The fabric of Britain as we know it is being ripped apart. So much is changing, almost behind our backs, we haven't got time to notice what is happening to us. And it is happening fast.

Tuesday, 3 January 2012

On The Ninth Day of Xmas, My True Love Gave To Me... Nine Ladies Lactating

Why the breastfeeding issue is important to us all and why the Government's maternity cuts are so short-sighted.

Health care costs money: a lot of money. In the UK, we are lucky enough to have a National Health Service (NHS), which means that the money for the treatment of most conditions comes from tax-payers' pockets.

Of course, the system also relies on the Government doing their bit and diverting the right amount of money towards the NHS. As we are repeatedly told at the moment, there is very little money to divert anywhere at all at the moment, so cuts are being made, and that includes cuts to the NHS.

That means less money to treat many different long-term conditions that nearly all of us will have come across either directly or indirectly in our lives - cancer, coronary heart disease, diabetes, obesity, asthma, Crohn's disease.

The Department of Health (DoH) has, thankfully, long ago cottoned onto the fact that preventing some of these conditions from developing in the first place would save them a great deal of money. So they embarked on various paternalistic schemes to try and persuade people to change their lifestyles, such as Change4Life, whose patronising literature encourages us to get active and eat a healthy diet.

The other area that the DoH has realised is vitally important when it comes to improving the health of the nation (and therefore saving money) is breastfeeding. Along with regular exercise and eating healthily, the one thing that will decrease your risk of developing all of the above conditions is starting out your life on a diet of nothing but your mother's milk. Breastfeeding also protects the mother against breast and ovarian cancer.

The DoH has known this for a long time, as has the World Health Organisation, hence the big pressure expectant parents experience to breastfeed their babies when they are born. However, they have, in my opinion, not only gone about their healthy living campaigns in all the wrong way, but also their breastfeeding campaigns. Telling parents to breastfeed their babies because it's healthier doesn't work very well.

Breastfeeding rates are creeping up slowly, but the number of women disempowered, hurt and angered by the incessant 'Breast is Best' message is also growing. It is incredibly short-sighted to tell women to breastfeed, but not to offer them enough support to enable them to do so. Even the National Institute for Clinical Evidence (NICE) recognises this fact, recommending that expectant parents are prepared and supported to breastfeed during the ante-natal period, as well as once their babies are born.

It has long been known that ante-natal breastfeeding education significantly improves the likelihood that breastfeeding will be successful for a new mother and her baby, and good ante-natal education doesn't cost very much. For example, the NCT quotes a price of £14.80 per hour per couple as their highest price (and they do offer discounted rates and some free places if couples can't afford to pay, by the way!). This is far, far less than it would cost the NHS to treat most of the conditions I mentioned above.

Which brings me to the point of this article. The Government have cut, and continue to cut maternity budgets, which means fewer midwives and less time available per mother. This has led to the shocking statistic that almost three quarters of parents living in poverty are having no access at all to ante-natal education. The impact of this is that labour and birth is likely to require more interventions, because an unprepared mother is less likely to use active birthing techniques and listen to her body.

More interventions usually means a more medicated birth and a higher risk that mother and baby will need to be separated for some time after the birth. More interventions also, to continue the financial focus of this article, cost more money and require more trained midwives and more clinical hours.

Medicated births, high-intervention births, and maternal-infant separation soon after the birth can all impact on a mother's perceived and actual ability to breastfeed her baby. Additionally, as well as increasing the risk of a breastfeeding-unfriendly birth, a lack of ante-natal education will in itself make breastfeeding less likely to succeed.

This is why the Government's decision to cut maternity funds is so incredibly short-sighted. Not only would more money diverted to maternity services ultimately save money in the short term, with lower-cost births and neonatal periods, it would also save money in the long term. It could potentially reduce the rates of many different conditions for the life-times of those babies whose mothers were fully supported to be able to breastfeed in the early days and weeks of motherhood.

I'd like to see money in the NHS being moved around and spent more judiciously instead of being cut, because they'd save a whole heap of cash if they stopped spending money on all the wrong things in all the wrong ways, and cutting funding to vital services now is going to cost far more money in the long run.

Guestfrother Clare Kirkpatrick
Author of FreeYourParenting 

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  1. I've recently been involved in a local NHS consultation about breastfeeding support in my borough. The report has been commissioned and the findings will be presented to the new GP consortia. Everyone in the process from local LINK to the report's author admit that the spending for breastfeeding support for anywhere other than areas of deprivation will depend on the whim of the consortia, not clinical need.

    Ironically you are more likely to breastfeed your baby if you do not live in an area of deprivation but you are less likely to have support to do so. This is one instance where spending money on those who are likely to use the service makes more sense. Of course the area of deprivation need support too - but they need it earlier at an education and antenatal stage to encourage people to start in the first place.

    ie: you have 100 women. Let's say 40% are from an area of deprivation and the breastfeeding initiation rate in that area is 20% so 8 women would start breastfeeding. The remaining 60% have an initiation rate of 75% so 45 women will start breastfeeding. So, instead of supporting those 45 women to continue breastfeeding all the support is provided to the 8 women. Surely ALL women should be supported but if there just isn't enough resource (and there should be as this post has pointed out it SAVES MONEY in the longer term) then surely targeting the majority makes more sense? When it comes to breastfeeding support it needs to be given to those who are going to use it, not those who we would like to use it but won't unless we intervene long before conception.

  2. I think the most significant point here is that ANY public health intervention style support for anyone will now rely on the whim of the consortia combined with the influence (or not) of the soon-to-be Local Authority employed public health workforce.

    The governance arrangements for public health under the government reforms are cloudy to say the least. I for one do not yet understand how PHE will work, or how the consortia propose to cater for their entire population - as opposed to their lists, or those on their lists who present regularly at GP surgeries.

    The flip side of (the demonised idea of) beurocracy is accountability. The flip side of (currently fashionable) local decision making is arbitrary differences in policy between areas.

    WRT breastfeeding I agree that the way forward currently is to normalise it as far as possible. Get the numbers up so it is a visible, normal part of life with babies. Then and only then start to focus in on the 'hard to reach' groups. While women from every walk of life are struggling to initiate and sustain breastfeeding, there is little to gain from focus on those who are (statistically) most likely to struggle.

    And never forget the power of lies, damned lies and statistics: most materially deprived people do not live in deprived areas. Focus misses the target.

    (Epidemiologist and PH person, currently on maternity leave)

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