxter said. I do hope that this debate will go some way towards helping to achieve that.
13:11
I join other members in congratulating Elaine Smith on obtaining this members debate. As others have said, she has made this a core issue throughout all parliamentary sessions, including by introducing a member’s bill that changed some of the public’s perception, but more needs to be done.
The 2011 publication “Improving Maternal and Infant Nutrition: A Framework for Action” was a useful document, and it should now be seen in the context of the early years collaborative, as it develops, and the family nurse partnership, among other initiatives. The report’s adoption of the World Health Organization’s view that breastfeeding should be exclusive in the first six months was also welcome. The report also recognises that breastfeeding is crucial for the development of the infant and for the good future health of the mother, including a return to pre-pregnancy weight, which is becoming increasingly important as obesity becomes ever more prevalent in Scotland.
Infants who get the immunological benefits of breast milk that cannot be supplied by formula have reduced risk of ear, respiratory, gastrointestinal and urinary tract infections; of allergic disease, including eczema, asthma and wheezing; and of type 1 diabetes. They are also less likely to be overweight, which again contributes to the major public health issue of obesity. Furthermore, infants who are breastfed are less at risk of childhood leukaemia and sudden unexplained infant death, and there might also be an association with improved cognitive development. Pre-term babies who are breastfed are likely to have better eyesight and brain development than those who are not and have a reduced risk of necrotising enterocolitis.
The factors that are associated with influencing breastfeeding are many and varied, particularly for pre-term babies where there can be considerable difficulty, and they might have to be tube-fed, as happened to one of my grandsons. It is particularly important that those mothers get the help that they need.
The quality of assistance during delivery and in the first few days is important, and yet we have a situation in which—instead of what happened when I was a student, when there were 14 days lying-in, as it was called—many mothers now go home within a few hours of delivery. Have we really adjusted the services to accommodate that? I believe that that is a factor in the poor rates of breastfeeding that we see.
Once mothers get out of hospital, getting professional and peer-to-peer support is important. Is there now comprehensive mapping of the accessibility of breastfeeding peer support groups?
The Government has to take some responsibility for our problems in that it cut the midwifery student intake by 40 per cent some three years ago. To be frank, that was a foolish decision. It was wrong for Scotland and certainly wrong for the UK, where there were and still are serious shortages of midwives. Worse still, it resulted in the precipitate closure of three university schools of midwifery. The subsequent partial reversal, with increases, came too late to reopen those schools.
At the same time, we have really serious problems with health visitor recruitment and training. That is still being left to health boards, which, again, is not the correct decision. The Government needs to take a far stronger hold of the training of health visitors, who can be critical to the sustaining of breastfeeding, not just its establishment.
The University of Dundee is involved in a programme of research. It has done very good work on incentives to stop smoking, and it is now doing a project, in association with an English unit, on the potential of financial voucher incentives for breastfeeding. It will be interesting to see what emerges from that research and whether the approach should be adopted.
One important issue that other speakers have not mentioned is the fact that Scotland has only one breast milk bank—there are 17 in the United Kingdom—and I wonder whether there are plans to extend that with a second. Because of our geography, running only one in Scotland is not a particularly good measure.
I also ask the minister to give us at some point—not in her speech, because she will not have time—an update on the implementation plan. In that regard, I echo Elaine Smith’s regrets that the post of a breastfeeding champion or lead was abolished and that no Government has ever led a debate on breastfeeding. Even with the extension that has been granted, this debate is far too short a time to debate this very important subject. Therefore, I ask the minister to try to get Government time to debate it much more fully. However, we have already had a good debate on the subject.
13:16
I thank my friend and colleague Elaine Smith for bringing the motion before Parliament and indeed for her unwavering commitment to the promotion of breastfeeding, which is an important public health matter. This is an excellent example of a campaigning MSP sticking with an issue and seeing it through in order to change the law and people’s lives.
Breastfeeding is the most natural thing in the world. It helps mother and baby keep healthy and develops attachment. As Dr Simpson described, it reduces the risk of a range of illnesses, such as cancer, diabetes and obesity—the list of benefits, both to the mother and the child, goes on.
We are in a bit of an anecdotal mood today. It may not come as a surprise to my sisters in the chamber to hear that I did not breastfeed my daughter, although given the weight loss advantages that Elaine Murray explained, I really wish that I had—maybe I would not have struggled to keep my weight down over the years.
Breast milk is readily available. There is no need to go to the shops. It is always at the right temperature. There is no need to mix it or faff around with packets. It comes on its own: there is no need for bottles, sterilising equipment or kettles—all the stuff that I remember from around 18 years ago. Importantly, it is free. Mothers who breastfeed save a significant amount of money because they do not have to pay for formula milk and all the palaver that goes with it. With all those qualities, it is surprising that breast milk is not the most expensive product on the planet, but it is a superfood that is absolutely free.
Despite that, as members have mentioned, the take-up rate throughout the UK is still very low. The highest initial rate in England and Scotland is 71 per cent, falling, after six weeks, to 22 per cent in Scotland and, remarkably, only 13 per cent in Northern Ireland. While we are not the worst in the UK, we have a long way to go to drive up rates. Duncan McNeil’s contribution was very powerful because take-up rates of breastfeeding very accurately reflect health inequalities throughout Scotland. We should address that across the range of portfolios in the Parliament.
