Agenda item

The Committee considered a report of the Director of Public Health which provided Members with an update on the progress made in addressing the Best Start in Life (BSIL) priorities and highlighted the importance of early intervention and prevention of Tobacco Dependency in Pregnancy (TDiP) / Breastfeeding (for copy of report and presentation slides, see file of minutes).

The report delivered by Andrea Bracewell, Advanced Practitioner in Public Health gave a brief update on the work undertaken to address some of the key priorities’, progress and challenges to improve outcomes in the first 1001 critical days for babies born to mothers who smoke. It also outlined the crucial role breastfeeding played in narrowing health inequalities for those born in more deprived communities, who experienced a higher prevalence of low birthweight and infectious childhood diseases.

Smoking Status at Time of Delivery (SATOD) is an indicator collected nationally.  Locally there has been gradual improvement in the number of mothers SATOD.  In the last five years County Durham has seen a 22% decrease in the proportion of mothers SATOD.  During 2022/23, however County Durham had the second highest SATOD rate in the North East.

In relation to breastfeeding, Members were advised of research undertaken in the County to provide insights from communities, looking at feeding practices and understanding beliefs and attitudes regarding breastfeeding.  The findings indicate that people from higher socioeconomic backgrounds were more likely to be breastfed and choose to breastfeed while those living in more deprived areas were less positive about breastfeeding.  The findings also indicate that the attitudes of young people (16-29) were similar to other age cohorts from people with lower socioeconomic backgrounds.  The findings from the research were being used to provide educational programmes.  The service worked closely with Family Hubs and data from work around differences in breastfeeding between areas has added to the understanding of breastfeeding in local communities serviced by Family Hubs.

The Chair highlighted that the Tobacco and Vapes Bill went to Government for consideration on the 5November 2024 which would make it illegal to sell tobacco products to anyone born on or after 1 January 2009.The Bill would also restrict the flavours, visual appearance and advertising of vapes with the aim of safeguarding young people. The Advanced Practitioner in Public Health responded that The Royal Collages had praised the implementation of these changes as it would decrease the number of mothers that smoked in future pregnancies. The Consultant in Public Health added that in the broader smoking agenda it was already illegal to supply tobacco to young people as it was an age restricted product. Tobacco packaging was unattractive with graphic photographs depicting health impacts of smoking and the move to further restrict outdoor smoking is part of the legislation and aimed to make the use of tobacco a less attractive activity.

Councillor Coult praised the great work that had been highlighted in a very challenging climate where vapes and smoking were being glamorised by social media and celebrities. The Advanced Practitioner in Public Health acknowledged these challenges and the continued need for young people to be made aware of the long-term harms of smoking, such as the heightened CO₂ levels monitored during pregnancy which highlighted the increased chances of a still birth or miscarriage for those who smoke in pregnancy. By giving mothers, the facts they were able to make informed decisions.

The Consultant in Public Heath advised that in relation to the broader smoking agenda work was taking place.  It was already illegal to sell tobacco products to children and young people and the Tobacco and Vapes Bill strengthens measures to reduce smoking rates.  The legislative programme to bear down on smoking making it more difficult and help communities see that smoking is less acceptable.

Councillor Walton added that assurance was needed from employers with supporting breastfeeding and talking about the negative impact of smoking on the health of mother and baby. There were still lots of opportunities to engage with young people before they become adults and consider pregnancy, therefore any work with employers, and apprentices within our own organisation and the NHS to highlight these key messages was valuable. 

The Advanced Practitioner in Public Health responded to questions from Professor Ciesielska regarding tobacco replacement and breastfeeding training for health staff. She stated that when a mother was moving towards tobacco replacement, generally this replacement therapy would not last longer than 12 weeks and vaping would only be advised as ‘less harmful’ than tobacco were a mother had previously been a tobacco smoker. In relation to breastfeeding training this was a mandatory requirement for staff involved in delivering through the family hub programme. Leaflets and communications were designed through a partnership of health professionals including education teams and midwives who meet annually. The national training delivered by midwives to expectant mothers was consistent with set lesson plans that followed the Solihull training programme.

Mrs Gunn noted that woman metabolised tobacco quicker when pregnant and enquired if there had been any research into increased metabolism in those mothers with ADHD or mental health issues. The Advanced Practitioner in Public Health responded that the cycle of nicotine addiction in the body drove the need for nicotine rather than the stress factors and that there were no specific evidence to share regarding the role of ADHD.

In response to a question from Mrs Gunn reading the possibility of working with local celebrities on breastfeeding promotion the Advanced Practitioner in Public Health stated that the authority were keen to use local women as role models, an example of which was a new breastfeeding promotion to be shown on local buses featuring local women. Care needed to be taken that breastfeeding products were not promoted when celebrities were supporting marketing campaigns for example breast feeding chairs were not required, specialist clothing for breast feeding in public were not necessary when a simple blanket would do the same job. Celebrities promoting the use of such aides could indicate that there was a cost to breastfeeding and we wanted to show its open to all and normalise the practice of breastfeeding.

Mrs Gunn noted that obesity and maintaining a balanced diet had not been highlighted when it was well documented as an impact on pregnant mothers and family health. The Advanced Practitioner in Public Health responded that the early years and pre-natal nutritional agenda sat with partners who worked toward those priorities. Partners in Best Start in Life Group, Healthy Weight Alliance and a specialist Matron based with County Durham and Darlington Foundation Trust worked in collaboration with the wider local agenda and champion breastfeeding as optimal for baby. The Chair added that there was the opportunity to join an online healthy weight webinar with Kelly Rose to be held on 26^th January 2025 and an item on Healthy Weight would be considered at a Special meeting of CYPOSC on 26 February 2025.

The Advanced Practitioner in Public Health responded to a point made by Councillor Andrews regarding the pressure on family finances due to high cost of purchasing baby formula milk. She agreed that while the cost was high there was also misconceptions among some parents on the quality of higher and lower priced brands due to the power of the marketing undertaken by the companies. Formula milk was unfortunately a multi-million-pound industry. However, through the insights work it has been noted that the cost of formula feeding had not been seen as a deciding factor on whether someone would breastfeed or not. Through the Healthy Start Scheme a small financial contribution was available for families towards the cost of healthy food for families and also this could be used to contribute to the purchase of formula milk, but the team continued to promote that breastfeeding was optimal for baby and was also free.

Resolved: That the contents of the report and presentation be noted.