Wednesday, May 16, 2007

Launch of the Breastfeeding Manifesto

Today was the launch of the Breastfeeding Manifesto, a seven-point plan to improve support and protection of a mother's right to breastfeed and to remove obstacles to breastfeeding. I went to the evening event and had a great time, meeting some of the other members of the manifesto coalition, the Minister for Public Health and Theo Walcott, the Arsenal and England footballer and one of the celebrities supporting the campaign. Here I am with Theo and his mother, Lynn, at the launch, showing them a copy of our new monitoring report (implementing the baby food marketing requirements in law is point 7 of the manifesto).

So why do we need a Breastfeeding Manifesto?

According to UK Government research, 9 out of 10 mothers who stopped breastfeeding by 6 weeks said they did not want to stop.

Wouldn’t it be great if 10 out of 10 mothers could say they stopped because they decided the time was right?

However long a mother breastfeeds, she is giving her child advantages compared to formula-feeding her child. Some breastmilk is better than no breastmilk, while the World Health Organisation recommends exclusive breastfeeding for the first 6 months, followed by the introduction of other foods and continued breastfeeding into the second year of life and beyond.

The important thing is that a mother should be able to decide when she will stop breastfeeding. Her decision shouldn’t be undermined by lack of support if she experiences breastfeeding difficulties. Or undermined because she is made to freel embarrassed breastfeeding if others are around, whether at home or in public. Or undermined because of promotion from baby food companies that idealizes artificial feeding and makes it appear the same, or almost the same, as breastfeeding.

You can sign up to the Breastfeeding Manifesto campaign, send a message to your Member of Parliament and find out full details at:

Here are the 7 points, with some of my reflections on them. For the official explanation, see the Breastfeeding Manifesto website.

1. Implement the Global Strategy on Infant and Young Child Feeding.

This was adopted by the World Health Assembly in 2002. As part of the International Baby Food Action Network (IBFAN), Baby Milk Action was very active during the drafting process to ensure that the strategy was as good as it could be. In particular we wanted it to reiterate the importance of implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions. The Code was adopted in 1981 as a ‘minimum requirement’ to be implemented by all member states in ‘its entirety’ (to quote the Resolution bringing in the Code).

2. Implement postnatal care guidance from the National Institute for Health and Clinical Excellence and the accompanying Public Health Evidence into Practice Document.

The evidence for the benefits of breastfeeding and risks of formula feeding is overwhelming. What works and does not work in helping mothers to breastfeed has been well researched. If we are serious about enabling all mothers to breastfeed as long as they want to, then best practice has to be implemented.

3. Improve training for health professionals.

And one of the most important ways to do that is to improve training for health professionals.

Part of this I would like to flag up here in reflecting on recent experiences. We should remember the role of peer-to-peer support.

On Monday I spoke at a Breastfeeding Awareness Week event in Cardiff. See:

There I heard how in the most disadvantaged communities breastfeeding rates tend to be lower and the importance of breastfeeding more marked. Breastfeeding reduces health inequalities (as we reported in our Update 39 newsletter). Research presented at the meeting suggested peer-to-peer support groups, particularly in disadvantaged communities with low breastfeeding rates, are the most effective way to help mothers breastfeed. So we need health workers to be trained not only on how to support breastfeeding themselves, but how to nurture mother support groups. The groups themselves need better government support.

We have just seen Netmums embroiled in controversy for going to Nestlé for funding. It is a forum with 300,000 members accessing it for support. While we disagree with Netmuims decision to go to Nestlé, we have to acknowledge there is a lack of government funding for the mother support sector as a whole and this needs to change.

4. Work with employers to create a supportive environment for breastfeeding mothers.

Caroline Flint, the Minister for Public Health, commented that existing Health and Safety guidelines call for support for pregnant and breastfeeding mothers, including comfortable environments for breastfeeding (which does not mean the toilet). Employers need to be encouraged to provide this. Some countries provide for statutory breastfeeding breaks, which mothers can use to feed their children or to express milk.

My wife, Sonia, who set up a human donor milk bank in Brazil, worked with businesses to set up comfortable facilities for mothers to express and store milk.

An aside about Brazil's experience

In Brazil, milk banks are appreciated as centres of excellence for breastfeeding support, having full-time staff assigned to them. Sonia was the paediatrician for her milk bank. There were also nurses, a psychologist and a speech therapist. It is hardly surprising that breastfeeding rates in Brazil are so much higher and increasing year-on-year. Sonia wrote an article for Practising Midwife in 2003 about her experiences in promoting, supporting and protecting breastfeeding. You can download the article at:

This gives the statistics for our home town in Brazil, São José dos Campos, São Paulo:

---Quote begins
The latest breastfeeding figures (based on interviews with the guardians of 1,882 children under one during the 2001‘vaccination day’) for the city show its strategies are working. At four months, 36.6 per cent of babies are ‘exclusively’ breastfed. At six months, 26.7 per cent are exclusively breastfed and 21.5 per cent ‘predominantly’ breastfed (breastfed with some water, tea or juice), making a total of 48.2 per cent ‘completely’ breastfed.
---quote ends

In the UK at 6 months 7% of mothers are exclusively breastfeeding in the UK, according to the latest government statistics.

