06 Nov

Prevention is better than cure

Shereen Fisher, BfN’s CEO, responds to Health and Social Care Secretary Matt Hancock’s vision for prevention released yesterday, and how it relates to investment in breastfeeding support.

The future of health in the UK is dependent on us all getting really serious about prevention[1]. Currently the NHS spends £1 in every £5 on health problems that are a direct result of our lifestyle such as obesity and poor diet[2]. We are told that not only will prevention help reduce the strain on the NHS but it will also improve all our health.

Getting serious about prevention must include getting serious about community level investment to enable all mothers who choose to breastfeed to do so, given the substantial evidence that links breastfeeding with improved health.

The Lancet[3] series on breastfeeding offers the most comprehensive review of all the evidence on breastfeeding to date and highlights breastfeeding’s role in the UK prevention agenda.

The authors state: “…how important breastfeeding is for all women and children, irrespective of where they live … Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media [ear infections]. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancers and diabetes [Type 2] in mothers.”

Importantly UK women and babies offer policy and health leaders an attractive opportunity. While breastfeeding rates in the UK are the lowest in the world the rates of initiation – women starting to breastfeed – have been increasing for the last 20 years (81%)[4].

Scotland’s infant feeding statistics[5] (November 2018) show signs of positive change – no happy accident but consequence of national leadership, strategic planning, partnership and sustained investment.

Women’s intention to breastfeed offers an important opportunity for health and wellbeing both for babies (next generation) and women themselves. However, individual will has to be met with support that effectively improves a mother’s breastfeeding experience and helps sustain her choice to breastfeed. Peer support can make a big difference here especially as over time it offers the chance for areas to recreate a culture where breastfeeding is familiar.  We also know that choice isn’t made in a vacuum but is heavily influenced by family members, hospital care, health care professional advice and societal views. Patient empowerment is an important theme in the vision of healthcare for the future yet women feel constantly disempowered in their efforts to breastfeed through the lack of support available to them.

With the NHS celebrating a landmark anniversary alongside £20 billion a year in extra cash now announced[6] NHS leaders will be putting forward a 10-year plan that will make crucial decisions about how the service will spend the money.

In the planning no doubt demands will be high, as cancer survival rates, mental health support, health inequalities and an aging population all vie for consideration, how should we use the government’s cash boost to tackle the priorities that matter most to us?

In the debate let’s remember the substantial benefits to health in breastfeeding for mother and baby as well as the sheer economic and environmental sense that breastfeeding makes.

In 2012 UNICEF UK[7] reported that just a moderate increase in breastfeeding rates could save the NHS millions. In 2016 the Lancet[8] series calculated that the overall savings would actually be in the order of billions, not millions, of pounds. Moreover, the measures required to support breastfeeding are relatively inexpensive and soon pay for themselves. Keith Hansen of the World Bank said …

“In sheer, raw bottom-line economic terms, breastfeeding may be the single best investment a country can make.[9]

The potential savings into the billions are important here because we all know that the cash boost being offered by government to the NHS and social care isn’t going to be enough. While the additional £20 billion a year (in five years) has already been welcomed, the Kings Fund has pointed out, that this does not come close to the amount required to improve services after years of underfunding[10]. On social care, the budget announcements will not be able to undo the cuts in services and underfunding of local government that has already occurred. These cuts that have caused losses to breastfeeding support services, many of which are located in areas of low breastfeeding rates and run by volunteers and supported by charities[11].

Knowing how the money works to support breastfeeding is essential and it is currently hard to know this in England. What we do know is that funding for community-led breastfeeding peer support has been cut because it sits within a shrinking public health budget devolved to local authorities. Despite excellent evidence-based commissioning guidance on infant feeding for local authorities[12] breastfeeding support services in communities is entirely optional.

This has led to mothers who choose to breastfeed being unable to access local services and leaves them failed and let down. This is just too precarious a situation for a public health priority as important as breastfeeding that if better funded and supported could serve us well in the prevention of infant mortality, obesity, type 2 diabetes, ovarian and breast cancer ….

