What do women

really want from

breastfeeding

support and

promotion?

Lessons for public

health

Dr Amy Brown, Swansea University

0

10

20

30

40

50

60

70

80

90

100

Birth 2 weeks 6 weeks 6 months 12 months

Norway

Australia

USA

UK

Adapted from data in Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., ... & Group, T. L. B. S. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490.

‘The reasons why women avoid or stop breastfeeding range

from the medical, cultural, and psychological, to physical

discomfort and inconvenience. These matters are not trivial, and many mothers without support turn to a bottle of formula. Multiplied across populations and involving multinational commercial

interests, this situation has catastrophic consequences on

breastfeeding rates and the health of subsequent

generations.’

The Lancet Series, 2016

Breastfeeding education and

promotion

• 1130 mothers baby aged 0 – 2 years, who had planned to breastfeed

• Closed items examined experience of breastfeeding education and promotion

• Open ended items exploring experiences of education and ideas for how this could be changed

Brown, A. (2016). What do women really want? Lessons for breastfeeding promotion and education. Breastfeeding Medicine, 11(3), 102-110.

86% agreed that it is important to promote breastfeeding

Just 10% believed breastfeeding education messages

prepared mothers for what it would be like to breastfeed a baby.

Breast is not best; it is the normal way to feed a baby

Tell us the truth – it can be challenging

Don’t focus solely on health impact of breastfeeding

Recognise that every feed makes a difference

Target a wider audience

‘Breast is best but this puts breastfeeding on an unobtainable pedestal for some people. This then makes infant formula seem to be reachable, normal and something that has all the stuff needed for babies. Instead breastfeeding should be marketed as normal and perfect.’

‘Breast is promoted as being best. So if you breastfeed you are the ‘best’ mother and doing the ‘best’ for your baby and making the ‘best’ choices. If you can’t breastfeed where does that leave you? A not good enough mother? A bad mother?’

‘Breast is not best, it is the normal way to feed a baby...’

‘Saying breast is best to a woman who is

desperate to feed but struggling to do so is like telling someone

how great this bus is, how fabulous and cheap the journey,

how much better it is all-round…but not telling them where

the bus stop is’.

‘It would have helped to have been honestly told that it's not a piece of cake and that you have to learn it and that it's normal to hurt/ feel uncomfortable for the first few weeks; that "it's natural" doesn't mean "it's easy and will just happen’.

Tell us the truth – it can be challenging...

‘It was all so positive. Breast is best for your baby. Breastfeeding will help you lose weight. Breastfeeding is a wonderful experience. Perhaps all true but in no way the whole picture. When I then found it difficult, at times demanding and my baby appeared to want to scream rather than feed serenely I felt like a complete failure and embarrassed and guilty that I felt that way to boot.’

Importance of responsive feeding

Feeding whenever baby

signals to be fed

Typically very frequently

Night feeding

Konner, M. and Worthman, C., 1980. Nursing frequency, gonadal function, and birth spacing among! Kung hunter-gatherers. Science 207(4432), pp.788-791

Society damages responsive feeding by:

Not understanding it

Dissuading or preventing it

Persuading other things more important

Creating anxiety over it

Brown, A., Raynor, P., & Lee, M. (2011). Maternal control of child‐feeding during breast and formula feeding in the first 6 months post‐partum. JHND, 24(2), 177-186.

Is he feeding again?!

My baby sleeps all

night

Are you sure you’ve got enough milk? Rod for your own

back! He needs a routine!!

You need to show him

who’s boss!!

He’s manipulating

you !!!

You’ll still be feeding him when he’s off to

university!!

YOU’RE JUST DOING IT ALL WRONG!!!!!

Is he really meant to

be feeding again?

What if I’m

starving him?

How do I know he is getting enough

Maybe I should try a top up

What if I’m just doing it

all wrong?

‘Although there are health differences between breast and formula fed babies they are not guarantees. Breastfed babies can still get ill so if mothers are sold the idea of breastfeeding on health benefits alone and then their baby gets sick it can make them feel like they did it wrong or that it wasn’t actually that good and they might as well formula feed as their friend who did have really healthy kids’.

Don’t just focus on the health reasons...

‘Breastfeeding is about so much more than health. It is about cuddles, and closeness and bonding. It saves time, costs nothing and you can never forget to take it out with

you. Why don’t we emphasise these things more?’

‘If you really want to boost breastfeeding, you have to abandon this black or white stance. I know exclusive breastfeeding is best but there are so many rules. No bottles before 6 weeks, no formula ever - no wonder people give up. It's a spectrum - exclusive breast at one end & exclusive formula at the other. Most end up failing to keep all the rules and giving up the whole thing’

Recognise that every feed makes a difference...

Although we do need to tell mums that it’s important, give them some credibility. Tell them the guidelines but explain how all breastfeeding counts. You might have a mum who baulks at the idea of 6 months, but 6 weeks or even 6 days seems achievable for her. That is better

than not at all.

• Educate fathers, family, society (80%)

• Educate the public (52%)

• Make breastfeeding more visible (55%)

• Highlight legal protection (26%)

• Advertise breastfeeding (42%)

• Use celebrities (34%) • Educate children (77%)

‘We definitely need to be telling new mums about why breastfeeding is so good but I think this should also be extended to everyone else. Everyone needs to know why breastfeeding is so important for mums to stand a chance of making this work’

Target a wider audience

‘You can tell women that breast is best til the cows come home. But if

their partner believes differently and the mother in law is trying to give

the baby a bottle, who do you think is going to win? Tell mums by all means but also tell their wider

family’

‘I know why breastfeeding is important. My partner knows why

breastfeeding is important. But it’s very difficult to put up with others’ ignorant views. Educate the general public and it

would be a lot easier.

‘The only thing you can do is make it more normal and

accepted. If everyone grows up seeing pictures of it, seeing it on tv etc and seeing people

doing it, it will be a normal natural thing to do’

‘Formula companies advertise by showing bouncy, happy

babies rather than just them sucking on a bottle. Maybe we need to see how we can

promote breastfeeding in other ways than the more

traditional.’

‘We’ve lost sight of what it’s like to breastfeed and need to get back to understanding caring

for and feeding babies. People label normal behaviour as

something that is wong and we need to get better

understanding and acceptance

Go into schools. Talk to the children before someone else

gives them the idea that breastfeeding is something to be

ashamed about and formula milk is normal

‘The success or failure of breastfeeding should not be seen solely as the responsibility of the woman. Her ability to breastfeed

is very much shaped by the support and the environment in

which she lives. There is a broader responsibility of governments and

society to support women through policies and programmes

in the community.’

Dr Nigel Rollins, WHO

We need to change the conversation around breastfeeding by stopping laying the responsibility for this major public health issue in the laps of individual women and acknowledging the role that politics and society has to play at every level. Unicef Baby Friendly, Call to Action 2016