Meeting of the Parliament

Meeting date: Tuesday, January 23, 2024

Official Report 958KB pdf

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Breastfeeding

The next item of business is a debate on motion S6M-11935, in the name of Jenni Minto, on celebrating and supporting breastfeeding in Scotland. I invite members who wish to speak in the debate to press their request-to-speak buttons.

14:31  

I am delighted to open this debate to celebrate and support breastfeeding in Scotland.

As the Minister for Public Health and Women’s Health, I am clear that improving the health of babies and young children is fundamental to underpinning Scotland’s overall population health. To enable us to do so, our ambition should be for every baby in Scotland to be breastfed. That is not to say that I do not believe that parents should have a choice about how they feed their children—they absolutely should—but those choices can sometimes be unduly influenced by external factors. For mums who either struggle to or just cannot breastfeed, there might be no choice at all, but those women who can breastfeed should be encouraged and supported to do so.

The United Kingdom has some of the lowest breastfeeding rates in Europe. Breastfeeding—the provision of human milk—is the most accessible and cost-effective activity available to public health and is known to prevent a range of infectious and non-communicable diseases. Despite recent welcome improvements in Scotland, the majority of babies are still wholly or partially formula fed for most of their first year of life.

The evidence about the benefits of breastfeeding for both mother and baby is clear and is about more than nutrition: the physical act of breastfeeding itself brings many additional benefits, and its contribution to the health and development of babies has lifelong impacts.

I have been listening to what the minister is saying because I am really interested in this subject. In particular, take-up of breastfeeding tends to be lower in areas of high deprivation. Has the Scottish Government done any research on that? Is there a clear focus on ensuring that we are getting to the people whom we really need to get to?

I will come to that idea later in my speech. We have done more than just research; we have put things in place, including family nurse partnerships.

The evidence is strongest regarding the benefits of exclusive breastfeeding during the first six months of life. To fully realise the potential that breastfeeding has for our nation’s health, we must listen to and act on that evidence. In November, I and my colleague the Minister for Children, Young People and Keeping the Promise launched the early child development transformational change programme in order to focus on driving change in children’s earliest years. Nutrition and health are key pillars of that programme. According to the World Health Organization, breastfeeding—alongside the quality of a young child’s diet—sets a trajectory for lifelong health and wellbeing.

Collective efforts across whole systems are needed to deliver on our ambitions to improve child health outcomes. In recent years, Scotland has seen a noticeable and positive shift in the rates of breastfeeding at birth and beyond, both among younger mothers and among those from more deprived areas, whose rates were historically low. We now have our highest recorded rate of breastfeeding at age six to eight weeks, which stands at 47 per cent. That is evidence that breastfeeding inequalities are reducing. That amazing achievement has been driven by the collective efforts of infant feeding teams across our national health service and their third sector partners to focus on what works best. I congratulate everyone involved, especially the mothers themselves.

Thanks to those efforts, alongside our additional investment of £9 million over the past five years, we now know what can and is making the difference that we want to see in Scotland. That investment has had some tangible long-lasting impacts, for example in NHS Ayrshire and Arran, where a peer-support project has been integrated into the local infant feeding offer, and in NHS Lothian, where targeted interventions were tested in one locality with low breastfeeding rates and were then successfully scaled up.

We also continue to invest in our national donor milk bank, which is the only one of its kind in the UK, so that it can innovate, expand and continue to provide a safe supply of breast milk to some of our sickest and smallest babies. I am grateful to those who continue to provide donor breast milk to support that work.

Will the minister take an intervention?

I would like to make progress.

Using human milk as a bridge to breastfeeding means that Scotland is following international best practice. Protecting, promoting and supporting breastfeeding is a fundamental principle of the World Health Organization’s “International Code of Marketing of Breast-milk Substitutes”. The code provides robust and clear direction to all countries on how to achieve that.

I am clear that regulation has, and continues to have, a clear role in protecting all parents from the impacts of inappropriate marketing and the promotion of infant formula. The code also prevents the free distribution of infant formula. It has been shown in many countries, including the UK, that such tactics seriously influence infant feeding choice. We have seen over many years—indeed, decades—how the marketing of infant formula has influenced parents’ choice. The most recent Lancet series on breastfeeding sets out clearly where those influences can cause harm. Those marketing practices undermine parents’ confidence in understanding their babies’ feeding behaviours as part of normal development. They also undermine breastfeeding.

Regulation on marketing—as opposed to alternatives, such as voluntary codes—remains the best way to achieve the desired approach consistently and equitably, and in the best interests of babies. Giving a child the best start in life can be seriously affected by today’s cost of living. We know that many families are struggling with the cost of infant formula, and I welcome the recent interventions to review the marketing of that product and the lowering of price. The cost of infant formula, which is the only other nutrition apart from breast milk that babies can be fed, has in some cases increased by 25 per cent over the past two years.

The Competition and Markets Authority and Glasgow MP Alison Thewliss, among others, have made the case for change. The CMA’s report stated that families could save up to £500 by buying cheaper formula options. I note that the costs of some infant formulas have recently come down, which is welcome, but they were already too high, leading to some families being unable to make formula feeds safely.

All babies should be fed safely and responsibly, and feeding choices should be fully informed, supported and free from harmful commercial influences. That brings me back to my overall ambition to improve the health of babies and young children as a fundamental underpinning of overall population health and a human right. Scotland will be the first UK nation to incorporate the United Nations Convention on the Rights of the Child into domestic law, thereby ensuring that we are a country that respects, protects and fulfils children’s rights. Protecting those rights means thinking differently and acting differently. That should include how we support the choices that women make on how long they want to breastfeed for.

One of the barriers relates to how new mothers are supported to return to the workplace. NHS Scotland has worked with breastfeeding experts to develop its new “Once for Scotland” guideline on breastfeeding and return to work, which was launched in November 2023 and has been welcomed by the sector. Although those rights are already enshrined in law, they are not always acted on in ways that make a difference. That can have an impact on decisions about how long babies are breastfed for, and even whether they are breastfed at all.

We know that, due to the on-going pressures on all families because of the cost of living crisis and the pressure to put the needs of their employers before the needs of their families, some mothers are returning to work earlier than they might otherwise have done, and that is influencing their infant feeding choices. The new NHS Scotland guideline is an exemplar of how employers can act positively to consider the needs of women as mothers first, and to support their breastfeeding goals. I would like all employers to look at the guidelines and focus on the action that they could take to make a difference.

I return to my points about culture and societal norms. Normalising breastfeeding is much harder than it should be. The debate is not about breastfeeding versus formula feeding; it is about gaining a deeper understanding of how infant feeding choices are made and, most importantly, how they should be supported.

However, making a difference takes more than supporting individual choice. It takes action by communities, senior leaders, businesses and organisations to gain the knowledge and understanding to change societal norms and culture around breastfeeding. It is about breastfeeding being visible in areas that pregnant women and new mothers visit regularly. I am pleased that, on my home island of Islay, the bookshop is breastfeeding friendly.

I admit that progress has been made. However, the Royal College of Midwives has said that midwifery is in crisis, due to turnover. In order to improve the culture, does the minister recognise that we need to do something to help our midwives?

It is clear that the Scottish Government recognises that, and that it has helped to increase the number of midwives. Yesterday, I spoke to two in my constituency. It is clear that, to enable mums and families to have the best start, we need to ensure that we have the right number of midwives. Through investment, the Scottish Government has helped to increase those numbers over the past few years.

Hollie McNish’s “Embarrassed”, about her experiences of breastfeeding her baby, is a stark poem, which, it could be argued, calls out some elements of society. I will quote a few lines:

“I spent the first feeding months of her beautiful life
Feeling nervous and awkward and wanting everything right
Surrounded by family ’til I stepped out the house
It took me eight weeks to get the confidence to go into town
Now, the comments around me cut like a knife
As I rush into toilet cubicles feeling nothing like nice
Because I’m giving her milk that’s not in a bottle”.

That powerful poem has made me look at things, and conversations that I have had since reading it have emphasised the powerful words that Hollie used. I recommend that everybody read it.

Scotland should and can do better. That is why, in 2019, we launched our national breastfeeding friendly Scotland scheme. Despite there being laws to support breastfeeding in public—including Scotland’s world-leading legislation on the issue—we still hear too many stories of mothers being stopped from feeding their babies, or feeling uncomfortable in doing so openly.

Will the minister take an intervention?

I am sorry; I must continue.

Seeing other women breastfeeding in communities, and hearing breastfeeding being discussed and promoted as part of a normal life that children experience when they are growing up, will also make a difference. At our recent national breastfeeding celebration event, I announced that, following a successful pilot, the early learning modules of the breastfeeding friendly Scotland scheme had been launched. Those resources will help to embed the normalisation of breastfeeding to our youngest children through play and learning, to support intergenerational behaviour change.

I am fully aware that there is more to do. Bringing all our learning, evidence and practice closer together can make even more of a difference. That is why we will work closely with our stakeholders to set out our route map for the future. There will be a focus on consistency and equity for evidence-based practice and support that is both universal and targeted. That will be developed around the 2018 becoming breastfeeding friendly review, and we will set out progress on those recommendations and the learning from our national improvement programme, which we aim to publish in the spring.

We will also be clear on how we will use data to measure progress over the coming years and how we can continue to share learning and innovation between cross-sector partners.

We know that mums and other new parents welcome and value support from their peers, especially for infant feeding. To better understand the reach and impact of peer support, we will review that across Scotland over the next two years. That process will be informed by new parents who have used such services or tried to access them and by our service providers.

We are clear that we remain committed to the UNICEF UK baby friendly initiative, for which all settings—maternity and community—in Scotland are accredited, and we continue to use those standards as a foundation for continuous improvement. Those standards are built around core aspects of infant feeding care, including skin to skin, the mother-baby bond and helping parents to respond to feeding cues.

Public Health Scotland’s “Off to a Good Start: All you need to know about breastfeeding” and the Parent Club website have great accessible information.

I want breast milk to be seen as the normal nutrition for babies and all new parents to have the information and support that they need to provide safe and responsive infant feeding, and I am determined to make that happen.

I commend the motion to Parliament.

I move,

That the Parliament welcomes that, across Scotland, breastfeeding rates have risen and that inequalities in breastfeeding rates have reduced in the past few years, in line with additional funding provided by the Scottish Government of over £9 million; notes that there continues to be a need for a cross-sectoral approach to support, promote and protect breastfeeding; agrees that mothers’ experiences should be continuously improved and supported through evidence-based practice; recognises that parents should be free to feed their babies where and when they need to, including in public spaces, and be supported to do this through businesses embracing the national Breastfeeding Friendly Scotland scheme; agrees that Scotland should continue to embed the UNICEF UK Baby Friendly Initiative across its maternal, neonatal and community settings, throughout the NHS and core nursing and maternity education curriculum; further agrees that infant feeding services should be recognised as a vital service and integral to optimising infant feeding support across the NHS and its partners; recognises that third sector and voluntary peer support remain pivotal to babies being breastfed in the first few weeks of life and beyond, and agrees that breastfeeding has a role in supporting the economy, and gives all children the best possible start in life.

Members may wish to know that we have a fair amount of time in hand this afternoon and that, if possible, they will receive time back for any interventions.

14:45  

The benefits of breastfeeding are well known, but the difficulties in establishing and sustaining it for mother and baby are not widely recognised. For many new mothers, breastfeeding can feel like an unexpected battle, especially after childbirth. Mothers are overjoyed but on their knees from exhaustion. There can be a poor latch, not enough milk, too much milk, thrush, blocked milk ducts, tongue-tie, mastitis, cluster feeding or infant weight loss. Something that is supposed to be natural can feel like anything but.

A mother shared with me that the problems that she experienced as she tried to breastfeed felt like her

“first failure as a mum”.

Another mum told me that she cried every time feed times came around, as she was told by hospital staff that “Breast is best.” She felt that she was failing when her baby did not latch or feed properly.

I worry that an unintended consequence of promoting and celebrating breastfeeding is that new mothers who cannot or do not want to breastfeed can feel a sense of shame. Policy makers and health practitioners need to be sensitive to that, because feeding a baby means so much more than policy guidance and Government targets.

Most new mothers will require some level of support to successfully establish breastfeeding. That support will often come from midwives, following the baby’s birth. They can advise on attachment and position, and assess the baby for a tongue-tie. However, midwives are increasingly called away from essential time supporting infant feeding to cover acute care.

Community midwives are also very important in supporting maternal and infant physical and mental health in the crucial first days. Postnatal care is often called “the Cinderella service”—something that midwifery services strive to provide but often struggle to deliver because the capacity simply is not in place.

