Building blocks for future families in a stable society – The NCT manifesto for the General Election

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Becoming a parent for the first time or adding to your family is a life changing experience. People who come through this transition feeling confident, capable and well supported are more likely to be able to form a stable family and develop into effective parents, giving their children a secure start in life.

We propose that the next Government make 7 promises to parents ensuring the best start for families in the UK and valuing the essential role that parents play in society.

We call on the next government to promise parents:

1. Guarantee high quality maternity services for all those expecting a baby

2. The ability to make decisions free from commercial pressure

3. The ability to make decisions about baby feeding and the support to carry out those choices

4. High quality preparation and support for all those with a new baby

5. The chance for all parents to make their own support networks

6. The ability to access an adequate income while also being active parents to their young children

7. The chance to have a say in services for them

We call on the next Government to:

• Provide enough midwives and support for those midwives so that they can provide the one to one, continuous support that parents-to-be need in a variety of settings including home. The system within which midwives work must change to one where each midwife cares for no more than 30 women in a year, supporting them before during and after their birth. All families should have their individual needs assessed so care can be planned accordingly

• Ensure the selection of midwives for training is based on criteria derived from understanding the characteristics of the most effective midwives. Training for all those working within maternity should have some joint modules, based upon shared values and evidence-based principles; the user experience and the importance of listening to users should be built in early in the training of all maternity professionals.

• Pay urgent attention to remedying the faults in the NHS financial system. The current system disincentivises investment in one-to-one midwife-led and out-of-hospital care for women and their families. This will mean making sure maternity services find it financially sustainable for every woman to be able to choose home, homely birth centre or as home like as possible an obstetric unit birth.

• Ensure that information available to parents-to-be is accurate and in line with evidence to give them the opportunity to make informed choices.

• Guarantee that hospital systems support the very different requirements for catering, hot water, birth pools, furnishings, ensuite toilets, sound proofing and accommodation needed in maternity provision compared to other parts of the hospital. Room design must make fathers feel welcome and to enable them to stay overnight with their partner without affecting the experience of other mothers in the maternity unit.

• Ensure experienced consultant obstetricians are available on labour wards throughout the 24 hours every day of the year taking responsibility for mothers with medical complications within the hospital and those being transferred in when needed from community services

• Introduce pilot Maternity Trusts set up to focus solely on the services for those becoming parents.

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Mothers and fathers deserve maternity services which help them make the best start to family life. Particular efforts need to be made to enhance services for families who are less likely to access care and to provide tailored services where needed. It should be made easy for parents to find a midwife right at the start who they can get to know and trust and who will support them until they are settled and feel able to care for their new baby. Each woman should be cared for in labour by a midwife who is responsible only for her, her baby and her partner. Maternity services should be organised to enable as many women and their partners as possible to have a safe and fulfilling birth. Women and babies who need medical care should have timely access to consultant obstetricians and skilled paediatric staff. For all families, care should be taken both to keep parents informed and involved in decision-making and to minimise unacceptable risks, trauma and pain.

Maternity services should fully include and respect the role that fathers play in their partner’s and children’s lives, with acknowledgement that there may also be stress and emotional pressure on them during the transition to parenthood. Every parent-to-be in the UK should be given a choice of where to give birth, including at least one midwife-led care option. In order to make an informed choice, parents-to-be need accurate and comprehensive information, in a readily accessible format, on the options in their area.

Every NHS room used for labour and birth must be suitable for women to have an active labour and a normal birth – the choice of the majority of women.

A woman’s communication needs during labour should be discussed during pregnancy so that clear arrangements can be agreed. Access to interpreters, and a midwife with a special interest in disability should also be available in all areas of the UK. Family members should not be relied upon for translation. Disabled women have widely varying needs and preferences. A midwife with experience and knowledge of disability issues should be available to advise and support other midwives and/or to discuss a woman’s individual needs and how best to meet them. The needs of disabled partners or fathers should also be addressed so that they can participate fully during the birth and contribute to care of the mother and baby in the postnatal period.

Why is this important? Being a parent is an important and difficult job which needs the new parent to feel well and empowered to undertake the physical effort and learning that is involved. Despite many improvements in maternity care, most parents-to-be still do not get the level of service they deserve and want, and which helps to ensure they start family life in good health and with confidence. Many women give birth in hospital facilities that are not fit for purpose while nine out of ten women surveyed felt that the physical surroundings could affect how easy or difficult it was to give birth. The birth rate is rising year on year and services are over-stretched. As a result, many new parents are not supported at a time when they need and value high quality care. A third of women recall their birth as in some way traumatic.

