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Seanad Éireann debate -
Wednesday, 12 Oct 2022

Vol. 289 No. 2

Breastfeeding: Motion

I move:

That Seanad Éireann:

recognises that:

- according to the Irish Maternity Indicator Report 2021, Ireland’s breastfeeding rates are among the lowest in the world. Only 62.3% of babies are breastfed at birth compared to 90% in Australia, 81% in the UK and 79% in the USA, with only 37% of babies discharged from hospital being breastfed exclusively. By the time babies are three months old that number has dropped to 31.2%, one of the lowest in Europe;

- the 5 year National Action Plan for breastfeeding in Ireland ran from 2016 to 2021 and included a target to increase breastfeeding rates by 2% annually. Data on breastfeeding rates only commenced in Irish maternity hospitals in 2019, and in that time breastfeeding rates have declined from 63.8% at birth in 2019 to 62.3% in 2020;

- the Lancet Series on breastfeeding in 2016 provides an in-depth analysis of the health and economic benefits of breastfeeding. The Series concluded that breastmilk makes the world healthier, smarter, and more equal; states that the deaths of 823,000 children and 20,000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion; confirms the benefits of breastfeeding in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers; and represents the most in-depth analysis done so far into the health and economic benefits that breastfeeding can produce;

- there is only one human milk bank on the island of Ireland, located in Co. Fermanagh;

- the International Code of Marketing of Breastmilk Substitutes (the Code) is an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding. It was published by the World Health Organisation in 1981 and is an internationally agreed voluntary code of practice, that Ireland has still not fully implemented;

- according to the World Health Organisation’s Marketing of breast-milk substitutes: National implementation of the International Code, Status Report 2022, 32 countries worldwide are currently ‘substantially aligned’ with the Code. Ireland is not one of these countries. The 2022 report concludes: ‘UNICEF and WHO maintain that the $55 billion formula milk industry uses systematic and unethical marketing strategies to influence parents’ infant feeding decisions and exploitative practices that compromise child nutrition and violate international commitments.';

acknowledges:

- the Programme for Government’s commitment to ‘promote an increase in the number of new mothers breastfeeding, by increasing support in our maternity hospitals and primary care centres, through access to lactation specialists and public health nurses’;

- according to a HSE press release of October 2022, 20 new infant feeding and lactation posts have been recruited in the last two years and 44 positions are available nationwide to support parents;

- 110 breastfeeding support groups are operational nationwide supported by the HSE;

- live chat and e-mail breastfeeding supports are available online with experts at mychild.ie Instagram and Facebook;

- the National Action Plan for Breastfeeding 2016 – 2021, has been extended by an additional 2 years to 2023;

- regulations to control the marketing, advertisement and promotion of infant formula and follow-on milk are proposed in the Online Media and Safety Regulations Bill 2021, currently at Second Stage in the Dáil. This Bill includes important provisions to establish Comisiún na Meán (referred to as The Commission). The Bill establishes a requirement for the Commission to introduce media service codes and online service codes having particular regard to the general public health interests of children:

- S 46N(5) Media Service Codes

Provision made for the purpose referred to in subsection (2)(d)(ii) may prohibit or restrict, in accordance with law, the inclusion in programmes of commercial communications relating to foods or beverages considered by the Commission to be the subject of public concern in respect of the general public health interests of children, in particular infant formula, follow-on formula or those foods or beverages which contain fat, trans-fatty acids, salts or sugars;

- S 139K Online Safety Codes

Without prejudice to subsection (2) or (4), an online safety code may prohibit or restrict, in accordance with law, the inclusion in programmes or user-generated content of commercial communications relating to foods or beverages considered by the Commission to be the subject of public concern in respect of the general public health interests of children, in particular infant formula, follow-on formula or foods or beverages which contain fat, trans-fatty acids, salts or sugars;

- although the promotion of infant formula, designed as a breast milk substitute, for newborn babies is prohibited under EU law, infant formula is cross promoted in the market through the marketing and promotion of follow-on formula, a product designed to substitute breast milk for babies over the age of 6 months;

- infant formula is essential for some babies and is a medical necessity that is life-saving in instances where breast milk is not available to babies. It is also a choice, of which all parents are aware. However, this product that is designed to meet the needs of a small number of people is marketed at all parents of new babies;

- bans are currently in place on all marketing of breast milk substitutes including follow on formula in Brazil, India, Afghanistan, Bangladesh, Ghana, Armenia, Fiji, Myanmar, United Arab Emirates, Nigeria, Thailand, Bahrain and Mongolia;

and calls on the Government to:

- support the Milk Bank Scheme in Co. Fermanagh, the only one of its kind on the island of Ireland, including:

- providing funding for resources in the data and technology tracing and in transporting milk supplies to recipients;

- providing funding to increase public awareness of the milk bank to encourage volunteers to contribute;

- carrying out a scoping exercise to explore the possibility of replicating the Milk Bank service in the Republic of Ireland with a view to working in collaboration and supporting the work of the existing Milk Bank in Co. Fermanagh;

- work with the HSE to expand the criteria for prescriptions for babies accessing milk from the Milk Bank, noting at present that only premature babies can access milk from the Milk Bank;

- develop a governance structure for breastfeeding in primary care and acute hospital divisions;

