JENNY McBAIN A Highland health board has enlisted the help of a well known children's author and illustrator, Mairi Hedderwick, to promote breastfeeding.
Hedderwick, an outspoken proponent of the "breast is best" approach, had to battle with her publisher to include illustrations of the mums in her stories breastfeeding, but has done so repeatedly over the years.
Now her pictures are to be used to promote the practice in the Highlands, after figures revealed last week showed average rates of breastfeeding dropping across Scotland this year, compared with 2006.
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Health visitor Louise Mackenzie, based in the north-west Highlands, is behind the poster campaign. She met Hedderwick at the Ullapool Book Festival last year and asked if she would allow NHS Highland to use her illustrations for a health promotion poster.
MacKenzie says: "Images in (Hedderwick's) books show the mother breastfeeding the baby as a normal part of Highland life. You don't draw images like that without being into, and for, breastfeeding. Mairi was very friendly and kindly gave us permission to make these posters."
Hedderwick is well known for tackling challenging themes in her picture books like sibling rivalry and animosity between grandmothers. However, she was quite taken aback when she presented Katie Morag and the Tiresome Ted for publication in 1987 and unexpectedly hit a cultural brick wall. Her pictures might be too graphic for children, she was told.
Katie Morag books are aimed at children aged three to eight. Katie Morag is a red-haired heroine who lives on the fictional Island of Struay with her family. An element of realism has contributed to the books' popularity but not everyone is accepting of this bold approach to the creation of children's stories.
Hedderwick's editor at the time was uncomfortable with images of Katie Morag's mother, Mrs McColl, breastfeeding her new baby. Hedderwick explains: "The editor was sympathetic because she had just had children but she was a little bit nervous about the picture and she wandered if she should let it go through because it's actually a naked breast: it's not just the child latched on.
"Mrs McColl's breast is exposed because the baby is looking back at her big sister Katie Morag." The editor's fears were not unfounded. Two libraries in Scotland refused to stock the books. A library in the city of Saginaw, Michigan, was forced to cover one illustration with marker pen.
Twenty years on, Katie Morag is enjoying enduring, iconic status and two of the titles are required reading in English primary schools. What is interesting, and shocking to some, is that Hedderwick still has to fight her corner in order to include natural images of a mother suckling her child.
She says: "I always try to make sure that if there is a domestic scene and if Mrs McColl is sitting and comfy then she has the baby at her breast but I don't show exposed nipples any more because it just makes the publishers too jittery. They don't like anything that might interfere with book sales."
At a time when provocative images of breasts proliferate, positive images of mothers breastfeeding their children are rarely included in the wider media. This may be one of the factors contributing to a downward trend in the numbers of women choosing to feed their babies naturally.
There are parts of the developed world where the promotion of breastfeeding has had a major, positive impact. In Melbourne in Australia more than 80% of mothers choose to breastfeed their children from birth. Some 25 years ago Vancouver in Canada had similar rates to Scotland in that around 60% of mothers favoured artificial feeding, but that situation has been reversed and now over 85% of mothers begin by breastfeeding their children and more than 50% are still doing so at six months.
Verity Livingstone is a GP and medical director of a large breastfeeding clinic in Vancouver. She is also international advisor for the World Health Organisation and UNICEF for the promotion, protection and support of breastfeeding.
Dr Livingstone was visiting Ullapool and dropped in to the poster launch. She says showing breastfeeding in children's books could well be beneficial. "I think it's a really neat idea to start promoting at the much younger level. We know that everything we learn in kindergarten stays with us so if we can expose young children to breastfeeding as a visual norm then when these children grow up they will grow up to consider it part of normal parenting."
In Canada each community has its own lactation consultant who is a well-trained nurse able to focus exclusively on supporting breastfeeding mothers and allowing them to access appropriate help when problems are encountered.
Dr Livingstone believes that the underlying approach to health promotion in Canada is an important part of the success story.
Hedderwick is determined to keep on doing her bit to help. Her latest book, Katie Morag and the Dancing Classes, depicts another typical scene of the baby at the breast. Even now decades on, Hedderwick's current editor had to be persuaded that such a picture has its place, even though it does not relate directly to the story. Hedderwick says: "I will always make sure my breastfeeding pictures stay in because I believe in it. Its a cosy, family situation and a backdrop to whatever action is going on. The baby would naturally be there with its mother and if it's feeding time it will be being fed.
"Picture books are the first way children extend their awareness beyond their own environment and authors and illustrators have a duty to make sure that images are positive and not stereotypical. When a child sees something for the first time that image sticks in their mind."
In fact, the Highlands is already ahead of the rest of Scotland with its uptake of breastfeeding from birth. More than 60% of new mothers choose to feed their babies in this way. The variation throughout the region might provide some clues as to why that is.
Health Visitor Louise MacKenzie says: "In Ullapool our figures are higher than the Highland average. We cover a wide geographical area but our population is smaller so all the medical staff actually get a chance to spend more time with clients and give them a better service.
"Inverness has got a population explosion and it's taking a little while for the health service to catch up, numbers-wise. If you've got fewer staff on the ground with a larger population it's going to be more difficult for staff to get to all their clients and to foster a good relationship with them from an early age."
From today children throughout the Highlands will see the new posters in schools, nurseries and health centres. They may go on to be a generation that follows the Vancouver example.
Studies suggests that successful breastfeeding depends largely on there being adequate staff in place to give expert advice and to support new parents. But if those in the creative industries follow Hedderwick's trail-blazing example it may help create an incentive for more to try to feed their children naturally.