1A quarter of all women are left alone at some point during their labour and birth when they were frightened. Intervention and lack of support is the main cause of the high level of trauma.

Choice of place of birth helps to ensure that a woman expecting a baby feels comfortable, safe and well-cared-for in the setting she has chosen to give birth. It also means that the appropriate type and level of support will be available for her during labour and birth, so that healthcare resources are not misused.

A father that is involved and enabled to manage the transition can better maintain the relationship with the mother, influence her positively and create better outcomes for the child There is a lack of awareness among health professionals and parent educators on the value of fathers’ active involvement in pregnancy and birth, the issues men face during the antenatal and postnatal period and their experiences and feelings about birth and baby care. Fathers are often the invisible parent, not actively contacted or engaged by public services relating to their children.

Guarantee high quality maternity services for all those expecting a baby

We call on the next Government to:

• Adopt the WHO code of marketing of breastmilk substitutes and subsequent resolutions.

• Phase out the use of commercial companies to distribute essential information for parents on statutory benefits and services and prohibit commercial companies from collecting data or promoting their products to parents while on health services premises.

• Ban product placement involving goods for babies and young children in UK broadcasting.

• Ensure that advertising for any product or service that could affect the health of pregnant women and babies is required to be evidence based.

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Parents should be provided with evidence based information in a way they can understand about services for them or their children and enabled to make decisions which are then respected.

Parents should be supported to make parenting decisions free from commercial pressure. Product placement involving goods for babies and young children should not be permitted in UK broadcasting.

All information on formula milks should be provided by those with no commercial interest in feeding choices. The UK government should adopt the WHO code of marketing of breastmilk substitutes and subsequent resolutions to ensure that parents can make infant feeding choices free from commercial interests .

Why is this important? Commercial companies advertise to sell their products. Advertising and promotion are persuasion activities and do not present information impartially or with reference to the full evidence base. Parents can therefore find themselves confused about which product to choose and making choices based on the most effective advert rather than the best product or often no product at all. This is particularly important when it comes to decisions that affect health.

When parents are pressured to spend money on consumer goods as a result of skilled advertising they may then struggle to cope with increase utility bills and lower household income that comes with being a parent.

2 The ability to make decisions free from commercial pressure

The method used in many advertisements reduces parents confidence and creates fear and sometimes has unintended negative consequences on parental behaviour.

In places where parents should be free from commercial pressure such as hospitals, company representative are allowed in to data collect from parents with babies only a few hours old. The result sale of this data means more sales calls and mail to new parents.

In a recent poll by Ipsos Mori for the NCT 62% felt it is important that information for new or expectant parents is provided by organisations which are non-commercial and independent from Government.

Advertising and promotion of breastmilk substitutes undermines the confidence of mothers who wish to breastfeed and reduces choice. The promotion of formula and follow-on milk is designed to increase sales - not to provide accurate information to mothers. Despite regulations prohibiting the advertising of infant formulas, advertising and marketing of other feeding products is currently permitted. Formula milks and Follow-on milks now look identical and, since they share the same name and logo, an advert for one automatically promotes the other. In a MORI survey, 60% of pregnant women and new mothers said they had seen advertising for formula milks in the past year. In fact these were probably for follow on milks, but this distinction is not clear.

We call on the next Government to:

• Ensure that breastfeeding is included in all education curricula to enable young people to grow up with an understanding of the benefits of breastfeeding. To guarantee that this education is accurate, up to date and free from commercial influence, information should be and is provided by independent experts.

• Provide for all maternity care providers and NHS maternity hospitals across the UK be resourced and supported to implement UNICEF’s Baby Friendly Initiative in hospital and community settings.

• Review relevant health professional training so that all receive sufficient training to enable them to provide parents with accurate information and appropriate practical and emotional support. Post registration training should be mandatory for all those offering help and advice to breastfeeding mothers.

• Legislate for breastfeeding breaks for women at work, in line with several other European countries. No UK Government so far has provided sufficient protection for women returning to work who would like to continue to breastfeed.

• Initiatives to increase awareness of the legal obligations on commercial and public venue owners to be breastfeeding welcome should be put in place. All publically funded facilities for families should be breastfeeding welcome. Additionally, the legal framework should be strengthened to prevent harassment and to ensure that those feeding babies of any age are supported to follow government heath advice.

