Changing the conversation-breastfeeding matters to babies, women, families, and society

We must work together to make it possible and easy for women to breastfeed

National Breastfeeding in Scotland Week is an important opportunity to reflect on whether we are all doing enough to enable women to breastfeed and what we could do better. 

Our knowledge and understanding of breastfeeding – and the impact of not breastfeeding – has developed rapidly over the past few years.  There is a critical need to shift the culture in Scotland and the rest of the UK, from one in which women often find breastfeeding difficult and may feel pressured to breastfeed, to one in which all women are offered the help and support they need to enable them to breastfeed. Significant societal barriers need to be removed for this to happen.

What we know:

  • There are significant and substantive differences between breastfeeding and not breastfeeding in regard to health and development outcomes, for both the baby and the mother [1],[2].
  • Despite Scotland’s ambition to be the best place for a child to grow up, breastfeeding can be hard for women to do. Women living in communities where breastfeeding rates have been low for generations may have little access to family or community support, contributing to ongoing inequalities[3],[4].
  • Although Scotland has strong legal protection for women who breastfeed in public[5], many women still find it embarrassing to breastfeed in front of others, whether in public or in their own homes[6].
  • Exposure to misleading advertising of formula may influence the public, parents, and health professionals to believe that these products are equivalent to breastfeeding. A WHO international code exists to limit the marketing and promotion of breastmilk substitutes, but is not properly monitored and implemented[7],[8]
  • Supporting women who wish to breastfeed is effective and cost effective[9],[10] yet high quality support whether in hospital or at home is not consistently funded or available for all women for as long as they need it.  Evidence shows that babies in neonatal units and their parents need special help to have close skin-to-skin contact and support for breastfeeding, but this is not consistently offered either[11]
  • Underlying these barriers, and contributing to public and professional ambivalence about breastfeeding, are media messages that often focus on negative aspects of breastfeeding[12] and which criticise those who speak up about its importance.  These messages often focus on the negative experiences of individual women, and seldom look further to consider why breastfeeding – a natural and physiological function of the human race – has become so difficult.  In contrast, formula feeding is often seen as normal and unproblematic.[13] Media messages about breastfeeding are further complicated by the pervasive hyper-sexualised images of women’s bodies.  As a consequence, young women have even reported that they feel it is immoral to breastfeed[14] 

As a result of these factors women often struggle and fail. They may experience efforts to inform and help them as pressure, and understandably become guilty and angry about not managing to care for their baby in the way they know is best.  This must change.

A new way of enabling breastfeeding is needed – one that tackles the societal barriers that individual women cannot tackle alone and creates a shift in the prevailing culture and attitudes to breastfeeding.  This should be put in place in a planned and coordinated way by decision-makers with funding, influence, authority and accountability, rather than relying on women’s own determination, the motivation of health professionals, and the work of voluntary organisations alone. It will require a coordinated cross-sectoral strategy that engages everyone in the conversations needed to create a positive environment for women, babies and families.[15]

We need to:

  1. Provide all women with the right support at the right time in the right place. This includes a fully funded system of support available in hospital and at home, provided by staff and volunteers who are supported, educated and skilled in the prevention and treatment of breastfeeding complications.
  2. Provide legal protection against misleading promotion and marketing of formula. Fully enact the WHO Code on the marketing of breastmilk substitutes, with adequate monitoring and enforcement.
  3. Ensure all health professionals (midwives, health visitors, GPs, obstetricians, paediatricians, speech therapists, neonatal nurses, nursery nurses, peer supporters[16], and specialist practitioners as appropriate), receive high quality education and training in line with the Unicef UK Baby Friendly Standards for education.
  4. Provide education for children about breastfeeding at all appropriate stages, as part of healthy lifestyle learning.
  5. Ensure all employers provide support for women in the workplace who are breastfeeding, in accordance with existing international regulations.[17]
  6. Provide accessible information for all, to educate and inform senior decisions-makers, health professionals, the media, and the public, about infant feeding and ways to support and enable women to breastfeed. This should include work with the media in all its forms – print, audio-visual, social. 
  7. Engage everyone – women, families, the public, decision makers, professionals, managers, teachers, the third sector, academics, employers, and government - in a different conversation. We need to listen to how we can work together to break down the barriers and create the circumstances in which babies can be breastfed, and women can enjoy breastfeeding