- provide breastfeeding training at undergraduate and postgraduate level across relevant disciplines;

- provide education on breastfeeding in all secondary schools as part of the current Social Physical and Health Education course;

- develop a clear referral pathway for mothers requiring additional breastfeeding support, before and after birth, to lactation consultants (IBCLCs) from GP’s, midwives, public health nurses and consultants;

- ring-fence funding for a public awareness campaign on the benefits of breastfeeding, both health and environmental;

- improve provision of information on accessing breastfeeding supports, including the promotion of voluntary groups such as La Leche League, Cuidiú and Friends of Breastfeeding and increase funding to these organisations, in recognition of the essential support services to people breastfeeding in Ireland provided through these voluntary groups;

- work with the HSE to ensure that where meeting spaces are available in public health facilities, breastfeeding support groups can have access to the space to host meetings;

- provide access to suitable breast pumps, free of charge, to all mothers of preterm and hospitalised infants, and breastfeeding mothers hospitalised after maternity /paediatric discharge with support and information from lactation specialists for all mothers who need to use breast pumps;

- implement evidence informed programmes and initiatives to provide support and address barriers for women, with a particular focus on young mothers under the age of 18 and women in the Traveller community;

- ensure clinical midwife/nurse specialist lactation consultants (IBCLC) are appointed within all Irish maternity hospitals and paediatric hospitals, according to a determined births-to support staff ratio, with dedicated CMS/CNS lactation in NICUs;

- ensure dedicated full-time lactation consultants (IBCLC) posts in each of the 9 Community Health Organisations (CHOs) are appointed, according to population need;

- extend the ‘Baby Bundles’ scheme nationwide, and ensure consultation with the Association of lactation consultants in Ireland and voluntary breastfeeding groups on the educational materials and equipment provided in the bundles in relation to feeding babies;

- ensure the Online Safety Codes and Media Services Codes as related to the public health interest of children, which are to be established upon passing of the Online Safety and Media Regulation Bill, are enacted as soon as practicable;

- ensure the Code is fully implemented in Ireland, and ensure no state funding for any marketing of breast milk substitutes is provided to any private sector companies, in particular companies that are marketing breast milk substitutes in international markets aimed at parents and health care workers, or funding initiatives that promote formula feeding including promotional material, free samples in hospitals, sponsorship of helplines and other fundraising activities.

I second the motion.

I thank all of our guests in the Visitors Gallery. I will list the organisations because it is important to show the breadth of the voluntary organisations that do such amazing work when it comes to supporting women and breastfeeding. We have Friends of Breastfeeding Ireland, Baby Feeding Law Group Ireland, Bainne Beatha, Cuidiú, the Association of Lactation Consultants in Ireland, Pavee Point and La Leche League, which also does huge work in the area of voluntary support.

That brings me to my first point. We are heavily reliant on the voluntary sector when it comes to supporting women. Breastfeeding is often quite an emotive topic. Over the past couple of days, as I have been walking around Leinster House, many politicians, both men and women, have shared their personal stories with me. Everybody has a personal story when it comes to how they feed their children and the kind of supports they feel they did not get. Journalists who I have spoken to over the past couple of days also shared their stories. This is an important day and I believe this is the first motion on breastfeeding to come to the floor of the Seanad.

It is important to point out that this is fundamentally about choice. How people feed their infants and children is a matter for themselves. However, what is important is that the State supports that. Some 62% of women start breastfeeding. Within a couple of days of women leaving hospital, however, that figure drops to 37%. It almost halves and then falls to 31% by month three. That is shocking and it is one of the lowest percentages in the world. We have to ask ourselves why that is. There are a number of factors involved but one is that some time ago we lost the tradition of breastfeeding. We lost that culture and it is important to bring it back. That starts at the very earliest age. We have a young man in the Gallery who supports breastfeeding mothers when they come to his house for the meetings of Friends of Breastfeeding.

This starts in the education system. Many people do not have the experience of having been breastfed themselves or having mothers or significant others in their lives who have that breastfeeding experience. So much of what happens in our lives as mothers is about a network. That is what the voluntary organisations provides and that network is missing from many people’s lives.

The low breastfeeding rates do not even touch the surface when it comes to some sections of Irish society. Looking at the Traveller community in particular, Pavee Point, which has done huge work on this, has found that only 2% of women in the Traveller community breastfeed. We have to be honest with ourselves. What has happened to date has not worked. There has not been enough work and some of it is a little bit cynical.

I have spoken about the formula industry in the House many times. Ireland is a large exporter of powdered milk. It exports formula milk all over the world. That has a devastating impact, apart from anything else, on some of the poorer nations across the globe, which is why the motion refers to the importance of ethical considerations. It also means that we have a lobby group and an industry that is putting vast amounts of money into advertising formula and free formula in hospitals. I was delighted that the Minister, Deputy Catherine Martin, was very much on board when we asked her to include a measure in the Online Safety and Media Regulation Bill to restrict advertising of formula.

It is important to note again at this point that this is not to say that those who formula-feed are doing anything wrong. However, there is something wrong when an industry goes out of its way to heavily market towards a vulnerable group. In the middle of the night, someone struggling to breastfeed who looks up supports for breastfeeding will see an advertisement for formula, which is not what she is looking for. This is about supporting a person’s journey in breastfeeding.

