Adapting Breastfeeding Support in Areas of Socio-Economic Deprivation: A Case Study Approach.

Abstract

Background: There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economically disadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledge about the interaction between context and intervention and how this affects women’s experiences. Methods: This interpretive study used a case study methodology to explore how and why two BPS services developed their services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS service development. Data collected across both cases comprised; observation (n=1), and semi-structured interviews with: mothers who had (n=10) and had not (n=9) engaged with the BPS services, peer supporters (PSs) (n=9), community health professionals (n=5), infant feeding co-ordinators (n=2), non-profit organisation managers (n=3), and public health commissioners (n=2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse the data. Results: The over-arching theme - ‘the transcending influence of society’ – offers insights into the underlying context and drivers impacting service development. It reflects how funding and data sharing arrangements determined service operation and the peer’s access to women. Four underpinning themes explain how: peer supporters were resourceful in adapting their services (‘adapting and modifying the support’); BPS organisations worked to enable women’s access to supportive breastfeeding environments, but did not necessarily focus service development on the needs of women living in areas of deprivation (‘supporting women’s journeys to access’); the BPS-professional connections for supporting access and how BPS could result in more supportive community environments (‘building relationships’); and how management practices precluded meaningful use of data to provide context led service development (‘ways of using knowledge’). Conclusions: Findings suggest that while PSs are commissioned to focus on those most in need, there is limited discussion, collection, or use of knowledge about women’s lives to develop needs-led service delivery. The key recommendation is the development of a social ecological tool to facilitate the use and application of contextual knowledge.

Non‐profit breastfeeding organisations' peer support provision in areas of socio‐economic deprivation in the UK: A meta‐ethnography

“…The finding that mothers' access to breastfeeding groups was facilitated by personal contacts (Ingram, 2013) and that groups may be attended more readily by more socially advantaged mothers (Fox et al, 2015) is supported by other literature (Hunt et al, 2021; Trickey et al, 2018). When combined with the finding that embedding services with health professionals enabled PSs better access to mothers, and that increased one to one contact resulted in more of women's needs being met, our findings suggest access is relevant in this context.…”

Intention to breastfeed and association with subsequent breastfeeding duration, a linked population level routine data study - The Born in Wales cohort 2018-2021

“…It is important to note that breastfeeding rates are influenced by various socio-economic factors, religion, education, and support services available. [6] Factors that influence women's breastfeeding decisions can include breastfeeding intention, breastfeeding self-efficacy and social support [7]. Breastfeeding promotion strategies conducted by midwives often include social support, however, there is minimal research surrounding intention to breastfeed and self-efficacy and whether this impacts future breastfeeding behaviour.…”

“…In fact, 80% of babies are breastfed at birth but only 1% are exclusively breastfed for six months in the UK [5]. These breastfeeding rates are lower among women in areas of higher deprivation and health inequalities [6].…”

The Use of an Incentive to Improve Breastfeeding Outcomes: The Effectiveness of Offering a Free Family YMCA Membership to Increase Support Group Participation

“…Furthermore, when community-level interventions are implemented, a combination of peer and International Board Certified Lactation Consultant (IBCLC) support can significantly increase self-efficacy and exclusive breastfeeding (Lee et al, 2019). What remains unknown is why some people do not access community-based breastfeeding support when it is available (Hunt et al, 2021).…”