Feed Statement on the National Maternity and Neonatal Investigation

This week (30th June 2026) Baroness Amos published the final report and recommendations of the Independent National Maternity and Neonatal Investigation. The report highlights key areas of concern, identifies barriers to delivering change and sets out recommendations aimed at delivering long-term systemic and cultural transformation in maternity and neonatal care.

Feed provided extensive evidence to the investigating team of how current infant feeding policy, which prioritises the outcome of exclusive breastfeeding over principles of informed choice, consent and individual patient need, harms women and their babies. We provided multiple stories from women themselves including those whose babies had been readmitted to hospital as a result of feeding related harm. Infant feeding issues are associated with the current record number of readmissions within the first 2 weeks of life – a rise captured clearly within NHS data and shared with the inquiry. Despite examples highlighting negative experiences from the pressure to breastfeed within the report’s supplementary materials, the report’s recommendations are silent on the need to address this. Infant feeding is a critical component of maternity and neonatal care. It may not be seen to have the same acute and devastating impact as substandard care during labour and birth, but the consequences of poor infant feeding advice and support can nevertheless be profoundly damaging and long lasting for women and their families. They and their experiences deserved inclusion in the Amos review.

There has been much concern this week about the removal of any criticism of the drive to achieve “normal birth” from the final report. The initial terms of the inquiry made clear it would seek to understand the degree to which specific beliefs and approaches informed culture and care within NHS maternity services, and our submission highlighted concerns about ideological influence within infant feeding. Infant feeding policy does not adhere to the same principles of informed choice and consent governing other forms of healthcare advice and intervention. Current policy within the NHS is widely underpinned by principles of the UNICEF Baby Friendly Initiative (BFI). UK BFI materials have included advice to staff not to “collude” with women seeking reassurance their baby will fare just as well if they are not breastfed, guidance which is neither appropriate nor clinically justifiable in a patient-facing setting. The Ockenden report into NUH highlighted that NHS guidelines based on BFI principles may fail to capture infants at risk of becoming very unwell. Some NHS guidelines include targets and thresholds specifically designed to keep supplementation rates low while breastmilk supply is establishing. These kind of targets, which are not based on individual need, are exactly what leads to harm. There is no good evidence that supplementation while breastfeeding supply is being established harms later breastfeeding (if that is what a woman wishes to do) and indeed evidence that it may well support it.

As highlighted by the report, our maternity population has more complex health needs and increasingly experience more complex births. Assisted or operative birth, blood loss and trauma are all known to influence initial milk supply (lactogenesis). A policy promoting exclusive breastfeeding from birth cannot therefore safely accommodate the needs of many women and their babies. As one woman told us:

I was at high risk of developing post-natal depression as a result of my inability to breastfeed and perceived ‘failure’ as a new mother; my baby lost a huge amount of weight and we were both in a bad way. One midwife told me I just needed to make myself smoothies and that would help. Eventually one supportive home-visiting midwife ‘took her official NHS hat off’ and unofficially told us that it wasn’t uncommon to be unable to breastfeed after a traumatic birth (which no one had told us)

Women deserve access to evidence-based information including the risks and benefits of the full range of options available to them. Infant feeding policy must move from an ideological position promoting one method above all others to ensuring every family can make the choice that is right for them and their individual circumstances, based on principles of safety and consent.  Any maternity service re-design based on the voices and concerns of women and their families must include a commitment to an infant feeding policy that actually meets their needs, and is driven not by ideology but by the need to provide the safe, supportive care families deserve.