Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life

The First 1000 Days of Life (from conception to the age of two years) are a critical window in a baby’s development. The 1000 Days concept was first widely used by the World Health Organisation and UNICEF, and there are currently numerous campaigns building on that theme.*

There is currently an inquiry into the First 1000 Days by the UK Parliamentary Select Committee on Health and Social Care. This blog brings together a few of the key concepts and resources on the importance of breastfeeding during the First 1000 days.

A joint supplement on the importance of breastfeeding in the first 1001 Days was produced by the UK breastfeeding organisations in 2015, which summarises much of the evidence.

A focused briefing on the the role of breastfeeding on infant brain growth and emotional development can be found here.

Breastfeeding: cornerstone of the First 1000 Days

Human babies are born extremely immature compared to other mammals; they are completely dependent on their mothers for milk, comfort and warmth.

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~ Grantly Dick-Read

Scientific research has continued to underscore the vital role that breastfeeding and breastmilk play in the development of the human infant. See our WBTi blog series for this year’s World Breastfeeding Week, from 31st July – 7th August 2018 for a review of the myriad ways that breastfeeding influences human development.

Breastfeeding: more than just food

This is the title of a series of blogs by Dr Jenny Thomas which focuses on some of the ways that breastfeeding contributes to immune development and more. Beyond physical health and development, however, breastfeeding also plays a key role in the healthy mental and emotional development of the infant. Breastfeeding provides optimal nutrition for the first months and years of life, alongside suitable complementary food after six months, but it also supports the development of the child’s immune system and protects against a number of non-communicable diseases in later life as well.

The World Health Organization commissioned high level reviews on a range of health and cognitive outcomes which were published in a special issue of Acta Paediatrica in 2015; these formed the foundation of the Lancet Series on Breastfeeding which was published in 2016.

The impact of breastfeeding on maternal and infant mental health and wellbeing.

Breastfeeding can help strengthen mother and baby’s resilience against adversity, and can protect infants even when their mothers suffer from postnatal depression. It supports optimal brain growth and cognitive development. Unfortunately, if mothers don’t receive the support they need with breastfeeding, this can significantly increase their risk of postnatal depression. A summary of evidence can be found here.

The role of breastfeeding in protecting maternal and infant mental health is often poorly understood – mothers who are struggling need skilled support to resolve breastfeeding problems if they wish to continue breastfeeding

What does the future hold?

It is essential that policy makers, commissioners, and researchers understand the evidence and importance of breastfeeding, so that women who want to breastfeed get any support they need. The WBTI report outlines major policies and programmes that national infant feeding strategies need to include; other research on the psychological and cultural influences on mothers’ infant feeding decisions will help policy makers to develop sensitive and sound policies and programmes to support all families.

In the end, it will be essential that families themselves are heard, in order to create the support systems that our society needs.

*Unfortunately a number of infant milk and baby food companies have jumped on the “1000 Days” bandwagon too, despite the fact that breastfeeding is the centrepiece of the original 1000 Days concept, and replacing breastmilk with formula or baby food actually removes that fundamental building block from a baby’s development.

Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She is a founding member of National Maternity Voices. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

Shared Parental Leave and the right to breastfeed on return to work

Guest blog by Rosalind Bragg, Director of Maternity Action

Maternity Action’s work centres on protecting the rights of pregnant women and new mothers in the workplace. As a member of the WBTi Core Group, Maternity Action was responsible for gathering most of the information on Indicator 4, “Maternity Protection in the workplace.” They have very kindly allowed us to republish their blog on the current status of breastfeeding in the workplace here during UK National Breastfeeding Weeks.

The original blog can be found on Maternity Action’s website here, along with a range of resources on maternity rights. Follow Maternity Action for updates on their campaigns on this and other important maternity rights.

The right to breastfeeding breaks and facilities is a gap in the policy framework to support new parents to balance work and family responsibilities. The current review of Shared Parental Leave policies is an opportunity to remedy this omission.

On May 15, we presented to the All Party Parliamentary Group on Infant Feeding focusing on Maternity Action’s campaigning against pregnancy and maternity discrimination and the particular challenges facing breastfeeding women in the workplace.

Women in the UK who wish to combine work and breastfeeding have very weak legal protections. Health and safety regulations provide breastfeeding women with the right to a place to rest and to a health and safety risk assessment. While some employers may offer regular breaks to breastfeed or express milk and a private space in which to do so, these are not required by law.

