Thank you for your interest in the consultation process for the proposed Breastfeeding (Scotland) Bill. The members of the bill proposal steering group and I have, throughout the drafting of this bill, recognised the benefits of a period of consultation.

The impetus behind this document is therefore to elucidate on the proposal and its possible implications and to encourage anyone who wishes to share their comments or experiences with us to do so. In carrying out this exercise we hope to be able to present the Scottish Parliament with an informed and comprehensive bill proposal.

Changing Scottish Criminal law is a complicated process but the opportunity now exists within our devolved Parliament to lead the way on this important child health issue.

Over the course of the next few pages you will be asked to assess the information presented and to consider the suggested questions. All comments will be welcomed and considered by the steering group prior to the bill being lodged.

Elaine Smith MSP

August 2002

Elaine Smith MSP for Coatbridge & Chryston has lodged a bill proposal which, if enacted, will validate the right of every child to be breastfed in public within Scottish law.

On 10th of June 2002 the 'Proposal for a bill to make it an offence to prevent a mother from breastfeeding her baby in any public place, or licensed premises where children are otherwise permitted and to make provision for criminal penalties' was outlined in the Scottish Parliament's Business Bulletin; and it is intended that this bill will be lodged in the forthcoming session for Parliament's consideration.

The proposal attracted the required number of cross-party MSP signatories within the allocated timescale and was, therefore, allowed to proceed. The signatories to date are: Brian Adam MSP (SNP), Denis Canavan MSP (IND), Susan Deacon MSP (LAB), Helen Eadie MSP (LAB), Dorothy-Grace Elder MSP (IND), Linda Fabiani MSP (SNP), Robin Harper MSP (GREEN), Dr Sylvia Jackson MSP (LAB), Kenneth Macintosh MSP (LAB), John McAllion MSP (LAB), Fiona McLeod MSP (SNP), Nora Radcliff MSP (LIB), John Home Robertson MSP (LAB), Tommy Sheridan MSP (SSP), Margaret Smith MSP (LIB), Jamie Stone MSP (LIB).

A steering group has been set up to consider the proposal, the drafting of the bill, the consultation responses and to advise on guiding the bill through Parliament The group which is chaired by Elaine Smith MSP, has a membership that includes the National Breastfeeding Advisor: Jenny Warren OBE, along with various academics, health visitors, a licensing official, an ex-Strathclyde Police officer, and Mike Dailly of Govan Law Centre.

A number of organisations are also represented on the steering group these include: La Leche League, The Scottish Consumer Council, The Gorbals Health Centre, The Royal College of Midwives, The National Childbirth Trust, The Child Poverty Action Group, UNICEF, The STUC, and UNISON.

Following consultation, a bill proposal will be lodged and the Presiding Officer will rule on its competence in accordance with the terms of the Scotland Act 1998. It will then be a matter for Parliament to decide on how the bill proceeds.

There currently exists something of an anomaly within Scottish society surrounding the issue of breastfeeding. Both the Government and the Health service are working hard to promote breastfeeding; setting targets which include seeing at least 50% of all new mothers breastfeeding by 2005, however, there is still no clear legal right to breastfeed in public and it is not illegal to request that a breastfeeding mother and baby leave public places or licensed premises (where children are otherwise permitted), or to subject them to the indignity of being asked to feed in a toilet or another similarly unsuitable place.

At present, there has been no overt commitment made by our society towards breastfeeding. Indeed, there are a number of examples of breastfeeding mothers being treated in a negative manner, such as being asked to leave premises or made to feel uncomfortable in carrying out what is, in fact, an entirely natural practice.

Furthermore, it is interesting to note that when the World Health Organisation issued its Global Strategy on Infant and Young Child Feeding, which the UK voted for at the World Health Assembly, it called on all governments to adopt imaginative national policies and strategies to support breastfeeding throughout society. By passing this proposed bill then, the Scottish Parliament could be seen to be delivering on this particular obligation in a pro-active and positive manner.

When asked to reflect on the need for this bill in Scotland Jenny Warren: National Breastfeeding Advisor made the following observations:

Social and cultural attitudes have increasingly been recognised as important influencing factors in the decision to breast or bottle-feed (Hamlyn et al, 2002). Children and families exposed to a predominantly bottle feeding culture, where there are also negative attitudes to breastfeeding, are likely to reflect the attitudes and practices of that culture, so denying them the opportunity to learn about breastfeeding as a beneficial activity at a biological, social and emotional level. Recent research has shown that there is still a lack of knowledge about the benefits of breastfeeding in the general public (HEBS 2001).

In Scotland, negative attitudes can be detected not only in the low incidence and duration of breastfeeding but also in the response of partners, family, friends and the general public towards breastfeeding mothers. Media reports highlight hostility to mothers who breastfeed in public settings (Martin and O'Hare, 1999), but in general the media represent bottle feeding as normal, unproblematic and associated with 'ordinary' families whilst breastfeeding is represented as problematic, humorous and associated with middle class or celebrity mothers (Henderson et al, 2000). A mother who bottlefeeds her baby in public attracts little or no attention but the breastfeeding mother often experiences negative comment or is asked to stop feeding and resume feeding in the public toilets. This has a negative affect on breastfeeding both in the short and the long term and causes distress to mother and baby. Embarrassment is commonly sited as a major factor for choosing not to breastfeed (Hamlyn B et al, 2002).

It is very encouraging that the number of women breastfeeding their babies at birth in Scotland has increased from 50% in 1990 to 55% in 1995 and 63% in 2000 (Hamlyn et al, 2002). This is a statistically significant increase and the largest increase in initiation and duration of breastfeeding of any UK country during this period. However, many women give up breastfeeding during the early weeks and at six weeks following birth 90% of women who had stopped breastfeeding said they had given up before they wanted to.

