Memorandum by The National Childbirth
Trust (WP 20)
INTRODUCTION
1. The National Childbirth Trust (NCT) is
the largest and best-known childbirth charity in Europe reaching
over 300,000 parents. For almost 50 years, it has offered wide-ranging
information and support across the UK and locally through its
network of over 350 branches. Consulted by decision makers on
all aspects of pregnancy, birth and early parenting, the NCT works
hard for improved maternity care and better services and facilities
for new parents. The NCT currently has over 59,000 members.
1.1 The NCT welcomes the opportunity to
contribute to an inquiry by the Health Committee into the Government's
Public Health White Paper.
1.2 In this submission, the NCT will comment
on aspects of the Public Health White Paper, which relate to pregnancy,
birth, breastfeeding and early parenthood. The NCT has primarily
focused on Chapter Three (Children and young people: starting
on the right path) as this section has most relevance to our work.
NCT RESPONSE TO
THE GOVERNMENT'S
PUBLIC HEALTH
WHITE PAPER
2. "Good maternity services support
parents, both mothers and fathers, before and during pregnancy
and after their child is born. Midwives provide advice about health
and targeted care to mothers, fathers and their families. They
have an important role in promoting health—helping pregnant
women to stop smoking, improving nutrition and rates of breastfeeding,
promoting mental health and building social support". (Chapter
3, page 52, Point 36).
2.1 The NCT welcomes the Government's commitment
to improving maternity services and to providing parents with
support before and during pregnancy and after their child is born.
The Public Health White Paper's emphasis on the role of midwives
in providing advice to families is particularly welcome. Midwives
can play a key role in delivering the Government's public health
goals, such as improving uptake of antenatal care and rates of
breastfeeding, and leading smoking cessation programmes amongst
pregnant women.
2.2 The NCT feels that the proposals outlined
above are an appropriate and effective method of delivering improvements
in maternity services. Midwives have unrivalled access to pregnant
women and new mothers throughout pregnancy, birth and the postnatal
period and are therefore in a crucial position to get to know
women and their families, appreciate the stresses and concerns
they face, and provide care and health advice which is tailored
to their individual needs and circumstances.
2.3 The NCT is concerned however, that the
current crisis in midwifery recruitment and retention may hinder
the ability of midwives to promote the Government's public health
goals and to deliver support and advice to parents. The RCM Annual
Staffing Survey 2004 reveals that long-term vacancy rates (those
lasting three months or longer) have increased to 68% of the total
number of vacancies (up from 53%). The survey also reveals that
81% of Heads of Midwifery in England have stated they are experiencing
some level of staffing shortage.[57]
2.4 Such high levels of midwife shortages
mean that women and their families will be denied the care and
support they need throughout their pregnancy, birth and postnatal
period. The NCT urges the Government to do more to tackle the
recruitment and retention crisis in the midwifery profession,
including funding more posts so that Birth rate Plus recommended
levels of staffing can be achieved. New and innovative ways of
working could be introduced into the profession in order attract
more midwives and keep them motivated. Opportunities here could
include carrying a caseload, providing care for home births and
working in midwife-led birth centres. At present there are new
opportunities to develop roles previously carried out by junior
doctors, with funding attached, but there is no equivalent funding
for new posts for the development of normal midwifery care. As
Children's Centres develop, their success in providing support
to parents during the transition to parenthood will be partly
dependent upon there being sufficient midwives employed in the
NHS to ensure that there are midwives available to work in the
centres, develop outreach initiatives and links with social services
which are enabling for parents and not solely based on a conservative
approach to child protection.