For most women, flexible working requests are the only legal avenue to seek adjustments to their working conditions to facilitate breastfeeding. Employers must seriously consider flexible working requests but can refuse them if they have a good business reason for doing so. On our advice line, we regularly hear from women struggling to negotiate flexible working arrangements on return to work. Employers can, and often do, reject reasonable requests for adjustments to working conditions.

Many of the UK’s trading partners have more constructive approaches to balancing breastfeeding and work. Germany provides paid breastfeeding breaks and facilities while the US provides unpaid breaks. Australia offers an alternative form of protection by prohibiting discrimination on grounds of breastfeeding. These are just a few examples. It is unsurprising that the recent World Breastfeeding Trends Initiative (WBTi) review rated the UK 67^th out of 91 countries on its law, policy and programmes that support breastfeeding women.

The current review of the Shared Parental Leave scheme provides an opportunity for Government to reconsider its approach to breastfeeding and work. In 2013, when debates were underway on the new scheme, Maternity Action campaigned for a statutory right to breastfeed on return to work. While this did result in ACAS guidance on the issue, legal protections were not forthcoming.

It is extraordinary that a scheme to encourage parents to share leave from their child’s first weeks should pay so little attention to breastfeeding. The Department of Health recommends exclusive breastfeeding for six months and breastfeeding in conjunction with solid food thereafter. Given the absence of legal protections for breastfeeding women, the vast majority of women who share leave will need to stop breastfeeding prior to return to work. This reduces the number of women prepared to share leave with their partner and also contributes to the UK’s low rate of breastfeeding.

Whether women breastfeed or not, and for how long, is a decision for each woman to make. The role of the law is to remove impediments to breastfeeding, enabling women to make decisions based on their own needs, not the convenience of their employers or other equally irrelevant factors. It is long past time that UK employment law caught up with that of its trading partners and provided formal legal protection for breastfeeding on return to work.

Rose’s Story — Maternity Protection (WBTi Indicator 4)

The WBTi UK Report recommendations for Indicator 4 are for government action, including legislative change:

Governments to legislate for reasonable breastfeeding breaks and suitable facilities for breastfeeding/expressing in workplaces and educational institutions.
Governments to ensure that tribunal access is available to women from all income brackets.
Government agencies to monitor provision for employees.
Governments to raise the minimum rate of maternity pay and maternity allowance to the recommended minimum wage level.

Legislation is needed, not just guidance

There is existing good practice guidance for employers (ACAS’ Accommodating breastfeeding employees in the workplace and Guidance for Employers: Accommodating Breastfeeding int he Workplace from Maternity Action) but to achieve real societal change there needs to be legislation. However, this requires all employers to value breastfeeding and perceive it as a normal activity so that the law can be implemented willingly.
Legislation would create a level playing field for business, too.

Rose’s story

I recently heard about Rose (not her real name). Rose is in her mid-twenties and breastfeeding her second baby. She found breastfeeding to be straightforward with both children. Rose planned to return to work when her second baby was 6 months old as the family needs two incomes to manage financially.

When her baby was 5 months old, Rose quickly found a highly suitable retail job, involving working some evenings and a Sunday shift. There would be no childcare costs as her husband is at home at those times.

However, induction for the job involve attending the store for the whole of one Friday. No information was given in advance about the timing of the lunch break so Rose could not arrange for her baby to be brought to her for a feed. She was very upset the evening before at the thought of being away from her baby for a whole day. Breastfeeding is a private matter for her and she felt too embarrassed to mention to her new employer that she is breastfeeding and also feared she might be seen as a difficult employee.

If employers expected that a mother with a young baby might be breastfeeding, and routinely checked whether she had any specific needs, mothers like Rose would be supported when they return to work, rather than facing additional stress and worry.

Resources

If you or someone you know needs advice on rights at work, including maternity pay and benefits, Maternity Action has information on its website and a telephone advice line:

https://www.maternityaction.org.uk/

Cover photo licensed by Adobe Stock

30. Photo for WBTi MAINN presentation — Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Breastfeeding at work – a gap in maternity rights

By Rosalind Bragg

Director, Maternity Action

Providing women with a clear legal right to continue breastfeeding on return to work should be a no-brainer for the UK Government. The Department of Health recommends that babies are exclusively breastfed for six months and then breastfed in conjunction with solid food, mirroring the World Health Organisation position. Bringing employment law into line with public health recommendations should be a simple matter, yet the Government continues to drag its heels.

A quick glance at maternity protections in other European countries, shows that the UK is something of an outlier. Breastfeeding breaks are enshrined in law in 36 of the European countries surveyed and the vast majority of these breaks are paid. The UK, by comparison, has no statutory right to breastfeeding breaks, paid or unpaid.

