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Mrs. Annette L. Brooke (Mid-Dorset and North Poole) (LD): I am pleased to have finally secured this debate. It seemed appropriate to raise issues relating to breastfeeding close to breastfeeding awareness week, which was, of course, earlier this month. The Minister will be aware that two relevant early-day motions were tabled that week, both attracting more than 70 signatures. One notes that the UK has one of the lowest breastfeeding rates in Europe and also identifies some of the many health benefits from breastfeeding. The other highlights issues relating to baby food marketing. I want to make it clear at the outset that I consider it an important matter of personal choice for a mother how her infant is fed. However, the provision of facts, support and encouragement for breastfeeding, and regulation of the marketing of baby milk, all help to support an informed choice.
I acknowledge that the Government are supporting important initiatives, but there is always more to be done, given the advantages of breastfeeding and the disadvantages of not doing so. The health benefits of breastfeeding are well known and I shall quickly mention a few. The risk of gastroenteritis, respiratory, urinary and ear infections, eczema and childhood diabetes are all likely to be reduced. There is widespread concern in Parliament and across the country about childhood obesity. That has been brought to a head, I imagine, by this morning's coverage on the "Today" programme of the leaked report.
"In 2002, the Committee on Medical Aspects of Food and Nutrition Policy reviewed the benefits of breastfeeding in its Scientific Review of the Welfare Food Scheme and stated that breastfed babies are less likely to become overweight as children. Since then, a further review in 2003, by Dewey et al, found that most large studies show a protective effect of breastfeeding against overweight in children and adolescents." [Official Report, 17 March 2004; Vol. 419, c. 3834W.]
I understand that further research is being carried out. I suggest that among all the other recommendations that are likely to emerge from the Health Committee's report when the final version is published and responded to by the Government, the starting point should be the baby's start in life or perhaps even the mother's diet. I am not an expert on that, but childhood obesity requires us to go right back to the beginning.
I visited a specialist children's dentist in my constituency last week and was surprised to learn of further benefits in relation to jaw development. There are also, of course, many health benefits for the mother, including reducing the risk of pre-menopausal breast cancer and ovarian cancer, not to mention aiding weight loss after pregnancy.
Around two-thirds of women start to breastfeed their babies in the UK. However, the last five-yearly survey carried out by the Office for National Statistics showed that 21 per cent. of mothers who started breastfeeding had stopped in the first two weeks and 93 per cent. of them would have liked to have breastfed for longer. Just one in five babies are receiving breast milk by the time they are six months old, although the World Health
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Organisation recommends that babies need nothing other than breast milk for the first six months of life. It contains everything that a baby needs. There are huge variations in breastfeeding rates according to social class, age and area, so it is important to tackle the inequalities.
Excellent work is taking place in many areas to support and encourage breastfeeding. I am particularly pleased that Poole primary care trust employs a breastfeeding co-ordinator and I congratulate Mandy Grant on her work. I recently attended the inaugural meetings of two new bosom buddies groups. One of my constituents, Julie Dyball, played an important role in the latest one to be set up in Upton. Through regular weekly meetings, it provides a social environment for mothers and toddlers as well as support from other mothers and breastfeeding counsellors. How does the Minister intend to ensure that good support is available across the country? Also, what support will he give to maternity units seeking baby friendly status? I am pleased that Poole hospital is likely to apply for that.
I have wondered about how I became quite so involved with breastfeeding because, until a year ago, I simply thought that I had been there and done that way over 30 years ago. I recall that my main motivation to breastfeed was based on economic grounds, an important factor for many mothers today, but perhaps not always recognised as there tends to be a lower rate of breastfeeding in areas of deprivation.