The Royal College of Midwives is clear that midwifery services in Scotland face some real challenges. That is why the Scottish Conservatives’ amendment emphasises the importance of staffing. Demographic and societal changes are putting increasing pressure on workforce demand, and the Scottish National Party Government is failing to step up to the challenge. Meanwhile, the retention of experienced midwifery staff continues to be an issue. Many want to leave the profession altogether because they worry that they cannot deliver the required quality of care.

The figures are striking. Globally, if almost all mothers breastfed, 823,000 infant deaths and 20,000 maternal deaths from breast cancer could be prevented. If Scotland is to realise the ambition to support women with their feeding journeys, it is vital that the resources are in place. Without those resources, the risk is that new mothers will feel the pressure to breastfeed without the interventions to succeed. That will impact not only on breastfeeding rates; it can have a damaging impact on maternal mental health.

Although midwives are a crucial source of support for mothers who want to breastfeed, peer support services have done much to help new mums as they establish breastfeeding, which can take several weeks. Breast buddies Angus is an amazing peer support group that provides weekly support sessions, local WhatsApp group chats, antenatal classes, one-to-one support by text and phone, and a private Facebook group. It provides the targeted support and community spirit that so many mothers miss during the isolation of early motherhood. It is in those initial days and weeks that it helps so much to have someone else say, “Me too” or “That’s completely normal”.

Cara Jamieson is one of the group’s wonderful volunteers who help countless mothers across Forfar, Montrose, Carnoustie, Arbroath, Brechin and Monifeith to navigate their feeding journeys. She says that the support network struggles to secure reliable funding from year to year. Like so many other third sector organisations that work alongside public services, it is desperate for long-term funding to help it to survive.

Cara has also shared her concerns about the centralisation of specialist infant feeding support services in Dundee. A new mum in Montrose who has a baby with a suspected tongue-tie must travel an hour each way to be seen at Ninewells hospital. Mothers who are recovering from caesarean sections must not drive, but accessing such specialist support by public transport takes up to two hours each way. I have regularly raised with the SNP-led Scottish Government the geographical disparities in specialist healthcare services, especially those supporting maternal mental health. Such postcode lotteries can act as a barrier to accessing care. Services must be delivered as locally as possible if we are to ensure that no mum is left behind.

There are other obstacles, too. For babies who require tongue-tie divisions, waiting list times can vary. Even a few days can feel like an eternity for parents whose baby is struggling to feed and is losing weight. Interventions to support feeding in the interim, including cycles of breastfeeding, pumping and combination bottle feeding, can be physically and emotionally exhausting for a mother who is in postpartum recovery.

Scottish Labour’s amendment is right to highlight the massive concern that

“health visits for mothers and babies are being reduced due to staffing pressures”.

That is happening in Angus, in my region, where health officials contacted parents to say that there would be no scheduled reviews between the three-month check-up and when children are aged between 13 and 15 months. There are very real concerns for the wellbeing of babies and families there, who will be left without support for a year.

We must recognise that breastfeeding is usually established in the first month to six weeks after the baby’s birth, so resources need to be available in that crucial window to support mothers who want to try it. So many mums want to persevere, but they find that they just cannot. That is why it is so interesting that, at the time of a health visitor’s first visit, when the baby is around 10 to 14 days of age, fewer than half of babies—37 per cent—were exclusively breastfed.

The drop-off rate for some mums can stem from embarrassment or anxiety about feeding in public. I share the aspiration that feeding should become normalised so that no one is worried about being judged. One mum shared with me that she was so nervous about feeding her baby in public that she sat on the floor of a nearby women’s toilet—another reason, I add, why preserving women’s spaces is so important.

Important, too, is the language used by health practitioners and by wider society. Women are not “chest feeders”—a term that I note has been incorporated into the NHS’s own guidance for managers and employees on breastfeeding in the workplace. That is wrong.

Breastfeeding can contribute to a beautiful bond between mother and baby. Its health and economic benefits are proven, but breastfeeding can be difficult, painful and exhausting. Pregnant women and new mums need to know that they are not alone, that it is not always a smooth journey and that support is in place to help them to navigate it. It is also important that we support midwives. The Scottish Government must ensure that support continues and that it meets the rising complexities in care and increased levels of demand.

I invite Ms White to move her amendment.

I move amendment S6M-11935.2, to insert at end:

“; recognises the benefits of breastfeeding to both the child and the mother, as well as the challenges that mothers can face as they try to establish breastfeeding, and acknowledges the importance of ensuring that midwifery is sufficiently staffed to support postnatal care and infant feeding as well as acute care.”

14:54  

I have a personal interest in this important topic, having many years ago trained as a dietician and met many mothers and babies over the years. It is also an area that Labour members before me have championed, and I cannot speak about breastfeeding in the Scottish Parliament without mentioning the world-leading legislation that was introduced to the Parliament by my friend Elaine Smith. The Breastfeeding etc (Scotland) Act 2005 makes it illegal to stop a mother feeding her baby under the age of two by breastfeeding or bottle feeding in premises where the public have general access. I am absolutely sure that that legislation has contributed to the improved rates of breastfeeding that are mentioned in the Government motion.

I start in agreement with the Government—I emphasise that Scottish Labour fully supports its initiatives to improve breastfeeding rates in Scotland, and I agree that closing the inequalities gap is paramount. Breastfeeding plays a big part in improving health over an entire life. I will take the intervention from Rachael Hamilton.

My intervention is about the breastfeeding act that Carol Mochan mentions. I breastfed three children but never in my time saw anyone use that act to protect their breastfeeding of their child under two. Is it time for us to have an awareness campaign to make sure that women are aware of the act? It has disappeared, in a sense.

Carol Mochan, I can give you the time back.

Thank you very much for that intervention. It is a very good point—time passes and we perhaps forget some of the legislation that has been passed when we could be making sure that people in our communities are aware of it. Funnily enough, I was at a women’s group earlier today over lunchtime, and I spoke about the 2005 act and how we make legislation work for people in their communities, so that intervention is relevant to me today.

To go back to speaking in general terms, children get one chance at childhood, and it is incumbent on us all, whether we are family members, members of the public or politicians, to do what we can to get it right for every child. From when a child is born, we should ensure that they have the chance to flourish and improve their health and wellbeing over their entire life—I think that all members agree that we should encourage that. At that wonderful moment, we also have the chance to improve the life of the mother. The long-term health benefits of breastfeeding are well documented. It is an amazing opportunity, and the Government must ensure that its approach to breastfeeding champions that fact.

It is clear that improving breastfeeding rates in Scotland would help to improve the health of babies and mothers and reduce inequalities in health, which is why this is such an important debate. Because there is such strong evidence that breastfeeding benefits both mother and baby, there is great value in the Government committing to invest in policies that support and promote it.

Public Health Scotland is clear that breastfeeding provides the best nutrition for babies and young children and supports children’s health in the short and long term. We have heard that breastfeeding reduces children’s risk of gut, chest and ear infection and leads to small but significant improvement in brain development. Breastfeeding benefits mothers’ health, with strong evidence that it reduces the risk of breast and ovarian cancer and some evidence that it may also promote maternal health and healthy weight and reduce the risk of type 2 diabetes.

The benefits of breastfeeding for both baby and mother are recognised across the world, and it is important to note that that includes high-income countries such as Scotland. At times, that can be questioned. It is perhaps easier to understand the benefits in less developed countries, but western society can overlook the fact that there are clear benefits. UNICEF UK is absolutely clear that increasing the number of babies who are breastfed could cut the incidence of common childhood illnesses, which would not only benefit that individual but could, it estimates, save the NHS across the UK up to £50 million each year. It is interesting that breastfeeding rates in comparable western countries, with similar population sizes and demographics, show that it is possible to dramatically increase rates with political will and a supportive breastfeeding culture. That means that continued investment and commitment from the Government is entirely sensible.

Comparing results can be difficult as many nations across Europe gather details in slightly different ways, but analysing the approach that is taken in countries with positive changes in rates helps to establish what can be done to introduce breastfeeding friendly initiatives. Over the past decade, UNICEF UK has complimented Scotland on its work in this area, highlighting marked improvements in breastfeeding rates, and particularly the rise in breastfeeding at six months—one of the studies that I looked at showed a rise from 32 per cent in 2010 to 43 per cent in 2017. Those results highlight the positive impact of national infant feeding strategies across Scotland, including supporting maternity and community services in Scotland to achieve baby-friendly accreditation—I will come back to that later in my remarks.

The latest figures show that two out of three—66 per cent—of babies born in Scotland in 2022-23 were breastfed for at least some time after birth, while 37 per cent were being breastfed at 10 to 14 days. However, it is thought that the increase in that figure was mainly due to mixed breast and formula feeding.

Although all improvements are welcome, we need to acknowledge that progress is slow and merits strong scrutiny from the Government to ensure that it is committed to on-going improvement. We also need to make sure that the data is easily accessible and user friendly. It is not easy to find like-for-like figures, but such information would be helpful when we are trying to support such initiatives and work constructively with the Government on the issue.

Current guidance recommends that babies should receive just breast milk for the first six months—we have heard that sometimes we are not very good at achieving that—and that solid foods should be introduced after that but that children should continue to be breastfed up until their second birthday or for as long as the mother and baby wish. In Scotland, we have some of the lowest breastfeeding rates in the world and we know that many women are stopping breastfeeding before they want to. We have a responsibility to make sure that that does not happen. As legislators, we must ensure that women have a real choice to breastfeed should they wish to do so.

As I have mentioned before, there is good evidence that interventions can work to improve breastfeeding rates. That is why Scottish Labour lodged its amendment today: to highlight the need to ensure that women have all the levers in place to support breastfeeding. Health visitor services are key to that. We are hopeful that the Government will see the amendment in the way in which it is intended: to nudge it to make commitments to support vital health visitor services across Scotland. Scottish Labour is concerned by reports that health visits for mothers and babies are being reduced due to staffing pressures. The amendment calls on the Scottish Government to guarantee that families are able to fully access the service.

I spoke to several women in preparation for today’s debate and every single woman mentioned to me that there was strong support in the hospital but an absence of support once they got home. If we want to support women to breastfeed—particularly to exclusively breastfeed—we need to have longer-term support, which is something that health visiting guarantees. I acknowledge that a more comprehensive approach is needed, as mentioned by the minister and Tess White. If we do not accept that, in reality, there are funding restraints and that sectors such as the NHS and the third sector are being stripped of funds, we are not doing the debate justice. To make such initiatives work, we need to have in place good training and provision for our health service workers and longer-term funding for the third sector.

I am conscious of time, so I will close by reiterating Scottish Labour’s support for a real choice for mothers to breastfeed. We support the legislation that is in place in Scotland and the schemes that are aimed at ensuring that breastfeeding is embedded in our communities and businesses across Scotland. We hope that the Scottish Government will address the issues that are raised in today’s debate to make breastfeeding a reality for all the mothers and babies who wish to breastfeed and would benefit greatly from it.

I move amendment S6M-11935.1, to insert at end:

“; is concerned by reports that health visits for mothers and babies are being reduced due to staffing pressures, and calls on the Scottish Government to guarantee that every family is able to fully access the Universal Health Visiting Pathway, which consists of 11 home visits to all families, including eight within the first year of life and three Child Health Reviews between 13 months and four to five years.”

15:04  

I am grateful for the opportunity to speak for the Liberal Democrats in this important debate, and I thank Jenny Minto for securing chamber time for it.

We have come a long way in this country in terms of our approach to breastfeeding, which was laid out in the Breastfeeding etc (Scotland) Act 2005. That legislation represented a step change in our attitudes and society’s attitudes to breastfeeding, which until then was still shrouded in stigma and was, at times, regressive.

Even after that legislation was passed, I came up against that stigma personally, when my wife and I went to a bar with our newborn son, Finn, some 15 years ago—a couple of years after the 2005 act was passed, or a little bit later. We were going to have some food with friends, so we rang up the bar and asked whether it was okay to bring a child in, and it said that children were welcome until 8.30. That was until Gill started to breastfeed Finn. We were made so uncomfortable that a member of staff suggested that the advice that we had been given was wrong and that we had to leave. We phoned the bar again later and were advised that there was nothing wrong with the advice that had been given originally. We could see that we had just made waiting staff feel uncomfortable.

Breastfeeding has an important role to play in children’s health outcomes. We know, for instance, that it helps to protect children from a range of infections and illnesses such as asthma, diabetes, obesity and heart disease. We also know that it has a role to play in protecting mothers from ovarian cancer and breast cancer. There are, of course, all the added financial advantages to families, who can save on the cost of formula.

