Quick Thoughts from Northern Ireland Breastfeeding Research

This morning I attended the Advancing Breastfeeding Research & Practice conference organised by NIPHRN (Northern Ireland Public Health Research Network) and DMRS (Doctoral Midwifery Research Society) which was held at Ulster University. This event looked at current research, and meta-analyses of breastfeeding interventions aimed at increasing breastfeeding rates, as well as discussing the importance of online peer support.

A common theme that came through the day is that what is currently being done to increase breastfeeding rates is not working. Interventions which work in other areas of the world, don't seem to work here, due to the culture around feeding in UK. New ideas are needed, some kind of a radical approach. An update from PHA Health Intelligence found that women felt there was a lack of consistency between midwives / Health Visitors, and a lack of support from some. Alison McFadden from Dundee University stated evidence that many HCPs don't have the required knowledge, attitudes or skills around breastfeeding but there was a lack of evidence of what works to equip staff effectively. She stated that there was a lack of quality information on whether increasing breastfeeding education in HCPs actually increases breastfeeding rates. This might seem surprising, but I'm sure we've all been to education or training sessions where we didn't actually apply what we learned!

The importance on online peer support was discussed and the session on the local BFNI Facebook group brought some audible gasps when the volume of posts and support interactions was given.

Two sessions that I want to draw out a little here however were the sessions on Motivational Theory and Behavioural Change. The Motivational Theory talk emphaised the importance of Self Efficacy and of Value. That to motivate any specific behaviour (like breastfeeding) you must have a balance of feeling capable and feeling like there is value to that behaviour. It talked about how the breastfeeding support is currently unbalanced, with Value being emphasised to women prenatally during antenatal education, but at this time they are not given information to feel confident in how to do it. Prenatally interventions emphasise Value but not Self Efficacy. After birth, they are given support around Self Efficacy (practical support on how to breastfeed) but are not given information on the value of breastfeeding (there is no real distinction drawn between breastfeeding and artificial feeding). We have a wider issue within society and health care provision that breastfeeding is not always valued. The session on behavioural change talked about the 3 components of change which are Capability, Motivation and Opportunity (Means, Motive and Opportunity by another name), and how each of these need to be addressed in interventions to change behaviour.

In all of these talks the interventions focused on breastfeeding women - trying to drive change in pregnant and postnatal women, but the Lancet Series on Breastfeeding (published earlier this year) was very clear when it said,

success in breastfeeding is not the sole responsibility of a woman — the promotion of breastfeeding is a collective societal responsibility.

What was clearly presented to the audience today was a message that we need to do something quite different when thinking about interventions - so I'd like to propose something different. We've tried interventions focusing on the pregnant and postnatal women, and we're not making any significant changes. We know that there is an issue within healthcare. Women report issues around perceived lack of Value in breastfeeding and lack of effective support from HCPs. That hits the Lack of Value and Self Efficacy strands of motivation. Women report that HCPs are very quick to suggest artificial milks both in hospital and in the community. Value and Motivation - how about we address these within the care provision setting rather than focusing on pregnant and breastfeeding women? How about we design interventions to drive behaviour change within healthcare as a driver of community change? How about we motivate HCPs to better support and value breastfeeding? We have some fabulous champions of breastfeeding within midwifery, nursing and medicine, but having some champions is not enough. When a fundamental part of a job is providing breastfeeding information and support, everyone needs to be a champion.

A couple of days ago a pregnant woman told me that in an antenatal visit she expressed a wish to breastfeed, and her concerns about it since she difficulty breastfeeding previously. She asked her midwives what help she could have. She told me that her midwife said, "Sure, why not just give a bottle?". In that one sentence we see both lack of value and lack of Self Efficacy. How about instead of focusing responsibility on the woman (as the Lancet says), we motivate HCPs to change behaviour in how they respond to breastfeeding challenges. How about we target interventions to promote the value of breastfeeding within health care professions?

How's that as a radical idea??