Ms Megan Etherton:

In our capacity as service users and running the campaigns, it is not within our remit or capability to assign costs to the action plan. The biggest gap in understanding regarding the potential cost of the action plan is the lack of reporting on progress to date. The most recent report we could find dates from 2017. The HSE has offered to forward us the implementation reports we have not been able to find online, but which we have been told are public. It would appear to a lay person that the costliest elements of any strategy will concern ongoing staffing costs. A key part of the action plan we would like to see implemented is proper staffing and to see the ratio of births to support staff increase. We were very happy with last night's announcement of the additional lactation consultant posts for maternity units.

However, the births to support staff ratio is not defined within the action plan. It is difficult, therefore, to quantify what level of support we might be aiming for. The New Zealand ratio was used as the benchmark for the additional posts announced last night. It seems most important, however, to focus on the impact of not investing in this regard. What will be the opportunity cost if we do not invest in women initiating breastfeeding? That is not just a financial cost. There are potential long-term impacts on the health service in respect of the health outcomes that women are missing out on by not being able to feed. I refer to cancer risks, potential osteoporosis and also impacts on the health of the child. There is an ongoing burden for the health service in that respect. Obesity is also another long-term concern, and that is connected with last night's announcement regarding the Healthy Ireland concept and Sláintecare.

We are also talking, however, about the environmental impact of endorsing all this use of formula, when it is not necessarily wanted or needed by every woman. It should definitely be available as an option, but we are now forcing people to use formula who might not necessarily want or need to do that. In addition to increased healthcare costs, there is also the question of how not investing in our human capital impacts our society. The financial costs involved in this regard must be considered as well. In some situations, significant costs are associated with breastfeeding, but we must also consider the ongoing cost of formula use for a family that may not want to take that approach. Equally, there is also the trauma we have just been speaking about. We could go through numerous stories from women who shared their experiences with us and how long those experiences have been sitting with them. They have told us that it has been such a relief to get this off their chests and to process their experiences.

As Ms Cahill mentioned, Cuidiú has recognised that aspect and the impact of the trauma. We would like to see some comparison made between the cost of the action plan on one hand and then the cost of not investing in this area on the other. We must understand the cost of not breastfeeding, and that has been done in other countries. Endeavours such as the World Breastfeeding Trends Initiative exist to allow us to benchmark how we are progressing and to see some transparency in respect of our progress. We are obviously headed in the right direction with these new lactation consultant posts, but we need to be able to see the outcome of a comparison and understand exactly where we are now. That is what is needed.