Once I started to talk to mothers in my constituency and members of the National Childbirth Trust, I became aware of how many dimensions, and obstacles and obstructions, there were to supporting breastfeeding today. On the support aspects, clearly it is important that there should be good training for all professional workers, including nurses and health visitors, who will be in contact with a new mother. I have been impressed by the work carried out by Bournemouth university on that issue. As a consequence of securing the debate, I received representations from the Royal College of Midwivesthe Minister will not be surprised by that. Although the Government plan to recruit more midwives, the latest statistics from the NHS and the Royal College of Midwives annual staffing survey reveal that we are not recruiting as many as we need. That shortage has an inevitable impact on how much support midwives can offer women on acquiring skills such as breastfeeding. That is an important point, despite the nature of the lobby. The training of breastfeeding counsellors who work on a voluntary basis is also important. Schemes such as bosom buddies could not exist without voluntary support.
During my trip to learn about breastfeeding in this day and age, I was shocked when I asked local GP surgeries and local primary care trusts about breastfeeding levels in my constituency. The statistics all seemed incredibly good. I have thought about that and it seems to me that we must not be complacent. There is a danger of focusing on the percentages of women who start breastfeeding. It is important to have comparable data, across different areas, monitoring the first six months and beyond.
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Last autumn, I learned from Poole PCT that guidelines were awaited, and I discovered from the response to a parliamentary question that guidelines for PCTs on the collection of statistics on breastfeeding initiation were made available to national health service staff on 28 November 2003. Are those guidelines being followed by all PCTs? What further steps is the Minister taking to ensure that there is good data on which to make further decisions?
On the cultural aspects, it seems that we have reached a strange position in society when some people become embarrassed at a mother discreetly feeding her baby in a public place. I was travelling on a crowded tube the other day, and a baby was crying. The mother addressed the situation quickly and efficiently. Result: happy baby and less stress for the other passengers, including me. Attitudes are slowly changing, but we have a long way to go. If a mother wishes to use a quiet and private place for feeding when she is out shopping, for example, the facilities are often poor, if there is any provision at all. Living in a tourist area, I am very aware that the facilities are lacking.
There can be no quick fix for societal attitudes, but leadership at a national and local level can clearly contribute over time. Support needs to come from society as well as from health professionals, family and friends. Greater understanding and positive attitudes are needed to encourage and support breastfeeding women and to enable them to carry on for as long as they would like. Ideally, breastfeeding should be a normal part of everyday life. I could not help but notice the contrast between the UK and Ghana during a visit I made to that country last year.
We have a strong call to make to the Government on the marketing of baby food. In 1981 the United Kingdom signed up to the international code of marketing of breast milk substitutes, adopted by the World Health Assembly as a minimum requirement to protect infant and young-child feeding, and hence their health. The international code is a unique and indispensable tool to protect and promote breastfeeding, and to ensure that the marketing of breast milk substitutes, feeding bottles and teats is appropriate.
It applies to all products marketed as partial or total replacements for breast milk, such as infant formulas, cereals, juices, vegetable mixes and baby teas promoted for children under six months. The United Nations Committee on the Rights of the Child has expressed concern about low breastfeeding rates in the United Kingdom and called on the Government to implement the code fully. Clearly, all the excellent supportive work and increases in breastfeeding initiation are undermined by company promotion that violates the code but is permitted by UK law. The market for breast milk substitutes is worth more than $20 billion; it is very big business. Monitoring by the International Baby Food Action Network found a surprising amount of illegal promotion as well as code violation.
Last yearI asked rather a lot of questions on this issue last yearI asked the Secretary of State whether he would take steps to ensure that jars of baby food could be labelled to say that breastfeeding is encouraged
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for six months rather than four. The answer was comprehensive. It stated:
"Current European Commission legislation provides that weaning foods may be labelled as suitable for infants from four months of age. This is due to be reviewed in the new year in light of the World Health Assembly (WHA) Resolution 54.2 on Infant and Child Nutrition to strengthen activities and develop new approaches to protect, promote and support exclusive breastfeeding for six months."[Official Report, 10 December 2003; Vol. 415, c. 502W.]