• Fully implement the remaining objectives of the Breastfeeding Manifesto which sets out evidence-based priorities for governments. (www.breastfeedingmanifesto.org.uk)

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Given the strength of evidence on the health benefits of breastfeeding, especially for those who have least chance of a healthy life, it is unfair to put parents in a position where they are pressured to breastfeed but live in a society that signals in many ways that breastfeeding is not acceptable or normal. All public places where babies might be should enable them to breastfeed or be bottle fed.

Parents-to-be should receive antenatal education on breastfeeding and have access to trained support when they need it. Parents should be given access to a trained supporter and to supportive diploma qualified breastfeeding counsellors as well as ‘drop-ins’ for support. All maternity services should be Baby Friendly accredited.

All children should grow up seeing breastfeeding as normal part of life and

learning about it at school. No child should reach adulthood without having seen breastfeeding close to and having a good understanding of how it works and what the benefits are.

All working women should have the right to breastfeeding breaks.

Why is this important? World wide, breastfeeding is the single most effective measure that can be taken to improve infant health.

Health outcomes are greatest when babies are breastfed exclusively for the first six months of life and breastfeeding continues when solid foods are introduced. Breastfeeding beyond the first year offers considerable benefits to both mother and child.

3 The ability to make decisions about baby feeding and the support to carry out those choices

Evidence shows that breastfeeding has profound effects on the developing immune system. Babies not fed mother’s milk have higher rates of infections of the ear, gut, respiratory and urinary tract. They are more likely to be admitted to hospital in their first year due to serious illness. Children who were not breastfed also have higher rates of type 1 and type 2 diabetes, allergic disease, asthma and lymphomas in later in life. Therefore, there is substantial financial benefit to the health service if all babies were solely breastfed.

We call on the next Government to:

• Ensure that relationship education and information on being a parent is included in the curriculum at school. This would enable adults to have an understanding of the responsibilities and changes of becoming a parent so they can prepare themselves and adjust their lives prior to embarking on parenthood.

• Increase the health visitor workforce, with training to support parents in the emotional transition to parenthood and as couples with a new baby. Access to these services should be universally available to all parents, while also ensuring that services can be targeted so those parents with the highest levels of need are supported fully. Parents experiencing mental distress should be able to access specialist services as a priority. This service should visit parents at home as well as supporting the provision of drop in services with the voluntary sector.

• Commit to supporting improving the co-ordination of children’s services and further development of Children’s Centres/Sure Start so that parents can have equal access to high quality support in the early years of their child’s life. All Children Centres must involve partnerships with the local voluntary sector and recognition should be given to voluntary sector expertise and experience in providing services of parents for parents.

• Fully support new parents in the early months of parenthood. Adapting to life with a new baby can put undue strain on parents and on the couple relationship and many get little or no support. Services should be available in the local community which are easy for all parents to access. Children’s Centres should offer a core menu of services to all parents and operate services so that parents always feel welcome and supported.

• Provide access to high quality antenatal education and preparation to all expectant parents free at the point of use.

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Becoming a parent requires an adjustment in your sense of who you are, in your relationship with your partner and with your own parents, family and friends. Both men and women need antenatal preparation which starts the process of helping them adjust to parenthood.

Once their baby is born parents should be provided with daily home visits from a health professional for at least 10 days or until they feel comfortable and confident in caring for their baby. The handover from midwifery care to another community health professional must ensure that parents are clear whom to contact and are not left feeling they are without a source of help. All parents should have universal access to support through children’s centres. All public facilities should be family friendly and welcome parents with young children.

All parents should have access to postnatal courses to support them in coming to terms with their new role. These should be run by qualified facilitators working in a client-led, participatory way, providing practical evidence-based information in response to individual need. Specific services should be designed with and for young parents and in parents’ first language where this is needed. Parents with particular needs, such as mental

health issues or disabilities should have additional support services tailored to their circumstances.

Why is this important? The way parents interact with and care for their children has a profound effect on their child’s future. Parents can be helped to do the best job they can by positive support and encouragement within services that enable them to adjust to their new role and work out how they are going to parent. It is strongly in the financial interests of the UK to invest in helping parents develop into confident and effective advocates and developers for their children.

Providing information and developing skills is helpful. Just telling parents what to do and how to do it is often disempowering and does not fit them to cope with the changes and challenges that parenting a growing child brings.

