Boosting breastfeeding in disadvantaged areas

Motivational technique could hold key to increasing breastfeeding rates

Public health experts are developing a new programme to encourage young mothers from disadvantaged areas in England and Wales to breastfeed for longer.

Breastfeeding has proven health benefits to the baby and mother. Breast milk possesses vital disease-fighting substances that protect babies from illness, while breastfeeding helps mothers recover from childbirth more quickly.

Yet recent figures show that the UK has the lowest rate of breastfeeding in the western world. Less than 40% of women breastfeed to six months – in deprived areas the figure can be less than 20% - and less than 1% are breastfeeding exclusively at this time.

The NHS and World Health Organisation (WHO) recommends that all babies receive breast milk exclusively for the first six months of life.

Researchers from Cardiff University’s School of Medicine believe that a counselling approach, originally used to treat alcoholism, could increase breastfeeding rates in poorer, white areas where birth rates are high.

Previous studies of this approach, known as Motivational Interviewing (MI), have revealed its effectiveness in tackling a raft of public health issues from helping people to overcome addiction and childhood obesity to dental problems and smoking cessation.

Programme leader Dr Shantini Paranjothy, a clinical senior lecturer from Cardiff University’s School of Medicine, said: “The findings from this study will help us understand how we can increase the duration of breastfeeding among young mothers.

“This is the first time a motivational interviewing approach has been used in a peer support breastfeeding study but the approach has been successful in other areas, including peer outreach for young people with HIV. I am delighted to be working in partnership with Public Health Wales on this project.”

Funded by the National Institute of Health Research (NIHR), the Cardiff team will work with parents and health professionals to develop a peer-support breast-feeding trial programme in three areas of England Wales where there are high levels of social and economic deprivation, high rates of teenage pregnancy and low rates of breastfeeding.

The trial will use community midwifery teams to recruit six to nine peer-supporters (mothers trained in MI and with experience in breastfeeding) to provide support to new mothers (aged 20 and below) over six months.

The success of this approach will be measured using structured telephone interviews with the mothers involved in the study and will draw from NHS and health visitor data to assess the health of the mother and babies, as well as the uptake of breastfeeding.

Cardiff University Professor Stephen Rollnick, who pioneered MI in the 1980s, describes it as “listening with a purpose – the opposite of telling people what to do.” He believes the approach gives mothers “the information and space to make their own decisions about what’s best for their little ones.

Among the techniques used in MI are open questioning, reflective listening and an emphasis on dialogue that’s led by the mother and not the MI counsellor. It encourages empathy, acceptance and compassion, and avoids directness, authoritarianism or judgment.

If successful, the team will aim to roll out the programme across the UK.