Ms Julia Drown (South Swindon) (Lab): I congratulate the hon. Lady on initiating this important debate. She explained the benefits of encouraging breastfeeding in this country and mentions World Health Organisation recommendations. It is estimated that 1 million babies may die across the world every year because of low breastfeeding rates. It is clear that a majority of people are in favour of breastfeeding and of doing more to encourage it, and we need to do more to approach the minority who are against it. Is it not crazy that breastfeeding is sometimes not allowed in workplaces or places that people visit even though it is safe to breastfeed in them? Of course, this place is one of those places.
Mrs. Brooke : I thank the hon. Lady for her intervention and endorse her comments about the worldwide situation. We are talking about 1.5 million children a year and a child dying every 30 seconds. Those are horrifying figures. There is also a great discrepancy between countries. At a reception here just a week or two ago, we heard that Brazil has introduced a strong law, which is well implemented, and what a difference that will make. I appeal to the Minister for the UK to show leadership. We should have stronger laws and better implementation of them, which I am sure would provide a model for the rest of the world. I shall leave my comments on the workplace until the end, because that is perhaps the more controversial point.
It is now more than 20 years since the inception of the code. That leads us to ask what is happening. The early-day motion tabled by the hon. Member for Birmingham, Selly Oak (Lynne Jones) was very good and comprehensive. I shall not read it all out today, because it picks out the points that we have just covered, but it rightly says that something needs to be done.
Of course, international companies will find ways around the legislation and regulations that we have had for a long time because their profits are bound to be enormous. Just imagine the profits that might be had by international companies promoting their wares in countries such as China, where 20 million babies are born each year. It is big money, which is why we need changes here.
What I found quite surprising in the work of IBFAN and, indeed, local reports is that the problem is not simply a matter of not having strong enough legislation; it is also the extent to which the code is violated. A local supermarket had a particular promotionI cannot remember whether it involved a two-for-one offer or extra reward pointsbut fortunately local members of the National Childbirth Trust took swift action, reported the matter to trading standards officers and action was taken. The work of trading standards officers, who enforce the narrow UK law, is to be commended, but they need more law to work with.
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Another problem is that, in hospital or soon afterwards, many mothers receive gift packs that contain samples of complementary foods, breast milk substitutes and follow-on milks, or vouchers. Leaflets for mothers are sometimes found in clinic waiting rooms. Companies often give branded gifts to health workers, ignoring the explicit ban on direct and indirect contact with pregnant women and mothers of infants and young children. Telephone care lines and websites compete with those of the NHS and mother support groups, which are in turn promoted to mothers in leaflets, parenting magazines, direct mail and on product labels. Companies use the same brand name for a range of products. Infant formula is labelled "for use from birth" and one or more follow-on formulas are labelled
"for use with older infants".
Follow-on formula did not exist when the code was adopted and has been described by the World Health Assembly as "not necessary". Companies can widely advertise follow-on formula in the UK. It serves to promote infant formula with the same brand name and clever packaging, which tends to idealise artificial feeding. There is also a problem with complementary foods, labelled
"for use before six months of age",
Returning to obesity, my hon. Friend the Member for Hazel Grove (Mr. Stunell) recently tabled parliamentary questions on the link between the high-sugar content of baby foods and obesity in children, and asked what information is available on baby foods and sugar. We must highlight the facts about fat, salt, sugar and other substances contained in complementary foods.
The Minister should respond positively to IBFAN's well rehearsed call for action. It suggests three strategies: a change in Government policy, which would include the prohibition of materials on infant and child care that are produced or sponsored by companies with an interest in infant feeding; new legislation implementing the code's provisions for feeding bottles and teats, including a ban on promotion; and revised legislation that would fully introduce all the revised EU directives.
On education, in the process of preparing questions I discovered that GCSE syllabuses on child care do not even cover the international code on the marketing of breast milk. That is appalling. Through my parliamentary questions, and having pursued the matter with the Qualifications and Curriculum Authority, I have received a commitment that the syllabuses will be amended when they are revised. That action will be implemented at the earliest opportunity. So that was a success, although it has opened up how much more must be done in education.
