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4 Policy context
International Policy
4.1 The World Health Organization Code of Marketing of Breast-milk Substitutes (The WHO Code) was launched in 1981 to promote and protect breastfeeding and to ensure the safe and appropriate use of breastmilk substitutes. This issue is reserved to the UK Government, which is a signatory, and in 1995 the UK Government implemented Infant Formula and Follow on Formula regulations rather than the WHO Code. A review of European Union recommendations, The European Union Recast Directive, is currently in process.
4.2 In 1990 the Innocenti Declaration was produced and adopted by participants at the WHO / UNICEF policymakers meeting - Breastfeeding in the 1990s: A Global Initiative. It stated that as a global goal for optimal maternal and child health and nutrition, all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4-6 months of age (since changed to around 6 months). Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, up to 2 years of age or beyond. This is to be achieved by creating an environment of awareness and support so that women can breastfeed in this manner.
4.3 The Baby Friendly Initiative is a global programme of UNICEF and the World Health Organization which works with health services to improve practice. Health care facilities which adopt practices to support successful breastfeeding receive the prestigious UNICEF/ WHO Baby Friendly award. In the UK, the Baby Friendly Initiative is commissioned by various parts of the health service to provide advice, support, training, networking, assessment and accreditation.
4.4 More recently the World Health Organization Global Strategy for Infant and Young Child Feeding was developed, with input from Scotland, to refocus world attention on the impact that feeding practices have on nutritional status, growth and development, health, and thus survival of infants and young children. The strategy, published in 2003, also offers an opportunity to renew the focus on the WHO/ UNICEF Baby Friendly initiative, The Innocenti Declaration and the WHO International Code of Marketing of Breast-milk Substitutes.
4.5 The document The protection, promotion and support of breastfeeding in Europe: a blueprint for action was launched in Dublin under the Irish presidency in June 2004. This framework informs the development of plans to protect, promote and support breastfeeding and recommends it to governments to provide European citizens with better information for the best start in life for their children. ANNEX B details how Scotland is currently performing in relation to the blueprint.
UK Policy (Reserved)
4.6 The Scottish Parliament works with other UK administrations in setting key policies relating to child and maternal health. The Scientific Advisery Committee on Nutrition ( SACN) is a UK-wide Advisery committee which advises all UK Health Departments as well as the Food Standards Agency. This expert group recommends exclusive breastfeeding for the first six months of an infant's life, after which solid foods can begin to be introduced. SACN then recommends that breastfeeding continues beyond the first six months, along with the inclusion of appropriate types and amounts of solid foods in the baby's diet. This recommendation is shared by the Scottish Executive as one which would truly improve the health of Scottish children.
4.7 The law recognises the importance of infant feeding. Pregnant employees in the UK are entitled to 26 weeks maternity leave. Some mothers may return to work whilst still breastfeeding and although there is no direct legal right to have paid or unpaid breaks or time to express breastmilk, there are opportunities to protect breastfeeding under Health and Safety Legislation and sex discrimination law. Employers have a duty to assess the risk to employees who are pregnant, have given birth within the last six months or who are breastfeeding.
4.8 Government schemes recognise the need for appropriate infant nutrition. Healthy Start will replace the former Welfare Food Scheme in summer 2006. This new programme seeks to use resources more effectively to ensure that pregnant women, new mothers, infants and young children in low income families have access to a healthy diet, with increased support for breastfeeding and parenting. This will be achieved through the provision of vouchers that can be exchanged, during and after pregnancy, at participating retail outlets for milk, fresh fruit and vegetables. Healthy Start will also maximise opportunities for healthcare professionals to offer good quality information and advice on nutrition, diet and health. It will offer much greater choice and flexibility and support healthy lifestyle choices whilst respecting individual rights
Scottish Policy (Devolved)
Health Improvement and Diet
4.9 Scotland has an unfortunate reputation for poor diet and, after smoking, diet is the most significant contributor to poor health. The Scottish diet is higher in fat, salt and sugar than the rest of the UK and typically deficient in fruit and vegetable consumption. In the 1990s national and international research began to establish a strong evidence base for breastfeeding as a key contributor to health improvement. This evidence is now reflected in Scotland's commitment to health improvement and set out in a range of national documents including:
- Eating for Health. A Diet Action Plan for Scotland 1996
- Towards a Healthier Scotland: 1999
- Social Justice - a Scotland where everyone matters: 1999 onwards
- Our National Health: 2000
- Improving Health in Scotland: The Challenge 2003
4.10 These documents send a clear message that health improvement is the single biggest challenge we face in Scotland to improve quality of life. They also stress the importance of targeting the early years and ensuring that positive health behaviours are fostered as early in life as possible.
4.11 The Scottish Diet Action Plan, published in July 1996, was informed by a strong evidence base. The plan's recommendations are being taken forward under the Scottish Executive's Health Improvement Challenge which recognised the promotion of healthy eating as vital to improving Scotland's health. Implementation of the Action Plan is currently being reviewed and results of this should be published in summer 2006.
Maternity and Early Years
4.12 A Framework for Maternity Services published in 2001 sets out principles for the provision of maternity services from pre-conception right through to the postnatal period and early parenthood. A number of these principles are relevant to nutrition and the Framework makes clear the importance of empowering, encouraging and supporting mothers to achieve healthier nutrition and lifestyles and providing comprehensive care and parent education. To support this there are a number of documents which give further advice to parents, clinicians and other interested parties. These include:
- NHS Health Scotland's Evidence into Action papers Maternal and Gestational Nutrition and Nutrition in the under 5s, which provide the evidence base for the importance of maternal nutrition for foetal and infant health and for nutrition in the infant and young child.
- Ready, Steady, Baby - the Scottish guide to pregnancy, birth and early parenthood - provides mothers with information on what to eat, which foods to avoid, vitamin supplements, advice on alcohol consumption, smoking and food cravings. It also contains information on breast and formula feeding, timely and appropriate weaning practices and other information to support new parents.
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