I have spoken to many people over the past year when working on this and doing other work on breastfeeding. One message that has come back very strongly is that we need to have a proper joined-up approach. We need more lactation consultants and I hope the Minister of State will give us information as to where the lactation consultants are that have been promised. We also need to make sure that every touch point a woman has in her journey also has that expertise on breastfeeding. Some public health nurses are doing great work but we have other public health nurses who do not feel they are qualified or are being supported by midwives and GPs with the information they are giving. There is a referral system in place but when somebody goes to their GP looking for support with mastitis, as I have in the past, or something else related to breastfeeding, the first answer that comes back is “Well, sure, use a bottle”. That might be the only contact somebody has because it can be cost prohibitive to visit a lactation consultant.

We have a lack of equality in our system where when it comes to issues related to women’s health, in particular, we are supposed to pay for it whereas other types of healthcare are delivered through the public healthcare system. At the moment, there is a postcode lottery and there is also a lottery based on how much money one has. That is just not good enough and it has to change.

The motion refers to the milk bank. There is only one milk bank on the island of Ireland, in Fermanagh, and it struggles for funding all of the time. Our hospitals rely heavily on it. Having spoken to people, I understand there are a few issues with it, one of which is that the level of donations it receives means that prescriptions for donated breast milk are only available to women who have a premature baby.

We need to look at expanding that so people who have children in critical care, for instance, and others would have access to those donations. It is also important to look at opportunities to have such a bank in the Republic of Ireland.

I thank the Government for the steps that have been taken to date but it is important to say that it is not enough. We have not seen all of the required lactation consultants come on stream. I will go back to where I started with the voluntary organisations. Having been involved in two such organisations and having supported and run breastfeeding support groups in my own house and elsewhere, I know that one thing that bothers people is the cost of finding space to run breastfeeding support groups. For that reason, the motion proposes that we use all of our healthcare clinics to provide space for these groups, which are doing hugely important work. It makes sense to do that because many of them are being funded by the HSE, so why would they not be able to use the spaces available? Furthermore, they are not being funded to the level that they need to be funded, as the motion points out.

I will be returning to this topic again and again because, as the Minister of State knows, it is something I feel very passionately about. It is really important that we, as public representatives, keep banging on the door to get all of the changes that we need implemented. It is also important that we work on a cross-party basis. This Chamber has demonstrated an ability to work on a cross-party basis to achieve our goals for women in this country.

I welcome Senator Pauline O’Reilly’s motion. This is an historic occasion. This is the first time that a motion on breastfeeding has been brought to the Seanad and that is worthy of note.

Ultimately, as Senator Pauline O'Reilly said at the start, this is about choice and giving women choice. All of the data stack up in terms of the benefits of breastfeeding. I was fortunate to be able to breastfeed four of my children. They will be mortified if they hear me saying this now but I was very lucky. I had difficulty breastfeeding my first baby but there was a wonderful lactation nurse in the hospital and I went back to her several times in those first very fragile couple of days and weeks. I also attended some La Leche League meetings but it took six or seven weeks for me and my baby to really get the hang of it. Had I not had any support then, I fear I probably would not have done it. That would not have been the end of the world but it was something that I was very determined to do. Those first babies are so important because I knew for my second, third and fourth babies that I could do it. I knew that it could be done. It had done it and I could do it again. There is a certain confidence that women need and that is where the support and the advice come into play - the security blanket of speaking with others who understand the issues and can help and explain them away.

The benefit of breast milk to infants is absolutely unchallenged but the benefit of breastfeeding to women is not given as much consideration. It is really important in the postpartum period and is one of the best things women can do to get back into shape. It can potentially delay the return of menstruation and is a method of contraception, if nothing else. There are lots of benefits to breastfeeding for the longer term health and well-being of both mother and child.

I am not going to speak for the Minister of State but am grateful to him for spending some time with our guests in the Public Gallery before the debate began. The Government hears the voices and the pleas of our guests. I am sure the Minister of State will address their concerns and the points made in Senator Pauline O'Reilly's motion. I thank our guests in the Public Gallery for being here today. As Senator Pauline O'Reilly said, women like me have relied on the voluntary support they have provided for years. Now it is time for the Government to step up to the mark and provide the support that is needed.

I thank Senator Pauline O’Reilly for this motion which I wholeheartedly support. The figures really illustrate how startlingly different Ireland is when it comes to breastfeeding rates. At birth, the rate here is 62% but in the UK it is 81%, in the US it is 79% and in Australia it is 90%. By the time women leave hospital, the rate has fallen to 37% but the fact that at three months old the rate is 31% shows that the most vital period is in the hospital. It is so important to make sure people are getting support in those early days.

That was my experience as well. I could not breastfeed exclusively but I really put so much effort into trying. I was given the impression when I was pregnant that the baby would nearly latch on itself when it came out. I was surrounded by contraptions to make it happen, including an industrial-sized pump that I can still hear to this day. My baby was very small when she was born and I remember that formula was just provided because the breastfeeding was not working. When I spoke to the nurse the next day and asked if someone could come and help me with the breastfeeding, the answer was that it was too late. I was vulnerable because I had a Caesarean section, was tired and so on but I really had to push to get that support, just to be able to do what I could do. That was nearly ten years ago. There was a lactation consultant in the hospital but by the time the consultant was free to speak to me, I was well gone.