2.5 Ongoing midwifery shortages could also
have a negative effect on the Government's breastfeeding initiation
targets, particularly amongst women from socially disadvantaged
backgrounds. Peer support groups, which are often initiated and
supported by midwives, are vital to giving women from disadvantaged
communities the opportunity and confidence to breastfeed their
baby. Support for breastfeeding could be improved through greater
Government financial support for the establishment of peer support
groups. The NCT would also like to see pre-registration training
for all health professionals who are in contact with new mothers
include knowledge about the physiology of breastfeeding, the health
benefits of breastmilk and the need for a woman-centred approach
to providing support. Post-registration training must also cover
these areas for all relevant health professionals so that parents
do not continue to receive inaccurate and inconsistent information.
Within GP appraisal and practice accreditation schemes, for instance,
inclusion of up to date, evidence based information on breastfeeding
and prescribing during lactation should be mandatory.
3. "From 2005, we will provide eligible
pregnant women (including all pregnant women under 18, breastfeeding
mothers and young children in low income families) with vouchers
that can be exchanged for fresh fruit and vegetables, milk and
infant formula through a new scheme—Healthy Start. The scheme
will be backed by a new communications campaign to help these
families improve their diets and wider health, and make effective
use of the vouchers. Infant formula milk will no longer be available
from healthcare premises, which will reduce its promotion in the
NHS." (Chapter 3, page 53, Point 38)
3.1 The NCT welcomes the principles behind
the Healthy Start initiative, which aim to increase pregnant women's
and mothers' access to fresh fruit, vegetables and milk. The announcement
that infant formula milk will no longer be available from healthcare
premises thereby reducing its promotion in the NHS is particularly
welcome. The NCT feels that the latter action will better enable
the Government to achieve its public health goal of increasing
breastfeeding initiation and duration rates in England: midwives
and health professionals should be able to focus more of their
time on supporting good nutrition practices and promoting breastfeeding
to pregnant women and new mothers. However, it is well recognised
that additional staff will be required to enable the necessary
training on nutrition and breastfeeding support for this already
hard-pressed group of professionals.
3.2 While the NCT welcomes any initiative
to promote healthier eating amongst pregnant women and new mothers,
we are concerned that the low monetary value of the Healthy Start
voucher significantly limits the amount of healthy produce that
can be purchased. Currently, the Healthy Start voucher has a proposed
monetary value of just £2.80 for pregnant women and children
over 12 months. The NCT would like to see a significant increase
in the value of the voucher or an increase in benefits for pregnant
women; this would enable pregnant women and new mothers to buy
more fresh fruit, vegetables and milk and to make real and sustained
improvements to their diets. In addition, the NCT would urge the
Government to equalise benefit rates for unemployed pregnant women
aged between 16 and 24.
4. "Further action will include the
review of Infant Formula and Follow on Formula Regulations (1995)
with a view to further restrict the advertisement of infant formula.
We will continue to press for amendments to the EU Directive on
infant formula and follow on formula." (Chapter 3, page 53,
Point 39)
4.1 The NCT welcomes the Government's announcement
that it will review the Infant Formula and Follow on Formula Regulations
(1995) with the view to further restricting the advertisement
of infant formula. The announcement that the Government will press
for amendments to the EU Directive on infant formula and follow
on formula is also welcome. The NCT has consistently campaigned
for further restrictions on the advertisement of infant formula
because of the negative implications of formula feeding for public
health. Research shows that formula fed babies are five times
more likely to admitted to hospital with gastro-enteritis in their
first year, twice as likely to develop eczema, wheezing and ear
infections and five times more likely to have a urinary tract
infection than babies who are breastfed for at least four months.
Research also suggests that on average, children who are formula
fed as babies have higher blood pressure, a greater risk of developing
obesity and childhood diabetes and lower scores in intelligence
tests. Restrictions on the advertisement of infant formula would
help the Government achieve its public health goals of increasing
breastfeeding rates while also tackling childhood obesity.