Suicide is now the leading indirect cause of maternal death. Loss of mother reduces the life chances of her child. Postnatal depression in women is around 20% and at an unknown level in men. Postnatal depression in mothers can affect the mental development of the baby.

4 Guarantee high quality preparation and support for all those with a new baby

Having a baby has a major impact on a couple’s relationship, with changes to the routines and patterns of life. Evidence suggests that couples, and particularly new mothers, become less satisfied with their relationship after having children and positive partner interactions can decrease while conflict increases. Maintaining a couple relationship has a beneficial effect on outcomes for the child.

Preparation for becoming a parent is essential in helping parents-to-be to adjust. Feedback from parents attending NCT antenatal courses provided via an NHS Trust indicated that almost all parents (96%) felt that the course gave them new information about life with a new baby. Confidence about being a parent increased from 62% before the course to 78% after the course.

We call on the next Government to:

• Commit to securing the future of Sure Start/ children’s centres so that parents can access local community based activities in which to form their own support networks.

• Provide all women and their families with information about availability, access and aims of all postnatal peer, statutory and voluntary groups and organisations in their local community, in keeping with the guidance from NICE.

• Ensure that the voluntary sector is supported to provide avenues for parents to get support and establish supportive peer networks.

• Establish core support services for parents and provide opportunities for peer relationships and networks to be formed.

• Enable all parents to participate fully in activities in their local community to enable supportive relationships to be formed. Social activities should be provided at no or low cost in established family support settings including children’s centres. Any public service for parents must be provided in settings which are accessible and welcoming to all parents.

• Adopt policies that support or do not prevent the development of well networked cohesive local communities.

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Parents should be able to meet other parents and get support from one another to establish social support networks and make friends.

The infrastructure of local social and family support services should value the role of mutual support and provide opportunities for mutual support at the heart of the local community for parents. Support should be given to ensuring that the voluntary sector in local communities can provide a supportive infrastructure for parents.

Why is this important? The NCT wants all parents to be and new parents to feel prepared and supported as they make the transition to parenthood. Parents who join a group, drop in or class during pregnancy have ready made contacts and support, helping to reduce the risks of feeling lonely, isolated and depressed after having a baby.

Evidence supports the view that informal social support can help people

negotiate stressful experiences such as childbirth and parenting. Parent mutual self-help support groups have a key role to play in strengthening families. Through group participation, parents can access information and support which helps them to find ways to deal with stresses and challenges in their new role.

Support groups are logistically versatile, because they can be offered in conjunction with other programs that focus on the prevention of child abuse and neglect, and implementation costs can be low.

Allowing the opportunity for parents to form their own networks also allows for specific needs to be met, including relationships to be developed with peers and those in similar situations, for example younger parents, lone parents, fathers and parents of disabled children.

By being involved in support groups and networking opportunities, parents develop

5 The chance for all parents to make their own support networks

relationships in their communities, which connect them to the services they need to support their family effectively themselves.

Mutual support groups are considered to be most effective in meeting a need for adult social contact where parents can share common experiences. This helps them feel less alone and feel more positive about their role.

We call on the next Government to:

• Provide greater information to publicise pregnancy-related rights and protection against maternity discrimination and employers should be informed, supported and monitored to prevent a further rise in cases.

• Ensure that fathers are able to access paid paternity leave irrespective of whether their partner has an entitlement to maternity pay and leave to allow all fathers equality of access to time to care for their children.

• Increase maternity and paternity payments to provide all parents with an adequate income when not at work to ensure that all parents can benefit from paid periods of leave for the full amount of time.

• Give all workers the right to request flexible working.

• Provide as a priority, adequate, affordable and accessible childcare if parents are to be supported to care for their family and also participate in paid work.

• End child poverty.

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Mothers and fathers deserve maternity Services and legislation must: support the need of parents to balance their home and work life; provide extended paid leave and childcare support for all mothers and fathers; and protect the employment rights of pregnant women and those returning after parental leave. Support should be given to voluntary organisations and opportunities for parents to access goods and services at a low cost. The next government needs to honour the pledge to end child poverty by 2020.

Why is this important? The NCT wants both mothers and fathers to be able to provide the caring and emotional support their children need and to have the time to sustain and maintain their relationship and generate the income they need to provide for their family, Poverty, broken relationships and

lack of warm attention from a consistent carer have a negative effect on outcomes for children.