Will the Minister liaise with his colleagues in the Department for Education and Skills, because teaching about breast feeding versus bottle feeding should ideally involve bringing a professional into the classroom? There is a lot of scope in personal, social and health education for sensibly promoting breastfeeding, which means tackling the matter from the beginning. There is much more that can be done, but, incredibly, text books do not cover the 1981 code.
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I have left the subject of the workplace until last, because I thought that that might bring some of my colleagues into the debate. There have been splendid initiatives on child care and on making it easier for mothers to return to work, but those sometimes introduce a third factor of having to give up breastfeeding. It is a tragedy when Government policies, in effect, work against each other. I am the last person in the world to want to introduce bureaucracy and put difficulties in the way of businesses, especially small businesses, but what surveys have been conducted on what would make it easier for mothers to continue to breastfeed when they return to work? I would not want to pronounce on the solutions to that, but surveys should be conducted.
We should think outside the box a little. Greater flexibility is probably needed, such as the ability to take a longer lunch hour. I would hope that larger companies provide suitable places for breastfeeding. If we are to have a holistic policy that is about the health of children, that policy must be examined from all angles and take into account the concerns of the Department of Trade and Industry, the DFES and the Department of Health. I hope that the Minister will take a lead across the Departments on those important issues, to help us to succeed in bringing our breast-feeding levels at least up to those of other European countries.
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) : I congratulate the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) on securing the debate and on taking an interest in a subject that, as she said, she thought she had left behind many years ago. However, she shares that interest with my hon. Friend the Member for South Swindon (Ms Drown). I am sure that this will not be the last time that we discuss the subject.
Breastfeeding provides the best possible start in life and has considerable benefits for mother and baby. As the hon. Member for Mid-Dorset and North Poole said, those benefits continue long after breastfeeding has ceased. That is why, in line with the World Health Organisation code, the Government recommend exclusive breastfeeding for the first six months of a baby's life, with continued breastfeeding along with complementary feeding after that.
The Government also recognise the positive impact on public health that will occur by increasing levels of breastfeeding. That will be particularly significant among mothers from disadvantaged groups. Indeed, two of the Government's priority areas for health improvementcancer and coronary heart diseasecould be positively affected by increasing breastfeeding levels. For example, mothers who breastfeed are less likely to develop pre-menopausal breast cancer and are more likely to lose the excess weight that they gained during pregnancy. Breastfed infants are five times less likely to be admitted to hospital with common infections, such as gastroenteritis or respiratory infections, during their first year of life. Moreover, there is emerging evidence that breastfed infants are less likely to become obese in later childhood.
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As far as reducing health inequalities is concerned, mothers from low-income groups are the least likely to initiate and to continue breastfeeding. "Tackling Health Inequalities: a Programme for Action", launched by my right hon. Friend the Secretary of State in July last year, sets out a framework with a strong focus on the prevention of health inequalities. It highlights the need to increase breastfeeding levels, especially among low-income groups.
The infant feeding survey in 2000 found that 71 per cent. of mothers initiate breastfeeding. However, there are striking differences in breastfeeding levels, related to levels of education, geographical location and age. For example, in the UK, 85 per cent. of mothers in higher occupations initiate breastfeeding compared with only 52 per cent. of mothers who have never worked. Some 78 per cent. of mothers aged 30 or over initiate breastfeeding compared to 46 per cent. of mothers aged less than 20.
That is why we have made a commitment in the NHS plan to increase support for breastfeeding and have set a target in the priorities and planning framework for 200306 to increase breastfeeding initiation by 2 per cent. per year, focusing in particular on women from disadvantaged groups. The Commission for Healthcare Audit and Inspection will be inspecting against an indicator to monitor progress towards meeting that breastfeeding initiation target.
In addition, a national service framework for children is being developed to set standards across the NHS, the social services for children and young people, and maternity services. Breastfeeding will be included in the development of that national service framework, which we hope to publish in July. The hon. Lady asked what the Government will do to ensure that there is consistent performance in increasing initiation rates. Those two elementsthe indicator and inspections by the Commission for Healthcare Audit and Inspection, and the national service framework for childrenwill be particularly relevant. Further work is also being undertaken by the Health Development Agency, which has appointed two collaborating centres in maternal and child nutrition. Their work will include increasing the body of evidence on what encourages breastfeeding and moving that evidence into practice.
