Feed inquiry: access to infant formula for babies living in food poverty in the UK
In Dec 2020 we undertook a comprehensive review of formula access pathways that found families living in food poverty face a postcode lottery when seeking formula for their formula fed babies. Shortly after, we launched an inquiry to assess the role of food and baby banks in maximising access to formula for formula fed babies in need.
We wanted to hear from food and baby bank service users, staff and volunteers and health and social care professionals who work in partnership with, or refer families to third sector support organisations for infant formula provision.
Our key aim was to gain an understanding of the experiences of families who seek support from food and baby banks and the professionals who support them, and to look at some of the factors that influence accessibility.
We received 172 responses from members of the public, families who have sought help in getting infant formula for their infants, and from staff and volunteers and health and social care professionals who work in partnership with, or refer families to, third sector support organisations. We conducted a detailed qualitative and quantitative analysis of the responses, the full details of which are presented in our full report along with our results, conclusions and recommendations.
We were overwhelmed with the response and thank everyone who participated. We massively appreciate you taking the time to share your experiences and expertise with us, thank you.
Summary of findings
Food poverty and food insecurity is a major public health concern in the UK
COVID-19 has exacerbated previously existing inequalities leading to an escalation in food poverty. For children this can be particularly devastating as experiencing childhood poverty has serious long-term effects including reduced life expectancy, poorer health and educational outcomes.
When families cannot access formula for their formula fed babies, infants may be at risk
Respondents highlighted their concern that any delay in accessing formula may lead to babies being underfed and provided real life examples of this, in particular, of families having to water down formula. These finding echo those of the All Party Parliamentary Group in Infant Feeding and Inequalities who reported similar in 2018.
The overwhelming majority of respondents recognise the essential role food and baby banks play in providing formula for formula fed babies experiencing food poverty
The vast majority of responders (99.3%) stated that food and baby banks are essential for supporting families living in food poverty, and have a vital role to play in the provision of infant formula (91.3%).
Guidelines that recommend food and baby banks don’t provide formula create barriers to access
Our data analysis highlighted that current UNICEF UK guidelines that recommend food and baby banks do not directly provide infant formula are causing problems at multiple levels; families face delays in getting formula for their babies, relationships between health care providers and third sector organisations are put under strain and healthcare providers are prevented from accessing support for the babies in their care.
Alternative routes of access to infant formula are inadequate
Responders expressed concern about inadequacies of alternate pathways of support (to which UNICEF UK recommend food and baby banks direct families instead of offering formula). Benefit applications take too long, don’t cover costs & aren’t available for all who need support. Furthermore, families often don’t have the means to access additional support pathways.
Formula can be provided safely at food and baby banks
Our inquiry found that formula can be provided safely by food/baby banks, alongside referring families to services that offer longer term support. It doesn’t have to be one or the other. There are brilliant initiatives out there plugging the gaps left by the current system to ensure no baby goes hungry. Our guidelines for food and baby banks on infant formula provision can support these organisations to provide first infant formula for formula fed babies experiencing food poverty.
Food and baby banks are not the answer to formula poverty
Obviously, food and baby banks are not the answer to formula poverty. We need systemic change. In the meantime, our data shows that we mustn’t limit formula access pathways – these need to be maximised to reduce the risks to formula fed babies caused by delayed access to their main or only food source.
We identified eight key themes that we explored further:
Babies have a right to be fed
Responders told us that babies are innocent and should not suffer at the hands of political decisions restricting their access to food. Parents and carers of young infants living in poverty deserve agency and autonomy. If a mother has the means and access, she can choose formula for her baby with no interference or oversight; those without funds deserve equality without discrimination.
When parents can’t provide for their children, parental mental health suffers
The emotional and mental impact of being unable to provide for your baby was highlighted by professionals & service users. responders told us of the distress and anxiety that parents experience when they are unable to provide food for their babies.
Poverty
The impact of poverty, including formula poverty, was strongly represented in the inquiry responses. There was particular concern that the benefits system is inadequate; access to funds takes a long time and doesn’t meet the basic financial needs of families. Healthy/Best Start schemes don’t meet the costs of formula and many are ineligible, including father, and families with No Recourse to Public Funds.