We should be proud of the distance that we have travelled in this country. It is a point of pride that we were the first country to legally protect breastfeeding in that legislation back in 2005. It was taken through Parliament by Elaine Smith of Labour and backed by Liberal Democrat-Labour coalition votes. The 2005 act made it a criminal offence to deliberately prevent someone from or stop them feeding a child under the age of two in a public place in Scotland.

Although we have come that distance, there is still work to be done to ensure that every mother has the support that they need to make the best and most informed choice for themselves and their baby. A recent infant feeding survey found that 65 per cent of babies born in Scotland were breastfed for at least some time after birth, and that 46 per cent of babies are still being breastfed after the six-to-eight-week mark.

What is notable about that survey is that mothers living in more affluent areas are more likely to breastfeed than those in deprived areas. That is a health inequality. We can see that there is also a disparity when we look at how health boards are performing in supporting mothers to breastfeed. Government must give health boards the support that they need to close the gaps, with a particular emphasis on those less-affluent areas. We cannot have a postcode lottery when it comes to giving children the best start in life.

It is also important to say that the decision whether to breastfeed is always solely the mother’s. Women must be given all the information about the benefits of breastfeeding and be provided with all the advice and in-person support, if needed, to help them to breastfeed, if they so choose. However, that support must always be support—never pressure.

Having a child is a life-changing event. For many people, sadly, that change is not as straightforward as they had assumed it might be or as we would wish it to be for them. The postpartum period is a very vulnerable time for new mothers, and some women find it more challenging than others to feed their baby. Breastfeeding can also become more difficult because of infection or mastitis. It is therefore vital that, when we talk about the benefits of breastfeeding, we do so in a way that does not stigmatise any mother who is unable to breastfeed or chooses not to.

There are cultural aspects to breastfeeding as well.

It is vital that any mother who struggles with postnatal depression is given all the support and care that they need to cope. It is deeply concerning that only 14 per cent of Scottish health boards met a UK-wide standard that was devised by the Royal College of Psychiatrists for specialist perinatal mental health support. That is an issue that I have raised in the chamber before.

Scottish Liberal Democrats were proud to be the first party in this Parliament to set out a comprehensive and dedicated strategy for improving the detection and treatment of maternal mental health issues to bolster our perinatal mental health offer, and it was gratifying when the Government adopted much of that blueprint. However, despite the good work that has been done in that area and the good progress that has been made, there sadly continues to be a postcode lottery for perinatal mental health services in Scotland. Women across Scotland cannot afford the Government resting on its laurels on the issue.

Protecting mothers and giving newborn babies the best possible start in life has to be an absolute priority for everyone in the chamber—not just the Government, but the entire Parliament.

We move to the open debate.

15:10  

I am delighted to speak in today’s Scottish Government debate on celebrating and supporting breastfeeding. Breast milk is the perfect source of nutrition for babies, and I am lucky enough to have fed three babies. We will hear much about the health benefits.

In the middle ages, breast milk was deemed to possess magical qualities, and that was not far from the truth. The motion is right to welcome the rise in Scotland’s breastfeeding rates, the Scottish Government’s targeted investment of £9 million and the support from infant feeding teams and family nurse partnerships, which is beginning to address the stark inequalities that exist for some groups. However, we need much more than that—we need a radical shift in thinking and actions.

Ambition is key and, for the long term, we should aim to double the current breastfeeding rate so that 94 per cent instead of 47 per cent of babies are breastfeeding at six to eight weeks old. We should look for creative ways to inspire many more young women to successfully nurture their babies for the first six months of life with breast milk only, as is recommended by the World Health Organization. We must do more to tackle social attitudes towards breastfeeding mums of all ages, in the recognition that women’s breasts are first and foremost for nurturing children.

That is a huge challenge, but it should absolutely be our ambition, because breastfeeding rates in other countries demonstrate that achieving that is entirely possible, as we have heard. The Scottish Government has a commendable history of investing in children’s wellbeing—from the Scottish child payment to prenatal care and the 1,140 hours of early years education. The baby box initiative is also noteworthy, and I hope to hear, from the minister, more detail about its role in normalising breastfeeding.

I note with interest the member’s reference to the baby box. What is in it to support women to breastfeed?

I hope to hear the detail on that. I asked a parliamentary question about that and the minister confirmed the position.

Not too long ago, most of our grannies embraced breastfeeding but—sadly—the huge surge in popularity of modern formula brought a significant shift in infant feeding practices. The decline in breastfeeding resulted in a profound loss of knowledge that had previously been shared across families and communities, and the network of support that so many mothers relied on for breastfeeding success disappeared in a short time. I acknowledge the role of artificial formula milk, but it should not be normalised as a convenient like-for-like alternative to breastfeeding, because it is not.

Beyond the well-established nutritional and physical health benefits of breastfeeding, a growing body of research highlights its far-reaching psychological effects—for example, breast milk stimulates cognitive, social and emotional brain development in our babies and children, and those advantages last a lifetime. The benefits are not confined to our children; breastfeeding mothers often report lower levels of anxiety and stress, and clinical evidence backs that.

Breastfeeding has qualities that make it really magical. The very first feed after birth is rightly hailed as a baby’s first vaccination—it is an injection of immunisation from the mum. When a mum or child is sick, breast milk adapts to provide specific antibodies to combat the illness. Morning breast milk has increased cortisol, so that it acts like an energy drink to wake up a child and, in the evening, melatonin rises and acts as a sleeping potion, which helps to develop a baby’s circadian rhythm. Best of all, when mums breastfeed, the love hormone oxytocin is released, which induces a strong sense of love, calm and connectedness between mums and babies.

I know from my work as a breastfeeding peer-support volunteer that many mums look forward to making the magical breastfeeding connection with their baby. Although a tiny number of mums cannot physically breastfeed, many mums feel as if they fail.

Most often, that stems from a lack of intensive support in the crucial early hours, days and weeks post birth. However, until we rebuild our multigenerational network of family and community knowledge, mums will still require the assistance of health professionals and volunteers to overcome challenges such as low milk supply, mastitis and latching issues.

I commend Stephanie Callaghan for her work on breastfeeding. I want to mention my experience in relation to health visitors. My daughter has not had all of her health visits. The health visiting service is so understaffed that it is unable to fulfil all the milestones in a baby’s journey. Does the member find that concerning? What can we do to encourage more people to become health visitors, to ensure that we have the support in place to help mums to breastfeed?

I can give you the time back for that intervention, Stephanie Callaghan.

I think that that is a little bit off topic, but we definitely need to work really hard to do that.

Not every mum will succeed at breastfeeding, but there is no need for guilt, because our best will always be good enough. Social acceptance also has a key role to play, and mums need to feel that it is okay to feed their baby wherever and whenever they are hungry. I urge employers to play their part by joining the breastfeeding friendly Scotland scheme. It is quick and easy to become a supportive space for breastfeeding mums.

Breastfeeding groups are vital, too. They provide a safe environment where mums can observe others feed and swap tips on suitable clothes for covering up during feeding. Let us face it: no mum wants their post-pregnancy belly on show. Witnessing the progress of mums who were struggling to feed one week but thriving the next is a big boost to confidence, and sharing challenges honestly with volunteers or other mums can sometimes be easier than doing so with busy health professionals.

Presiding Officer, I could talk about breastfeeding all day. Much of my passion comes from personal experience, but it is also to do with the mountains of irrefutable evidence showing that breastfeeding gives our babies and children the very best start in life. That is certainly worth celebrating and supporting.

I will finish with Keith Hansen’s words in his contribution to The Lancet breastfeeding series, which encapsulate the extensive health, nutritional and emotional benefits that breastfeeding provides to children, mothers and wider society. He said:

“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

Thank you very much, Ms Callaghan. I remind members that we have a bit of time in hand, so anyone taking interventions should get the time back.

15:17  

Today’s debate focuses on the important topic of breastfeeding. Colleagues from all parties have recognised its importance in their speeches and have been sharing their vital personal experiences; indeed, we have just heard a very good speech in that regard. I, too, want talk about my personal experience, as bringing life into the world is one of the greatest experiences and joys, and I feel very lucky to have done so. It is a very exciting time but, as others have recognised, it can bring a whole host of challenges for many mothers, including breastfeeding.

As I said earlier, I breastfed my three children. It had its ups and downs: I lurched from euphoria to exasperation; I put a lot of pressure on myself and felt judged; and I felt the stigma of feeding in public, as some members have described. I worried all the time that my baby was hungry—I worried, too, that they had had too much.

I had mastitis, and very large refrigerated cabbage leaves became my best friends. I felt very awkward—[Interruption.] The Presiding Officer does not understand that, ladies—he is frowning. Presiding Officer, you buy a giant cabbage and put it in the fridge. Once it is cold, you peel off the leaves one by one and then you—well, I will leave it to your imagination what you do with those leaves next.

I struggled with learning the basic skill of breastfeeding and latching on. Some midwives and health visitors were helpful—some were not. Some of us have slightly forgotten to talk about the mother’s health today, but the fact is that, to succeed at breastfeeding, mothers must also look after themselves nutritionally and emotionally. They must be able to get plenty of rest, but that is sometimes not the reality.

By the time that I had cracked breastfeeding—and there were a lot of cracks—I had to return to work. Members will never believe this, but I went back to work when my eldest was 12 weeks old and my middle daughter 14 weeks old, so by the time that I had got to grips—

Will the member take an intervention?

Yes.

I am grateful to Rachael Hamilton for taking my intervention, and I am loth to interrupt her speech, which I am enjoying very much, as it is bringing back a degree of nostalgia about my early days of parenthood. I recall being taught to help my wife to achieve the latch that the member describes. Does she recognise that fathers can be part of the breastfeeding journey and can support their wives in more than just moral ways, but sometimes in technical ways, too?

I totally agree that paternal support has to be recognised and can be encouraged. Awareness of that will, I hope, filter out of the chamber today. My husband was not helpful in that regard, but he was very good at making a nice cup of tea at about five in the morning.

As I said, my eldest daughter was 12 weeks old when I went back to work and my middle daughter was 14 weeks. I am digressing slightly here, but I could not believe it when, after requesting part-time hours, I was told that I was not allowed to have them because, if I had that, the men in the organisation, who represented about 95 per cent of the staff, would also have to have part-time hours. As far as I remember, I did not notice any of my male colleagues breastfeeding at the time. Thankfully, the Government has updated employment conditions for maternity leave and has improved flexibility, which is really important when it comes to the health aspect for women who are bringing up children and breastfeeding.

A few days after giving birth to my third daughter, I became really unwell. Eventually, after six weeks, I was diagnosed with a very painful condition called rheumatoid arthritis, which I have talked about in the chamber before. It meant that I had to get help from my parents. I had to move in with them, and they had to help me pick up Willa so that she was in the position for breastfeeding as well as help with all the other things that go along with having a newborn.

Preparing for this speech reminded me of that experience. When I thought about it, I saw that the challenges that I faced were perhaps similar to the challenges of being a single mother, having a disability, having other illnesses, having a caesarean with no help at all or having twins or triplets. In those situations, it is almost impossible to look after yourself without support or to eat and sleep well and, therefore, it is impossible to give breastfeeding your best go.

Why did I choose breastfeeding? It was possibly for the same reasons that others chose it, but a question remains as to why one in three babies in Scotland are not breastfed at all, despite its being free and convenient, which was attractive to me, and despite its having huge health benefits, as my colleagues have mentioned. There is a vast disparity between breastfeeding rates in the most affluent areas and those in the most deprived.

The minister mentioned that breastfeeding rates have been climbing in Scotland, but it is vital to understand why they are not higher. The levers that we have to change that where possible are important, and I hope that the minister will take away action points on that from today’s debate. We need to ask what is preventing women from breastfeeding, other than the basic things that I have highlighted. We should also note that, for many women, it is difficult—it is an emotionally taxing experience and, as has been highlighted, it is not easy for everyone.

My experiences of midwives and health visitors were mixed but, of course, most of them work round the clock and are fantastic. They are supportive and do an incredible job, and their support, advice and encouragement can make all the difference. The minister will recognise, and will be the first to admit, that there is more work to be done, but it is the grass-roots organisations that are pulling out the stops to support women with breastfeeding.

