Chairman: Graham, I shall ask you, the Minister and Penny T. Dictator to say a couple of words, if you wish, about where we are at the moment. Who would like to start?

Ms Diana T. Obsfucator: Thank you, Mr. Chairman, and members of the Committee. I am pleased to be here this afternoon. I would first like to set out the Government's position in a basic, plain way. It remains that it is a fundamental right that  mothers should be free to breastfeed their child, if they wish to do so. We acknowledge that views on breastfeeding are polarised, with breastfeeders feeling that health professionals do not understand the range of approaches that they can take, and breastfeeders unwilling to accept that in a minority of cases breastfeeding may not be up to scratch...

...In 2007, the Government published non-statutory guidance on monitoring breastfeeding which set out the legal requirements, and the approaches that we expected health professionals and breastfeeders to take in working together to ensure that breastfed children receive good nutrition. However, it became clear during 2008 that neither breastfeeders nor health professionals felt that the guidance was working, and that is the reason for the review.

Graham's recommendations fall into three broad categories: first, registration and monitoring; secondly, providing far greater support to breastfeeders; and, thirdly, mechanisms for breastfeeders' needs to be considered explicitly in healthcare strategies.

I need to say at this point that I am not able to go into very much detail about the proposals on monitoring and registration today. As you know, they are out for public consultation, which ends on 19 October. We will have to consider carefully the consultation responses before proceeding. I would like to emphasise that no firm decisions have yet been taken.

Breastfeeders have repeatedly asked for additional support, and I am pleased to say that we have listened to them. I hope that members of the Committee had an opportunity on Friday to see the response from the Secretary of State to the recommendations in the report....

...If we proceed to legislate, we intend to require healthcare providers to broker arrangements so that breastfeeders who wish to make use of supplementary feeding devices or breast pumps can access this equipment from centres reasonably close to where they live and at no cost. We will also put arrangements in place for authorities to consider breastfeeders' needs strategically, so that they are systematically considered and appropriate service is provided.

Finally, if and when the recommendations of Graham's review are fully implemented, breastfeeders will still have a considerable degree of freedom. They will not be operating outside the law, as is the case in the Netherlands and Germany where breastfeeding is illegal. They will not have their children tested for nutritional deficiency, as in Finland and Norway, nor follow a prescribed diet, as in Denmark. England will still be one of the most liberal countries in the developed world in its approach to breastfeeding, reflecting the careful balance we have to strike between a child's right to nutrition and a parent's right to feed their child in conformity with their beliefs and philosophies. I very much look forward to the report that you will produce after you have taken evidence.
 
Chairman: Thank you for that, Minister; it got us off to a good start. Is there anything you would like to add, Graham?

Graham Breastman: My thanks for this opportunity. I have not actually said anything about my report since I submitted it to the Secretary of State, and there are some good reasons for that. There were lots of invitations to talk about it, but I chose not to because I thought it would be prejudicial to an open process of consultation. To echo the Minister's comments, if all the recommendations are implemented, there is nothing to stop breastfeeders, many of whom I have met who do a thoroughly good job for their children, continuing. They would be subject to registration and to what I regard as light touch monitoring, but as the Minister as pointed out, in one of the most liberal regimes in terms of a developed nutrition system, we now have greater access to a range of feeding methods. I stated in my report that it seems perverse for any Government to express concerns about this group of people, yet not offer any resources to them.

If I were before you, Chairman, as a Director of Children's Services and you asked me, "What do you know about alll of the breastfed children in your care?" and I replied, "I'm awfully sorry, but I can't tell you very much about them," I suspect that I would not remain in the post for very long. That, frankly, is the situation in relation to breastfeeding. That doesn't mean to say that it is bad; it means to say that we don't know.

Children have a moral right to be nourished; I place great emphasis on that. My report, I hope, sets out to balance the rights of the child with the rights of parents. It seems timely on the 20th anniversary of the UN convention that we seek to examine whether or not this sector of the community actually honours children as expressed in the UN convention. I spent some time in my report discussing that and placed the recommendations in that context.

All that being said, if anything, the report is most critical of health providers. If implemented, it will hold them to account through an audit regime for their systems of monitoring breastfed babies. I think it raises real questions about the support they have given and should give to children with additional feeding needs; about their training, or the absence of it, of staff...

...I tried very hard to represent the views of the countless breastfeeders who often spoke of their despair -I do not use that word without some caution, but it was genuine despair - at the early years system. They had concerns about the understanding of health professionals who did not appreciate the aims of breastfeeding mothers... Breastfeeders often viewed breastfeeding as a place of last resort where their babies could seek comfort when all else had failed... Added to that, there was a whole group of parents who had a philosophical belief in breastfeeding. There was a clear conviction on the part of many of them that they could do it better, and I respect that belief.

But in turning now, to safeguarding, I recognise that this was the most controversial element of the report. Many parents felt that the initial press coverage of the review found them guilty, and they had to prove their innocence. I regret that, because I don't think that is true, and I cite what they said to me-that hard cases make for poor legislation. And where there was no evidence-for example, on forced breastfeeding, where I actually looked at the report that went to the Home Affairs Committee -where I could find no evidence, I said so. In regard to safeguarding I simply ask two questions about well-being and safety. They are on page 28, paragraph 8.2. Basically, my two questions were, "Are the concerns for child protection over-represented within the breastfeeding community; and if so, what could have been done through better regulation to ameliorate those effects?"

Finally, with regard to nutrition itself I recommended further work to be done, to determine, in the context of what constitutes not 21st-century formula feeding, but 21st-century infant nutrition that is required, what is "suitable" and "full-term", now. The definitions that we have got are only defined by case law. They are not legal, and they are pretty woolly. Although I came to no firm conclusions I recommended that further work be done on that; indeed, in the same way that I recommended that we explore more about child-led weaning. We don't know enough; we don't know enough in terms of research, particularly on what are the outcomes for children as a consequence of that.

I began by saying that I'd written this report in seeking to balance the rights of children with the rights of their parents. I hope that, if implemented, it gives children a voice. I know that in itself is contentious. But I have also tried to give breastfeeders a voice. I recommended that they be engaged in the process of determining what is "full-term" in breastfeeding, that they be involved in training, that they be involved in all the things that follow, and that, crucially, health professionals create a forum whereby they regularly hear from breastfeeding parents about the services that are provided.

I believe that the breastfeeding community has much to offer in developing our understanding of the effectiveness or otherwise of bottle-feeding. It holds a mirror up to bottle-feeding, and to that end, I have to say, Chairman, I have been somewhat surprised by the reaction of a vociferous minority -and I do think it is a vociferous minority; I can actually count the number of people who have done it. I have found the remarks of some of them offensive, but I draw comfort from an academic friend of mine who says that often personal attacks are made when logic has been defeated. I don't regard those people as a majority. I think that I have benefited enormously from learning of their experiences, but I actually think that the change in regulation and greater scrutiny is essential for the children.