Becoming Breastfeeding Friendly Scotland: report

Theme 2: Reinforcing political will for breastfeeding among high level decision makers

Recommendation 2: To gain and maintain support from policy officials as well as other influential officials (for example, councils and the relevant Royal Colleges) in order to collaborate and formalise efforts for legislative change and advocacy for breastfeeding.

Relevant BBF Scotland Gear scores: Political Will: 3.0; Advocacy: 2.0; Legislation and Policies: 1.6

Why are these recommendations necessary?

Political will is fundamental to establish and maintain supportive environments through legislative, policy, programme and resource commitments: 'The success or failure of breastfeeding should not be seen solely as the responsibility of the woman. Her ability to breastfeed is very much shaped by the support and the environment in which she lives. There is a broader responsibility of governments and society to support women through policies and programmes in the community.' (WHO, 2016)

Rollins et al^[25] in the Lancet's Breastfeeding series (2016) make six recommendations. Among them is an emphasis on political will where politicians demonstrate that they value how breastfeeding promotion can save both lives and money, in spite of the complexity of making impact statements and opposition from industry partners. The economic gains provided by breastfeeding through increased cognitive function, reduced health-care costs, and the benefits of breastfeeding to the environment should be fully appreciated and evaluated when funding for the promotion and protection of breastfeeding is assessed. Such outcomes could be used as strong levers to promote, protect and support this political will as well as the objectives it sets out to empower. The authors emphasise that it is vital that political partners appreciate the importance of mainstreaming breastfeeding across preventative strategies and programmes and use their influence to tackle the structural and societal barriers that entrench inequalities through deterring women from breastfeeding.

Likewise, the BBF Scotland committee highlight the value of strong, expert and effective leadership to enable transformational change, acknowledging that this will continue to require dedicated time, skill and considerable effort as well as high level official and ministerial support. It is notable that in Scotland, breastfeeding is increasingly mainstreamed across the policy context: in Improving Maternal and Infant Nutrition: a Framework for Action (2011); Breastfeeding Programme for Government and A Healthier Future Scotland's Diet & Healthy Weight Delivery Plan^[26], with ministerial involvement in key events. In order to maintain and extend the work streams delivered through these structures, the BBF Scotland committee advocates ongoing financial prioritisation and consistent expert support which is protected from variation in budget planning and secondment issues. Robust political understanding and commitment will underpin such developments.

What do we want to happen?

• New Ministers to confirm ongoing support and to agree advocacy involvement aligned to the Breastfeeding Programme for Government.
• Ministers to show a good example by ensuring that they endorse breastfeeding as the norm and the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA resolutions as the norm; Ministers do not engage or take sponsorship of any kind nor endorse products from companies covered within 'the Code.'
• High profile and influential individuals to engage with and appreciate the health and socio-economic value of breastfeeding and raise awareness in the context of Scotland.
• Cross party cooperation to deliver sustainability and commitment across portfolios (e.g.: health, employment, education, environment and business), to align with and support a whole system approach.
• To support the leadership of the Breastfeeding Programme for Government (Scottish Government Breastfeeding Programme Lead) to ensure that effective cultural and clinical change happens and is embedded through evidence based strategy.
• Key officials in policy support arenas to fully commit to supporting policy and Scottish Government.
• A cohesive network of advocates to promote breastfeeding across Scotland and to produce a national advocacy strategy and identify further Scotland based champions; this network should include all relevant sectors, i.e.: health, employment, education, environment, business, the third sector etc.

How will this be done?

• Through meetings with new Ministers and other policy officials to engage them in the work and the need to continue and extend this support and commitment more widely.
• Policy team and professional advisor will meet with Ministers and agree long-term plan under the Breastfeeding Programme for Government.
• Policy team and professional advisor will meet with other officials to gain support for the Breastfeeding Programme for Government long-term plan.
• Through exploration of good practice case studies examples of good political commitment to a long term plan^[27],^[28].
• There has been progress made on this as there have been quarterly meetings set up with third sector organisations across Scotland to discuss breastfeeding and share best practice. Ongoing work with the Royal Colleges will provide additional support and insight through, for example, the Royal College of Midwives, the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists; also the CNO, CMO and Directors of Public Health.
• The new National Advocacy post, under the Breastfeeding Programme for Government and hosted by NHS Ayrshire and Arran, will be able to provide support and partnership, with leadership from the Scottish Government's Marketing and Insight team, and Breastfeeding Programme Lead.

What is the likely impact of these recommendations?

• Accessible and timely intelligence available to key decision makers.
• Political will for breastfeeding is embedded and reinforced by clear strategy.
• Enabling environment strengthened through improved action on legislation, policy, programme and funding.
• These recommendations would also inform and strengthen associated strategies and plans: eg: obesity, maternal mental health, oral health.

Reinforcing political will for breastfeeding among high level decision makers

Aim: gain and maintain support from policy officials as well as other influential officials in order to collaborate and formalise efforts for legislative change and advocacy for breastfeeding

Working with key decision makers and policy officials, this recommendation set out to deliver the following objectives

• To confirm ongoing strategic support among key decision makers
• To agree advocacy involvement aligned to the Breastfeeding Programme for Government
• To support BPfG* leadership to deliver effective cultural, legislative and clinical change through evidence based strategy
• Key officials in cross-policy support arenas fully commit to supporting Scottish Government policy on breastfeeding

What will success look like?

Based on best evidence, this would deliver…

• Accessible and timely intelligence available to key decision makers
• Political will for breastfeeding is embedded and reinforced by clear strategy
• Enabling environment strengthened through improved cross-policy action on legislation, policy, programme and funding

* BPfG: Breastfeeding Programme for Government