4.2 While the NCT welcomes further "amendments"
to the EU Directive on infant formula and follow on formula, we
would encourage the Government to take more decisive action to
deliver its public health goals on breastfeeding. The NCT urges
the Government to fully implement the Global Strategy on Infant
and Young Child Nutrition, and the Blueprint for Action for the
protection, promotion and support for breastfeeding in Europe,
both of which call for full implementation of the International
Code of Marketing of Breast-milk Substitutes and subsequent relevant
Resolutions. UK governments have consistently supported the Resolutions
on the International Code at an international level, but failed
to provide the protection and support for breastfeeding provided
by these Resolutions in the UK. We see no reason why mothers and
babies in this country should continue to be suffer biased and
misleading information, inadequate support for breastfeeding in
public places and within the legal system, lack of facilities
when women return to work and poor access to evidence based information.
4.3 Although the majority of women in this
country want to breastfeed, more than one third change to formula
milk in the first six weeks and nine out of 10 of these women
would have liked to breastfeed for longer. This is an indication
of the lack of support evident in the health service and the wider
society. Although babies from disadvantaged families may be particularly
susceptible to the infections and diseases made more likely by
formula feeding, their mothers are least likely to start breastfeeding
and continue for shorter periods. Improving breastfeeding rates,
particularly among this group of women, would therefore have a
significant impact on their children's short term and long-term
health with fewer visits to their GP[58]
as well as the advantages referred to in 4.1 above.
5. "Our goal is to halve child poverty
by 2010 and eradicate it by 2020. This will be achieved by a combination
of hard work by people and the opportunities created by government.
The Child Poverty Review reinforced the importance of commitment
across a wide range of public services to improving poor children's
life chances and tackling cycles of deprivation. This includes
initiatives that improve health outcomes for children, such as:
— Supporting parents (Chapter 3, page
43, Point 5)
"A key aspect of this work will be to support
parents during pregnancy and in the very early years of parenting
to break the cycle of inequalities between generations. The strategy
to support parents in these early stages includes:
— Continued support from maternity
services and health visitors;
— Improvements to public support on
nutrition in the early years;
— Improved support for learning and
development in the early years;
— Sure Start—which works to combat
disadvantage in childhood" (Chapter 3, page 52 Point 34)
"The Government's national target to reduce
health inequalities as measured by infant mortality by 2010 is
already focusing action on improving services and support for
pregnant women, new mothers and their babies." (Chapter 3,
page 52, point 35)
5.1 The NCT welcomes the Public Health White
Paper's emphasis on tackling poverty by providing greater information,
support and advice to parents. Parents from disadvantaged groups
and communities may find it more difficult to access or maintain
contact with traditional maternity services, which could mean
that they miss out on care leading to them and their babies experiencing
poorer outcomes and further disadvantage. Wider access to antenatal
and postnatal services, as indicated in the Public Health White
Paper, would help meet the needs of socially excluded and disadvantaged
families.
5.2 Without a clearer definition of what
"supporting parents" constitutes, it is difficult to
assess whether the Government's proposals will be appropriate,
effective or represent value for money. Nevertheless, the NCT
welcomes the Government's proposals to roll out Children's Centres
across England, which will provide integrated services in one
location. Proposals to create 2,500 children's centres by 2008
and 3,500 centres by 2010 could make significant headway in tackling
poverty in this country.
5.3 We believe that Children's Centres should:
— Provide antenatal and postnatal support—including
reaching out to fathers and hard-to-reach groups.
— Offer facilitated mutual support.
— Provide access to trained breast-feeding
counsellors.
— Encourage and facilitate user-involvement.
— Disseminate parent-centred, evidence-based
information.
The NCT has expertise in these areas and also
offers training for professionals in a parent-focused approach,
supporting breastfeeding, parent-led birth preparation classes,
running groups for young parents, and running "bumps and
babies" and "early days" groups.
January 2005
57 http://www.rcm.org.uk/templates/news/detail.cfm/585. Back
58
McConnachie A et al (2004). Modelling consultation rates
in infancy: influence of maternal and infant characteristics,
feeding type and consultation history. Br J Gen Pract 54:
598-603. Back
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