If we are going to get serious about prevention in health then there needs to be a clear strategy and leadership for breastfeeding. Government’s role is key here in taking responsibility for building an environment that promotes, protects and supports breastfeeding[13], not just for the next year but for the next 20 years.

This should include at a minimum the following very important steps many of which are recommended by National Institute for Clinical Excellence:

  • Appoint a national multidisciplinary infant feeding board or committee with strong leadership to ensure evidence on infant feeding is understood and enshrined in policy
  • Ensure that Baby Friendly accreditation becomes a minimum requirement for all maternity settings (achieved in Scotland and Northern Ireland) (NICE recommended)
  • Ensure that all mothers regardless of where they live, receive skilled evidence-based breastfeeding support, making this provision a mandatory responsibility by protecting the public health budget that protects health visiting and breastfeeding peer support workers (NICE recommended)
  • Protect all families from aggressive marketing of formula companies by enacting into UK law the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions (NICE recommended).
  • Require employers to provide breaks to breastfeeding mothers to allow them to breastfeed or express milk at work.

With careful, long term thinking and action the prevention agenda offers great focus to help us plan the health and wellbeing of the UK for the future. The health of women and babies will be stronger still for joined-up planning and provision of quality breastfeeding support. Let us not forget all our responsibilities in supporting breastfeeding and ensuring that its role in the prevention agenda is fully acknowledged.

 

 Footnotes:
[1] https://publichealthmatters.blog.gov.uk/2018/11/05/matt-hancock-my-vision-for-prevention/

[2] Anita Charlesworth, Chief Economist, The Health Foundation interviewed for Healthy Visions BBC Podcast / https://www.health.org.uk/Running-to-stand-still-why-20-5bn-is-a-lot-but-not-enough

[3] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (30 January 2016), Victora, CG et al, The Lancet Volume 387, Issue 10017, 475-490 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

[4] Infant Feeding Survey 2010 (2012), Fiona McAndrew et al, Health and Social Care Information Centre https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

[5] Scottish Government Infant Feeding Statistics 2017/18 http://www.isdscotland.org/Health-Topics/Child-Health/Publications/index.asp#2275

[6] NHS funding: Theresa May unveils £20bn boost https://www.bbc.co.uk/news/health-44495598 17/06/18

[7] Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK (October 2012), Renfrew, M et al, Unicef UK https://www.unicef.org.uk/babyfriendly/about/preventing-disease-and-saving-resources/

[8] Why invest, and what it will take to improve breastfeeding practices/ (30 January 2016), Nigel C Rollins et al, The Lancet Volume 387, No. 10017, 491-504 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext

[9] The Power of Nutrition and the Power of Breastfeeding (2015), Keith Hansen, Breastfeeding Medicine, Volume 10, Number 8

[10] The Kings Fund, NHS Funding: What we know, what we don’t know and what comes next https://www.kingsfund.org.uk/blog/2018/06/nhs-funding-what-we-know

[11] Open Letter on the crisis in UK breastfeeding https://ukbreastfeeding.org/open-letter/

[12] https://www.gov.uk/government/publications/infant-feeding-commissioning-services

[13] https://www.unicef.org.uk/babyfriendly/about/call-to-action/

29 Oct

Response to the Guardian article Wednesday 24th October – Breastfeeding rate declines in England as advice goes unheeded

Image result for shereen fisherOur CEO Shereen Fisher responds to the recent Guardian article on declining breastfeeding rates.

The appalling fact that England (one of the biggest economies in the world) lags behind in breastfeeding rates often makes headline news and it did again last week. However, the suggestion in the Guardian article is that this is because current strategies employed by public health are not working, and women are not listening to the advice they are given. The generic claim that all breastfeeding rates are declining is also a bit misleading.