Yesterday, I visited the charity Berwickshire Swap at its industrial unit in Eyemouth. The team, which is led by Lianne Drummond, runs a sustainable children’s clothes swapping service across the Borders and responds to families in need with emergency clothing parcels. The organiser, Lianne, told me that, at all the swap events, there is a quiet area where women can breastfeed, which is fantastic. It also helps address the issue of social isolation, and the women can chat with one another about some of the problems and issues that they might have. Of course, breastfeeding is a very natural thing to do, so why should they not do it?

Breastfeeding in the Borders, which has 30 volunteers, is another incredibly important support service. When I tried to intervene on the minister, I was going to make the point that, as well as the paid individuals whom she highlighted in her speech, there are people who provide support off their own bat. There are many such people across all our constituencies and regions, and we should give them credit.

Yesterday, Julie from the breastfeeding in the Borders service told me that, in 2022, it helped 344 women through one-to-one support, which is fantastic. Indeed, local mums have said that

“It’s such a valuable resource ... You are amazing, keep doing what you are doing”

and that it is an

“Incredibly supportive service”,

so well done to Julie and the breastfeeding in the Borders service.

As others have said, we clearly need more public acceptance of breastfeeding. In the 2017 Scottish maternal and infant nutrition survey, nearly a quarter of women said that they felt uncomfortable about breastfeeding in public.

Do you want me to close, Presiding Officer?

Yes, I think that you need to conclude.

We all know the benefits of breastfeeding, so it is vital that not just women and mothers but everybody celebrates and supports breastfeeding in Scotland.

Thank you, Ms Hamilton, particularly for the personal tutorial elements of your contribution.

15:26  

I am having flashbacks to smells of sour milk and cabbage, so I thank Rachael Hamilton for that.

I am delighted to take part in this debate on a subject that is very close to my heart—no pun intended. Today, I am, of course, speaking as an MSP, but I am also speaking as a mother who breastfed six children in very different circumstances. Each experience was unique. Although I loved it, it was sometimes fraught with significant—and painful—challenges.

Before I begin, I emphasise that I have the utmost respect for the varied choices and circumstances of all parents. Some face medical, physical or personal issues that make breastfeeding difficult or impossible. It is vital to remember that the ultimate goal is the child’s health and wellbeing; we must all embrace the “fed is best” principle. What matters most is that children are nourished, loved and cared for, whether through breastfeeding, formula feeding or a combination of both. In Scotland, we must strive to create an inclusive society in which everyone feels supported, irrespective of feeding choices.

In reflecting on my own journey, I cannot help but recognise how different each experience of postpartum motherhood was for me, particularly my first time as a mother, aged 16, in 1991, and my last, at the age of 36, in 2011. The societal landscape around breastfeeding and maternal support underwent a significant transformation over those two decades, but so did I, as an individual.

Navigating the challenges of breastfeeding as a young mother, aged 16, was daunting. The support and messaging around breastfeeding were different then, and advocating for myself, as a young person, in the face of those challenges was not always easy. I was more vulnerable, less informed and heavily reliant on the support systems around me. That is the reality for many first-time mothers, especially those in non-supportive environments, so the role of professional support in those formative stages cannot be overstated.

That experience starkly contrasted with my journey at age 36, when I found myself being more confident and assertive. The societal messaging around breastfeeding had evolved, and so had the support structures. More important, I had evolved, too. I was better equipped both emotionally and intellectually to advocate for my needs and those of my child.

The needs of each of my children were different, and my body responded differently each time. From feeding for three months to doing so for as long as two years with another of my children, what stood out was the incredible support that I received from midwives, health visitors and those in my circle.

After feeding your baby for three months, did you find it a bit of a nightmare to have to wash and sterilise bottles, heat up milk and mix bottles? I certainly found that incredibly difficult and, had I realised that, I would never have given up breastfeeding.

Speak through the chair, please.

I will go on to talk about why it ended a bit early, but one of the perks of breastfeeding is its convenience and, particularly, the cost.

The guidance, encouragement and expertise that I got from the professionals and my circle around me were vital, as they helped me not only to feed but to believe in my ability to nourish and nurture. That is vital, because I can attest to the fact that, unfortunately, the negative perceptions and a lack of understanding from those around me at one time in my life, coupled with my vulnerable postpartum state, led to a premature end to one of my breastfeeding journeys. I was disappointed with that, but it just shows how far support can take us.

Such contrasts and experiences highlight an essential aspect of our discussion: the varied needs of mothers at different stages of their lives. They underscore the importance of tailored support and recognising that a one-size-fits-all approach does not suffice. After all, every mother’s journey is unique, and our support systems must be flexible and responsive to those varying needs.

As we delve deeper into the subject of breastfeeding in Scotland, it is crucial to acknowledge and celebrate the Scottish Government’s commendable efforts and achievements in this policy area. The Scottish Government has not only recognised the importance of breastfeeding but taken concrete action to support it across the nation.

One of the most notable achievements is the significant investment of more than £9 million in breastfeeding initiatives. The Scottish Government has shown a strong commitment to enhancing breastfeeding support services. That funding has been instrumental in increasing breastfeeding rates and reducing inequalities in breastfeeding across Scotland, and it reflects a dedicated effort to ensure that all children, regardless of their background, have the best start in life.

Furthermore, the Government’s endorsement of the UNICEF UK baby friendly initiative and its integration of that initiative in maternal, neonatal and community settings have been game changing. By embedding that initiative in the NHS and in core nursing and maternity education curricula, Scotland has taken a comprehensive approach to improving the quality of care for mothers and babies. The initiative not only promotes breastfeeding but supports mothers in developing a strong bond with their babies, which is crucial for the overall wellbeing of mother and child.

In addition to those initiatives, the Scottish Government has actively worked towards creating a supportive environment for breastfeeding mothers in public spaces. The national breastfeeding friendly Scotland scheme, which encourages businesses and public spaces to welcome and support breastfeeding mothers, is testament to that effort. The initiative is a significant step in normalising breastfeeding in public and making society more inclusive and supportive of mothers’ choices.

Members should note that, although supporting breastfeeding in public is vital, calling for rooms where breastfeeding can be done in private adds to a mother’s choice. Last night, I asked my daughter, my first child, whom I had the honour and joy of seeing breastfeeding my two granddaughters—her two children—for her thoughts on the debate. She said that, ultimately, it was about support and choice. Although it is great to encourage breastfeeding in public, many women want to feed completely topless. Some have fussy feeders who wriggle and roll around and make a mess, which they find quite difficult to navigate in a public setting. Therefore, they prefer a private place, so it is essential to have that option.

I express my gratitude to the Scottish Government for its support and commitment to breastfeeding, because I know how important it is. Those efforts have not only made a significant difference to the lives of countless mothers and children but positioned Scotland as a leader in promoting and supporting breastfeeding.

15:34  

I am grateful for the opportunity to speak in the debate. Breastfeeding can be an emotive subject. Although we are celebrating the benefits and importance of encouraging breastfeeding, we recognise that every child’s feeding journey is different. A number of factors will impact on a decision or the ability to breastfeed. Our role as parliamentarians and policy makers is to ensure that those who want to breastfeed are supported as well as they can be.

The decision to exclusively breastfeed, to mix feed or to formula feed is not one that we should question on an individual basis, but we must provide a supportive, encouraging and enabling environment for every woman who wants to breastfeed. We should ensure that every public space is a welcoming environment. Elaine Smith’s member’s bill, which has been highlighted this afternoon, gave women the right to breastfeed in public spaces without challenge. It was a groundbreaking piece of legislation that challenged public attitudes and provided protection for breastfeeding women, but we can do more to ensure that the environment is supportive.

Although we welcome the overall increase in breastfeeding rates and recognise the related health benefits for children and mothers, we must note that breastfeeding rates in Scotland and the UK are comparatively low. In recent years, positive steps have been taken to address public attitudes and in the provision of information and support, but we can do more to address the differences in rates that persist across age, location, ethnicity and socioeconomic background.

There are strong generational and peer group pressures on mothers when they are making decisions about how to feed their baby. The PHS report on infant feeding statistics from November last year shows an increase in breastfeeding among younger age groups, which is really positive, yet the gradient across age groups persists. In 2022-23, mothers aged over 40 were more than three times more likely to breastfeed than mothers aged under 20. Babies born to mothers in more affluent areas are still much more likely to be breastfed than those who are born in the most deprived areas.

We need to ensure that expectant mothers have access to the information and help that they need to make a decision on breastfeeding. We need support groups to be available in familiar community settings, and we need better co-ordinated and comprehensive provision that is clearly communicated from an early stage.

A finding from the UNICEF report “Implementing the Becoming Breastfeeding Friendly initiative in Scotland” was that breastfeeding needs to be improved. The third sector and voluntary organisations play a vital role in that area, but it is the role of health professionals to signpost and support women. We cannot wait until mothers are struggling to breastfeed before we let them know what help is available to them. Being a new parent can be exceptionally difficult, and, although feeding is a personal journey, it is not one in which mothers should ever be left feeling alone or unsupported.

We have seen an increase in rates across all health boards since 2012-13, but geographical inequalities have also increased during that time. Those rates are impacted by a range of factors including age, level of deprivation and ethnic diversity, as well as attitudes in the local community, but they highlight the importance of delivering local support that recognises those factors. NHS Fife’s annual report on children and young people for 2023 shows that, although the rate of breastfeeding at the six-week to eight-week mark increased in the past 10 years to 41.9 per cent, it is still below the overall rate for Scotland, and there continues to be a sharp drop in the number of women who start breastfeeding compared to the number who continue to do so at six to eight weeks.

I am keen to hear more from the minister about how more localised and targeted steps could be taken to focus support on areas where rates remain low and to reduce the number of women who stop breastfeeding earlier than they might wish to. If we are to get any closer to the WHO’s recommendations for exclusive breastfeeding until six months, we must not only increase the initial rate but address the drop-off, and that needs to begin as early as possible. Research has also shown that decisions about infant feeding tend to be made prior to pregnancy or in the first trimester, which underlines the importance of public information on attitudes and the impact that that has on those decisions.

Support for feeding must be provided for at the stage of home visits for newborns. Scottish Labour has called for a home visit by a breastfeeding support worker within the first week that a baby spends at home, as well as further consultation to ensure that their needs are met. Our amendment today highlights reports of visits being reduced as a result of staffing pressures, which will be covered by other colleagues in their contributions, but we have to ensure that all families can access the health visiting pathway.

Although the Government’s motion highlights a role for breastfeeding in supporting the economy, the Scottish Parliament information centre’s briefing notes the additional cost of formula feed. However, we also need to recognise that there are economic challenges related to breastfeeding. An article that was published in the US last year, titled “No such thing as a free lunch”, looked at the direct marginal costs of breastfeeding, including equipment, modified nutritional intake and time opportunity for breastfeeding mothers. A breastfeeding mother needs to be a well-nourished mother. She also needs access to simple things such as bras and clothing that enable breastfeeding, which can be out of reach for some mothers.

It found that breastfeeding for a year could cost significantly more than a year’s supply of formula. The time opportunity cost for breastfeeding for three to four hours per day might be prohibitively high, particularly for those on a lower income or with other caring responsibilities. That needs to be part of our approach to ensuring that breastfeeding remains a viable option for those who wish to do it.

Although we are focused today on the importance of encouraging and celebrating breastfeeding, I will briefly touch on increasing costs related to formula feeding and the related risk to the health and safety of babies. I recognise that the minister has raised that.

There are a number of reasons why mothers—including mothers who breastfeed or have breastfed—choose formula milk. We must ensure that there is an affordable and consistent supply of infant formula. The UK Government has a role in strengthening the law around marketing, and both of our Governments must ensure that the level of support that is provided through schemes such as best start keeps pace with inflation and increasing costs, so that infant formulas are affordable within the allowance. In times of financial difficulty, babies being fed infant formula can be increasingly vulnerable, and it is vital that services work to ensure that timely and sensitive support is provided.

Will Claire Baker take an intervention?

I am about to close, but I will take Meghan Gallacher’s question.

Does Claire Baker welcome the recent efforts by some supermarkets to lower the price of formula to make it more affordable for families who are experiencing a tough time just now because of the cost of living crisis?

I very much do, although such efforts are a bit overdue and there are still families who cannot afford to purchase. Last week, in Lochgelly, I visited the big hoose Fife project, which has a partnership with Amazon. One of the biggest supply demands that it has is for infant formula and infant and baby essentials.

Encouraging and supporting breastfeeding is an important public health activity and one that we must continue to work at. There is much more that we can do to ensure that support is available more readily, more locally and at an earlier stage. By delivering that alongside making improvements in public attitudes, creating feeding-friendly places and having supportive employment practices, we can create an environment that helps more women to begin and continue their breastfeeding journey with their baby.