This reflects a variety of negative influences including the difficulty of identifying somewhere to feed outwith the home. Breastfeeding women are significantly more likely to experience this problem than bottle-feeding mothers. Women who are older, affluent, in full time education beyond the age of 18 years and do not smoke are more likely to breastfeed. (Hamlyn, et al, 2002) The mothers who have most to gain in terms of their own and their babies' health, namely the young, poor and least educated, are least likely to breastfeed.

Women in Scottish society who have the greatest health and social deficits are least likely to choose to breastfeed and site embarrassment as a major factor (Hamlyn B et al, 2002). They are more likely to be dependent on public transport and lack the confidence to breastfeed in public. Such barriers could be avoided by an increased public acceptance of breastfeeding as a loving and nurturing maternal behaviour

Jenny Warren, National Breastfeeding Advisor, August 2002

The proposed law would validate the right to breastfeed in Scots law and would send a strong message that society supports breastfeeding. Furthermore, it is hoped that, over time, a change in law would affect a widespread change in society's attitude towards breastfeeding.

There would be little point in changing the law without applying some kind of sanctions. The sanctions proposed would be aimed at public bodies and businesses, rather than individuals and would be intended to act as a deterrent to stopping or segregating a breastfeeding mother and baby. The proposed fines would be based on the standard fine scale currently in existence and would not exceed level 4 on this scale (£2,500).

Examples of existing laws where fines have been applied in the past include the wearing of seatbelts, drink driving, littering and Part V of the Disability Discrimination Act 1995, which created a level 4 offence for failing to comply with public transport access requirements for disabled persons. These examples then, can be seen to provide some evidence to the claim that changes in law are often required in order to effect long-term changes in public attitudes. If the bill were to involve a change in civil law rather than criminal law, the onus would then lie with the mother to take a civil action and thus to endure the associated costs, time and effort involved in such cases. A system of fines seems to be more direct, less costly for all involved and would be more likely to act as a deterrent to treating breastfeeding babies and mothers in a negative way.

There is no doubt, and plenty of evidence, that breastfeeding is the best way to feed babies. It confers health advantages beyond infancy, into childhood and possibly adult life as well as having a positive influence on the future well being of breastfeeding mothers.

National Breastfeeding Advisor, Jenny Warren, outlines the many health benefits which society would incur if breastfeeding rates increase by stating:

Breastfeeding is universally acknowledged as important for both maternal and infant health. There is evidence for both the short term and long term health benefits of breastfeeding. Not only does breastfeeding protect infants from infections of the respiratory, digestive (Howie et al, 1990) and urinary tracts, (Piscane et al, 1990) it also protects against ear infections (Duncan et al, 1993) and offers some protection against atopic or allergic illnesses such as eczema.

The health benefits have been shown to carry on into childhood, with children who have been breastfed having a significantly reduced incidence of obesity (Reilly and Armstrong 2002) and childhood onset diabetes (Mayer et al1998). They also have lower blood pressure and cholesterol levels. (Wilson et al, 1998) Premature babies fed on human milk have a vastly reduced incidence of the potentially life threatening neonatal necrotising enterocolitis (Lucas and Cole 1992) and have been show to have improved vision and increased IQ (Lucas et al 1993). Women who breastfeed have a reduced risk of premenopausal breast cancer, (Newcomb et al 1998 ; Collaborative Group on Hormonal Factors in Breast Cancer 2002) ovarian cancer Hartge et al, 1989) and a reduced incidence of hip fractures in later life (Cumming and Klineberg 1993).

Jenny Warren: National Breastfeeding Advisor August 2002

If society accepts that "breast is best" then it seems reasonable to commit to that by passing legislation to make it illegal to stop a baby being breastfed in the places outlined in the bill proposal. Such legislation would send the message that society supports breastfeeding mothers and babies and would be likely to assist in changing attitudes to breastfeeding in public. However, this consultation period is designed to allow views to be considered prior to any proposal for a bill being lodged in the Scottish Parliament.

Prior to the bill being laid before Parliament, it will be helpful to receive comments to inform the process.

Questions you might consider are:

1. Do you believe that it is a child's right to be breastfed by his/her mother?

2. Do you think it is acceptable to breastfeed in public?

3. Do you think it is acceptable to bottle feed children in public?

4. Should children have a right to be breastfed whenever and wherever it is required?

5. Why do you think that some people see breastfeeding in public as a problem?

6. What action would you suggest to effect a change in public attitudes to breastfeeding?

7. Can you identify barriers which deter mothers from breastfeeding their babies from birth?

8. What barriers would you identify to explain the drop-off rates at 6 weeks old?

9. Do you believe that society has a duty to support and encourage breastfeeding mothers?

10. Do you believe society has a duty to children to support and encourage breastfeeding?

These questions are for guidance and all comments, however brief, are encouraged and will be welcomed. Please address all correspondence to:

Elaine Smith MSP
Unit 65
Fountain Business Centre
Coatbridge
ML5 3AA

Cumming R G, Klineberg R J (1993) Breastfeeding and other reproductive factors and the risk of hip fracture in elderly women. International Journal of Epidemiology 2(4):684-91.

Duncan B, Ey J, Holberg J, Wright AL, Martinez FD, Taussig LM (1993). Exclusive breastfeeding for at least four months protects against otitis media. Paediatrics 91(5):867-872.

Hamlyn B, Brooker S, Oleinikova K, Wands S (2002). Infant Feeding 2000. A survey conducted on behalf of UK Health Departments by BMRB Social Research.

Hartge P, Schiffman MH, Hoover R et al (1989). A case-control study of epithelial ovarian cancer. American Journal Obstetrics and Gynaecology 161(1):10-16.