It is true that our national rates are low compared with other countries and that our very unequal society means that in many areas of the country to breastfeed will make you feel like a social outcast. However, broadly speaking initiation rates are good in the UK with around 80% of women breastfeeding their babies at birth. This presents an enormous opportunity to work with the early desires of women and families to breastfeed – the Unicef Baby Friendly Initiative along with improved antenatal education has made an important contribution to progress in initiation. However, then the picture becomes more complicated. More than 3 in 5 women stop breastfeeding earlier than they want to and often the emotions around not being able to breastfeed can cast a long shadow of disappointment. Whatever one makes of breastfeeding and the state of it in the UK, it is unarguable that breastfeeding matters to women and families. It is also unarguable that women and families don’t get the support they need to sustain breastfeeding.

The uneven and variable nature of support was well-depicted in the recent Channel 4 Dispatches programme – ‘Breastfeeding Uncovered’. We know that breastfeeding in the north of England, (where in some areas fewer than 1 in 5 mothers sustain breastfeeding to 6-8 weeks) is considerably more difficult than in some London boroughs where more than 4 in 5 reach the same. It doesn’t take a genius to know that the missing ingredient that helps to explain the difference is ‘support’. The sad truth is that we know that the vast majority of reasons women give for stopping breastfeeding are issues that can easily be resolved with good quality support.  Support should be honest, unique, independent, and personalised. It needs to be well-funded and it should not operate in a vacuum. It should be evidence-based and integrated with a whole system approach that cares for a women in the pre and postnatal period. Where women choose not to breastfeed or are unable then their choice should be supported and respected as well so the health and wellbeing of all babies can be upheld.

The provision of support for new mothers and their families is grossly inadequate and varies widely across the UK.  Women are very aware of the benefits of breastfeeding through health promotion but receive very little support in making breastfeeding work for them. This leaves women feeling that they have failed, but actually they have been failed by the lack of support available to them.

It’s not that advice on breastfeeding is going unheeded by families, it is that there is not enough support built in at the right time and in an organised way for women and their families to feel they can act on this advice.

We don’t have to look too far to get ideas as to what it takes to improve the situation for women and breastfeeding. Scotland, through their Programme for Government fund, have taken the key next step to invest in breastfeeding at every level, this is despite years of low breastfeeding rates. They are moving to strategic action that is rooted in the best evidence to uphold the health and wellbeing of women and babies – other countries should follow this example.

References

The UK has some of the lowest breastfeeding rates in the world:
81% breastfed at birth but falls to 17% exclusively breastfeeding at 3 months and 1% exclusively breastfeeding at 6 months
http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/UK-Breastfeeding-rates/

Health benefits of breastfeeding are well researched and evidenced – there are benefits for both mother and child:
http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/
This includes the potential to reduce infant mortality from SIDS and Necrotising Enterocolitis, Infant mortality rates in the UK are currently around 4 deaths per 1,000 live births, with babies born to younger mothers being at increased risk at 5.5 deaths per 1,000 live births:
http://www.ons.gov.uk/ons/rel/vsob1/child-mortality-statistics–childhood–infant-and-perinatal/2012/stb-child-mortality-stats-2012.html  (accessed 17/06/2015)

The financial benefits of breastfeeding have been shown – on an individual level, infant formula is expensive for families to buy and on a national level, there are huge savings to be made in the NHS if more mothers were supported to breastfeed their babies for longer:
http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing-policies-and-guidelines/Preventing-disease-and-saving-resources/

More than 3 in 5 women stop breastfeeding earlier than they wanted to:
http://data.gov.uk/dataset/infant-feeding-survey-2010  The vast majority of reasons women gave for stopping breastfeeding are issues that can easily be resolved with good quality support.

Breastfeeding Uncovered – Dispatches
https://www.channel4.com/programmes/dispatches/episode-guide

Scotland – Programme for Government – Breastfeeding
https://beta.gov.scot/publications/nation-ambition-governments-programme-scotland-2017-18/

26 Oct

What Breastfeeding Looks Like

We recently appealed for photographs showing what breastfeeding looks like in your everyday lives. The response has been immense, and the photos are so wonderful and varied, showing breastfeeding anywhere and everywhere…often in some quite comical situations!

Everyone has a small part to play in normalising breastfeeding and removing the stigma that can be attached to something that should be as commonplace as eating a sandwich. This might be by feeding your child in public, or by supporting others who you see feeding, with a kind word or just a smile. Thank you so much to everyone who contributed photos for this project, it is our hope that they will be shared and seen widely and will also do their bit to help make breastfeeding the norm.