We can take some encouragement from an increase in breastfeeding initiation rates in the UK. However the news on duration is not so good. While initiatives such as UNICEF Baby Friendly are doing much to improve support in hospital, once mothers have left they may lack support systems and are bombarded by formula promotion. The new UK Government report states:

---Quote begins
Among mothers who did breastfeed initially the proportion still breastfeeding at six
weeks and at six months was the same in 2005 compared to 2000. Only at nine
months was the proportion of mothers still breastfeeding higher in 2005 compared with
2000. However, in Scotland the proportion of mothers still breastfeeding at six weeks
and six months fell in 2005 compared with 2000.
---quote ends

So why are rates relatively high in Brazil and increasing, but low in the UK with some of the rates static or moving in the wrong direction?

A quick answer is that Brazil long ago decided to implement something very much like the 7-point Breastfeeding Manifesto.

Successive governments have put in the required resources and legislation to promote, support AND protect breastfeeding, and reaped the benefits as breastfed infants are less likely to become sick.

5. Develop policy and practice to support breastfeeding in public places.

This requires cultural change. So education, backed by enshrining the right to feed an infant in public in law, is required.

6. Include breastfeeding education (free from commercial influence) in the curriculum

Views on infant feeding are generally formed before women and their partners come into contact with information through ante-natal care. Also, in the more deprived areas where breastfeeding may be uncommon a child may grow up without seeing a sibling or neighbour’s child breastfed. Baby dolls usually have feeding bottles as a standard accessory.

Schools are essential to provide accurate and independent information about breastfeeding.

7. Adopt the WHO International Code and subsequent, relevant Resolutions.

In the UK advertising of breastmilk substitutes is widespread and there are no regulations at all on the promotion of feeding bottles and teats.

The UN Committee on the Rights of the Child called for the Government to introduce the Code in 2002 and we hope the current review of our current weak law will bring it into line.

We are asking supporters to write to Public Health Minister, Caroline Flint MP, who spoke very supportively at the launch event tonight. Please do write and send the postcards available on the Breastfeeding Manifesto website to your MP. Even if a politician supports the campaign, the more they can demonstrate the public are calling on them to take action, the more strongly they can argue the case in government. For our suggested letter see:

I had the opportunity to speak with the Minister and hand her a copy of our Hard Sell Formula pamphlet which exposes the integrated strategies baby food companies use to undermine breastfeeding and promote their brand names and products, even before a mother's baby is born.

Here I am pointing out at a mail shot pictured on the pamphlet. It was sent by Cow & Gate to a new mother. Here is the image. This is the back of the folded card.

It says:

'I’m thinking of getting a t-shirt made – ‘Danger! Sore boobs!’

It is branded with the Cow & Gate logo used for the formula and inside encourages mothers to go to the Cow & Gate website, which promotes the formulas, and to telephone the Cow & Gate careline. Ostensibly offering to support mothers, it preys on a mother's concerns and pain she may be experiencing to promote its formula brand name on the card and specific products on the site.

Some mothers do experience pain as they and their child get used to breastfeeding. As Caroline Flint said at the event, we should not pretend breastfeeding is immediately an easy and pleasurable act for all mothers.

But if a mother experiences problems she needs help from health care professionals and mother support groups, not a mailshot dropping through the letter box promoting Cow & Gate. This mailshot seems to have been timed for when a mother is most vulnerable. The person who sent it to us in July 2006, wrote:

---Quote begins
My daughter had a baby 3-4 weeks ago. She did receive a Bounty pack and did join the Boots baby club (or whatever it is called!) But nowhere did she ask for any formula information or careline etc. This appears to be unsolicited mail. Does this contravene the Code? I feel it does.
---quote ends

It most definitely does breach the Code. Article 5.5 prohibits companies seeking direct or indirect contact with mothers, whether it refers specifically to infant formula in the first instance or not.

But in the UK, companies can argue they have broken no law in promoting their infant formula brand name in this way. And they get away with it and many, many other forms of promotion, some of which are described in the Hard Sell Formula pamphlet.

Article 11.3 of the Code calls on companies to abide by the marketing provisions independently of government action. They don’t. The best way to stop companies from undermining breastfeeding and ensuring that mothers receive accurate and independent information, however they decide to feed their infants, is by putting the Code and Resolutions into law and enforcing it.

We can all play our part in making all 7 points of the Breastfeeding Manifesto a reality. Even young men. Perhaps especially young men.

So the final word goes to Theo Walcott:

---Quote begins
I have grown up knowing how important breastfeeding is as my mum was a La Leche League breastfeeding leader. Healthy eating is a very important part of my life as a professional footballer. I support the Breastfeeding Manifesto as it would help to ensure the first step to a healthy lifestyle for all children.
---quote ends

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