Endorsed by the following signatories

Professor Mary Renfrew FRSE, Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee

Professor Annie Anderson, Professor of Public Health Nutrition, Centre for Public Health Nutrition Research, School of Medicine,

University of Dundee

Dr Alison McFadden, Director, Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee

Gillian Bowker, Neonatal Infant Feeding Advisor, NHS Greater Glasgow and Clyde

Dorothy Bradley, Specialist Practitioner, NHS Lothian

Bridie Cowan, Infant Feeding Advisor, NHS Greater Glasgow and Clyde

Dr Helen Crawley, Director, First Steps Nutrition Trust

Dr Linda de Caestecker, Director of Public Health, NHS Greater Glasgow and Clyde

Shereen Fisher, Chief Executive, Breastfeeding Network

Professor John Frank, Chair, Public Health Research and Policy, University of Edinburgh

Jill Gibson, Infant Feeding Coordinator, NHS Grampian

Gina Graham, Breastfeeding Support Coordinator, NHS Fife 

Lucy Harkins, Infant Feeding Advisor, NHS Lothian

Professor Pat Hoddinott, Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling

Vivien Hutchison, Community Infant Feeding Advisor, NHS Lothian

Jacqueline Imrie, Infant feeding Advisor, NHS Lothian 

Ashley Jack, Infant Feeding Advisor, NHS Lothian

Barbara Jessop, Health Improvement Specialist-Maternal and Infant Nutrition, NHS Borders

Melissa Kallat, Lead Infant Feeding Advisor, NHS Lothian

Karen Mackay, Infant Feeding Advisor, NHS Highland

Joanne McCormick, Infant Feeding Advisor, NNU, NHS Lothian

Thomas McEwan, Lecturer in Midwifery (Maternal, Child & Family Health), University of the West of Scotland

Dr Alison McFadden, Senior Research Fellow, Director, Mother and Infant Research Unit, University of Dundee

Dr Rhona J McInnes, Associate Professor of Maternal Health & Consultant Midwife, NHS Lothian 

Nikki Ould, Infant Feeding Coordinator, NHS Forth Valley

Donna Robertson, Infant Feeding Advisor, NHS Fife

Elaine Ronald, Infant Feeding Advisor/Infant Nutrition Co-ordinator, NHS Forth Valley

Susan Short, Public Health Nutritionist, NHS Lanarkshire

Dr Valeria Skafida, Lecturer in Quantitative Social Policy, Programme Director of MSc Policy Studies & MSc Comparative Public Policy, School of Social and Political Science, University of Edinburgh

Elizabeth Smith, Community Infant Feeding Nurse, NHS Ayrshire & Arran

Carol Sutherland, Infant Feeding Advisor, NHS Tayside

Anne Tainsh, Professional Lead for Scotland, Baby Friendly Initiative, UNICEF

Alison Thewliss MP, Scottish National Party

Tracy Thornton, Infant feeding Coordinator NHS Highland 

Dr Steve Turner, Scottish Officer of the Royal College of Paediatrics and Child Health

Professor Charlotte M Wright, Professor of Community Child Health, School of Medicine, Glasgow University and Honorary Consultant Paediatrician, Royal Hospital for Children, Glasgow

The Association of Breastfeeding Mothers

[1] Babies who are not breastfed have increased likelihood of developing infectious diseases such as gastrointestinal disease, respiratory disease, and otitis media; and of developing longer term complications such as diabetes and obesity. Preterm babies who are fed on breastmilk substitutes are more likely to develop necrotising enterocolitis and sepsis, both life-threatening complications.  Babies’ development is affected by not being breastfed, with detrimental effects on IQ, educational and behavioural outcomes. The longer women breastfeed for, the less likely they are to develop breast and other reproductive cancers.  (The Lancet Series on Breastfeeding

[2] Soccianti C, Key T, Anderson AS et al (2015) European Code Against Cancer 4th edition

[6] McAndrew et al. Infant Feeding Survey 2010

[11] Woodman K. Providing the best meeicine: summary of the evidence in support of breast(milk) feeding in neonatal units. 2017. NHS Health Scotland.

[14] Dyson L, Green J, Renfrew M, McMillan B, Woolridge M. Factors influencing the infant feeding decision for socio-economically deprived pregnant teenagers: the moral dimension. Birth, 2010. 37(2):141-149