Here’s a full round up of all of the photos we received – click on each one to view the full image, and hover to see accompanying captions and comments. Unfortunately we are only a small team and are unable to accept any further submissions for this page or the original Facebook album – however if you’d like to share your image, you can do so by adding it as a comment to the Facebook album.

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This project was originally inspired by this post:
https://www.romper.com/p/what-does-breastfeeding-look-like-these-photos-celebrate-the-diversity-of-experiences-9926018

 

19 Oct

Facing Fears

Kirsty Cummins is one of our National Breastfeeding Helpline Link workers, who has written this post about her own experience of anxiety and how she is beginning to overcome it in her role as a breastfeeding supporter.  

Fear. It’s a funny thing isn’t it. Most of us live in fear of something. Chest squeezing, breath taking fear tucked away inside our breast, kept on a low burn as much as possible it can rear up and get you when you least expect it. Taking the wind out of your sail and putting you firmly in your place.

I have lived in fear nearly all my life. From small person wobbles such as the squirmy, unknown feel of the sea bed under my feet when my Mum forced me to paddle, to the terror I felt when I happened upon “Jaws” being viewed in a neighbour’s living room in all its terrifying splendour at the age of 5. (I haven’t been able to watch it since.)

As I grew older I developed an anxiety disorder. I didn’t know that’s what it was.  I just thought I was mad and panicked all the time that I couldn’t control life. Would someone die if I didn’t turn the light on and off a certain number of times, would something terrible happen to a loved one if I didn’t wash my hands in a certain way? What I didn’t realise at the time was that in trying to control life and death, stuff that I actually couldn’t control, I was unable to deal with the things that were my responsibility, such as study and relationships and other such teen angst. I would never socialise and talking on a phone has always been difficult because of the fear of the unknown and the need to keep myself tiny and unnoticed.

I have had treatment. I sought help when I couldn’t look after myself any more. And that was and is a long term project but also a wonderful thing. Through years of up and downs, undiagnosed post natal depression and other such low jinx I wished of a way to take control.

This insight into a life of worry and nervousness has made me wonder often about our fears. What fears we have as parents and how our modern life affects those to a lesser or greater degree, with instant access to answers or opinions that we used to have to seek in other ways. The need for us all to go back to trusting our instincts, hidden under a huge pile of ‘other’. The voices that live inside us, and the knowledge passed down from Grandmothers and from inside the cells in our bodies, carried through the generations, is still there but no longer encouraged in quite the same way.

Recently I have been pondering the fears we carry as volunteers supporting other parents through times of worry or uncertainty. What makes some people fearless and certain they can make a difference, whilst others hide their knowledge and instincts, terrified they might get it wrong?

My reluctance to be a helpline volunteer has always been based around fear. The fear that I am not good enough to support another person. That if I get it wrong something terrible might happen. In a bid to avoid manic light switching or some such antic aimed at being the high master of control, I avoid. Avoid. Avoid. In talking to people who wish me to support I feel unable to be honest, with them or myself and have always talked vaguely about my true feelings out of embarrassment.

A plethora of excuses may come up that loosely express my fear, but not enough to convey just how terrified I am. Our greatest defence in the fight against fear is, more often than not, knowledge. If we know more we may fear less. When the terrified abseiler is gently guided through moving themselves down the rock face passing the rope through their hands, they are guided by the words of the instructor. That knowledge from another gets them down and the feelings of elation when reaching the bottom make it all worthwhile.

When I look down into the pit of worry and feelings that I am not good enough, I don’t believe in my knowledge, or intuition or listening skills. They don’t feel good enough to guide me.

Someone very brilliant recently talked to me about voicing those helpline fears out loud. As I said how I felt it made total sense. “It sounds so silly but it isn’t silly” I said as I expressed my fear that it felt like a baby’s life was in my hands if I took a call. The ugly face of not good enough was there again, taking control and making me feel useless. But actually as I said it I realised that I do have the tools to support and with that added bonus of modern tech allowing us to signpost instantly, we have so much to give.