I really do not want any woman to feel guilty about not being able to breastfeed. One does what one can. I do not want them to feel guilt or to feel less than. I am not going to try to put pressure on any woman. The pressure should be put on the system that is just not working for women. So many women put pressure on themselves to be perfect and it is hard for them when they have the impression that breastfeeding is natural and easy but they find it is not. For some people it is easy but for others it is incredibly difficult. In my case, no matter what I did it was never going to work in the way I wanted it to work. We need to provide multi-level supports. This is a public health issue and ambition and it must be reflected in our public health system at every touch point. This is about having lactation consultants in the hospitals and providing support for people when they leave hospital. The public health nurse that I had was brilliant. I could have hugged her whenever I saw her and I am sure so many women feel the same way when they have a new baby. The public health nurse for those first two weeks, which feel like two years, becomes part of one's inner circle. The public health nurse really helped us through that period.

This is about all of the touch points and having the expertise in place but it is also about education. I worked in advertising for over 15 years and one of the accounts I worked on back in the day was that of the health promotion unit of the HSE.

I featured in an ad about breastfeeding because it was targeting young women before they were even likely to think about breastfeeding. It was very much putting it out there on their horizon as something to think about - trying to make them aware of it now as opposed to something they will think of when they are pregnant. I do not know where those ads have gone because they were very informative and were about the benefits of breastfeeding. Even though we know about the topline benefits, and I know the benefits because I have had children, not everybody knows just how good breastfeeding is for baby and for mum. It is disappointing that over the past number of years our breastfeeding rates have declined. When we have a breastfeeding strategy, we need to put the money into education, as I have already said.

A number of other issues were mentioned in the Senators’ motion. We need to think about universal design when we are considering our public realms. Women are lactating. The number of times that I pumped and fed babies in toilets needs to be thought about. We need to approach breastfeeding as another everyday occurrence where we are just feeding our babies. We need to support women in that regard, along with the groups that help. We have a cultural barrier and memory loss around breastfeeding.

I note that the lactation consultant positions have not been filled. Are these part of the HSE national panel of recruitment? Do these positions have to go through that panel in order to be recruited? We have to put much more into delivering these services for people when they actually need them.

I warmly welcome the motion and congratulate Senator Pauline O’Reilly on it. It is great. It is very long - at three and half pages - because it is filled with practical, specific and real measures that could be implemented and would make a great difference to women and to breastfeeding. As the Senator has mentioned, the recommendations in the motion relate to matters like accessible HSE spaces, the availability of breast pumps and very important things like lactation consultants.

I want to pull back a little bit to look at where we are in Ireland. We are in a situation here where we are outliers. The percentage of babies who are being breast-fed at three months has dropped to just 31%. We talked about a 9% figure during the debate on the Online Safety and Media Regulation, OSMR, Bill. I congratulate the Minister, Deputy Catherine Martin, for engaging with Senator O’Reilly and myself. I also congratulate all of the groups that were mentioned earlier and in this motion for their work. The Minister gave the space in the OSMR Bill for the regulation of the advertising and promotion of infant formula, or indeed a ban as that is an option within that Bill. I hope that will be taken up by the new media commission when it is in place.

The figure we discussed previously - just 9% of babies being breast-fed at six months versus an average of 40% internationally - is very stark because it means that the majority of the peer experiences that people have involve not being supported. When we talk about choice, it is there, but what we are actually talking about here is support because when it comes to choice, we know that women want to breastfeed. That is why we have over 60% of women breastfeeding in the hospital and choosing to do so at that early point. It is very much about supporting that choice. Again, not all will choose to breastfeed, but the 60% of women who want to breastfeed and express such a wish at the beginning should be supported to ensure we do not have that figure falling down to 37% by the time they leave the hospital. This issue is not around choice but is around a choice not being supported. I agree that what happens in that early period of time in the hospital is crucial when we see a reduction of almost half in the number of women who are breastfeeding.

It is very important that we have proper lactation supports. We must recognise that because, historically, Ireland has had a low level of breastfeeding, people do not have as much peer support, which is why they need public support in this regard. Sometimes there is a sort of reverse logic whereby this can be a framed as an either-or situation, but we need to be really clear. Breastfeeding is something that has public health advocacy on its side, and has civil society advocates promoting it. Formula milk has a very significant industry with a very significant advertising budget behind it. We are talking on the one side about a public health message and then, on the other side, about the kind of very insidious marketing we heard about during the OSMR Bill - the late-night pop-ups and the talk-to-another-mum idea, which breached all of the standards in the WHO code on the marketing of formula. The standards are very clear about what should never be presented or tagged in as other information, and specifies that new mothers should not be targeted. These actual guidelines, which have been in place since the 1980s, have been breached in the marketing strategies.