Why are take-up rates so low? There are undoubtedly educational and cultural issues, such as lack of knowledge, fear, embarrassment, stigma and social awkwardness. Some women are afraid to breastfeed in public because of the reaction of others. Mention has been made of stories of people being asked to leave restaurants, bars or shopping centres by owners who appear to be living in a wholly different age.
Today of all days, we should reflect on the further misuse of social media in the case of Emily Slough. It is remarkable that she had her photo taken without her knowledge, that it was then put online and that her character was attacked by people who neither knew her nor cared for her and who gave no thought whatever to the impact on her and her family. I find it thoroughly depressing that the wonder of technology is being used in such a way. At the same time, it is inspirational that she did not give in to those people and was inspired to act. That is the way to deal with those who disparage people and engage in character assassination from behind their computer screens in their lonely bedsits.
The Breastfeeding etc (Scotland) Act 2005, which Elaine Smith introduced, protects the rights of mothers. We should not forget that it made it illegal to prevent or to attempt to prevent mothers from breastfeeding in public. It also sought to make breastfeeding a social norm. That is what it should be—something that is totally natural. I hope that the Government will continue to work to promote the multitude of good reasons to breastfeed, and that it will work with our councils, our colleges and universities, our workplaces and our communities to break down the barriers that prevent more women from breastfeeding. I encourage Elaine Smith to keep up her highly effective campaigning on the issue, and I am sure that she will receive support from across the Parliament.
Two weeks ago, a conference was supposed to be held on Scotland’s health challenges at Our Dynamic Earth. The conference was cancelled because speaker after speaker withdrew after it emerged that the event was being sponsored by Nestlé, which is one of the large corporations that Elaine Smith mentioned, whose activity in the developing world undermines breastfeeding among the populations of those countries. That is very much a live geopolitical issue—it has not gone away.
13:27
Will the cabinet secretary consider committing to meet the authors of the “Preventing disease and saving resources” study, given the amount of money that their research proves the NHS could save?
Due to the large number of members who want to speak in the debate, I am minded to accept a motion without notice to extend the debate by up to 30 minutes.
Motion moved,
That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Elaine Smith.]
Motion agreed to.
13:06
I thank you all for your forbearance.
The next item of business is a members’ business debate on motion S4M-09422, in the name of Elaine Smith, on celebrating and supporting breastfeeding in public.
Motion debated,
That the Parliament notes with concern reports of a recent incident in which a mother, Emily Slough from Rugeley in Staffordshire, was labelled a “tramp” on a social networking site after a stranger took a photograph of her as she sat on steps breastfeeding her eight-month-old baby; notes that the photograph, which was taken without Emily’s permission, was then uploaded online and believes that the misogynistic, derogatory and disrespectful comments that were subsequently posted could cause upset and concern to nursing mothers; understands that, as a result of this scandal, Emily organised a mass breastfeeding protest on 15 March 2014 in which thousands of mothers came out in support of breastfeeding in public across the country, including across Scotland; recognises that, in Scotland, mothers are protected under the Breastfeeding etc. (Scotland) Act 2005, which makes it illegal to stop, or attempt to stop, mothers breastfeeding in public; notes the view that, to reassure mothers and to help breastfeeding in public become a social norm, this legislation should be used and publicised across the country, including in Coatbridge and Chryston; acknowledges what it sees as the huge health benefits of breastfeeding; understands that a recent UNICEF-commissioned report, Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK, outlined how increased breastfeeding rates could improve public health, produce long-term health benefits, allow considerable savings to be made by the NHS and provide a mechanism for improving health outcomes across a range of social groups; congratulates Emily Slough on her campaign, which it hopes will help raise awareness of the need for changed attitudes towards breastfeeding in public, and believes that mothers who are engaging in normal, nurturing maternal behaviour should be celebrated and supported by society.
12:40
I thank Elaine Smith for securing the debate and setting out so many of the benefits of breastfeeding. As members said, Elaine has been a long-term ambassador for breastfeeding. I remember nagging my daughter to breastfeed her first child, who was born in 2001, when the Parliament was meeting up the road, and proudly reporting back to Elaine that my daughter had breastfed for several months.
Cara Hilton’s experience reminded me of when my children were born in Dundee royal infirmary, around 40 years ago. I was the only mum to breastfeed on a Florence Nightingale-type ward of nearly 30 women. It was interesting to learn how little has changed.
Like other members, I condemn the action that was taken against Emily Slough in Staffordshire, when a photograph was taken without her permission and placed on a social networking site, where it attracted disrespectful comments. I am not sure whether the incident would have been in breach of the Breastfeeding etc (Scotland) Act 2005. Perhaps the minister will make that clear. As the motion says, the 2005 act
“makes it illegal to stop, or attempt to stop, mothers breastfeeding in public”.
What happened to Emily Slough was certainly in breach of the tone and intention of the 2005 act, which were about reassuring mothers and helping breastfeeding in public to become a social norm.
Elaine Smith talked about the 2005 act, but, as is so often the case, the issue is not the legislation, which is fine, but how the legislation is enforced and implemented. That is what really matters.
The benefits of breastfeeding to babies and mothers have been well stated by all speakers, and they range from protecting babies from common childhood diseases to helping mothers to return to their pre-pregnancy weight, as Elaine Murray said. One of the most important benefits must be the convenience—there are no bottles to be sterilised and there is a constant supply.
I am a strong advocate of breastfeeding, but I am aware that many mothers want to breastfeed but find it difficult. We need to recognise that.
On that point, does Mary Scanlon agree that support from professionals is vital?
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