What the APPGIFI forgot to mention

The All-Party Parliamentary Group on Infant Feeding and Inequalities (APPGIFI) recently released a report following their inquiry into the Costs of Infant Formula Milk for Families, with discussion on the rising problem of food poverty in the UK. The report highlights many points that have been identified in previous research:

• the cost of infant formula significantly impacts on some family budgets

• families who cannot afford formula may resort to unsafe practices in order to feed their babies

• where breastfeeding is contraindicated, families who have been advised to formula feed may be at particular risk of hardship

• the Healthy Start scheme is valuable but needs to be reviewed

• there is a lack of adequate support for families who formula feed

These are all valid concerns and not surprising to anyone who routinely works with formula feeding families. However, there are a few key points regarding the report that we feel require clarification:

This isn’t an official parliamentary report

This should have been stated on the front page of the report along with the disclaimer that the views of the report are the views of the group alone according to the rules governing all APPGs (point 23).  The problem with not making this clear is that because this isn’t an official parliamentary report we cannot rest on our laurels and assume that the government will take action to address any of the points raised. In Scotland, the Healthy Start Scheme is currently being reviewed with food vouchers set to rise by 37% per week, but this still requires action in the rest of the UK. If we want to improve things for all families we still need people power.

The APPGIFI are not recommending a taxation on infant formula

We have been assured by Alison Thewliss MP, albeit over twitter, that the recommendation by the group that the government consider other fiscal measures such as taxation… to better support women to both breastfeed and use infant formula does not refer to a taxation on infant formula itself. The wording in the document is quite ambiguous so we hope that the APPGIFI will make this crystal clear.

UNICEF guidelines prohibit formula distribution from many food banks

While the document makes six mentions of food banks and uses figures obtained from the Trussell Trust on food poverty and insecurity, there is no mention or discussion of the fact that UNICEF guidance prohibits the distribution of infant formula from many UK food banks. From our own investigation into this matter we found that while larger food banks such as the Trussell Trust are unable to distribute infant formula milks, smaller, more local food banks often can and families who request infant formula milks are frequently referred on to these smaller organisations. The difficulty with this is that the supply of formula isn’t guaranteed adding yet another layer of complexity to the lives of people who desperately need support. When families are struggling so severely that they are turning to food banks to survive, denying them the resources to feed their babies and failing to acknowledge this within a document that is supposed to address this, written by a group set up to champion ‘Infant Feeding and Inequality’ is shocking.

The WHO Code prevents discounts, promotions or collection of loyalty points of first infant formula

Many parents reported to us that they move from infant formula milk to follow on milk because they were able to purchase follow on milk for less money due to special offers and because purchase of follow-on milk allowed them to collect store points which they were able to use to spend on food for other members of the family.

It is surprising then that the while the inquiry pointed out that there are no benefits to switching to follow-on formula which they state is unnecessary and unsuitable, the report recommends that the UK bring[s] the International Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions (the Code) into UK law to remove advertising of breastmilk substitutes to the general public. The inquiry makes no attempt to consider the impact that current Code implementation has on families’ purchasing decisions or how denying parents the option of purchasing cheaper follow on milk will impact on their finances.

We don’t know how the APPGIFI identified key report themes

The inquiry received 108 responses, the majority of which were from parents.  It’s not clear from the report which of the key themes were identified by parents and which were identified by healthcare professionals or organisations, or whether both parents and other respondents even identified the same things as being important.  Without seeing a summary of the data we don’t know how the APPGIFI group identified and weighted the key themes upon which their recommendations are based.

Conflict of interest is unclear

Whilst the inquiry isn’t bound by the same requirements for rigour and transparency as academic research and government reports,  for the sake of clarity and credibility, it is important to know who stands to make financial or other gains from implementation of the recommendations within the report. Many of the organisations or persons who responded to the inquiry and who were thus allowed to comment on the draft report prior to its final publication – Infant Feeding Support UK included – could potentially gain if the recommendations within the report are implemented. For example, La Leche League, who responded to this inquiry, have recently benefited from investment into breastfeeding support by the Scottish government.  It is unclear whether any of the other respondents have similar COIs and this should have been clearly stated in the report. Together with the lack of data transparency this is concerning.

What did families say?

As the subject of the inquiry was the cost of infant formula milk for families, their voices should have been prioritised and distinguished from the responses obtained from larger organisations and health care providers.

Overall, there are a lot of positives to take away from this inquiry but it’s clear that a lot of work remains to be done to ensure families voices are heard and that actions to end food poverty and inequality for UK families are prioritised.  Please join us so that we can work together to address these issues so that every family gets the support they need to feed their babies safely and with love.