Heather 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.
Trickey, H. 2013. Peer support for breastfeeding continuation: an overview of research. Perspective – 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 real. European 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 settings. Maternal and Child Nutrition 14(1), article number: e12559. (10.1111/mcn.12559)