Fear, my old nemesis, can be thwarted if I use my greatest weapon. Honesty. Being truthful to myself about my fears and using the support I know I have available could actually get me past this block.

The warm hand of support from a helpline volunteer can and does make all the difference to new families. And that is possible over the phone. Your love, warmth and ingrained desire to be part of the supportive community – the grandmother full of wisdom just for ten minutes in someone’s life – is what you have control of and what changes lives. Yours and theirs.

04 Oct

Guest Blog by Smita Hanciles – The Power of Peer Support

Smita Hanciles works for Central & North West London NHS Foundation Trust and leads the Camden Baby Feeding Service. Here’s a taster of her presentation at our conference this Saturday (6th October), on the power of peer support. If you’ve been unable to get a ticket, follow #BfNConf18 on social media to catch our updates throughout the day.

There is evidence that establishing breastfeeding can be protective of maternal mental health and aids with bonding.  When establishing breastfeeding is challenging or even unsuccessful, particularly when a mother really wants to breastfeed, the mother can be left vulnerable and at increased risk of post-natal depression. At points of such vulnerability, does having access to a trained breastfeeding peer supporter in addition to her own network of relationships provide a source of emotional co-regulation and co-learning?  Does this help increase resilience and possibly decrease the risk of anxiety and depression and any negative impact on bonding?   These are the questions we have been asking in Camden as we introduced a group of new volunteer breastfeeding peer supporters into the Baby Feeding service.

We often think of support for breastfeeding and support for perinatal mental health separately and services generally focus on one or the other.  There are peer support projects for mothers who need help with feeding their baby and there are now separate peer support projects for mothers experiencing mild to moderate postnatal depression and anxiety. However, this way of delivering care doesn’t factor in that one impacts on the other and can’t easily be addressed separately.  What would happen if we supported new mothers in a much more holistic way?  Or maybe we already do this as peer supporters but just don’t describe it as such.

Having reflected on what we actually spend our time doing in the Baby Feeding drop-ins in Camden and on the stories of mothers we support, we recently decided that instead of describing ourselves as solely providing peer support for women experiencing difficulties with feeding or establishing breastfeeding, we would emphasize that we also provide listening support to those who had intended to exclusively breastfeed but were experiencing challenges or were not able to for various reasons.  We added the Baby Feeding service to the Camden Perinatal Mental Health services register under services for the ‘mild /moderate’ end of mental health concerns. We hoped this would help with the recognition of our role in providing emotional as well as practical feeding support and as a place from which referrals to more specialist help could be made if necessary.

I recently saw a poster with the words ‘I sat with my anger long enough, until she told me her real name was grief’. Mothers struggling to breastfeed can feel angry with services that failed to provide the right support or even at themselves or their baby. However, the anger could be borne from a sense of grief over the loss of the breastfeeding relationship they had wanted or looked forward to.  They are unlikely to seek help from other mental health services in this situation but still need to be listened to and for their feelings of loss to be acknowledged as a normal response and justified.  They don’t want to be told their feelings are unreasonable because they can always just give a bottle and as long as the baby is fed, it’s all ok.  They also need support to accept and embrace a different feeding relationship from the one they had anticipated whether it is mixed feeding or bottle feeding with EBM and /or formula.

We approached the Maternal Mental Health Alliance and began a discussion about how to join up different elements of support for new mothers and how we could best train and develop our volunteer peer supporters to work in a more holistic way. This resulted in a diverse and knowledgeable working group coming together including all the main voluntary sector organisation that train peer supporters to develop competencies for the Infant feeding workforce in relation to perinatal mental health.

We know from countless stories of mothers we have supported that breastfeeding peer support has the power to change a mother’s story and experience of care. Those of us who provide peer support have the privilege to hear a mother’s story, to become part of her story as we come alongside to help empower her to find the way forward that is right for her.  Can receiving peer support help a mum change the way she views her own story?  Providing peer support can often help reframe our own stories and see them differently.   If our story was one of painful experiences or even trauma, we can often realise the pain wasn’t in vain but has provided the backdrop to another mother feeling supported and empowered.