15:41  

Approximately 20 years ago, a younger me, as a trainee social worker, attended a parents group setting with my then practice teacher. When I returned from the session, I was apologised to for the fact that one of the mothers had been breastfeeding during it. If I am absolutely honest, I had not even noticed, but I started to reflect on that experience—the fact that I can still remember it now probably tells you something. In my early 20s, I had not even thought of breastfeeding as a thing, which is probably why I had not noticed it. However, why had I also been apologised to for its potentially making me feel uncomfortable? It is clear that, at least at that time, there was still stigma and breastfeeding was more likely to take place in non-public settings.

As the Government’s motion states, we must celebrate progress where it happens. This afternoon’s topic of debate is an opportunity to celebrate and continue to support the positive trends in breastfeeding rates across Scotland. It is important that, like Carol Mochan, Claire Baker and other members, I pay tribute to my former colleague and constituency predecessor Elaine Smith for her great work in this area.

Breastfeeding is a multifaceted topic that touches on issues such as health and wellbeing, public education and poverty and inequalities in Scotland today. Breastfeeding is undoubtedly the best method of ensuring that newborns are nourished and providing the healthiest foundation for a child’s short-term and long-term wellbeing. The NHS currently recommends that babies should be exclusively breastfed for the first 26 weeks of their lives.

Studies indicate that breastfeeding helps to reduce a baby’s risk of infections, diarrhoea and vomiting, obesity and even cardiovascular disease in adulthood. Likewise, for mothers, there is increasing evidence that breastfeeding can lower the risk of various diseases. For those reasons, it is self-evident that improving breastfeeding rates in Scotland would improve the health of babies and their mothers, which would, in turn, reduce health inequalities.

The data is promising, as other members have said. Just over 20 years ago—probably around the time that I just talked about—44 per cent of babies were being breastfed by the time that they were 14 days old. That figure increased to 53 per cent in 2019, and the most recent post-pandemic figures show the rate to be 57 per cent. By the time that babies are six to eight weeks old, the figure stands at 47 per cent. Although those stats are encouraging—they are the highest figures on record—more can be done to continue the upward trend.

I fully support the Scottish Government’s decision to invest more than £9 million of funding to support breastfeeding since 2018. The funding has helped to provide sustainability for the protection, promotion and support of breastfeeding in Scotland. However, as we have heard today, the Scottish Government cannot work in a vacuum but relies on the knowledgeable and valued experience of the healthcare practitioners, third sector groups and peer support bodies that help to identify on-going issues and best practice to increase those rates.

I am reflecting on my own experience as a dad and the experience of partners in general. We have heard the testimony of Karen Adam and others. Where there is a partner, partners must be educated about the stress, tension, expectations, judgment, stigma and everything else that goes with being a new mum and that we might never know. Active partners very quickly see the consequences of those things. My partner and I were fortunate to attend a National Childbirth Trust antenatal class along with other couples. An active role for fathers and all partners ahead of birth and in the weeks afterwards is vital in giving the support that mums deserve and merit.

I can give you the time back, Mr MacGregor.

I could not agree more. The member knows that the cross-party group on shared parenting often looks at such issues, and I know that he is very active in that group.

It is the goal of the Scottish Parliament and, I hope, of all parties in the chamber—I have not heard anything today to suggest otherwise—that Scotland should be a breastfeeding-friendly place for all. Although the trends are positive, the data shows inequalities that must be a focus for future support. Breastfeeding rates are highest among older mothers from less deprived areas, so we must encourage higher rates of breastfeeding from younger mothers in the most deprived areas.

I give particular credit to the infant feeding teams across our health boards, whose diligent work ensures that mothers are offered the help with positioning and attachment for breastfeeding that empowers them with the confidence to breastfeed. Stephanie Callaghan gave a powerful speech about what that support can mean. I also make special mention of those who work with the family nurse partnerships, whose home visiting programme helps to educate first-time young mums about how to improve their children’s health and development. Those schemes must be supported and invested in, because they have been proven to increase breastfeeding rates in the cohorts that need that most.

We must do more to normalise breastfeeding here, in Scotland. Business owners who sign up to the breastfeeding scheme are making a positive contribution to the health and wellbeing of Scotland’s families and children, as well as making new mothers feel welcome and accepted. The more businesses that sign up to the scheme, the more breastfeeding will be normalised, with any perceived stigma evaporating over time. If that continues, there should be no time when anyone is apologised to because someone is breastfeeding.

I have already spoken about how those from more deprived backgrounds have lower reported rates of breastfeeding. That issue is exacerbated by the on-going cost of living crisis, which further jeopardises that already at-risk group. Increasing food prices have a knock-on effect on the diets of those who live in more deprived areas. It is only right to recognise, as others have done in this debate, the shocking cost of formula milk. I know that food banks and charities in my constituency often help families with that particular cost. The situation really must change.

I have three kids and am lucky that all three were breastfed by their superstar of a mum, who is a superstar not just because of her breastfeeding but in general. They were all breastfed for different lengths of time, and it is right to acknowledge that there is no right amount of time and that every child is different. Others have also made the important point that, although we absolutely must end the stigma around breastfeeding, we must not go too far the other way. A woman must never feel shamed or belittled for not breastfeeding. A mother’s decisions and those of her family are extremely complex.

I am at the age when, in the past 10 years, I have started a family, as have many folk in my social circle. Some have decided to breastfeed but some have not, and it is not my business or anyone’s business to know why they have not done that. Both choices are okay. I hear more and more often that mothers are feeling guilty for not breastfeeding or not doing it for long enough. That is not on. The minister touched on that subject, and I know that she will agree. We must always send the message that parents love their children and are doing the best for them—a point made by Stephanie Callaghan and Karen Adam. We should support and inform, but respecting the mother’s decision and the uniqueness of her situation is also important. We do not want to be here in 10 years’ time celebrating breastfeeding rates of 70 or even 90 per cent but having to highlight that those who do not do so are feeling somehow persecuted.

With continued investment and engagement with stakeholders, there have been promising increases in the rates of breastfeeding in Scotland. We have more to do, however, and providing support to the mother and the family while investing in our health services is the key to achieving that aim.

15:50  

First, I acknowledge the progress that Scotland has made in improving infant nutrition overall. The act that many members have mentioned, as well as several policies and initiatives aimed at creating a supportive environment for nursing mothers, have helped to make progress. All those efforts are a commendable step forward towards a healthier and accepting environment for breastfeeding mothers, and they make up a strong legislative framework to protect those mothers and their infants across a broad range of public spaces, while serving to encourage the practice across our country.

I take this opportunity to mention the incredible work that health boards and third sector partners are carrying out across the country. In Central Scotland, initiatives such as the Breastfeeding Network Forth Valley and breastfeeding groups across the NHS Lanarkshire area offer an incredible range of support to mothers and their infants. Several groups run weekly and offer mums the opportunity to get advice on breastfeeding and to share their concerns with experts and one other.

There is no doubt that those are all significant steps towards supporting breastfeeding practices, but there is still work to be done, especially to overcome the barriers that remain in place. We cannot talk about breastfeeding without addressing the fact that infant feeding differences are strongly tied to a mother’s socioeconomic status. Wealth disparities affect how long a mother can continue to breastfeed. Factors such as poverty, food scarcity and income insecurity are all significant challenges to breastfeeding. Therefore, we must also tackle social determinants of health, alongside the legal protections that have been put in place. Supporting mothers and acknowledging the barriers that they face is key to addressing the gaps in breastfeeding practices and the uptake of breastfeeding across our country.

For many, returning to work is a time when breastfeeding stops or is supplemented with formula, due to practical issues such as shift times, storing breast milk safely or even being able to pump while at work. The practical challenges will be markedly different for those working in an office environment with supportive colleagues, as opposed to working in a public-facing role or a manual role, where even wearing a pump may be difficult. As I have said, we have made great strides in what we want to see, and I am sure that there are some phenomenal workplaces that support women to breastfeed, but the practicalities are one of the issues that we need to overcome. I am very pleased that it is the Minister for Public Health and Women’s Health who is leading the debate, but a lot of work needs to be done in some of her colleagues’ portfolios to ensure that we can make the next strides forward.

Mothers, as many members have said, should be supported, not shamed, regardless of how they choose to feed their babies. We must acknowledge that breastfeeding is a personal choice and, while promoting the benefits of breastfeeding, we must also respect and support those who, for various reasons, cannot breastfeed. Every mother’s journey is unique, and creating an environment of understanding and acceptance is crucial in dispelling judgment and fostering inclusivity. For some, there are physical, emotional and practical reasons why breastfeeding is just not for them and their baby. We need to ensure that, in our pursuit of higher rates of breastfeeding and better experiences of breastfeeding, we do not stigmatise those who cannot. We need to ensure that the most important thing is good growth and nutrition for the baby.

Even though we have come a long way, several of the barriers to breastfeeding are rooted in stigma and societal attitudes. Even in spaces where breastfeeding is encouraged, many mothers continue to feel uneasy breastfeeding in public, because they fear conflict or judgment from strangers. That fear is not always felt evenly, with mothers who are younger, experiencing poverty or from marginalised communities often reporting increased surveillance and stigma. That is why several women routinely choose not to breastfeed outside the home. For those who do, the experience is often uncomfortable. The legal protections for breastfeeding in public are often present, but they are not always widely respected.

It is crucial that we empower mothers with the knowledge that they need to make decisions based on their individual circumstances, free from judgment. One key aspect of that is the need to dispel myths surrounding breastfeeding, as misinformation often contributes to unnecessary anxiety and deters some mothers from choosing to breastfeed. By promoting accurate and accessible information, we can empower women to make decisions that align with their personal circumstances, and we can work towards countering the stigma and changing many of the attitudes that weigh down on mothers.

We must also work harder to tackle the socioeconomic barriers that make breastfeeding impossible for some. It is important to point out that safe breast milk, infant formula that is prepared correctly with safe water, or a combination of both, are fine choices for full-term infants. For meaningful interventions that lead to positive outcomes for infants, we need support for the logistical needs of disadvantaged families, as privilege and better health outcomes go hand in hand.

The debate around celebrating and supporting breastfeeding in Scotland is an opportunity for us to unite in our efforts to support families and their newborns. We commend the progress that has been made, but we also recognise the need for continued advocacy, education and targeted measures to deal with the socioeconomic barriers that burden many mothers across Scotland. By promoting informed decision making, dispelling myths and addressing the stigma that surrounds breastfeeding, we can work together to create a society in which mothers feel empowered and supported in their choices. However, we must always approach that discussion with empathy and a shared commitment to valuing and supporting each family’s distinct journey.

15:55  

I refer members to my entry in the register of members’ interests, in that I hold a bank nurse contract with NHS Greater Glasgow and Clyde.

Every child should get the best nutritional start in life, and families should be able to make fully informed choices on how they feed their baby. Understandably, during the debate, we have encouraged women to breastfeed and we have discussed a range of policy initiatives to drive up breastfeeding rates. However, I put on record, as some of my colleagues have done, that we should be mindful that some women find breastfeeding challenging, or cannot breastfeed even if they want to do so.

For some women, breastfeeding is contraindicated due to the medication that they are prescribed for any of a variety of physical and mental illnesses. In my experience of working for more than a decade in perinatal mental health, some of my most difficult conversations with mums have been about the choice between medication for their illness or the continuation of breastfeeding—in particular, in cases in which mums were very depressed and felt that breastfeeding was the only thing that they were doing right.

However, no matter how someone feeds their baby, midwives and health visitors are there to help parents with lots of good advice, which is also online, including on the parentclub.scot website, in addition to the wealth of support that we have heard about during the debate—for example, through peer supporters and volunteers.

Breastfeeding provides the best nutrition for babies and young children and supports children’s health in the short and longer term. According to the World Health Organization:

“Protecting, promoting and supporting breastfeeding will save more lives of babies and children than any other single preventive intervention. Globally, exclusive and continued breastfeeding could help prevent 13% of deaths among children under five years old.”

There is strong evidence that breastfeeding reduces children’s risk of gut, chest, and ear infections and leads to a small but significant improvement in brain development and IQ.

Breastfeeding also benefits mothers’ health. It lowers the risk of developing breast cancer—particularly in mothers who had their children when they were younger—and, the longer mothers breastfeed, the more the risk is reduced.

A US study in 2019, which UNICEF cited on its website, found that, compared with never breastfeeding, breastfeeding a baby was associated with a 30 per cent reduction in epithelial ovarian cancer risk. In addition, there is some evidence that breastfeeding may promote maternal healthy weight and reduce the risk of type 2 diabetes.