Current legal protection for breastfeeding

This is not to say that there is no legal protection for breastfeeding in the UK. It is possible, in some cases, to use health and safety law to argue for working arrangements which facilitate breastfeeding. The recent EasyJet case is an example of this. Women can also make a flexible working request for changes to their working hours and conditions which allow them to breastfeed. But flexible working requests can be refused by the employer and the health and safety protections are limited in their scope. For many women, the current legal framework does not deliver the protection they require.

When Maternity Action has raised our concerns with Government, we have often been reminded about the generous period of maternity leave in the UK. We are certainly appreciative of the 12 months leave entitlement, but we are also very aware that there are very good reasons why women would return to work without taking their full year of leave. UK statutory maternity pay is quite modest by international standards. After six weeks at 90% of income, it drops to the low flat rate of £140 per week for 33 weeks, which is below the minimum wage.

Maternity Discrimination

Maternity pay is not the only factor leading to women taking less than their 52 weeks of maternity leave. High rates of maternity discrimination are prompting women to return early out of fear for their job. The introduction of Shared Parental Leave has enabled women to share up to 50 weeks of their maternity leave with their partners. There are also many women working in the gig economy who don’t have leave entitlements, placing their livelihood at risk if they take extended breaks.

Support the Action Plan from the Alliance for Maternity Rights

Maternity Action fed our concerns about workplace maternity protections into the WBTi report for the UK. We have also incorporated the call for a statutory right to breastfeed at work into the Action Plan developed by the Alliance for Maternity Rights, a coalition of parenting groups, unions, advice services and health professionals convened by Maternity Action which works to end maternity discrimination. We held a series of Parliamentary events to give profile to our call for action on maternity rights at work.

Following the announcement of the general election, Maternity Action produced a manifesto calling for each of the political parties to protect maternity rights. Key amongst our manifesto asks is a statutory right to breastfeed in the workplace. The election offers a good opportunity to raise the profile of this issue with Parliamentarians. You can help by contacting candidates in your area, asking them to commit to support the manifesto. You can email your candidate through Maternity Action’s website and find other candidates online. Protecting breastfeeding rights should be a no-brainer.

WBTI UK Report: Gaps and Recommendations on Maternity Protection in the Workplace

Rosalind Bragg is the Director of Maternity Action, a national charity advising pregnant women, new mothers and their families about rights at work, the benefits system, breastfeeding rights and access to support services. Since she joined the organisation in 2008, she has led campaigns to challenge pregnancy discrimination at work, improve support for asylum seeking women and to ensure access to maternity care for vulnerable migrant women.

Rosalind has worked in policy and management roles in the voluntary sector and civil service in the UK and Australia focusing on social justice and human rights. She has worked predominantly in the areas of employment, health and migration.

Getting breastfeeding to work – more on Indicator 4 of the WBTi (Maternity Protection)

When the Industrial Revolution began, women started to go out to work in large numbers and breastfeeding began to decline, spurring the development of alternative ways of feeding babies. Yet, 200 years on, the question of how to combine breastfeeding and work still remains for women around the globe.

In the UK in 2015, MPs themselves are struggling to secure the right to breastfeed their babies in the chamber of the Houses of Parliament itself!

Once again, the Global Strategy on Infant and Young Child Feeding is clear that there are proven ways to make this work. It calls on governments to produce “imaginative legislation” to protect the breastfeeding rights of working women.

In particular, it recommends that legislation be compatible with the International Labor Organisation’s standards, which state that there should be an entitlement to:

health protection, job protection and non-discrimination for pregnant and breastfeeding workers
at least 14 weeks of paid maternity leave
one or more paid breastfeeding breaks or daily reduction of hours of work to breastfeed

as well as recommending that space be provided nearby for working mothers to breastfeed or express their milk.

There is also a recognition of the extra challenges faced by women who work in the “informal economy”, such as those in casual or freelance work, who don’t always have the same protections as other women.

Each year, the World Alliance for Breastfeeding Action produces a snapshot of the state of maternity protection around the world, which makes for some interesting comparisons.

Indicator 4 of the World Breastfeeding Trends initiative (WBTi) looks in much more detail at the laws and practices in each country to score them on the maternity protection they offer. Fathers are recognised too, because of their important role in nurturing babies and supporting breastfeeding, so the length of paternity leave is also included in the score.

How do you think the UK compares to other countries in protecting breastfeeding mothers at work? What was your experience of returning to work while breastfeeding? What would have made it easier?

Breastfeeding trends (UK)

Working together to improve breastfeeding in the UK

Category: Indicator 4

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life