We are now looking for ways to collect evidence of the impact breastfeeding peer support has and how it contributes to perinatal mental health. We are still very much on a learning curve with this piece of work and I hope to share more during my presentation.

26 Sep

Guest Blog by Sally Etheridge: ‘I just really wanted to breastfeed’ – How stress affects how babies are fed, and how mums feel about it.

Sally Etheridge is an IBCLC who will be giving a presentation at our conference entitled “Breastfeeding Struggles”.  Here she gives some background to the subject and explores how stress can impact on feeding journeys. Come along to the conference on 6th October to hear more – information and tickets here.

As mother to mother breastfeeding supporters, we may often be especially aware of some of the personal challenges she is facing that are affecting how she feels about life, and becoming a mum, and how these might be affecting how breastfeeding is going – and her chances of achieving her goals around feeding her baby. While there has been a shift in understanding around maternal mental health issues, and better support offered to mothers with depression and anxiety, breastfeeding supporters may recognise that many mums face challenges that we can do little or nothing to change. We may recognise too that there are many mothers who never access our groups and who are much less likely to access breastfeeding support. Poorer communities, women from  different cultures and ethnicities, those for whom English is not their first language, women facing all manner of stressful situations that may be outside our experience. Yet as breastfeeding supporters, we want every mum and baby to be able to enjoy a loving relationship, and enjoy breastfeeding, especially those mothers who always expected to breastfeed.

Leicester has high numbers of mothers like this, and Mammas Community Breastfeeding Support Programme works hard to find innovative and low cost ways to support every mum whatever personal challenges she faces. My presentation focuses on a study I carried out, talking to a number of mums who faced high levels of stress, about how this impacted on how they fed their baby – and what helped most.

04 Sep

Guest Blog by Heather Trickey – What sorts of breastfeeding peer support interventions should we be developing?

Heather TrickeyHeather Trickey is a researcher in parenthood and public health at DECIPHer, Cardiff University.  Here she writes about the importance of not just implementing peer support systems for breastfeeding mothers, but, crucially, ensuring that those systems are effective and fit for purpose.  She’ll be talking in more detail on the subject at our conference on 6th October – buy your tickets here.

 

Breastfeeding peer support is considered an important intervention for supporting women with breastfeeding and is recommended by the World Health Organisation, by NICE, and by UNICEF UK. The evidence for breastfeeding peer support in a UK context is mixed, UK experimental studies have tended to show little or no impact on breastfeeding rates. As Dr Gill Thomson (UCLAN) and I have discussed, are lots of reasons why that might be, these include poor intervention design and implementation failure under experimental conditions (Thomson and Trickey, 2013; Trickey 2013).

Some lessons for peer support design

Earlier this year we published a realist review of breastfeeding peer support interventions (Trickey, Thomson, Grant et al, 2018). We identified some key lessons for design. For example, we found intervention goals need to have a good fit with the goals of mothers, that the intervention needs to be linked into existing health care systems, that help won’t reach many mothers unless it is proactive and for UK mothers it needs to come soon after the birth, that peers need to be confident and friendly for mothers to feel comfortable, that relationships need to need to be warm and affirming, that peers supporters themselves need to feel valued, and the intervention needs to enhance rather than displace existing care.

But we also need think about peer support in the bigger picture…

The UK has one of the lowest breastfeeding rates in the world, and there are big differences in rates at area level depending on level of deprivation. Our review found that we need to develop better ideas about how changes in attitudes and behaviours happen at the level of a whole community. We concluded,

“In the absence of overarching theories of change for infant feeding behaviour at community level, it is difficult for intervention planners to target breastfeeding peer support interventions to maximum benefit”.

So, what is the longer term objective for society? And what needs to happen, where, why and for whom and in what order to meet that goal? Should the focus be on encouraging getting more mothers to initiate breastfeeding, or on helping mothers to continue for as long as they want? Should interventions pay more attention to the needs of mothers using formula milk, whose babies are most at risk of infection? Should we be measuring breastfeeding rates, or should we be considering women’s experiences or changes in wider societal knowledge and attitudes as a way of measuring ‘success’?

