Breastfeeding. Although I have spent my entire working life trying to improve care for women who want to breastfeed, I still hesitate to write openly about it. This is because breastfeeding is such a fraught subject in the UK, often viewed as difficult to achieve, and sometimes seen as unnecessary because of a mistaken perception that formula milk is a close second best.
Each time I write about breastfeeding I face a dilemma. On the one hand, there is more evidence than ever before that breastfeeding has long-lasting and profound benefits for both mother and baby. On the other hand, simply stating this fact causes pain and anger for the many families who tried really hard to breastfeed but were not able to. I really do understand that pain, because those people are also my own friends and family.
But does that pain and anger mean we ought to keep quiet about breastfeeding? Or should we do everything we can to remove those barriers which prevented women from successfully breastfeeding in order that more babies can be breastfed in future?
At the start of this year powerful new evidence funded by the Gates Foundation and published in the Lancet delivered a resounding verdict: breastfeeding saves lives and improves health in every country in the world. It helps reduce obesity, cancer, diabetes and leads to higher IQ. But the Lancet report also found that women are constantly failed by the societies in which they live, because without a supportive environment around you, breastfeeding can become almost impossible.
In the UK we have excelled at placing barriers in the way of women who want to breastfeed, whilst at the same time insisting that "breast is best" - a lethal combination which sets women up to fail and then makes them feel really guilty about it. The result is that the UK has some of the lowest breastfeeding rates in the world.
In the past, well-meaning breastfeeding promotion has sometimes been insensitive and over-zealous. This can and is changing with maternity units and health visiting services working hard to ensure that care is mother-centred and free from judgement.
But at the same time we have a far bigger mountain to climb in terms of removing the barriers - social, cultural, practical and economic - that prevent successful breastfeeding.
Today, Unicef UK is launching a campaign to Change the Conversation around breastfeeding. The aim is to stop piling pressure on individual women to breastfeed, and instead build an environment that is supportive of breastfeeding for any woman who chooses to do so by removing the barriers which block successful breastfeeding.
In our Change the Conversation campaign we are calling on health departments across England, Northern Ireland, Scotland and Wales to lead the way in removing the barriers to breastfeeding. These barriers are many and varied; they include insufficient professional support to get breastfeeding off to a good start, not enough community support to deal with problems a bit further down the line, a lack of understanding about how important breastfeeding is for health and brain development, and numerous clever formula milk adverts that undermine a woman's confidence in her own body's ability to make enough milk for her baby.
There are also ways that those of us who are not politicians can help to remove barriers. We can call on shops and restaurants to be breastfeeding-friendly, ensure that our workplace has breastfeeding-friendly policies, be non-judgmental around how an individual woman is feeding her baby (an outsider can never know the different pressures she may have come under), and of course, gently speak up on behalf of a breastfeeding woman if she is being given a hard time in a public place.
What we really need to address is the fact that breastfeeding cannot be the responsibility of an individual mother living in a society that normalises bottle-feeding and makes out breastfeeding to be controversial, difficult and unnecessary. That is the conversation we need to change. Instead, let's talk about removing the barriers that stop women breastfeeding, and then allow mothers to carry out their own informed decisions with dignity and respect. Above all, by adding your voice to our campaign, let's insist our governments show leadership and respond to the overwhelming evidence around the benefits of breastfeeding.
There are four things that health departments must do to build a society supportive of breastfeeding:
1) Develop a National Infant Feeding Strategy Board in each of the four nations, tasked with creating a strategy and plan to deliver the goal of ensuring more babies are breastfed.
2) Include breastfeeding in all policy areas where it has an impact: obesity, diabetes and cancer reduction; emotional attachment and subsequent school readiness; improved maternal and child mental health; wellbeing in the workplace and environmental sustainability.
3) Implement effective evidence-based initiatives such as the Unicef UK Baby Friendly Initiative across all maternity, health visiting, neonatal and children's centre services and local peer to peer support.
4) Protect the public from harmful commercial interests by adopting, in full, the International Code of Marketing of Breastmilk Substitutes.
You can join our call to governments across the UK to take urgent action to remove the barriers to breastfeeding in the UK. That's the conversation that we need to be having now. Will you join us?