We have a kind of reverse stigma whereby public health, with the tiny amount of resources it has to advertise compared with the industry, is told it is terrible and it makes people feel bad if it tells them about breastfeeding. It is a reverse situation because nobody wants to make anybody feel guilty. What people want to do is to let mothers know about breastfeeding and support them. Our public health messaging should not have to compete with the industry. Indeed, we need public health practical supports for those who cannot breastfeed, such as the breast milk bank which was mentioned by Senator Pauline O’Reilly. The only such bank we have in the country is in Northern Ireland. We do not have one in Dublin, in Cork or in other centres of population. One of the reasons for this is that it does not make anyone any money; it just helps women and children, and public health. That is exactly why this option should be made available to support people.

Coming to the end of the motion, one other aspect of it which I wish to commend as very important is that it has a great deal in it about the international dimension of this issue. The fact is that internationally, and these are very striking figures, the deaths of 823,000 children and 20,000 mothers could be averted through universal breastfeeding every year, according to The Lancet. We are talking about hundreds of thousands of lives which are directly affected by this. When we talk about aggressive marketing, there is a reason many countries, including many developing countries, have tried to bring in bans on formula advertising. That is because it costs lives. Ireland has a responsibility in this area because we are one of the largest exporters of infant formula in the world and we need to be very careful ethically about how that is marketed, not just in Ireland but internationally. For example, one third of Ireland’s infant formula is exported to China, and breastfeeding rates in China have halved in the past ten years. That did not happen by spontaneous choice but is happening through an industry positioning itself in a market and promoting itself. We need to lead ethically in this area by giving real public health supports in their fullest sense to the women of Ireland by regulating this industry and how it advertises and promotes itself, not just in Ireland but internationally. Again, I commend the motion to the House and thank Senator O’Reilly.

I support the motion and commend the Senators from the Green Party for bringing it forward. The benefits of breastfeeding to both babies and mothers are well documented internationally. I was surprised by the figure in the motion that we only have 62.3% of babies in Ireland being breast-fed at birth. This is far behind most of the western hemisphere.

I appreciate that the motion recognises the medical necessity of formula-based milk for some babies and infants but it is true that the industry has got out of hand and that infant formula is being heavily marketed towards much too wide a parent population.

The Fermanagh milk bank scheme has done brilliant work for so many mothers and babies. I would like to see every support given to it and for milk banks to be opened in this country also.

I spoke to a lactation consultant who told me all about the work done by these professionals with mothers of newborns and the progress they are able to make in this most vital area by providing practical direction to new mothers and giving them a greater sense of security and confidence in breastfeeding their child. However, she also spoke of the low numbers of qualified lactation consultants in the country and I think the motion puts forward some suggestions that these consultants have been calling for. This includes providing breastfeeding training at undergraduate and postgraduate level across relevant disciplines, developing a clear referral pathway for mothers requiring additional breastfeeding support before and after birth to lactation consultants from GPs, midwives, public health nurses and consultants and providing education and breastfeeding in all secondary schools as part of the current SPHE course. This increase in training and awareness is the best way to increase the prevalence of breastfeeding in Ireland.

I have a slight concern around recent reports of viral RNA being found in the breast milk of women who received the mRNA vaccine. This was reported in the Journal of the American Medical Association Pediatrics , JAMA, last month. Breastfeeding women were largely excluded from mRNA trials and so while infants younger than six months are not being advised to receive mRNA vaccines the passage of these vaccines into breast milk, resulting in infants’ exposure at younger than six months was not investigated. While thus far only trace amounts have been detected and not in all instances – though it was over 50% in the JAMA peer-reviewed study - it would be nice if the manufacturers of these vaccines would address the issue with clinical trials. I am sure the breastfeeding mothers would appreciate a level of certainty around this area.

I must give a shout out to an organisation and its volunteers that I know really well, namely, Blood Bikes East. It is a dedicated team of motorcycle drivers who are transporting breast milk as well as blood from all over the country and all across Dublin by bike to hospitals and babies in the Rotunda Maternity Hospital. This is in instances where the mother is critically unwell, being cared for in the Mater and their premature baby in the Rotunda needs his or her mother's milk. Lisa Carroll, who is the Rotunda’s lead midwife in the lactation team, said the breast milk, which is often hand-expressed by the mother, gives vulnerable babies a fighting chance. It goes to show the importance of breast milk and I agree with the calls in this motion to support and promote the practice in this country for the betterment of future generations.

I absolutely support breastfeeding at birth but we must not shame those who are unable to do it, and for many reasons young women may not be able to breastfeed. Breast is best but there should not be any shaming around those who cannot breastfeed.

I apologise for missing most of the debate. I was attending the media committee. I commend the motion. I wish to give particular reference to the parts of it that stood out for me. These include providing access to suitable breast pumps free of charge to all mothers of pre-term and hospitalised infants and breastfeeding mothers hospitalised after maternity discharge. It also refers to implementing evidence-informed programmes and initiatives to provide support and address barriers for women, with a particular focus on young mothers. It calls on the Government to ensure clinical midwife or nurse specialist lactation consultants are appointed within all Irish maternity hospitals and paediatric hospitals. I welcome those aspects of the motion.

I have a quick comment to make on the all-Ireland nature of this issue. I heard mention as I came in of the proposals for replicating the milk bank in Fermanagh in the South. The bank in Fermanagh provides an excellent service for many in the South and indeed the milk provided is often from those in the South. Sinn Féin welcomes such co-operation in essential health services. I strongly encourage the development and strengthening of such a cross-Border approach. Support for the milk bank scheme in County Fermanagh builds on existing expertise and services and allows for the effective pooling of limited financial and other resources across the island to ensure the development and continued provision of a high-standard service for all.