As the motion by the Minister for Public Health and Women’s Health states, breastfeeding rates have risen in the past few years. That is to be welcomed. Infant feeding statistics that were published in November 2023 found that two out of three babies born in Scotland in 2022-23 were breastfed for at least some time after their birth; and that, over the same time period, 57 per cent of babies were being breastfed at 10-14 days of age—an increase from 44 per cent in 2022-23.

However, in the UK, we have some of the lowest breastfeeding rates in the world. Although many new mums start breastfeeding, some stop within a few months. Often, that is because they feel that there is a lack of support, particularly when they want to feed their baby outside of the home, or because they deem breastfeeding to be unnecessary, because formula milk is seen as a close second best.

There is therefore an understandable desire to increase breastfeeding rates through a number of interventions, some of which have been mentioned. They include interventions through education, peer support and within the health service itself, to ensure the availability and quality of breastfeeding support for new mums.

Part of ensuring that breastfeeding rates increase involves normalising breastfeeding in our public spaces and influencing public attitudes to it. The Scottish infant feeding survey in 2017 identified that mums understood that they could breastfeed in public areas, but almost half lacked the confidence to do so.

The Scottish Government launched the breastfeeding friendly Scotland scheme, which is implemented locally by NHS boards and aims to support families in a number of ways. The scheme helps to provide mums with positive experiences of breastfeeding when out and about to allow them to feel confident and supported. It raises awareness of the Breastfeeding etc (Scotland) Act 2005, which many colleagues have referred to in their speeches, and the Equality Act 2010, which protects mums who feed infants in public places or establishments that allow children access. The scheme also ensures that organisations are aware of their responsibilities under that legislation.

I am proud to say that, according to the online map that shows breastfeeding friendly Scotland scheme venues, around 40 venues in my Rutherglen constituency have signed up to the scheme. They include schools, pubs, pharmacies, community and third sector facilities and shops. I was delighted to sign up to the scheme in 2020. Finding a place to feel comfortable breastfeeding their baby can often make parents—particularly new parents—feel anxious. Signing up to the scheme is a small but simple way to support them on their breastfeeding journey. I want to ensure that my constituency office is an inclusive space for all staff, constituents and visitors, so it is important that that extends to babies who are being breastfed as well.

When I was the Minister for Children and Young People, having Scotland’s baby box as part of my portfolio was a highlight. In order to support parents with breastfeeding, the baby box contains nursing pads and information on breastfeeding. In 2021, Ipsos MORI undertook an evaluation to assess the impact of the baby box scheme in Scotland in respect of its short-term and medium-term outcomes. The study found that a quarter of parents felt that the box had helped to support breastfeeding, and 21 per cent said that it had informed them about breastfeeding. Higher numbers of respondents were positive about the inclusion of the leaflet on breastfeeding. Sixty-six per cent stated that they found it very or fairly useful.

I know that a lot of thought and work go into the items that are included in the baby box, but maybe the Minister for Public Health and Women’s Health could liaise with the Minister for Children, Young People and Keeping the Promise to see whether there is scope to further help mums to breastfeed through the contents of the baby box. Perhaps the minister could mention that in her summing up.

Positively, increases in breastfeeding over the past 10 years have been greatest among groups with historically lower rates, such as young women and those who live in more deprived areas. That could be a sign that interventions are working, but we should not ease up.

It is clear from the tone of the debate that we all share the commitment to give children the best possible start in life. We can help to realise that aim by giving mothers the cross-sectoral support that they require in their early days of parenthood.

16:03  

I do not think that anyone can dispute the health and wellbeing benefits that breastfeeding provides not just for mothers but for babies. I, too, welcome the tone of the debate.

It is right that we celebrate the progress that is being made in encouraging mothers to breastfeed, but we should also acknowledge that some mothers experience challenges when it comes to breastfeeding and that some mothers cannot breastfeed at all. We have struck the right balance today in making sure that the messaging is clear.

I have come to the chamber today with two asks of the Scottish Government: to carefully consider the messaging around stigma both against women who breastfeed in public and against mothers who cannot breastfeed—many members have pointed that out—and to carefully consider the support that mothers are meant to receive after their baby is born.

I make those asks of the Government because some mothers struggle to breastfeed. That was certainly my experience when I became a new mother in 2022. I do not think that I will ever forget how crippled by anxiety I was and how isolated I felt when I had to end my breastfeeding journey. I just felt as though I was not able to provide for my baby. It was an awful time. However, it is important to me to share my experience, because I want to give mothers who have struggled a voice and to ensure that they do not feel alone. The debate on breastfeeding is all very upbeat and positive, but it carries an undertone for those mothers who, for many reasons, struggle when they try to give their babies the best possible start in life.

I will draw on my own experience. I was so excited to start my own breastfeeding journey. In the run-up to Charlotte’s birth, I had spent weeks and months reading as much information as I could, I had bought equipment and I was so ready to welcome the new addition to my family. However, breastfeeding just was not meant to be. The reason was that I had a traumatic experience during my daughter’s birth, because I had taken morphine during her delivery. Charlotte was sleepy due to the side-effects of the medication that I had taken and she had absorbed, so the latching and the initial breastfeeding were not as natural as they should have been. However, as I had been going through labour, no one had explained to me the impacts of taking that medication and its consequences for my baby. Had I had another option, I would probably have reconsidered my decision for that reason—as I would do were I to be in the same circumstances again. In my view, it gave me a bit of a setback in breastfeeding my baby.

However, nothing that occurred during labour or the birth process stopped me breastfeeding; that happened shortly after I was able to bring Charlotte home. New mothers receive many visits from midwives and health visitors. A midwife who weighed Charlotte noticed that her weight had gone down. Again, I had not been informed before the birth that that was natural for breastfed babies. The midwife suggested to me that Charlotte could go on to combination feeding. However, that was not what I had planned or what I wanted for my baby. That put me in the position of asking myself what I should do. Should I still try to breastfeed, as had been my plan, or should my baby go on to combination feeding, as the midwife had suggested? We followed the latter path. In the end, Charlotte just wanted to bottle feed and was not much interested in breastfeeding any more. Unfortunately, that ended my breastfeeding journey after four months. It certainly was not what I had planned or what I wanted, but it was the option that was available to me at that point in time. I know so many other mothers to whom that has happened.

Another issue that cropped up throughout my pregnancy and after Charlotte was born was the number of midwives and health visitors I encountered and was introduced to—they chopped and changed so many times. I ended up with three midwives, and I am currently on my fourth health visitor. Such inconsistency does not allow new mothers to bond, build important relationships and share information. They need to build a level of trust and feel that the professionals are looking after them so that they can then give them the best information to help them to support their babies.

That is why one of my asks of the Minister for Children, Young People and Keeping the Promise concerns the support that new mothers receive once they have had their babies. We must examine the resources that are available for midwives and health visitors. I know that the lack of such resources is rife in Lanarkshire, the area where I am from, but it is replicated in many other health board areas across Scotland. That does not give mothers and babies the best start, because they do not have a bond with someone they trust. We must consider the support that women receive once their babies are home and they are starting the process of being new mothers.

Having said that, I do not blame our incredible NHS workers, who do so much. Being understaffed and overworked adds to the pressures that they face, which in turn does not give mums the best start when they bring their babies home.

I know that I am over time, so I will conclude there. I say to the minister that we need to listen to mothers if we can, particularly those who are struggling to breastfeed, and we need to look at the process and the support that mothers receive once they bring their baby home. We need to ensure that they have access to a consistent health visitor and a consistent midwife to ensure that they get the best possible support so that they can provide for their baby.

16:10  

I welcome the opportunity to speak in the debate about the important progress that has been made in Scotland to becoming a breastfeeding friendly nation. I have enjoyed the contributions so far. Like Clare Haughey, I am a registered nurse, although my experience is much less than that of my colleague Ms Haughey, in that my training was in general nursing and I did not work much in the field of midwifery.

I will focus my remarks on the progress that has been made in Scotland and on some fantastic examples of what is happening across Dumfries and Galloway in my South Scotland region. The Scottish Government is committed to supporting breastfeeding through policy, investment and interventions that support breastfeeding without shame or stigma. The Scottish Government has provided additional investment to support breastfeeding, particularly in the days immediately following birth. More than £9 million of additional funding has been made available since 2018 to support breastfeeding friendly principles.

Taking a fully rounded approach that is inclusive of stakeholders such as healthcare practitioners, the third sector and peer support groups is the most effective way to address breastfeeding concerns. Interventions in the health service such as ensuring the availability and quality of breastfeeding support for new mothers continue to be important. Equally, wider interventions are continually required, including positively influencing public attitudes towards breastfeeding, objectively promoting more appropriate marketing of formula milk and ensuring supportive employment policies that allow women to continue to breastfeed after returning to work. I welcome the minister’s commitment to doing so and to ensuring that the promotion of breastfeeding is continued.

Although the UK Government discontinued the UK-wide infant feeding surveys that were carried out every five years from 1975 to 2010, the Scottish Government commissioned its own national maternal and infant feeding survey in 2017. That provides continued insight into the changing environment of breastfeeding, the common challenges that it faces and the areas that are most impacted by them. The survey, along with continued medical research, demonstrates that breastfeeding provides the best nutrition for babies and young children and supports children’s health in the short and longer terms.

It is worth repeating what Carol Mochan said at the beginning of the debate, which is that current guidelines recommend that babies should receive breast milk for the first six months of life and then, after the introduction of solid foods, continue to breastfeed up to their second birthday or for as long as the mother and baby wish to. I know that that is not always possible, and I welcome Karen Adam’s comments and those of others in the chamber about how emotionally taxing and difficult it is to fail to feed adequately when a woman’s choice is to breastfeed. We need to recognise and not stigmatise people who cannot breastfeed their babies for whatever reason.

There is strong evidence that breastfeeding reduces children’s risk of gut, chest and ear infections, which was interesting to read, and leads to a small but significant improvement in brain development. Rachael Hamilton said that we need to remember that breastfeeding also benefits mothers’ health. We have strong evidence that it reduces the risk of breast and ovarian cancer, and it is worth repeating that it can reduce type 2 diabetes and promote maternal healthy weight, as Clare Haughey mentioned.

The benefits of breastfeeding for the baby and the mother are recognised across the world, including in high-income countries such as Scotland. Improving breastfeeding rates in Scotland would therefore help to improve the health of babies and mothers and reduce inequalities in health. It is welcome that the Scottish Government is committed to making Scotland a breastfeeding friendly place for all. That means focusing interventions to target areas of inequality. It is worth repeating that increases in breastfeeding over the past 10 years have been greatest in groups with low rates historically, such as young women and those living in the most deprived areas.

The latest infant feeding statistics show a continued narrowing of the breastfeeding inequalities gap, and the additional investment has been both targeted and based on best evidence regarding what works. Scotland’s infant feeding teams are pivotal in that effort, and the Government will continue to use all means necessary—including Scotland’s baby box, which a few members have mentioned—to normalise breastfeeding in Scotland.

One of the reasons why I was interested in the debate is that, in 2016, I had a staff member who was blatantly criticised and made to feel uncomfortable in a cafe in Dumfries while she was breastfeeding. That was 10 years after the Breastfeeding etc (Scotland) Act 2005 was brought in. I then wrote to all the cafes and restaurants across Dumfries and Galloway to ask whether they knew about the breastfeeding friendly scheme and whether they would participate in it.

I received some responses, and some of them were positive. The chief executive of NHS Dumfries and Galloway—Jeff Ace, at that time—launched a scheme at Threave gardens in Castle Douglas to widen and raise awareness about the breastfeeding friendly scheme in Dumfries and Galloway. After today’s debate, I will follow up with the businesses across Dumfries and Galloway to find out whether they continue to participate in the scheme and whether they are promoting it.

Finally, I ask the minister to continue to do all that she can to encourage businesses to become breastfeeding friendly and to encourage mothers to breastfeed.

16:16  

In recent years, I have worked with and on behalf of women in Dundee and Angus on issues including the provision of breast cancer care in NHS Tayside, female access to mental health services and waits of many years for treatment for pelvic organ prolapse. All too often, issues relating to women’s health in Tayside—and, I believe, across Scotland—are sidelined, minimised or just ignored altogether, with half the population still treated as a medical anomaly. The mesh scandal is, of course, one of the most tragic and egregious illustrations of that culture and practice.

