Mums Deserve Support, Not Direction

So, the National Childbirth Trust (commonly known as NCT) have decided to shift their policy from ‘promoting breastfeeding’, to ‘supporting breastfeeding’. (http://www.telegraph.co.uk/health/healthnews/9029811/Trust-drops-evangelical-breastfeeding-message.html)

Hardly on a par with the headlines of the day, but a significant development for an organisation and charity perceived by many as the leading proponent of breastfeeding, after the NHS. Interestingly its decision, which moves it away from the monolithic NHS position of ‘Breast is Best’ comes following a number of years of closer collaboration with the NHS as a commissioned provider of antenatal classes in a number of areas of the UK. It also follows the government stripping out funding for breastfeeding awareness as part of its cost cutting. (Just to clarify, this doesn’t mean the NCT will therefore be promoting formula feeding, or even suggesting it is on a par with breastfeeding, merely that it isn’t focusing on promoting it as it used to.)

I’m pleased that they are taking on these difficult questions and undergoing a re-evaluation of what they stand for and why. Breastfeeding is already hugely promoted by the NHS, but as many new mums discover, it is the support that is lacking. New and expectant mums speak frequently and openly of feeling pressurised to breastfeed, not supported. And also of the perceived stigma, isolation and lack of care they can receive when they decide not to.

The NCT is a big ambassador for empowerment; most of its activities revolve around educating and arming women with information about pregnancy and childbirth to make ‘informed choices’ during labour. It stands to reason that this same logic should be applied to its stance on breastfeeding. If women are respected and independent to make their own choices, then any policy which clearly directs them to a specific appropriate behaviour is, to my mind, a fundamental contradiction of principle.

The national NHS policy of ‘Breast is Best’, is one that I have always been uncomfortable with, both from the point of view of respecting women’s autonomy, and of the reality of how this impacts upon care. ‘Breast is Best’ may be an accurate scientific conclusion based on the currently available research*, but a scientific fact alone does not good health policy make. Responding to the immense social, economic and personal factors which influence a woman’s maternal experience (including the decision to start or cease breastfeeding) with a simple ‘it’s best’ policy fails to respect women as complex beings in the context of the diverse world we live in. It’s comparative to running the obesity campaign on the slogan ‘Slim is best’. It’s stating the blooming obvious and offers little more. It also misses the basic fact that to get equal outcomes, we must identify and address the diversity of the starting position. Informed choice is just that. Getting information, making a choice. Only promoting one option isn’t offering all the information.

Similarly, the Telegraph article suggests that the NCT are pursuing this in the context of reaching a broader audience. They are white and middle class, and the women at the blunt end of maternity care frequently are not. On this point the NCT are making a savvy move. No doubt they will have faced some fierce opposition from ardently pro-breastfeeding quarters of their grassroots, but by acknowledging that the issue is more nuanced than a hardline attitude can accommodate sets them ahead of an NHS struggling to reach the very people it should, while it is increasingly looking beyond itself for provision of services, including ante-natal education.

From my experience as a past volunteer with an NCT branch, I’d confidently say this decision reflects the reality of women’s experiences under a ‘Breast is Best’ policy. They don’t need more direction; those that know where they want to go just need the support to get there. Nevertheless, it’s going to be the women who don’t or cant access the antenatal and postnatal support who remain the toughest challenge, especially for an organisation whose bedrock are currently those who’ve already got the best outcomes. A welcome step in the right direction, on a long walk ahead.

(*the scientific value of breastmilk was widely and wrongly called into question by hysterical reporting this year – see http://www.analyticalarmadillo.co.uk/2011/01/starting-solids-facts-behind-todays.html for a summary of what was actually said and what it means)