Breastfeeding welcome here?

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Breastfeeding in public is often a topic for debate. Although a very personal decision for parents, breastfeeding in public spaces is viewed as a social issue with divided opinions. This article looks at the benefits of breastfeeding for mothers and babies versus the influence social attitudes can have, and asks if attitudes towards breastfeeding in public places in Northern Ireland are changing.

Image by Dave Clubb

A new 10-year strategy Breastfeeding – A Great Start: A Strategy for Northern Ireland 2013-2023  was published in June 2013. The purpose of the Strategy is to improve the health and well-being of mothers and babies in Northern Ireland through breastfeeding. It sets out the strategic direction to protect, promote, support and normalise breastfeeding in Northern Ireland for the next ten years.

The International Breastfeeding Symbol (image: WikiMedia Commons)
The International Breastfeeding Symbol (image: WikiMedia Commons)

The UNICEF UK Baby Friendly Initiative (BFI) accreditation has been awarded to nine hospitals in Northern Ireland, meaning that 93% of all births in Northern Ireland take place in a UNICEF BFI environment that promotes breastfeeding for new born babies. Despite this, Northern Ireland has the lowest rates of breastfeeding in the UK.

The Public Health Agency promotes the ‘Breastfeeding Welcome Here’ scheme. It was initiated in 2005, with the aim of encouraging and improving the ‘social acceptability’ of breastfeeding in public places. A business or organisation that has joined the scheme displays a sign so that mothers who want to breastfeed know they will be welcome.

The scheme applies to premises that are open to the public, such as cafes, museums, libraries, supermarkets and council buildings. In March 2016 over 400 local attractions, businesses and council venues had signed up to the scheme, including the Northern Ireland Assembly that signed up in 2015.

Are attitudes to breastfeeding changing in Northern Ireland?

The Northern Ireland Health Survey for 2015-16 reported that 71% of respondents (72% of females and 69% of males) agreed there should be a law in Northern Ireland to protect women who wanted to breastfeed in public.

Global academic and government research consistently indicates that breastfeeding has long term benefits for the health of infants and their mothers. The World Health Organisation (WHO) recommends that a baby is exclusively breastfed for the first six months of life, and for at least the first two years to gain the optimum health advantages for both mother and baby. Children who are breastfed for a longer period are less likely to suffer childhood infections and have higher levels of intelligence than children breastfed for a short time, or not at all. Breastfeeding also offers mothers protection from breast cancer, with growing evidence that it may also protect against diabetes and ovarian cancer.[i]

There have been indications that more women in Northern Ireland may want to breastfeed. Between 1990 and 2010, the number of mothers who were breastfeeding their babies when they left hospital had almost doubled from 36% to 64%. In 2013-14 the percentage of babies being breastfed when they left hospital had increased to 45%, but had dropped to only 5% by their first birthday.

Many factors influence a mother’s decision not to breastfeed, or to cease breastfeeding. The reasons mothers give range from medical and cultural to discomfort and inconvenience. For example, it is harder to involve others in feeding when a baby is being breastfed, and breastfeeding can be time consuming and tiring. Also, if there is a lack of peer knowledge and influence from other women in the family, this may have an effect on a mother’s confidence around breastfeeding, especially if it is her first baby.

The British Nutrition Foundation criticises the way breastfeeding is promoted by targeting mothers and using the repeated argument that ‘breast is best’ followed by a list of health benefits. In order to change social attitudes, they argue that a societal approach is needed that targets both genders, all age groups, and all socio-economic groups. Similarly, in a recent research study, women said they wanted the messages about breastfeeding to change from being ‘best’ to being ‘normal’ and include wider values than just health benefits. They also felt that since it was the attitudes of others that directly or indirectly affected their decision to breastfeed, educating society in general would be a better approach.[ii]

While some mothers are unable to breastfeed for a variety of reasons, and others may not wish to, there are indications of cultural and social attitudes having an influence. This is an issue where views are divided as highlighted in November 2016 when an incident occurred when a mother was breastfeeding her 11 week old baby in a Belfast restaurant.