We have had a considered debate this afternoon, with members keen to see further improvements in what is a very important factor in maternal and child health for women and families across Scotland. There has been some progress on breastfeeding rates in recent years: the percentage of babies who are still breastfed at six to eight weeks increased by three percentage points between 2019-20 and 2022-23. Public Health Scotland attributes the majority of the increase to an increase in mixed breast and formula feeding.

Public Health Scotland has also observed increases in breastfeeding rates over the past 10 years among groups with historically lower rates—such as younger women and those living in more deprived areas, which are groups that my colleague Claire Baker was keen to highlight. We have heard a little in the debate so far about the cultural and economic barriers to breastfeeding for women from those groups. However, in 2022-23, fewer than half of all babies were breastfed at six to eight weeks.

The benefits of breastfeeding for mother and baby have been laid out and they are significant. They include a reduction in infections, diabetes and obesity for the baby, and a reduction in the risk of breast cancer and ovarian cancer for the mother. That, in turn, leads to economic benefits. Studies have shown that, when women who breastfeed return to work, they are less likely to miss work due to their baby being ill.

There seems to be a welcome consensus on the need to promote the choice of breastfeeding and to support mothers and babies throughout. In that vein, I recognise the brilliant work that the breast buddies volunteers in Dundee and Angus do in giving friendly peer support to new mothers at a time when a friendly face is required and when some women find themselves isolated, perhaps without connections to other family members who could support them.

However, I question the extent to which the Government can celebrate and support breastfeeding in Scotland—as suggested by the motion—in the context of precarious health visitor services in parts of the country. I was contacted by a constituent in Angus earlier this month who had been informed that his family would not receive a visit from a health visitor for up to one year, with the cut being blamed on staffing pressures. Parents are being told not to expect a visit when their baby is between the ages of three months and 13 to 15 months. That could mean a full calendar year with no input from a health visitor at all.

We have heard a lot today about the importance of those health visitor engagements and working with midwives in the home. I hope that the situation in Angus is temporary, but it leaves service in the area well below the Government’s national standard and illustrates how stretched services are.

The Scottish Government’s universal health visiting pathway entitles all families to 11 home visits, including eight within the child’s first year of life. The Government rightly states:

“Health professionals, particularly Health Visitors, have a vital role to play in supporting children and families in the first few years of a child’s life.”

We could ask what we are doing telling families that they are entitled to such a vital service if funding and staffing pressure on the ground mean that there can be a postcode lottery. Midwives in Angus are already missing out on visits, which the Scottish Government’s own publication says are intended to observe developmental progress of the child, give advice on weaning, share information on local community services and check for signs of depression in the mother.

Members have done a good job of highlighting some of the issues pertaining to mental health, the importance of that in new mothers, the challenges that all families can face and the risks associated with them.

Anecdotally, I have heard from health visitors in Angus that there are staff members who have as many as three times the standard case load of families to visit. With the best will in the world, health visitors will struggle to deliver the same high-quality service, including support and advice on breastfeeding, which we are discussing today, when they are so overburdened.

The context in which the cuts are being made must also be stated. Since the pandemic, there has been a marked increase in the number of infants with developmental concerns. In 2023, Public Health Scotland reported that the number of children with development concerns was increasing year on year. The Royal College of Speech and Language Therapists has reported that an increasing number of young children are struggling with basic language skills.

The cuts to health visits are the last thing that families need. Visits from health visitors can be a lifeline for mothers who are adapting to the challenges of parenting, and they are an opportunity for early detection of any deterioration in the mother’s mental health. Depriving families of those visits risks the wellbeing of not only the child but the whole family.

There is a concerning trend in NHS Tayside whereby a temporary crisis situation becomes the norm, with people across the region being forced to live with services that fall below national expectations. Colleagues are right to highlight the centralisation of services in Dundee and how much more difficult it is for people in peripheral areas to access those services through many hours spent on public transport. I commend members for having made those points. I would appreciate it if the minister, in her closing speech, could tell us what has been done to deal with the acute staffing pressures for health visitors in Angus, to ensure that that does not become the norm.

I would also welcome any information that the minister can provide about the national picture for health visitor services. I remain concerned that those staffing pressures are not isolated to Angus. In her closing speech, will the minister commit to publishing statistics on how many and which health boards have full compliance with the guarantee on health visitors and the amount of appointments that families should be receiving? In which health boards across the country are families getting the services to which the Government says that they are entitled?

I call Rona Mackay, who is the last speaker in the open debate.

16:23  

As we have heard in the debate, breastfed babies are getting the best possible start in life, and that is what we all strive for in Scotland. I am proud that the Scottish Government has supported and promoted breastfeeding to reduce inequality rates, while supporting the UNICEF UK baby friendly initiative across neonatal and community settings.

There is strong evidence that breastfeeding reduces children’s risk of gut, chest and ear infections and leads to a small but significant improvement in brain development, which Michael Marra has just highlighted. Breastfeeding also benefits mothers’ health, with strong evidence that it reduces the risk of breast and ovarian cancer and some evidence that it may promote a healthy weight and reduce the risk of type 2 diabetes. The benefits of breastfeeding for both baby and mother are seen across the world, including in Scotland.

Reducing stigma and outdated attitudes to breastfeeding in public is key. This is 2024, and women must feel comfortable feeding their babies whenever and wherever they need to. Indeed, it is a criminal offence to stop a woman breastfeeding in a public place—something that I feel is often forgotten. Since 2005, if a person deliberately prevents someone from or stops them feeding a child under the age of two in a public place in Scotland, they are committing a criminal offence.

Asking a mother to move or to leave the premises completely is also an offence. A child should be fed when required and in the most appropriate place for them, without the fear of interruption or criticism. Anyone who tries to stop a mother breastfeeding or to stop a mother or carer bottle feeding can be prosecuted and ordered to pay a fine if they are found guilty.

As the motion says,

“third sector and voluntary peer support remain pivotal to babies being breastfed in the first few weeks of life and beyond”—

preferably until six months of age. For a variety of reasons, support is often needed to help and encourage women to breastfeed, so it is important that help is always on hand for mothers and, in particular, for new mothers.

I stress—I am pleased that every speaker has stressed this—that women who are unable to breastfeed for whatever reason or who choose not to should not be pressured or guilt-shamed. As the minister said, women should be free to choose, depending on their circumstances, and they should never think that they are not doing the best for their baby if breastfeeding is not for them. There should be no stigma here, either. Childbirth is exhilarating and exhausting in equal measure. Some women struggle to breastfeed through no fault of their own, but they should always be supported to be comfortable with their feeding method.

Supportive employment policies that allow women to continue to breastfeed after returning to work are essential. The national breastfeeding friendly Scotland scheme marks a continuation of our commitment to a breastfeeding friendly Scotland for all and builds on the 2005 act. BFS is a national scheme that people can sign up to for free, and it is backed by the Scottish Government and run by local health boards.

The scheme aims to help businesses and people who breastfeed to know their rights and responsibilities and to raise awareness of the 2005 act and the Equality Act 2010. Employers should support mums to feel confident about breastfeeding on the premises. If a customer complains about a breastfeeding mum, the business will inform the customer that it is signed up to the breastfeeding friendly Scotland scheme and advise them about the legislation.

The UK Government discontinued the UK-wide infant feeding survey, which was carried out every five years from 1975 to 2010, but the Scottish Government commissioned its own national maternal nutrition and infant feeding survey in 2017. That provides continued insight into the common challenges that are faced and the areas that are most impacted by them. It is encouraging that the increases in breastfeeding over the past 10 years have been greatest among groups that have had low rates historically, such as young women and those who live in the most deprived areas.

The latest infant feeding statistics show a continued narrowing of the breastfeeding inequalities gap, and our targeted investment is based on the best evidence about what works. The family nurse partnership has had a crucial role in supporting breastfeeding by teenage parents, many of whom are in the lowest Scottish index of multiple deprivation areas.

To breastfeed successfully, mothers have to eat and to eat well. Food insecurity makes it harder to breastfeed; the cost of food is impacting how pregnant women and new mothers get what they need. The desperate cost of living situation is forcing families to make choices that no family should have to make, especially during the first 1,000 days that comprise pregnancy and the first two years of life, which are core to health and development. The Food Foundation’s data shows that 27 per cent of UK households with children who are under four experienced food insecurity in January 2023, which is higher than the rate for households with only school-age children or no children at all. That cannot continue.

There have been terrific contributions from across the chamber. The key messages are that, as my colleague Karen Adam said, fed is best, but choice must be supported for every mother, because we all want the best start in life for our children.

I call Carol Mochan, who joins us remotely, to close on behalf of Scottish Labour.

16:29  

I agree with the Government and with all the other parties across the chamber by emphasising that Scottish Labour fully supports initiatives to improve breastfeeding rates. I wish that I could mention every member who has spoken, but I do not write quickly enough to have noted them—or perhaps I cannot read my writing.

I thank everyone who has contributed to this important debate, which has been excellent, with members having the opportunity both to speak and to welcome interventions. The contributions have been varied, which is beneficial when debating such issues.

I thank the minister for her contribution and her acknowledgement that Scotland should and must do better. It is helpful if we acknowledge that we really want to improve and that we challenge ourselves to change the breastfeeding rates in Scotland.

I also thank the minister and other members for congratulating mothers, families and communities on the contribution that they have made to the change in breastfeeding rates and to the change in cultural norms around breastfeeding. Many members have spoken about the change that we have made in our communities in terms of supporting mothers to feel comfortable breastfeeding. We have so much more to achieve, as everyone acknowledges. As I have said, that is an important point.

It is clear that improving breastfeeding rates in Scotland would help to improve the health of babies and mothers, and to reduce health inequalities. Many members have spoken about that. Therefore, today’s debate is significant in the context of health inequalities. We must continue to make progress on breastfeeding, and we must have a relentless focus on tackling inequalities, as members of all parties have mentioned. Indeed, Scottish Labour is strongly of the view that closing the gap in inequalities in this area is paramount, as breastfeeding plays a big part in improving health over an entire life, and every child deserves that opportunity.

Emma Harper mentioned targeted interventions. I agree with that. If we are to ensure that that happens, we need the Scottish Government to have a laser-sharp focus on how we fund, promote and encourage practice and policy.

I thank Rachael Hamilton for reminding us, in her intervention, that legislation is only as good as its implementation and how our communities find that it works for them. It is impossible not to thank her for the personal nature of her speech—the Presiding Officer referred to it as a “tutorial”. Helpfully, that led us to explore why women who tell us that they would like to breastfeed sometimes give up. That is an important point for us to bear in mind when thinking about what we are doing here in the Scottish Parliament: we are trying to set the scene to allow people to have a choice. Many members have mentioned the need for people to have a choice.

Alex Cole-Hamilton’s experience perhaps did not quite paint the same picture as Rachael Hamilton’s, but it was important, as it highlighted the role of fathers and other family members.

I take the opportunity to add that the points on perinatal health are very important. I did not pick that up in my opening speech, but I hope that the minister will make a few comments on the topic in her closing remarks.

Stephanie Callaghan made a personal contribution in which she spoke about the joy of supporting others to meet their goal of breastfeeding. I have met and spoken with many peer supporters. Many members have spoken about the peer support model and the need to ensure that it is funded and gets the support that enables it to continue. It will be essential that we see the data on the review that the minister mentioned.

Karen Adam is still standing after having six children. It was lovely hearing her pay tribute to all parents, whatever they choose to do. Many members mentioned that point. Claire Baker put it very well in her remarks when she spoke about every journey being different. Our job is not to place the onus on women; rather, it is to provide a supportive environment. I think that everyone who has spoken in the debate has made the point that it is for us as legislators to get the environment right to provide that choice.

The minister made extremely important points about marketing practices. Although I did not have time to raise the topic in my opening speech, it would be useful to hear more about how we ensure that there are tight marketing controls.

The minister and others noted the worrying cost of formula milk, which is causing distress to mothers. I know that my colleague Monica Lennon has raised that topic in questions to the Scottish Government. Claire Baker made a very important reference to affordability and the need for a consistent approach in ensuring that best start allowances meet the needs of families who choose to feed formula to their babies.

Tess White raised the important role of midwives and the pressure that they are currently under. It is important to promote the profession as a good career option, but also to retain the staff who are currently in the system, as their great expertise and knowledge are so important. We know that that is a problem, and Scottish Labour will support Tess White’s amendment at decision time.

On similar lines, I hope that the Government will support the Scottish Labour amendment, which recognises the pressures on the health visitor service. Michael Marra, who has been approached on the issue, illustrated how stretched health visiting services are in his area, but we know that that is not the case only in the Angus area. As he said, we do not want a postcode lottery, and we do not want that situation to become the norm. Having guaranteed health visitors is so important for this issue and many more.

