Steady decline in number of women nursing their babies is blamed on lack of public efforts to counter prejudice
Claire Jones Hughes was mortified when she was told by fellow diners in a cafe that she should be more discreet when breastfeeding her four-month-old daughter. “It was very unpleasant watching you feed,” she was informed. But this was affluent, liberal Brighton. Another customer came to her rescue, ordered the group to “get in the 21st century” and, rather than hide away, Claire decided to take a stand. She took to the internet and organised a breastfeeding “flashmob” attended by 60 mothers who, just days later, proudly nursed their babies by the town’s clock tower.
Claire, a customer services manager, had made her point and acceptance of public breastfeeding, even in this bastion of tolerance, was given what health professionals would say was a welcome nudge. Yet such a display of unashamed public breastfeeding is unlikely to happen in large swaths of the country, figures from the Department of Health suggest. In Brighton, 67.1% of new mothers were partially or totally breastfeeding their children when they reported for a checkup six to eight weeks following their child’s birth, according to statistics for the first three months of 2013. Yet in other parts of the country the figures remain resolutely low.
In middle-class circles it is fashionable to criticise the “lactivists”, the volunteers and professionals who rather zealously warn of the dangers of formula milk. But far from women being unfairly pushed into breastfeeding, in many parts of the country the reluctance to even entertain the idea of using anything other than formula milk is firmly entrenched.
In Hartlepool, in the north-east, between January and March this year only 57 mothers told healthworkers at their six- to eight-week checkup that they were giving breastmilk to their child – 19.3% of maternities in that period and three fewer women than attended Claire’s demonstration. On the other side of the country in Knowsley, in Merseyside, an even smaller proportion of mothers were partially or totally breastfeeding by the time of their six- to eight-week checkup – 17.6%. In north-east Lincolnshire, it was 19.7%, in North Tees 21.5% and in South Tyneside 22.6%.
Nationally, in 2012-13, just 47.2% of women were totally or even partially breastfeeding around six to eight weeks after the birth of their child, unchanged from the year before. Furthermore, the Observer reports a decline in the number of women trying to breastfeed in the 48 hours after childbirth – the first year-on-year dip in almost a decade. The proportion of women who initiated breastfeeding, defined as just once bringing a child to the nipple, let alone feeding it some milk is down 1.2% on last year (about 5,700 fewer mothers), suggesting that the trend towards breastfeeding of the last decade has stalled.
From 2004 the proportion of women initiating breastfeeding went up one percentage point every year from 66.2% to 74% in 2011-12, with a smaller increase between 2010-11 and 2011-12. Now even that nudge, in what study after study says is the right direction, has dissipated.
It is this limited but potentially significant fall, and those stark figures in Hartlepool, Knowsley and elsewhere, that the Royal College of Midwives (RCM) has in mind as it shares its concerns about the government’s seeming lack of interest in the issue. A decision by the coalition to stop funding for National Breastfeeding Awareness Week and to scrap regional co-ordinators of infant feeding is shortsighted, says Janet Fyle, professional policy adviser at the RCM. Progress has been slow in encouraging wider breastfeeding since formula milk came to be perceived as the modern and convenient way to go in the 1960s but there is a clear danger that the country could now be going backwards.
“Over the last 10 years we have had a lot of initiatives to try to encourage breastfeeding, lots of engagement with parents, and we had regulations to control advertising from formula milk companies. There was a focus on the issue. I am not saying it was perfect, but there was an improvement in initiation of breastfeeding and prevalence.
“But in the last three years there has been a loss of focus on breastfeeding per se … We would drag out a minister and focus on changing things in areas with low rates. But things have not been moved on in the last three years and we seem to be stalling. You need a national campaign. There’s been inaction.”
Studies show that affluence in an area is a strong indicator of whether breastfeeding is taken up. The council tax valuation of local properties has even been shown to closely predict the proportion of women in any given area who breastfeed. Then there is the propensity for white women to breastfeed less than those from ethnic minority groups. Southwark and Lambeth, London boroughs containing large ethnic minority communities, have the third and fourth highest proportions of women who continue to breastfeed after two months, 81.8% and 76.6% respectively. And there are particular cultural issues to deal with. In Knowsley, Matthew Ashton, the acting director for public health, said there were strong communal ties, little migration inwards or outwards, and an entrenched preference for formula milk that was proving difficult to usurp. “It is done out of love, they believe they are making the right choices,” Ashton said.
Over in Hartlepool, Annie Wallace, the council’s breastfeeding co-ordinator, said its feedback was that women didn’t feel comfortable breastfeeding in public. Councillor Cath Hill, portfolio holder for children’s services in the area, has admitted that, while she regards breastfeeding as “the most natural thing in the world, in Hartlepool breastfeeding is seen as unnatural and abnormal”. The council has started encouraging cafes and restaurants to put up signs to indicate that they are breastfeeding friendly.
There is plenty of effort being expended by volunteers and health workers. But today’s statistics suggest it might not be enough. It is yet to be seen whether the coalition takes the latest figures as the warning shot many believe they will prove to be.