What stops mothers breastfeeding?

There are certain characteristics that can mean a woman is less likely to breastfeed.

  • Age – teenage and young mothers;
  • Education – mothers who have left education early;
  • Socio-economic status – mothers from deprived areas, unemployed, or in low income households.

When a mother leaves hospital breastfeeding her baby, it is often social attitudes and practicalities such as returning to work that influence whether she will continue to do so.

Cultural and social attitudes have a strong influence on whether women decide to breastfeed, or continue to breastfeed. Women have reported being embarrassed in public places and certain social situations, and they are also sensitive to the embarrassment of others. This applies not only to members of the public, but also to friends and family. Some women said they had adopted a certain ‘etiquette’ when breastfeeding in public where they tried to find a quiet place away from others. However, this strategy has meant some mothers have resorted to feeding their baby in public toilets; neither comfortable nor hygienic. So ambivalence towards breastfeeding was not only caused by being seen as socially inappropriate, but also as insensitive to the feelings of others.[iii]

Returning to work can also be a problem. Breastfeeding tends to decrease around 4-6 months. This trend has been linked to mothers returning to work, although it has been found that low cost interventions by employers can reduce absenteeism and improve staff commitment. Childcare arrangements also make a difference. If babies are cared for by family, friends or neighbours they are less likely to be breastfed. This was found to be the case across all socio-economic groups. Formal childcare offered more support for mothers to continue breastfeeding when they returned to work. For example, by offering storage facilities for expressed milk. Strangely, rates of breastfeeding were lower among advantaged families who used formal child care on a full-time basis, despite higher income and better educated mothers being more likely to breastfeed.[iv]

Can legislation make a change?

The Scottish Parliament took the view that legislation would be the best way forward. It is the only jurisdiction in the UK and Republic of Ireland with legislation in place to protect a mother who wants to breastfeed in public. The Breastfeeding (Scotland) Act 2005 came into force in 2009. It makes it an offence to prevent or stop someone feeding a child in public if the child is under two years of age. This applies to either breast or bottle feeding. Employers must also ensure that anyone is able to feed a child on their premises unhindered. A public place is described as any place where the public, or a section of the public, through payment or otherwise is permitted to be. The Act in Scotland also requires Scottish Ministers to promote and support breastfeeding and disseminate information that encourages breastfeeding. It is estimated that the cost of introducing legislation similar to Scotland will be minimal, since there has only been one prosecution in Scotland since the Act came into force in 2009.

Claire Hanna MLA planned to introduce a Private Member’s Bill in the Northern Ireland Assembly to put in place legislation that would ensure that mothers who wish to feed their infant in public will be legally protected. Subsequently in January 2017, the Health Minister, Michelle O’Neill, announced that she intended to bring forward legislation to protect women wishing to breastfeed in public in NI.

The NI Public Health Agency has been promoting breastfeeding in Northern Ireland for many years through breastfeeding awareness weeks, DVDs for mothers, fathers and grandparents, and the ‘Breastfeeding Welcome Here’ scheme. Legislation can be a first step or a last resort to protect mothers who want to breastfeed while attitudes slowly change.

[i] Victoria C. G. et al, ‘Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect’; Lancet 2016; Vol. 387: pp475-90

[ii] Brown, A, (2016), What Do Women Really Want? Lessons for Breastfeeding Promotion and Education. Breastfeeding Medicine, doi: 10.1089/bfm.2015.0175

[iii] Leeming, D., Williamson, I., Johnson S., and Lyttle, S., Socially sensitive lactation: Exploring the social context of breastfeeding. Psychology & Health, 2013, 28(4):450-68.

[iv] Rollins N. C. et al, ‘Why Invest, and what it will take to improve breastfeeding practices?’ Lancet 2016; 387: 493-504