What else do peer supporters do?

We need to get smarter at understanding how peer support interventions can contribute to delivering the kind of big community-level changes that we will need in the UK if we are to ensure that all women’s decisions are respected and supported and that women who decide to breastfeed have a better time and can meet their feeding goals. This means thinking about all the things that peer supporters do alongside helping individual mothers. We need to develop different sorts of theories and outcome measures which can underpin more holistic, community-focused interventions.

My talk for the BfN conference will draw on findings from my PhD research. This builds on the findings of our review, drawing on conversations with groups of parents, peer supporters, health professionals and policy makers to ‘think outside the box’ and consider all the different ways that peer support makes a difference. I conclude that we need to develop interventions that reflect the potential for peer supporters to enhance existing social networks, counteract inadequate existing services, advocate for services, and diffuse attitudes, knowledge and skills within their social networks.

References

Trickey, H. 2013. Peer support for breastfeeding continuation: an overview of researchPerspective – NCT’s journal on preparing parents for birth and early parenthood (21), pp. 15-20.

Thomson, G. and Trickey, H. 2013. What works for breastfeeding peer support – time to get realEuropean Medical Journal: Gynaecology and Obstetrics 2013(1), pp. 15-22.

Trickey, H.et al. 2018. A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settingsMaternal and Child Nutrition 14(1), article number: e12559. (10.1111/mcn.12559)

 

 

 

24 Aug

Guest Blog by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

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Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

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There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
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In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
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Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
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This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
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How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
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I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

24 Aug

Guest Post by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

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Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

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There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
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Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

31 Jul

BfN Statement on Channel 4 Dispatches Programme 30/07/2018 – Breastfeeding Uncovered

Dispatches presenter breastfeeding her baby

Dispatches presenter Kate Quilton

Negative cultural attitudes towards breastfeeding are common place in the UK and often this is reinforced by media messages.

However, last night’s Dispatches programme demonstrated sensitive and robust journalism on the emotive and polarised issue that is breastfeeding.

The Breastfeeding Network is a charity that supports women and families in their choice to breastfeed in a culture that often treats women negatively for pursuing an unpopular choice.

The programme highlighted the progress that science and medical experts have made in acknowledging the make-up of breastmilk and the impact breastfeeding can have on infant and maternal health. It also looked at the marketing of breastmilk substitutes and how much care has to be taken to ensure breastfeeding is not undermined in health care settings. The lack of evidence-base for formula products’ claims to resolve sleep and colic problems is clearly misleading parents, exploiting families’ tight financial budgets and failing to resolve the problem.

The programme also highlighted the shocking truth that investment in health even where the evidence-base is strong does not always follow, nor can it compete with a multi-billion pound industry that seeks to dominate the choices of parents and families. Protection and scaling up of breastfeeding can only be truly tackled where we work together to create the environment to enable women and their families to choose it.

The programme spoke directly with breastfeeding women and allowed them to voice their concerns around the lack of support for breastfeeding – an issue that BfN are all too aware of – many of our face-to-face peer support services have seen significant cuts in recent months and years, meaning many families are no longer able to access good quality peer support in their local areas.

Many women featured in the programme also spoke out about their concerns around breastfeeding in public.  Many women tell us that they worry about feeding out and about, feeling intimidated and worried about being treated negatively. The presenter Kate Quilton said she sometimes felt like a ‘social outcast’ – women tell us this all the time and that is why having peers in your community to support you is so critical for many women.

We were pleased to see the portrayal of the issues and the balanced journalism presented by Dispatches that reinforces the high quality evidence in the field of infant feeding helps us to continue to change the conversation around breastfeeding and move to its normalisation, so that more parents can feel they can choose to breastfeed.

If you are affected by any of the issues raised please contact the National Breastfeeding Helpline on 0300 100 0212 – open 9.30am-9.30pm 365 days a year.

The programme is available for 30 days on C4 catch up.  If you only do one thing to celebrate World Breastfeeding Week, please share this link with your local councillor and MP.