I also support baby boxes. The proposed baby bundles have been mentioned and while Sinn Féin supports the extension of such practical and necessary support nationwide, we call for such bundles to be supplied in baby boxes. These boxes allow the child to sleep close to his or her parent on a safe surface with room to breathe and can be used in place of a crib. They can be used for a period of five to six months and save the parent in the region of €100. Such boxes have the dual benefit of recognising and assisting those who may be facing financial difficulties following the birth of their child, while also providing a multipurpose and re-usable storage system for items contained within the bundle.

Perhaps most importantly, this motion will raise awareness about public breastfeeding. Nobody should have to eat their lunch in the toilet. It is not the mother's or the child's fault, or their problem, if people are offended by something that is completely natural. I support the motion and commend the Green Party Senators for bringing it forward.

I thank Senator Pauline O'Reilly and her colleagues for tabling this Private Members' motion. I am delighted to be here. I am responding to the motion on behalf of the Minister for Health, Deputy Stephen Donnelly, and the Government. It is great to see so many people who have advocated for this very important policy. I see a lot of friends who I have worked with in the Department over the last two years, ably supported, I understand, by Ben. They are very welcome and I believe they do great work as well, so I thank them very much. The motion calls for a range of supports and measures relating to breastfeeding in Ireland. The Government is not opposing the motion as it aims to promote an increase in breastfeeding rates in Ireland through a number of measures and supports.

I welcome this opportunity to update the House on the work my Department and the HSE have been doing in this important area and the broader area of women's health. This discussion is especially timely given that last week was the HSE National Breastfeeding Week and given the emphasis on women's health in recent budgets, including budget 2023. The Healthy Ireland framework, which was published in 2014, and the Healthy Ireland strategic action plan, published in 2021, set out a vision for improving the health and well-being of our citizens. Ireland continues to have a culture of bottle feeding. Promoting an increase in the number of new mothers breastfeeding is a priority item in this framework. We all know how important it is that our children get the best possible start in life and this is something all Government partners have prioritised in the programme for Government. In 2016, the HSE launched Breastfeeding in a Healthy Ireland: Health Service Breastfeeding Action Plan 2016-2021. This is our roadmap for progressing supports for breastfeeding in Ireland and it has been extended out to 2023. My Department works closely with the HSE national breastfeeding co-ordinator, who has overall responsibility for the implementation of the action plan and with the national breastfeeding implementation group to progress a range of actions under the action plan's priority areas.

I would like to highlight to Senators some of this progress that is of particular relevance to the issues in this motion. Midwives and public health nurses are the primary front-line staff to support breastfeeding, from the antenatal period with the delivery of breastfeeding preparation and antenatal classes, to enabling mothers to establish breastfeeding in the early days and weeks.

Breastfeeding mothers receive follow-up support throughout the postnatal period where needed. The HSE provides and funds voluntary breastfeeding organisations to provide community-based supports throughout the country. There are approximately 110 breastfeeding services available nationwide, and many are returning to in-person meetings each week as suitable spaces within communities are secured and more staff and volunteers to run the groups are available.

In order to support those mothers who need extra support to breastfeed, for whatever reason, infant feeding and lactation nurses and midwives in HSE services provide a specialist support service. In 2021 the Minister for Health announced funding of €1.58 million as a ministerial priority to provide an additional 24 lactation consultants to ensure nationwide availability of and access to such specialised lactation support within hospital and community services. That is annual, recurring funding. That brings us to the 34.5 new dedicated infant feeding and lactation posts approved in the past two years alone, of which 20 have been filled, with a further 11 in recruitment. Filling approved lactation posts remains a priority for the HSE to further build and enhance breastfeeding supports across all community healthcare organisations and hospital groups. In total, there are 44.6 whole-time equivalent dedicated lactation consultant posts across maternity hospitals and units and public health nursing services to provide specialised care for mothers experiencing challenges with breastfeeding. Each hospital and community service with these post-holders has a pathway of care to access lactation specialist services when required. Infant feeding and lactation midwives and nurses also play an important role in supporting pregnant women and mothers from marginalised groups or communities and who need additional support to breastfeed. The HSE, as the House will be aware, has partnered with Pavee Point to develop culturally specific health information on breastfeeding.

The health service breastfeeding action plan supports as best practice the use of expressed breast milk where breastfeeding is not possible. Access to suitable breast pumps is provided free of charge to all mothers of preterm and hospitalised infants as well as breastfeeding mothers hospitalised after maternity or paediatric discharge. In addition, all maternity and children's hospitals have clinical guidelines relating to the care of sick and preterm babies and the prioritisation of mothers' breast milk and donor-expressed breast milk, DEBM. Such breast milk is available in all hospitals providing care to these babies. The HSE has a national purchasing contract in place with the Western Health and Social Care Trust Human Milk Bank, which is based in Enniskillen. The HSE does not currently have plans to establish or to operate a human milk bank in the Republic of Ireland, but this will be kept under review in line with clinical infant feeding guidelines and availability of DEBM.

