All Party Parliamentary Group on Infant Feeding and Inequalities
Report by Anna Burbidge, March 2018
A meeting of the All Party Parliamentary Group (APPG) on Infant Feeding and Inequalities took place on Tuesday 20 March, 2018 at The House of Commons and was chaired by Alison Thewliss MP. The APPG brings together MPs, Peers, external organisations, policy stakeholders and interested individuals, giving them the opportunity to work together and discuss important issues related to infant feeding, including areas where support is needed. Its aim is to make sure infant feeding remains a priority for HM Government with a view to reducing inequalities and improving health.
Matters occurring since the last meeting
1. Scottish Maternal and Infant Nutrition Survey 2017: Summary of Key Findings
The survey was carried by the Scottish Government to look at the behaviours, choices and experiences of pregnant women and new parents, comparing them to the recommendations made in the Maternal and Infant Nutrition Framework for Action of January 2011.
The survey gathered information from three separate groups: expectant mothers more than 20 weeks pregnant; mothers of babies aged 8-12 weeks; and mothers of babies aged 8-12 months. This information shows the extent to which mothers made recommended nutritional and health adjustments before and during pregnancy; it provides insight into pre-birth feeding intentions and experience after birth; it shows the extent of awareness of the Healthy Start Scheme, and it provides an understanding of how different population groups vary in their practices.
The survey gives some very important insights into how women feel about breastfeeding. While 75% of respondents gave their baby breastmilk at some stage, the early drop-off rate continues to be an issue. By the time infants were six weeks old, only 55% of respondents were feeding them breastmilk. A third of them fed their babies infant formula within the first 48 hours, often while still in hospital.
In the early days at home breastfeeding mothers cited attachment issues, concerns around milk supply and maternal issues as their main difficulties and these, along with it being “too difficult” were the main reasons for stopping. 75% of those who stopped would have liked to have given breastmilk for longer.
Nearly a quarter of mothers were made to feel uncomfortable when breastfeeding in a public place. Even though it is illegal in Scotland to prevent a child under two years from being fed either breast or formula milk in a public place, 3% of those who responded to the survey were asked at some point either to not breastfeed or stop breastfeeding while out.
Commenting on this, Alison Thewliss said that the results of the survey were, nevertheless, encouraging as they showed an increase in mothers continuing to breastfeed up to six months after birth (43% as compared to 32% in 2010) and an increase in the overall duration of breastfeeding. The survey also showed that there is still a lot of work needed to support mothers with early concerns.
2. Busting the myth of science-based formula
Attention was drawn to a new report by the Changing Markets Foundation and Globalization Monitor which has revealed a lack of scientific consistency in the composition and claims of over 70 Nestlé infant milk products sold in 40 different countries. The report investigated the general, nutrition and health claims on infant milk products for babies under 12 months sold by the market leader Nestlé and revealed many cases of inconsistent behaviour.
3. Care of premature babies in hospital
In February 2018, The Lancet Child and Adolescent Health journal published the results of a trial conducted in Australia, New Zealand and Canada which showed that letting parents get directly involved with the care of their premature babies in intensive care units could help with the health and wellbeing of both baby and parents. The babies put on more weight and continued to be breastfed more often than those cared for by hospital staff alone. Parents who were involved in their baby’s care had less stress and anxiety.
The Scottish Government has announced a £1.5 million Family Fund for parents of premature babies to help with the additional costs they face, such as for travel and food while their baby is in hospital.
Alison Thewliss had written to the Department of Health and Social Care, Nutrition Legislation, to discuss the sale of infant milks labelled “Foods for Special Medical Purposes” (FSMP) which are freely available to purchase in the UK, despite the fact that consumers may be getting inaccurate information about their efficacy.
A letter from Jeremy Hunt MP, Secretary of State for Health and Social Care to Keith Vaz MP was shared. Keith Vaz had forward comments to Mr. Hunt on behalf of Sally Etheridge, Programme Lead, Leicester Mammas CIC (Community Interest Company). Sally had expressed her concerns about the lack of promotion of breastfeeding. Mr. Hunt replied that the Government is implementing the vision set out in the World Breastfeeding Trends Initiative’s UK report. He added that the Maternity Transformation Programme was seeking to achieve the vision set out in the report by bringing together a wide range of organisations to work in nine areas, focusing on pregnancy and providing the best possible start for babies.
LLLGB is proud to acknowledge that Sally Etheridge is a former LLL Leader and Helen Gray, one of the authors of the WBTi report, is an LLL Leader in London.
Presentation: Dr. Helen Crawley, First Steps Nutrition Trust, ‘An inquiry into the costs associated with feeding babies in the first year of life’
Dr. Crawley suggested that an inquiry was needed into the cost of formula and the impact on the family food budget. For hard-pressed families the cost of formula could account for over a quarter of the family food budget. Although Healthy Start vouchers of up to £6.20 a week are available, if using one of the four main brands, it cost between £8.37 and £10.30 a week to feed a 2-3 months old baby, as the cost of a tin is around £9-11.