Safety and risk
In contrast to UNICEF UK’s assertion that direct provision of formula to formula fed babies experiencing food poverty is not advised ‘due to concerns for the safety of the baby’, our analysis found that the main concern of families experiencing food poverty was the risk of babies not being fed. The risk of underfeeding babies, or of families being forced into unsafe infant feeding practices like watering down formula was a much more significant concern than any perceived risk of formula provision. This was echoed in the responses from professionals supporting families; 35% of professionals who responded referenced risk associated with not providing infant formula.
Access to resources verses knowledge of feeding methods
The inquiry highlighted that lack of knowledge of what services are available is a barrier to accessing support. The analysis also demonstrated food and baby banks are knowledgeable on infant feeding and can signpost families to relevant infant feeding support services alongside providing feeding equipment to formula feeding and breastfeeding Mums.
Current guidelines on formula provision create barriers
The inquiry found that current UNICEF UK guidelines that recommend against direct provision of formula to formula fed babies by food and baby banks are creating barriers to access. This is causing problems at multiple levels: families face delays in getting formula for their babies, relationships between health care providers and third sector organisations are put under strain and healthcare providers are prevented from accessing support for the babies in their care.
The right and wrong feeding choice
A “correct” way to feed a baby was referenced in 22% of all responses in the sense that breastfeeding is seen as the right choice, whereas formula feeding is to be discouraged. Respondents expressed a concern that UNICEF' UK’s policy recommending against direct formula provision at food and baby banks penalises Mums who are unable to, or choose not to breastfeed, and are a means of imposing breastfeeding by denying access to formula. The idea of a privileged few making decisions on behalf of women who’s circumstances they do not understand was also referenced in the responses.
Gold standard practice
There are a wealth of initiatives to maximise formula provision pathways already in place. With a co-ordinated, joined up approach, these could be developed or widened to expand access of formula to formula fed babies in food poverty across the UK.
More must be done to tackle the issue of access to formula, and the wider issues of poverty. Current initiatives, and innovative ideas offer potential solutions to the problem but ultimately it will require working together. Combining the efforts of the NHS, social services, government and third sector organisations is required to improve the support of infants in poverty and to ensure no baby goes hungry.
Recommendations
1
Organisations who support families living in food poverty should implement initiatives that maximise safe pathways of infant formula provision for formula fed babies living in food poverty
Infant formula is being distributed from food and baby banks to formula fed babies in need, and that due to critical need this practice will continue. In order for this to be done safely, and in a way which respects agency and autonomy of families, health, social care and third sector organisations must work together to develop adequate formula provision pathways.
• We recommend a pilot scheme of free formula provision be implemented in Scotland.
• Free formula provision at local pharmacies could be a viable option
• A set of professional standards for safe formula provision to which food and baby banks can choose to adhere, and which would satisfy health and social care workers, should be agreed among stakeholders. Feed have developed such guidelines to support organisations wishing to provide formula.
2
Public bodies, in particular health and social care providers, must fully assess the policies and guidelines they choose to adopt to ensure they meet the needs of the families they care for
The current guidelines on formula provision at food and baby banks – namely the UNICEF UK guidelines that recommend against direct provision – have had a detrimental impact at multiple levels. These guidelines have been widely adopted in their original form by Health Boards across the UK and used as a tool to prevent third sector organisations from providing food to formula fed babies in a safe and efficient way is extremely concerning. Thus, we strongly recommend that health and social care providers do not fetter their discretion by the application of policies which may result in external bodies dictating their judgement as to what is allowed in terms of formula provision to formula fed babies in food poverty. Where merited, public health and social care organisations must consider deviating from the UNICEF UK guidelines to meet the needs of infants under their care.
3
Implement the recommendations made in our review of formula provision pathways published in December 2020
In our Dec 2020 review we made a number of recommendations in order to improve access to formula for formula fed babies in food poverty. We reiterate those recommendations below:
• The government must take immediate action to clarify the current law on the provision of infant formula at food and baby banks.
• Food and baby banks and other such services should accept and provide First Infant Formula to parents and carers of formula fed babies up to one year of age.
• The Government must take immediate action to remove current barriers to formula access.
• The government must continue to invest in longer term solutions to child food poverty.
• Guidance should allow for safe direct provision of first infant formula for formula fed babies in need and ensure equity of access for all