The HSE policy on the marketing of breast milk substitutes and new standards for infant feeding in maternity services requires that there is no advertising of formula milk, teats, bottles or soothers in any part of the maternity services and that staff take active measures to protect themselves and parents by not participating in formula industry-sponsored training and events. The HSE provides evidence-based, impartial information and support on feeding options and does not advise on any particular brands where others are formula-feeding.

Under the HSE nurture infant health and well-being programme, funding for initiatives to contribute to increasing the rates and duration of breastfeeding includes the development of new standards for antenatal education, nutrition, e-learning modules and a suite of breastfeeding training programmes. Since 2018, blended learning training programmes have been provided, which has made training more widely available to a broader range of front-line staff who support mothers. The new infant feeding and lactation nurses and midwives in the HSE will provide an additional resource to ensure that training is available in all community services.

The mychild.ie website, part of hse.ie, provides information to parents-to-be and parents of young children. The website is part of a suite of information supports provided both directly by practitioners and online. This website covers pregnancy, labour and birth, and babies and toddlers. As a father of two young children, aged five and two, the website was very useful to my wife and to me, my wife mostly. It was very welcome.

In the past four years the HSE has invested in a promotional campaign for parents aged 25 to 45 on mychild.ie and, as one of the most popular topics, breastfeeding features strongly in that ongoing campaign. The HSE also runs My Child social media channels on Facebook and Instagram, where breastfeeding topics are regularly featured. Once a year the HSE runs National Breastfeeding Week from 1 to 7 October. This year the week focused on encouraging parents to take up the free expert help available. Parents can also contact a team of lactation consultants through the "Ask our breastfeeding expert" service on mychild.ie. This service is available seven days a week, with the live chat service available from 10 a.m. to 3 p.m., Monday to Friday.

We are all aware of the impact of advertising on people's behaviour. Ireland has signed up to the WHO international code of marketing of breast milk substitutes, which aims to stop the aggressive and inappropriate marketing of breast milk substitutes. My colleague, the Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media, Deputy Catherine Martin, is currently bringing the Online Safety and Media Regulation Bill 2022 through the Oireachtas. The Bill has passed all Stages in the Seanad and has moved to the Dáil. When enacted, the Bill will dissolve the Broadcasting Authority of Ireland and establish a new regulator, coimisiún na meán. Under the Bill, broadcasting codes will ultimately be superseded by media service codes, which will apply to both video-on-demand and broadcasting services. Furthermore, an coimisiún will be enabled to make online safety codes which apply to designated online services, such as video-sharing platform services - for example, YouTube. Similar to current broadcasting codes, these new media service and online safety codes may provide for the regulation of commercial communications relating to foods or beverages which may be the subject of public concern in respect of the general public health interests of children, including infant and follow-up formula. The significant work being delivered in the breastfeeding area is part of a wider effort to invest more significantly in women's health. The Minister for Health has made women's health his top priority, with €69.2 million of our health allocation in budget 2023 ring-fenced for women's health. I would like to take this opportunity to highlight a number of positive developments in the past two years.

We have secured the €10 million allocation for the women's health fund again in 2023, maintaining this vital mechanism for the delivery of Ireland's first ever women's health action plan, which was published last March. Through that action plan, we are building a national network of new services, including 20 gynaecology clinics, 12 of which are already open, and six fertility hubs, five of which are now open. Under budget 2023, €10 million has been allocated for the first time to provide access to publicly funded IVF treatment, benefiting couples at an extremely difficult time personally and financially. Last month we launched the free contraception scheme for women aged 17 to 25. We will expand the scheme in 2023 to cover all women and girls aged 16 to 30, subject to legal advice and consultation with regard to 16-year-olds. In 2022 we have made significant progress in tackling period poverty, allocating €710,000 to support period poverty measures for Travellers and Roma within local authorities and to support organisations working with those most at risk.

Furthermore, in a measure that will have a real-time impact on the cost of living for women, we have removed VAT on hormone replacement therapy, HRT, and newer period products such as period underwear and menstrual cups.

Pads and tampons were already subject to a VAT rate of 0%.

We are developing six specialist menopause clinics – one in each maternity network – for women who require complex, specialist care. Three are already open and the remaining three are due to open this year. Last week saw the launch of the Irish College of General Practitioners' quick reference guide to the menopause. We are finally lifting the taboo by talking empathetically about it. I am referring to both men and women.

I thank the Senators for tabling this motion on a topic of key importance to the health and well-being, present and future, of children born in Ireland. I would like to finish on a positive note. The latest breastfeeding data from 2021 indicate a 4.8 percentage point increase since 2019 in the number of babies breastfed at the first public health nurse visit, bringing the percentage to 58.8%, exclusive and non-exclusive. This is going in the right direction but significant progress still needs to be made to increase breastfeeding rates. With the prioritisation of women's health, including in the Seanad and through many of the initiatives of my Department and other Departments, I am confident we will see further progress. Many of the initiatives have come from the Seanad. I thank the Green Party Senators for introducing this important motion to the House. With regard to women's health, with the increase in supports for breastfeeding we will see progress over the coming years. I thank the Senators for their words, views and suggestions. We will try to take them on board.

