Chamber and committees

On a point of order, Presiding Officer. I would have voted no.

Good morning, minister and your team. My question is about costs and regulation. I understand about care, but cost is also part of care. In the press recently, it was highlighted that funeral costs are on an upward trajectory. There are eye-watering figures of more than £4,000 for funerals. Each funeral company can set its own fees. I hope that you will agree that £4,500 is a lot of money.

There are also what are known as paupers’ funerals, which could be regulated. The costs of those can and do vary for each area; they can vary from £683—that is a figure from Edinburgh—to more than £1,000. The data that I have managed to find was from 2015—it is not recent. It showed that there had been 549 paupers’ funerals in Scotland, which cost the public purse half a million pounds. Can that be looked at? If it cannot be incorporated into the code, can you look at it?

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?

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.”

The work of MSPs is wide ranging. The press often picks up on our adversarial politics, but the work that we do to build relationships, find consensus and increase understanding together is often overlooked. That is why I am grateful to Emma Harper for providing MSPs with the parliamentary time in which to discuss our involvement with the British-Irish Parliamentary Assembly. The most recent BIPA debate in the Scottish Parliament took place in 2012, so another one is long overdue, and I thank Emma Harper for highlighting the Assembly’s work.

As a newly elected MSP in 2021, I jumped at the chance to participate in a different type of parliamentary engagement. As Emma Harper pointed out, last year BIPA provided a valued forum for parliamentarians to discuss and develop dialogue on issues in the north of Ireland. In particular, it offered an unrivalled opportunity to learn about the peace process and the courage and humanity that have been required to maintain it.

I was fascinated to hear about the real change makers: those who really made a difference in the Good Friday agreement, such as John Hume, Mo Mowlam, President Bill Clinton and Bertie Ahern. As Emma Harper pointed out, we met the Women’s Coalition—the women who really were at the tipping point of change—which was a tremendous privilege for us.

With cross-party participation from across the British isles, BIPA has provided a wider arena for discussion and co-operation. I have particularly enjoyed meeting people and finding out what matters to them. I have learned so much about the power of talking, sharing a meal and debating calmly, with gentleness and humility, topical issues of mutual concern. The importance of that should not be underestimated.

Emma Harper touched on the structure of BIPA. Much of the day-to-day work is carried out in the four cross-party committees, which meet regularly.

If it is allowed, Presiding Officer, I say to Emma Harper, “Thank you, ma bonnie quine.” The report, which was published in May 2023, was tremendously rich and focused on indigenous languages, as Emma Harper said. My love of language started at university, when I did a special project on Scots and Scottish languages, so I was delighted to work on the topic. Professors of Doric and professors from all over Scotland contributed to that debate. It was tremendously rich. As we know, language can sometimes be co-opted for the wrong reasons but, as the report concluded,

“BIPA is well-placed to continue to monitor the health of indigenous minority languages”.

Therein lies the beauty of BIPA. It transcends the political and finds common purpose among those with opposing views. It is a rich environment for learning and it allows legislators to build bridges—it is important that we do that rather than exist in our silos. I therefore look forward to my continued participation and to my committee’s next meeting in February, and I deeply thank those who support the work of BIPA across the British Isles—including our clerks, who support us so well.

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, too, thank Ruth Maguire for securing the time for this debate on such an important issue. Her work and Rhoda Grant’s work on the topic long pre-date my time in the Scottish Parliament.

I understand that how Scotland addresses prostitution and protects vulnerable women has been discussed and debated in this chamber many times but, as Ivan McKee pointed out, there has, sadly, still been no real resolution. The Scottish Government’s 2021 programme for government committed

“to develop a model for Scotland which effectively tackles and challenges men’s demand for prostitution.”

Work is on-going, but the commercial sexual exploitation of women continues every day, often with harrowing consequences.

There are questions over the policy approach to a model for Scotland. Do we tackle prostitution in law or through other mechanisms? How do we change behaviour and reduce demand? How do we mitigate the unintended consequences of criminalising the purchase of sex? There are ideological questions, too. If two consenting adults agree to the purchasing of sex, should that be acceptable in the eyes of the law? Can there ever be an equal distribution of power in a situation where sex with women is a commodity bought by men?

Ruth Maguire’s motion focuses on international insights and learning, but I note that the Netherlands is not mentioned. Some time ago, I lived and worked in the Netherlands, where prostitution is legal as long as it involves sex between consenting adults. The Netherlands has a liberal approach in which prostitution is normalised, and I have reflected on that for many years. Since I was elected, however, I have opened conversations with sexual violence support services and advocacy groups such as Beira’s Place and the Women’s Support Project, and they have had a massive impact on me.

Prostitution is not about pleasure or gratification; it is about exploitation and violence. I am still developing my position on how we address such a complex issue, but the immovable starting point for me is how we best protect vulnerable women from coercion, violence and abuse. In the Netherlands, the fact that prostitution is legal does not make it safe. Forced prostitution, underage prostitution and unsafe working conditions still happen, but underreporting to police about what happens in the room is common practice because of prejudice. I note with interest that the Dutch Government has been working to improve the social and legal position of sex workers.

Diane Martin CBE, chair of A Model for Scotland, has urged the Scottish Government to be courageous as it tackles the sex trade. I pay tribute to her courage and her work, and I hope that MSPs will answer her call to action as we look at how to protect women from sexual violence.

Scotland deserves a fresh approach to deliver a modern, efficient and local NHS, but the stark reality is that, although winter for the NHS is especially difficult, it is now “Condition: critical” for the health service all year round. Seventeen years of SNP mismanagement means that the system is at breaking point. The buck stops at Bute house, and there is no one else to blame.

North-east residents who are affected by the Scottish and Southern Electricity Networks pylon and substation proposals have increasingly shared their concerns with me about the consultation process for the new infrastructure. They feel that it is being railroaded through. That has impacted the community’s wellbeing and has caused significant distress to many. Surely there must be a better way of engaging with affected residents. As energy infrastructure projects ramp up, will the minister commit to listening to communities about the way in which the consultations are run and work with the developers to improve them?