At last year’s BfN Annual Conference, Alaw Thomas-Davies and Rachel Evans’ presentation, “Influences on infant feeding behaviours in the UK: What does the evidence tell us?”, prompted plenty of discussion and questions from our attendees. We shared some of these questions with Rachel, who answers them below.
We were pleased to present at the 2025 Breastfeeding Network conference about a recent evidence review carried out by Public Health Wales and its application in a project “Empowering Communities: Partnership approach to enhancing breastfeeding awareness and culture in low prevalence, socially deprived areas”.
The evidence review was the first to consider feeding choices through a behavioural science lens. It reinforced the need, recognised by the Welsh Government, for action on social norms to improve breastfeeding rates.
Informed by these findings, we formed a partnership including Public Health Wales, the Breastfeeding Network and two South Wales health boards to apply for a grant from the Welsh Government’s Child Poverty: Innovation and Supporting Communities fund.
The proposed project had three elements:
- Training of Breastfeeding Helpers (two cohorts) and Breastfeeding Supporters (one cohort)
- Promotion of the National Breastfeeding Helpline.
- Delivery of First Milk Matters training (four courses).
While beneficial in their own right, these interventions were not new; the innovative element of the partnership was to deliver the three elements together in target communities. The communities of Rhondda and Newport were nominated by health board partners because they had low breastfeeding prevalence and lacked local support for breastfeeding.
All elements of the project were successful. 22 volunteers were trained, 17 of them recruited from within target communities. Use of the National Breastfeeding Helpline increased in target areas and across Wales. 35 attended First Milk Matters training, and it was well evaluated. However, the “ripple effects” of this project were wider:
- Several volunteers secured employment in local health boards or training places for nursing and midwifery.
- First Milk Matters attendees reported direct impacts on their work, e.g. in family centres and baby banks.
- Welsh language capacity on the National Breastfeeding Helpline increased.
- Local infant feeding teams noted an increase in interest and curiosity about breastfeeding.
The evaluation, carried out by Swansea University, noted that the best breastfeeding interventions were multi-layered and that this small project had achieved what many larger projects do not.
How can we help other areas with low breastfeeding rates to make these changes?
Partnership was key to the success of this project. Local health board teams were well placed to understand where the need was and to help with practical planning such as locations of training and groups. The BfN were able to implement tried and tested interventions quickly and effectively. Swansea University supported the project with a robust evaluation. Where we have not succeeded has been in sustaining the change; while some elements of the project have continued funding has not been secured for all elements.
For Public Health Wales, I see our role as being able to advocate for change. Shifting social norms is a nebulous, challenging concept; but we can now use this project as an example of a relatively low cost practical intervention to make a change.
What is the best way to reach mums with information on breastfeeding support, particularly in communities that may not traditionally champion breastfeeding?
There is evidence that peer support is more successful when volunteers reflect the communities they serve. This is why we recruited volunteers from target areas, with the aim of supporting visible breastfeeding communities. First Milk Matters also improved the knowledge and understanding of those working with young families in the communities, who may not have experienced breastfeeding themselves or in their families. When considering “ripple effects” from the interventions, we also thought that staff attending this training would carry this knowledge with them beyond the workplace, into their own homes and families.
Finally, we were guided by research carried out by the BfN prior to implementation within the target communities, so included the voices of those we were trying to reach.
The impact of commercial milk formula advertising
While not directly reflected in the research reviewed, there were certainly elements which could be linked to the influence of commercial milk formula advertising. For example, perceived convenience of formula and lack of understanding of the differences between formula and breastmilk. However, the review was unable to go beyond the findings of each piece of research.
At Public Health Wales, we would like to see legislation in line with the WHO Code. While that has not been the outcome of the CMA report and recommendations, we do believe that the recommendations offer opportunities for improvement in this area. There are also improvements to be made by increasing knowledge and understanding of formula marketing, which First Milk Matters offers. The manager of a local baby bank attended a course as part of the project, and made immediate changes to how the baby bank managed infant formula.
If you’d like to learn more about the training provided by The Breastfeeding Network:
For health professionals: www.breastfeedingnetwork.org.uk/get-involved/training-for-health-professionals-and-others/
Peer supporter training for volunteers: www.breastfeedingnetwork.org.uk/get-involved/train-to-be-a-registered-volunteer/