Having spoken to women who have been committed to breastfeeding, I know that it is the vital support at home that really makes the difference. Every single one of the women I spoke to in preparation for this debate mentioned that there was support in the hospital but an absence of it once they were at home. That is an important issue. If we want to support women to breastfeed, and certainly to exclusively breastfeed, we need to provide long-term support in the home, and health visitors are vital to that.

Scottish Labour will support the Government motion. I hope that the debate encourages us all to work together to further improve the rates among all mothers and babies who wish to breastfeed.

I call Sandesh Gulhane to close the debate on behalf of the Scottish Conservatives.

16:36  

I draw members’ attention to my entry in the register of members’ interests, which shows that I am a practising NHS general practitioner. Relevant to this debate is that I am also a father of two.

Two thirds of the 48,000 newborn babies in Scotland each year start life by being breastfed, but by the time of the mother and child six-to-eight-week review, almost half are still being breastfed. Of course, breastfeeding rates vary across our population; breastfeeding is much more common among older mothers and those from less-deprived areas, and just 38 per cent of white Scottish babies are being breastfed by the time they are two months old.

Meghan Gallacher gave us her very personal story and reminded us that some mothers and babies cannot breastfeed, or find it incredibly difficult. Some mothers might be on powerful medications for cancer or for heart or kidney disease, so breastfeeding might not be the healthy option. Others have hypoplasia of the breast, so they do not produce sufficient milk. We should also consider that up to a third of breastfeeding mothers develop mastitis.

We should be aware that 10 per cent to 20 per cent of mothers suffer with their mental health during pregnancy or in the year after the perinatal period. We are talking about depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder and postpartum psychosis, which affects up to two in every 1,000 mothers who give birth.

I would like to take a moment to talk about maternal mental health. Many mums who are pregnant and who are taking medications such as sertraline, to help with their mental health, stop their medication because they worry that it will affect their baby. I appeal to everyone who is watching, please, to speak to their GP before doing that, because I see the devastation that is caused by the deterioration of maternal mental health, which is far more detrimental. Mental health struggles can also seriously impact on breastfeeding. We must avoid making mothers feel guilty because they cannot breastfeed, or choose not to.

Another condition that is not well understood is gastro-oesophageal reflux. Around 7 per cent of babies experience severe reflux, whether they are breastfed or formula-milk fed. Reflux usually happens because the baby’s oesophagus—the food pipe—has not developed, so milk can come back up easily through the sphincter. The oesophagus develops as babies get older, and the reflux usually stops. However, when they are little, reflux causes sickness and a lot of discomfort, and some babies do not gain weight. They squirm during feeding, some vomit, and they are uncomfortable after feeding. The condition is often silent and causes huge distress to parents, but goes undiagnosed.

The message is that, although we favour breastfeeding, as Karen Adam stated, mothers who formula feed are not harming their children. We should make no mothers feel stigmatised. A loved and cared-for baby will thrive.

I am reflecting on Sandesh Gulhane’s comments. Does he agree that the most important thing is that mum and baby are happy and healthy? Yes—breastfeeding might be the most appropriate pathway, but given that some families will have mental health vulnerabilities, having happy, healthy and well-fed babies should be the first priority. Breastfeeding is a bonus, but ensuring that babies are happy and healthy should be at the heart of everything.

I absolutely agree that, at the end of the day, it is most important that we have happy and healthy babies. People should remember that breast milk can be expressed and put in a bottle. That is okay, too. There is no wrong way, as long as the baby is happy and healthy.

Tess White spoke about the first feeds being helped by our midwives, but they are increasingly being called away from spending essential time supporting infant feeding to cover acute care. Health visitors are essential not just for breastfeeding, but for the general health and wellbeing of mums and babies, but they are becoming increasingly rare because cash-strapped councils are choosing not to replace retiring health visitors, which will leave mums and babies in Scotland to suffer. Tess White proved that by saying that, in Angus, some families will not be seen for a year.

Although I am unable to breastfeed, skin-to-skin contact with my newborn promoted a dad’s bond, as did bottle feeding and—apparently—changing nappies.

Carol Mochan and Rachael Hamilton spoke about wonderful legislation in relation to feeding children under two, and I challenge the minister to provide reassurance that she will promote that.

Stephanie Callaghan was right to say that breast milk contains “magical” properties; Alex Cole-Hamilton described them and the benefits of breastfeeding to mums, babies and the family budget. That is important because, as Rachael Hamilton told us, positivity can quickly lead to frustration and upset, because it is not always straightforward to breastfeed. The support of health visitors keeps mums breastfeeding, but we know how difficult it is to find a health visitor.

As a doctor, I say to Rachael Hamilton that cold cabbage leaves have a place, as do cream and antibiotics, but perhaps people should speak to their doctor before they speak to their grocer.

Although we should encourage and support breastfeeding, we should not stigmatise mothers who cannot do so for health reasons, or even for societal reasons.

The Scottish Government must address the huge pressures on our midwifery and health visitor services. We are losing skilled midwifery staff because many are worried that they cannot deliver the required quality of care. Issues with recruitment and retention and workforce planning require urgent attention, if we are to foster a supportive environment for breastfeeding. Midwives and health visitors play a pivotal role in educating and assisting new mothers, promoting successful breastfeeding practices and supporting mothers who face breastfeeding challenges.

16:43  

I, too, thank members for their contributions and for the tone that they have taken to this important debate. We have talked a lot about promoting breastfeeding and telling stories. I appreciate the stories that we have heard from members right across the chamber, and I am sure that new mothers will appreciate them, too. I thank Rachael Hamilton, Meghan Gallacher and everyone else who shared their story.

As I said in my opening speech, improving the health of all babies and young children is one of the driving forces behind my on-going commitment to support breastfeeding. We must continue to build on the good progress that has been made in Scotland so far so that we reduce early inequalities that harm generations. As Alex Cole-Hamilton said, it is about support, not pressure.

I turn to the two amendments. We will accept Tess White’s amendment. It is important to note that we hugely value our midwifery workforce and the high-quality care that midwives offer across Scotland. Health visiting remains a universal service, and teams across Scotland work hard to deliver that entitlement. The latest published data shows that the vast majority of eligible children between the ages of 10 days and five years receive health visitor contacts. We continue to work closely with health boards to monitor the delivery of the universal health visiting pathway in order to best ensure that young families get the support that they need.

I turn to the points that Michael Marra made. Scottish Government officials are meeting health boards—the Tayside meeting is in early March. We are also meeting all Scottish executive nurse directors to discuss outcomes from the evaluation of the pathway. I thank Michael Marra for raising and sharing his constituent’s experience, which my officials have noted.

Coverage of child health reviews is routinely published in national statistics. We do not publish information on all visits; that is held at board level. Monitoring was done during Covid-19 to prioritise early visits and child health reviews. As I have said, we continue to work with boards.

I will touch on Carol Mochan’s amendment. I am sorry that we cannot support it, but I recognise her nudge.

I am keen to understand the Government’s thinking about why it could not support the amendment in Carol Mochan’s name on behalf of the Labour Party. Surely the pathway is supported and is in the Scottish Government’s policy. We are looking to have the statistics published, and it would be great if the minister could provide them to members and put them in the Scottish Parliament information centre. However, if the Scottish National Party says that it is committed to the pathway, why can it not guarantee that people can expect it as a right across Scotland?

The Scottish Government has invested £40 million to recruit an additional 500 health visitors. Following that investment, their numbers have remained largely stable. However, we continue to work closely with health boards to monitor the delivery of the universal health visiting pathway to best ensure that young families get the support that they need.

Will the minister give way?

I would like to make progress.

There was a lot of discussion about peer support for infant feeding, which is essential. As part of our quality improvement programme—an additional investment of more than £9 million over five years—we have provided more than £1.6 million to third sector peer support charities to increase research and deliver the national breastfeeding helpline. I understand that the breast buddies programme in Angus received funding in the past year, which is driving increases in breastfeeding rates in that area. That shows the importance of third sector peer support. Rachael Hamilton referenced the breastfeeding in the Borders support service, and I thank her for the work that she is doing. We also contribute funding towards the national breastfeeding helpline, which provides support via phones and closed social media groups.

There is a lot of publicity on breastfeeding legislation, which is included in “Ready Steady Baby!” and on Parent Club’s website. Joining instructions for that website are found in the baby box. To celebrate the 10-year anniversary of the Breastfeeding etc (Scotland) Act 2005, we had a breastfeeding week. Perhaps there is an opportunity to do one in 2025 or on the act’s 21st anniversary in 2026. Nine years ago, we agreed not to sunset the legislation.

Last summer, I attended a breastfeeding picnic outside Parliament, and there was great publicity from that, not to mention the knitted breastfeeding boob that I have in my office. As MSPs, we should sign up—as Clare Haughey suggested—to our constituency offices being breastfeeding friendly workplaces. I also mention Inverclyde, where a mural on a gable end became a talking point in the community—it was a breastfeeding mermaid. There is a lot of publicity happening.

I was pleased that Clare Haughey and my colleague Marie Todd were instrumental in the introduction of the baby box. Clare Haughey clearly outlined everything that is in it, referencing Stephanie Callaghan’s question. I am happy to work with my colleague Natalie Don to discuss what we can do about the current contents.

I also want to touch on Alex Cole-Hamilton’s point about recognising the role of partners and fathers. We worked with the Fathers Network Scotland to put content for dads on the Parent Club website, and we ran a social media campaign on the role of partners, which was promoted and accessed widely. That is a key thing to talk about.

I am grateful to the minister for picking up on my remarks about the role of partners and fathers. When we were expecting our first child and attending National Childbirth Trust classes, an entire class was dedicated to how the dads could support their partners who were having difficulty securing a latch with their baby against a nipple and other difficulties around breastfeeding. Is there a way in which the Government could help to expand that kind of intervention to other groups?

I suggest that a lot of work is being done in that area. The “Off to a Good Start” leaflet and various others support that. When I met two midwives in Argyll and Bute yesterday, they talked about that.

Claire Baker touched on the costs of breastfeeding. I restate that all infant formula is nutritionally equivalent and that price is not an indicator of quality. I agree with Claire Baker’s point that price reductions are very welcome. It is a pity that they did not happen sooner, but further reductions are needed, and perhaps a price cap should be considered. Formula is a vital product in the first year of life, and profits should not be put over health.

Gillian Mackay and Claire Baker talked about the social determinants of health, and Rona Mackay and various other members talked about the best start foods and payments that the Scottish Government has introduced. We should recognise that best start foods provides a weekly payment that is more generous than those in the rest of the UK. We will increase best start foods to a minimum of £5.30 a week from 1 April, subject to parliamentary approval.

In my speech, I mentioned how many of the factors for improving breastfeeding rates lie outside the minister’s portfolio. Will she take into conversations that she has with other ministers and cabinet secretaries the need for them to look at how workplaces and others enhance their support for breastfeeding?

I thank Gillian Mackay for reminding me of that. I think that I am suffering like Carol Mochan in not being able to write everything down quickly enough. I will welcome the chance to speak to colleagues about that.

I quote Fulton MacGregor, who said that we cannot act in a vacuum. We must learn from women who have felt unsupported or unheard and share that learning across sectors, including maternity, neonatal and in the community. Failure to learn can impact on mothers’ mental health and their confidence to breastfeed in the future. As Karen Adam said, each individual breastfeeding journey is different, and flexibility in support that is tailored to need is so important.

Clinical and support staff receive training on baby-friendly standards during periods of formal education and in practice. We must ensure that that is of the highest quality as embedded in holistic care. The UNCRC will afford more recognition across sectors that the needs of babies and young children must be fully considered in all that we do. That includes receiving adequate nutrition and supporting their parents to provide that.

I recognise that, even when a mum wants to breastfeed her baby, it is not always easy, especially in the early days. Without the right support, it can be hard to meet individual breastfeeding goals. We have some excellent support across Scotland, which I have already highlighted, as have other members. That includes our Parent Club website, local infant feeding teams, the national helpline and specialist and peer support. We need to listen to mums and new parents to learn how to continuously improve those offers to better meet their needs. I want every new mum in Scotland to feel that they have a real choice in how they feed their baby, and I want breastfeeding to be the easiest choice.

I am delighted to have had the opportunity to commend the motion and to hear the thoughts and views of members from across the chamber.

That concludes the debate on celebrating and supporting breastfeeding in Scotland. It is time to move to the next item of business.