Introduction

The theme of International Women’s Day (IWD) this year is Choose to Challenge. The IWD website explains: ‘from challenge comes change. So let’s all choose to challenge.’ However, challenging can take courage. It’s preferable if it can be done in a way that shows understanding – as a critical friend – rather than confrontational, as the latter can trigger a defensive reaction that blocks change.

The WBTi report in 2016 showed that considerable change is needed to support breastfeeding better in the UK. This is part of achieving a larger picture in which babies are valued and there is no discrimination against women. In part it is a human rights issue. ‘Women have the right to accurate, unbiased information in order to make an informed choice about breastfeeding … and they have the right to … appropriate conditions in public spaces for breastfeeding which are crucial to ensure successful breastfeeding.’

IWD is also an opportunity to celebrate women’s achievements. How amazing it is that the female body naturally produces milk that is just right for her baby – in nutrition and immunity – and the milk changes to match her baby’s changing needs. But childbearing is no reason to discriminate against women in a different role – in the workplace. And, turning to economics, GDP does not include unpaid work or the production of human milk, leading to the anomaly that increased formula sales increase GDP and greater production of valuable human milk reduces it!

What are some ways of challenging?

Challenging government

This could involve commenting on draft laws when they are out for consultation and/ or supporting amendments, as is happening with the Domestic Abuse bill currently going through Parliament, which currently overlooks the impact on babies. Writing to your constituency MP to raise awareness of an issue is another way. The UK Regulations on Infant Formula and Follow-on formula are still considerably weaker than the WHO International Code and are not enforced, but it is also useful to consider when effort to challenge is most likely to be productive. Revised guidance that was due to come into force in February 2021 has been delayed by a year, but the pandemic has led to some government department timescales slipping.

The original guidance from Public Health England about vaccinations for breastfeeding mothers was discouraging but members of national breastfeeding support organisations and the GP Infant Feeding Network (GPIFN) challenged this, and the guidance was improved. The guidance now states that, although there are no data, ‘vaccines are not thought to be a risk to the breastfeeding infant, and the benefits of breastfeeding are well known.’

Another opportunity is provided by public consultations on NICE guidance when new guidance is produced or existing guidance is reviewed, as for the Postnatal Guidance in the autumn of 2020.

Commenting on articles or writing them

Recently, several letters were sent to the editor of ‘New Scientist’ following publication of an article which misunderstood why infant formula is not made available at Food Banks, despite Unicef UK already having produced an information sheet.

An article by Naomi Joffe, Flic Webster and Dr Natalie Shenker in 2019, Support for breastfeeding is an environmental imperative, was published in the British Medical Journal, helping to raise awareness among the medical profession.

Challenging myths and poor information on social media sites

Misinformation can spread quickly so it is important, sensitively, to try to prevent its spread.

Challenging supermarkets/ pharmacies and advertising

This could be about special offers in stores that break the UK Regulations; finding the courage to raise this with the manager raises awareness and hopefully lead to change. Advertising that is misleading can be reported to the Advertising Standards Authority. There is relevant information on the Baby Feeding Law Group (BFLG) website.

Representing and supporting parents

This might, for example, be working to improve practice by representing service users on a Maternity Voices Partnership or local Breastfeeding Strategy group. It could also involve empowering a mother who has received poor care to make a complaint.

Trained supporters educating and helping parents help to spread evidence-based information and challenge myths. Mothers can face a variety of barriers to achieving their breastfeeding goals – being separated unnecessarily from their baby, poor and conflicting advice, undermining comments, over-cautiousness when medicines are prescribed……..Enabling them to overcome such barriers can be like starting ripples in a pool that then influence others positively.

Looking to the future

The pandemic has shown that people with underlying health issues such as obesity or diabetes, which are linked to a poorer immune system, are at greater risk of severe Covid-19. Breastfeeding helps babies establish a balance gut microbiome which in turn aids the development of a strong immune system.

With global warming and the overuse of the Earth’s resources, it is essential to reduce carbon emissions and live much more sustainably. Breastfeeding is the most locally produced food there can be. In contrast, the manufacture and use of formula milks leaves significant carbon and water footprints.

Thus supporting mothers to breastfeed for as long as they wish helps in very significant ways – improving population health and protecting the Earth. In addition, mothers who achieve their breastfeeding goals are less likely to suffer mental ill-health or have feelings of guilt, loss and failure. Infants have a right to the highest attainable standard of health and they also gain because they receive breastmilk and experience the nurturing effects of breastfeeding for longer.

Patricia Wise is an NCT Breastfeeding Counsellor, a member of the WBTi UK Steering Group, and the author of Supporting Mothers Who Breastfeed: A guide for trainee and qualified doctors

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