I thank the Chair for allowing me to contribute after the Minister of State. I thank the Minister of State for addressing the motion. I also thank my colleague, Senator Pauline O'Reilly. We need to start thinking outside the box about how to increase the breastfeeding level. Ireland is lagging behind globally, including in Europe, I suppose. In my area, Ballinasloe, a parent group called Cuidiú has started to encourage and support women, particularly first-time mothers, with breastfeeding. It is a real challenge because we do not have such support groups in every town and village across Ireland. I appreciate that the Minister of State, in his response, spoke about lactation consultants and said funding was allocated in 2021. The website www.mychild.ie targets women between 25 and 45. Sometimes the information on websites can be quite passive. There needs to be an interactive campaign for mothers of every age, particularly young mothers. The challenge is that it is such an anxious time. I can only imagine. Considering that mothers are in hospital for only a short period before being sent home, we must consider the supports they have.

I am very interested in the idea that Senator Pauline O'Reilly referred to, that is, using our secondary schools. We must consider how we can engage with young women at a very early stage. It is true that our culture in Ireland is not supportive of breastfeeding at the moment. This has been the case for far too long. Maybe there needs to be a step change in how we tackle this and engage with it. Again, it always comes down to the mother and her choice. There should be more awareness regarding the reasons for choosing breastfeeding over formula. If any mother is thinking about the natural protection breast milk affords to her child, it really has to be made clear. It is possible that engagement at an early age is a great way of doing so.

Through our advertising and the ways in which we now introduce this topic, including speaking about it in the Seanad, we are raising awareness and facilitating conversation so people can talk about the subject without fingers being pointed. We really want to be in a position in which mums can discuss this matter, make informed choices and be supported where needed along with their children.

I thank the Minister of State, Deputy Feighan, for speaking to us about this. We need to consider a step change.

I thank the Senators and the Minister of State for engaging on this important topic. It is true that much work has been done but we are not seeing the cultural shift. That is just a reality. The numbers reflect an increase but include those who are doing both breastfeeding and using formula milk. It is important to point out that the rates do not refer to breastfeeding exclusively.

It is also important to point out that while Ireland has signed up to the WHO's international code of marketing of breast milk substitutes, it is not in compliance with it. We are not outliers in that regard because no European country is in compliance. As Senator Higgins said, some of the countries across the world impacted most by the aggressive advertising of formula companies are the ones who have tried to bring in bans on advertising. We need to follow suit and be leaders in that regard.

I want to mention a few points the Senators have raised. I thank the Minister of State, Senator Hackett, for her personal stories. We talk about breastfeeding an awful lot together and try to be as creative as possible. As Senator Higgins has said, we are trying to devise practical solutions. We have experienced a lot of these issues ourselves. Many of the people we are in contact with also have.

I thank the Minister of State, Deputy Feighan, for taking on board the suggestions because we need to see a step change.

I thank Senator Currie for her personal story. It is not always easy to share with people the difficulties one faces, but it is important to do so. The point the Senator made on putting pressure on the system rather than woman is really important and one we must keep reiterating. If we do not, we will be fearful of talking about this topic for fear we will be shaming women. That is not what we are doing; we are shaming a system that has let women down. That is what we will continue to do if we do not address this.

On the remarks of Senator Higgins, Ireland is an outlier when it comes to its rate of breastfeeding. That is just the reality. In this regard, let me return to my point on secondary schools. Senator Dolan and I are members of the education committee, and that is why she raised a point I have made quite a lot over the past couple of days. We need to make use of secondary schools because people do not have the relevant experience in their homes. I am referring not only to girls but also to boys and people of all genders and skills because they comprise the support network. They need to see what a good latch looks like. We must start talking about breasts as things that actually perform a function for young children, and that means talking about the subject to young boys as well as young girls.

I thank Senator Keogan for the point she raised. It was remiss of me not to speak about the blood bikers. Theirs is a really important function. I have met some in Galway. North–South co-operation involving Fermanagh, which Senator Warfield spoke about, has been key. We have been very reliant on it in Ireland. I believe we need to examine whether we could develop our own system here. The North–South co-operation with the blood bank could be replicated in respect of many things that happen on this island.

I have spoken about each of the Senators' suggestions. I have two more points to make.

I note the Minister of State did not mention the Traveller health action plan. It is hugely important that we see progress on that. The Traveller community has waited long enough. The Joint Committee on Key Issues affecting the Traveller Community, of which I am member, wants to see the action plan but we also want to see action. Members of the Traveller community are tired of asking for plans. They want to see delivery on the ground. The 2% breastfeeding rate among Travellers is shocking and impacts on the health of the community, both psychologically and physically.

I thank and pay tribute to Councillor Kate Ruddock who is seated in the Gallery. She is the newest councillor for the Green Party having become a councillor on Monday. She works as a researcher for the party and has done huge work on this issue in the past year. We rely heavily on members of our party and volunteers with whom we have contact to bring forward these issues. I thank everyone involved and I assure them that we will continue to push this issue. It is important that the Government made the decision not to oppose the motion. It will be important for us to see our suggestions taken on board. The motion gives us a blueprint and encouragement to continue to apply pressure.

Question put and agreed to.
Cuireadh an Seanad ar fionraí ar 5.02 p.m. agus cuireadh tús leis arís ar 6.03 p.m.
Sitting suspended at 5.02 p.m. and resumed at 6.03 p.m.
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