Last year, the three-year infant feeding initiative was successfully completed. It was supported with just under £3 million from the public health development fund. The overall aim was to consider ways to increase breastfeeding rates among disadvantaged groups. As part of the initiative, 79 best-practice projects were funded. The majority were local projects looking at best practice and practice development.
The Department of Health commissioned an evaluation of the 79 projects and the findings were published in a report in December last year. The report makes clear the important contribution the projects made to understanding how women from disadvantaged backgrounds can be supported and encouraged to breastfeed. The strategies and lessons learned from the 79 projects need to be shared and disseminated to those supporting and encouraging mothers to breastfeed to assist them in delivering the priority and planning framework target. For example, some of the key findings relating to antenatal education
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and peer support programmes support other research findings, which means that midwives and health visitors have a key role to play in increasing breastfeeding rates.
I acknowledge the comments made by the hon. Lady about the recruitment of midwives. That is exactly why the Government, working with the Royal College of Midwives, have developed a six-point action plan to improve the rate of recruitment. I note what she says about lobbying from the RCM, but I assure her and the RCM that we are making significant progress. I wish I could wave a magic wand and produce all the midwives that we need, but I cannot.
We have produced a practical, user-friendly resource pack for health professionals, based on the evaluation of the projects and current research evidence, and plans for its dissemination are in place. The resource pack has drawn on the experiences of all those involved in breastfeeding. Genuine local partnerships involving health professionals, the voluntary sector and mothers enable communities to identify and prioritise local need and ensure that effective interventions and resources are targeted on the areas with the greatest need. The commitment in the NHS plan to reform the welfare food scheme will also ensure that children in low-income families have access to a healthy diet and will help to bring equality to mothers who are breastfeeding.
We consulted on proposals for reform towards the end of 2002 and published our response to the consultation setting out our intentions to introduce a new scheme in February. The healthy start scheme provides vouchers for fresh fruit and vegetables as well as liquid and infant formula milk from the beginning of pregnancy, and an additional voucher from birth for the first year will be available to all mothers. Breastfeeding mothers have long felt that they lose out and the new scheme redresses the balance. It will also increase the choice available to all mothers in the scheme. Healthy start will free the NHS and child health clinics from the obligation to supply infant formula milk to mothers on the scheme, which will enable health professionals to concentrate on what they do best: providing high-quality care, advice and support to pregnant women and their families.
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We are taking other steps to raise awareness of the issue: national breastfeeding awareness week, funded by the Government, is an annual public health campaign and is a main vehicle for raising awareness about the health benefits of breastfeeding. The hon. Lady referred to this year's campaign, which took place two weeks ago, in support of the priorities and planning framework target to encourage new mothers and mothers-to-be to "give it a go". Although the evaluations of this year's campaign have not yet been collated, the media coverage on breastfeeding was supportive and all the broadsheet press mentioned the campaign.
National breastfeeding awareness week is channelled through the NHS. Last year, health professionals distributed more than 1.25 million pieces of material produced by the Department of Health, professionals and voluntary organisations, who also helped to generate more than 550 regional press reports about breastfeeding during last year's campaign.
The Government are committed to the promotion and support of breastfeeding internationally, which brings me to the concerns that the hon. Lady expressed about the World Health Organisation's international code of marketing of breast milk substitutes. The World Health Assembly adopted the WHO code of marketing breast milk substitutes in 1981 prior to the development of what are now called follow-on infant formula milks. The WHO code, which the Government support, aims to protect and promote breastfeeding and establishes principles for ensuring the proper use of breast milk substitutes, including their marketing and distribution.
Rules on the composition, labelling and advertising of infant formula are harmonised throughout the EU by the EU directive on infant formula and follow-on infant formula. The principles of the WHO code relating to the labelling, advertising and provision of information about infant formula are incorporated
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