Families need the opportunity to decide on how to share and provide care for their children and how to take part in paid work. Flexible working practices are helpful in enabling parents to choose what works for them. While there have been improvements in provisions for mothers, leave and paid leave especially for fathers still lags behind. Maximum flexibility around the opportunity to take parental leave is important, as families make arrangements in many different ways, and parents may for example benefit from both having some time off work together with their baby later than the immediate postnatal period.

6 The ability to access an adequate income while also being active parents to their young children

With the economic downturn there has been a rise in the number of cases of women facing maternity or pregnancy discrimination. The EHRC estimate that 30,000 women lose their jobs each year as a result of being pregnant.

Maternity and paternity leave payments currently lag behind minimum wage and create a situation whereby time off to care for young children is not available to those with few other resources to rely on. This results in many mothers in low paid jobs returning to work earlier than they might wish to increase the family’s income.

The UK has one of the worst rates of child poverty in the industrialised world. Ending child poverty would improve the life chances of millions of children and their families as well as representing a saving of an estimated £25 billion a year to Government.

We call on the next Government to:

• Establish a commission into family life and parenting young children to fully understand the challenges of modern parenting and the needs of parents. The development of such a commission should be done with full involvement of parents themselves and its tactics should be based on the principles of inclusion, partnership and participation. The research should be repeated at regular intervals

• Develop central coordination structures to improve interaction between the ranges of bodies currently engaging with users. These include Children’s’ Trusts, maternity services liaison committees and local involvement networks among others. Central guidance on meaningful and effective involvement of users should be provided across government.

• Provide resources to ensure that user involvement can be fully representative, allowing for outreach, training and expenses so that all parents have the opportunity to be involved in the design, development, monitoring and evaluation of services to meet their needs.

• Develop a user monitoring survey to track the experience of large number of parents over time.

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Parents should be consulted and involved in any decisions which affect their families so they can feel confident that their role as parents is valued and that services can be of benefit to them. Existing structures for the involvement of parents and users of services should increase participation of more vulnerable families and particular groups of parents with specific needs and be enhanced so that they are more influential.

There should be a national commission into the realities of parenting in the UK today, allowing parents to identify the main challenges to parenting and to evaluate the services they use

Why is this important? Understanding what users want and how they experience the service delivered is

a vital part of creating, developing and maintaining and identifying excellence.. The most appropriate judge of whether a service met their individual needs is the parent. The users themselves are often able to creatively suggest and help the health service adjust their services to meet what is needed. When users are given access to data such as safety information they are able to work effectively to create services that are both safe and user friendly. We welcome commitments to ensure that parents are consulted when services are changed, but more should be done to ensure that the voices of parents involved in consultations carry equal weight as those of professionals.

Structures which provide facilities for decision making between parents or users of services and professionals and

7 The chance to have a say in services for them

managers have been established for a number of years but parents frequently report challenges in fully taking part in such structures. Barriers to meaningful involvement include lack of support for childcare and family commitments, lack of accessibility of meetings and venues, with the majority held in venues and at times to suit professionals, and lack of training for users to feel confident in multi disciplinary partnerships.

Additionally, a plethora of structures now exist within services but are often not linked so that major decisions can be made without reference to the structures that involve users.

The involvement of users does not currently provide for a fully representative body of users to be involved due to lack of outreach to underrepresented groups and the persistent barriers to users’ involvement can be exacerbated in marginalised groups. Neither is there regular market research to ensure the voice of these groups is heard even if they cannot be at the relevant meetings.

The realities of life for parents and parents to be are not paid sufficient attention, especially from their own viewpoint. Understanding what parents need and what they think of supports and services designed to help them can not only improve efficiency and effectiveness for statutory services but also empower parents to get further involved in the infrastructure of services in their local community.

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As the UK’s largest charity for parents, NCT supports over two million mums and dads every year through pregnancy, birth and early parenthood.

• We provide courses, helplines and reliable information, as well as a fantastic network of local groups run by parents for parents.

• With over 100,000 members, we are a voice of change for parents, campaigning both in local communities and through lobbying governments across the UK.

• We are committed to a progressive parent-centred, family-focused research and policy programme, including the provision of evidence-based information for parents and health professionals.

Enquiries: 0300 330 0770

Breastfeeding line: 0300 330 0771

Pregnancy & birth line: 0300 330 0772

Postnatal line: 0300 330 0773

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