When mothers are asked why they choose a particular brand of formula, they say they are looking for the best and often rely on advertising for information. Women tend to be loyal to one brand, so formula companies work hard to establish this by producing a range of products with the same branding. Marketing to health professionals is allowed for all milks, including infant formula, and it is possible this could influence the information parents are given. The brand of milk a baby is given in hospital may also affect a woman’s choice. In the past it had not proven practical to use unbranded products due to the cost involved, but it was felt this would be the preferred option to avoid appearing to promote a particular brand
Previous discussions with mothers had shown that mothers focussed on finding an infant formula “closest to breastmilk”, but now women might focus more on “the right formula for their baby”. Specialist formulas tend to be about £2 more expensive than regular ones and this results in a lot of extra revenue for producers. All formula has to have specific ingredients, but some add ones which are unnecessary. Parents are being encouraged to spend more for something which is no better.
Dr. Crawley proposed the formation of a cross-party steering group to champion change, which could be followed by a Call for Evidence, additional research and data collection, leading to a summary report with recommendations. Babies are often not considered in reports on poverty and this would be an important step towards their inclusion.
Presentation: Rosie Dodds, First Steps Nutrition Trust, ‘Overview of Healthy Start scheme and how it can be improved’
The NHS Healthy Start Scheme has replaced the welfare food scheme which was just for milk. Healthy Start vouchers for parents on income support and financial benefits, plus all pregnant women under 18, can be used for milk, fruit and vegetables.
Rosie said women in low income groups are less likely to access maternity services early, have a well-balanced diet or breastfeed their babies, but the scheme does not seem to have helped with this. Low income or vulnerable groups have higher infant mortality and low birth weights. Diet in pregnancy and early years influences future outcomes, also considering that women often influence family dietary decisions.
When looking at food insecurity in the UK few reports look at children, and none to date have considered children under five. Rosie said a 2017 UNICEF report showed that 10% of children in the UK lived in severe food insecurity, and 2.3% of parents (usually mothers) skipped meals. Families tended to go for high sugar/high fat foods and had inadequate intake of certain nutrients or fruit and vegetables. This could cause harm to both mental and physical health and also impacts on a country’s economic and health costs.
The take-up rate of Healthy Start vouchers has declined; this could be due to fewer families receiving benefits, but also barriers to accessing the vouchers families are entitled to. Families may not be getting the right information and families for whom English is not the first language may not be aware of the vouchers. The complexity of claiming adds to friction and delays.
It was pointed out that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) scheme in the US for low income families provides peer support for breastfeeding. Legislation needs to take into account the effect that support for families has on health outcomes, not on companies.
Update from Jackie Doyle-Price, Department of Health and Social Care, Parliamentary Under Secretary of State for Mental Health and Inequalities
Jackie attended the meeting with Wendy Nicholson from Public Health England (PHE). Jackie said that the Government was aware of the public health benefits of breastfeeding and was committed to promoting it. Jackie said she felt it was important to put more effort into engaging fathers. She was also aware that informal milk sharing was something that needed looking into and that new guidelines would be published.
Wendy said breastfeeding was a priority area and PHE wanted to ensure midwives promoted initiation and gave support for its sustainability. They were looking at international benchmarks to see what was needed to improve breastfeeding support, and were gathering evidence for an action plan. She outlined the role of PHE in delivering the Maternity Transformation Programme (MTP), saying that breastfeeding was one of the core areas for the programme. Local authorities need to understand their obligations and provide integrated breastfeeding support.
It was added that the Secretary of State will be talking more about breastfeeding in the future.
Points from the floor
It was pointed out that the WBTi recommendations were gathered from many different organisations working with breastfeeding mothers and so they already provide an action plan. However, the National Maternity Review did not especially look at breastfeeding. WBTi also emphasised that we need a national strategy. Scotland had one, and there is a global strategy so there are existing examples to look at.
There was a request for the reinstatement of the Infant Feeding Survey to allow support organisations and health professionals to see the true situation.
The Baby Milk Action representative pointed out that misleading information from formula companies is undermining breastfeeding support and these companies should not be allowed to educate mothers.
Legal Action for Women raised the important point of discrimination against breastfeeding women in family courts and prisons. When women are separated from their babies, both the mother and baby’s health is affected.
The topic of mental health was raised. Early intervention is best in the support of mental health and this includes supporting breastfeeding, as it has been shown that mental health improves if a mother is breastfeeding. The support strategy for mental health addresses multiple issues and breastfeeding rates go up when supported.
The next APPG on Infant Feeding and Inequalities meeting will be held on 15th May 2018.