It all started in Vancouver in the spring of 1993 when I attended the International Confederation of Midwives Congress to launch British Journal of Midwifery (BJM).
I was fully aware of the sensitivity surrounding formula milk advertising when, primarily as a result of its activities in the developing world, Nestlé had become a bête noire. We had prepared for an ongoing, lively discussion after the editorial board of BJM agreed to accept formula milk advertising, but not the venom of a very small group of midwives. The board agreed to the sponsorship for reasons that are as germane now as they were then.
Mark Allen Group is a publisher, not a moral guardian. If an advertisement is legal and does not do incalculable harm, we have a duty to publish it. Imagine the minefield we would enter if selecting advertising were left to the personal whims of the editor or publisher. Formula milk constitutes the vast bulk of advertising spend and, without it, journals like BJM would not be able to provide such a good service. Unlike some other midwifery journals, which have pursued an erratic approach to formula milk advertising, BJM has followed the same policy consistently for 26 years, during which time, it has become one of the world's leading midwifery publications. This is not because of its acceptance of baby milk advertising, but because, as a successful, independent and respected voice, it has never compromised on the quality of its peer-reviewed articles.
BJM is aimed solely at professional midwives. It is up to midwives to decide what information they wish to pass on to the women in their care.
Breastfeeding is, of course, nearly always the best solution and during the 26-year history of the magazine, our articles have always championed this cause. However, women have a right to choose. Some women find it very hard to breastfeed: my daughter-in-law was one who desperately wanted to do so and was upset when this proved impossible. For a caring profession, it really is unacceptable that women are made to feel inadequate or guilty if they are not able to breastfeed.
Recently, the landscape has changed again. Due to the NHS Long-Term Plan (NHS, 2019), the Government is piling on the pressure for midwifery units to deliver ‘an accredited, evidence-based infant feeding programme, such as the Unicef Baby Friendly Initiative’ (NHS, 2019:49).
Unicef's Baby Friendly Initiative, in trying to implement the World Health Organization's recommendations on breastfeeding, is to be applauded, but the means by which it strives to reach this end, are controversial and provocative. It places midwifery units in an invidious position: if they do not play to the Unicef tune, they risk not being accredited and losing money and prestige as a consequence. Many midwifery units will feel that they have little choice but to go along with Unicef's game plan.
All midwives will understand the need to increase rates of breastfeeding in the UK. However, as professionals, they will no doubt also wish to consider all the options, in order to provide the most appropriate advice and support for each individual woman in their care.
We agree with the Government's aspirations in wanting to improve breastfeeding rates, which in some parts of the country are very low. Indeed, UK breastfeeding rates are lower than other countries in Europe and there is considerable variation between different parts of England. Some 84% of infants are breastfed between 6–8 weeks in London compared to 32% in the north-east of England (Victora et al, 2016; Public Health England, 2018).
However, such an all-encompassing and prescriptive approach is likely to fail. Forcing people to achieve goals, however admirable, does not work, which is why Unicef and the Government need to tread more warily. The threats implicit in Unicef's policy, whereby professionals are actively discouraged from attending events promoted by formula milk companies, are ultimately likely to alienate midwives, the majority of whom have a much more nuanced and sensible outlook.
Let's face it: hypocrisy is also involved. It is often the very midwives who shout the loudest who, at the same time, have accepted the largesse of baby milk companies when asking for funding to attend educational events.
Education and persuasion should be the way ahead, not the seemingly petulant intransigence of the nanny state. Professional freedom and integrity lie at the heart of this issue. That is why BJM will continue, editorially, to promote baby friendly initiatives, while reserving the right to accept formula milk advertising in its commercial pages.