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Decisions Around Infant Feeding Are About Reproductive Choice

15/11/2016 12:05

There are clearly a number of different perspectives at play in the furore that followed the revelation that a particular Tesco store in Essex will not give car parking vouchers to women whose sole purchase is formula milk. It's a pretty strict, though not unreasonable, interpretation of UK regulations based on an EU directive that forbids any promotion of formula milk - including related freebies (so in this case a car parking space) and for some therefore evidence that the sooner Brexit can free us of these barmy rules the better.

The regulations governing the promotion and marketing of formula milk based on an WHO international code of conduct, yes which fall within an EU directive, but yes which we'd have a version of anyway. So while this story tells us little about the merits or otherwise of Brexit, the way in which it has played out illustrates the huge tensions that exist today between the ideal way to feed your baby (breastfeeding) and the way in which most women end up doing so (formula feeding).

Official policy recommends to women that they breastfeed exclusively for the first 6 months - that is they give their baby nothing but milk from their breasts - because breastmilk provides everything a baby needs for those few months of its life. Women are aware of the benefits of breastfeeding, and that's why more than 80% of new mothers breastfeed at birth. But that proportion starts to fall - so that by three months fewer than one in five babies are exclusively breastfed (though many more will be receiving both breast and bottle), and by 6 months just 1%. The fact that 99% of women do not follow official policy suggests we have a policy that is completely out of step with the reality of new mothers' lives, not that women themselves are doing something wrong.

There is categorically more that can be done to support women who want to breastfeed through better access to skilled advice and help if and when they want it. But we need to accept that with all the support in the world some women will decide that breastfeeding - or at least exclusive breastfeeding - does not work in the context of their lives and families. As more fathers are expected and expect themselves to take a shared role in caring for a new baby, it is unsurprising that formula milk offers a way for them to take part. Women caring for other young children may find breastfeeding unpredictable and time consuming at a time when the baby is not the only one who needs them. Formula milk may be expensive, but breastfeeding is not "free" in terms of women's time, as is widely held. Exclusive breastfeeding is time-intense - a 2013 study found that women who breastfeed spend 7 hours extra week feeding milk. The authors noted that "this may contribute to premature weaning for women who are time-stressed, lack household help, or cannot afford paid help".

And some women simply don't want to use their breasts in this way and are satisfied with the alternative available. That's fine too.

There is a wealth of literature documenting the health benefits of breastfeeding versus formula feeding which strongly suggests that breastfeeding can provide protective effects against certain illnesses, including respiratory, gastrointestinal and ear infections - although the scale of the benefits need to be kept in perspective. While this comprehensive review for example concluded that exclusive breastfeeding could half the number of hospital admissions for diarrhea, the base line numbers were small - only around 1% of the thousands of babies studied were admitted for this in the first place. That is not to suggest the risk reduction is not real - but that we do need to understand the level of risk in the first place.

As for the long term benefits, the World Health Organisation systematic reviews of the impact into adulthood finds no evidence of benefits for blood pressure or cholesterol (the risk factors for cardiovascular disease), a possible reduction in obesity and therefore diabetes - but this may be because 'in most study settings breastfeeding duration was higher in families where the parents were more educated and had higher income levels', and obesity is often associated with socio-economic deprivation. On IQ they found a increase, on average by 2 points, even after maternal intelligence was accounted for, but acknowledged that the actual meaning of such a tiny increase would be open to debate.

Women should not be lied to or misled by formula milk makers, and we need regulations to ensure this is the case. But we don't need to oversell the many benefits of breastfeeding for either mother and baby to ensure women make the "right" choice. Breast is best, but it may not always be best for all women, all of the time.

Bpas supports reproductive choice. We support the right of women to choose to be pregnant - or not. We support women's right to make their own decisions in pregnancy and birth. We believe women are capable of making their own decisions about what is best for them, in the context of their own lives, and the decision to use one's own body to feed a baby is very much a matter of reproductive choice. Women need evidence-based information on which to make those reproductive choices, and they can be trusted to do so.

They don't need to be treated like dimwits. The ban on free car parking vouchers or benefits from any customer reward scheme for those buying formula is absurd. But it's mainly insulting, built on the premise that given the prospect of a few extra points on their Boots card once a week women will ditch the breastfeeding and reach for the bottle.

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