A woman’s right to choose must extend to decisions on breastfeeding

In Scotland, MSPs will soon vote on a bill to introduce buffer zones around clinics and hospitals to protect women from anti-abortion protesters. A committee in Parliament is considering a petition on formally decriminalising abortion. And the Government recently confirmed that access to at-home abortion pills would continue permanently.

Still, the mantra “our bodies, our choice” is about more than just abortion – and there are other areas where women’s agency and right to choose is little more than an afterthought.

Last week, the British Pregnancy Advisory Service (BPAS) published research about women’s struggles to afford formula milk for their babies and argued that the issue has been deprioritised because of an uncompromising focus on urging mothers to breastfeed because of the associated health benefits.

This, the organisation says, is a matter of reproductive choice because breastfeeding requires “women’s bodily labour”. Meanwhile, soaring costs and a lack of support around accessing and using formula milk means too many women are left struggling both financially and emotionally.

UK guidance recommends that food banks do not accept formula

It strikes me that this is a subject that feminists and anti-poverty campaigners alike should be shouting from the rooftops about, so the work of BPAS in calling attention to it is welcome.

BPAS found that three major brands hiked up their prices over the past two years by 34%, 26% and 18% respectively, which 65% of women responding to a survey said had made them anxious or worried about covering costs for their baby.

To add insult to injury, parents are not able to use supermarket loyalty points, coupons or vouchers towards formula milk, because the UK has adopted an international code and EU regulations which bar any form of promotional device linked to these products.

And, for those who fall on hard times and visit their local food bank, new parents looking for baby milk will more than likely be left empty-handed because of United Nations Children’s Fund (Unicef) UK guidance which recommends that food banks don’t accept formula donations.

These are facts which, quite honestly, I was shocked to learn. One would think we were speaking about alcohol and cigarettes, not sustenance for babies which – with access to the right quantities of clean or boiled water – is perfectly safe and healthy.

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The caveat about water is, of course, an important one, because in other parts of the world, this is by no means a given and the unscrupulous marketing of these products to mothers in those regions has led to significant health problems for infants.

However, treating this as an issue to which a one-size-fits-all approach can reasonably be applied across the globe, never mind at an individual level, is surely – dare I say – a case of throwing the baby milk out with the bathwater.

The fact that there are health-based advantages to breastfeeding does not mean that formula-feeding is unhealthy or bad for babies – although you could be forgiven for believing that to be the case based on how strongly its use is discouraged.

More to the point, there are a number of reasons why women don’t want to or simply can’t breastfeed: some find it painful or uncomfortable; some worry their babies are not getting enough milk; some have babies who struggle to breastfeed.

Others find that using formula frees up more time for other caring responsibilities or work, or that it allows their partner to share more equally in parenting. Some women, for many of these same reasons, feel that trying to persist with breastfeeding takes a toll on their mental health.

Policy on breastfeeding must be based in reality

Within this context, although 72% of women in the UK start out breastfeeding, by six to eight weeks after birth, nearly two in three babies are being fed entirely or partially with formula. This falls far short of the UK and Scottish governments’ recommendation – in line with guidance from the World Health Organisation – that babies are exclusively breastfeed for the first six months.

It is my firm belief that policy should be based on reality. No policy that leaves a majority of new parents facing extortionate costs to feed their baby can be considered progressive or fair. Nor can an approach that leaves most mothers open to feelings of stigma and inadequacy for failing to live up to the expectations that health professionals consistently relay to them.

A number of research studies with mothers have found that feelings of shame and guilt about formula feeding are common, while many report a lack of support and information from health services about how to use formula in the best way for their child and cope with any challenges. It seems that, in a bid to encourage breastfeeding, formula feeding has become a taboo subject which means too many mothers are simply expected to figure it out for themselves.

Given the strong links between class and infant feeding choices, this state of affairs is particularly dire. In Scotland, 63% of babies in 2021/22 who were born to mothers living in the least deprived areas of Scotland were either exclusively or partially breastfed by six to eight weeks, compared to just 31% of babies born to mothers in the most deprived areas.

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Age is also strongly correlated with these statistics, because the most common maternal age at first birth in the most deprived areas was found to be 21 years old, compared to 32 in the least deprived areas.

This picture is, justifiably, seen as a reason to invest in the promotion of breastfeeding in deprived areas. Women who want to and can breastfeed should absolutely have all of the information and practical support they need to enable that decision for themselves and their baby.

However, presenting this as the only option, endorsing blanket policies making it harder for low-income women to afford their chosen feeding method, and remaining silent while formula companies laugh their way to the bank – because people shouldn’t be buying the stuff anyway – is paternalism, pure and simple.

BPAS recommends that infant formula should be recognised as an essential product and be subject to price controls and caps; a feasibility study on the potential for a nationally or locally commissioned first infant formula milk; a change in guidance to allow people to buy formula with loyalty points or coupons; and public health information to ensure parents know that there are no benefits to buying more expensive formula products.

Above all, the organisation advises putting women’s choices at the heart of infant feeding policies. And who could argue with that?

If approaches to women’s health are to reflect the values of respecting, informing and empowering individuals to make their own choices, this must apply to infant feeding just as it does to any other issue impacting on women’s bodies.