A breastfeeding drive in Brighton and Hove began by asking what was holding some mothers back. Sue Curtis reports
With increasing breastfeeding rates a key part of the government's drive to reduce health inequalities, Brighton and Hove Healthy City Partnership is using social marketing tools and techniques to help make it easier for women to breastfeed in public and when returning to work.
Brighton and Hove's target is to increase by 2 per cent the number of mothers breastfeeding at six weeks after their baby's birth, with a proportionately higher increase in disadvantaged areas.
To find out and understand what prevents some mothers from breastfeeding, Brighton and Hove City primary care trust worked with social marketing consultancy Brilliant Futures.
"The subject of breastfeeding in public and at work can provoke some really strong views, both positive and negative, and we wanted to capture as many as possible to inform the way forward," says director of public health Tom Scanlon. "We wanted to know where the best places might be, what mums, their partners and family might be looking for, as well as how they and everyone else felt about breastfeeding in public.
"We wanted to hear from those who are not traditionally engaged in the debate, for example teenage boys, employers, fathers and grandparents.
"A wide range of tools and techniques were devised by Brilliant Futures to make sure we were able to get under the skin of what people in Brighton and Hove really thought, felt and did in relation to breastfeeding."
The primary care trust allowed three months for an initial research and consultation phase. First, a full literature review was carried out, revealing that while a lot of research has been done on breastfeeding generally, there is little existing research into breastfeeding in public and when returning to work.
For the qualitative research, different methods were used to appeal to different audiences, ensuring the PCT reached those who might be hard to engage. These included:
Stakeholder interviews and an email survey involving professionals such as community midwives, breastfeeding co-ordinators and support workers, health visitors and National Childbirth Trust representatives.
A filming event in the style of the Big Brother diary room, which took place in a local shopping centre. This appealed to diverse audiences, from teenagers to pensioners, and generated 50 interviews and more than four hours of footage.
Creative workshops targeted 10 different groups, using demographic and behavioural segmentation. These used an eye catching illustrated storyboard to stimulate discussion and generate deeper insight, gaining a real picture of motivations, attitudes and beliefs.
Nine thousand postcards were distributed through retailers, cafés, children's centres, leisure centres and various other baby-friendly and public access venues, plus a door-drop to family households inviting people to have their say.
A Best for Babies interactive website, which used social networking to get people to join in the debate. People were able to exchange views, post blogs and view video clips and images. They were also encouraged to complete an online survey. The website received 1,200 hits during the consultation period.
Participants were kept involved throughout the consultation and invited to an open meeting where the research findings were presented and discussed.
Initial findings highlighted different attitudes to breastfeeding in public and confirmed that younger mothers from lower socioeconomic groups are less likely to breastfeed than their older, more middle class counterparts.
Shops and shopping malls were cited as not providing places to breastfeed - as one young mother said, "who wants to eat in a toilet?" - and employers were criticised for not providing places for breast milk to be expressed and stored.
Mutual respect was identified as an important issue, with people commenting that breastfeeding should be done in a way that is respectful to members of the public.
Other key themes suggested:
social and cultural views act as a barrier to breastfeeding;
positive role models are needed, particularly for younger mothers and mothers from lower socioeconomic groups;
opinions of family members are hugely influential;
breastfeeding support groups and some health professionals can be perceived as overzealous and alienating;
there can be a lack of support for breastfeeding immediately after birth;
more non-commercial baby-friendly venues and settings are needed;
a directory of breastfeeding-friendly cafes, pubs and restaurants is needed;
employers need to be made aware of the benefits to themselves and society of supporting employees who are breastfeeding, and have a duty to support breastfeeding mothers when they return to work;
public facilities need to be provided that not only support breastfeeding but also help with the general practicalities of parenting when outside the home;
mothers need help to develop the confidence to breastfeed in public and the ability to do it discreetly;
any policies or practices that are developed must respect the sensitivities and feelings of people who are not comfortable with breastfeeding in public.
The consultation has generated in-depth insights from a wide range of people, including the traditionally hard to reach, and resulted in recommendations (see below). It has also helped to open a dialogue with important influencers and stakeholders, gaining their support.
The PCT and council have embraced the potential of social marketing to influence strategy and policy development rather than using it as a short term, tactical campaign and the findings and recommendations from this project are being incorporated into the city's childhood obesity and breastfeeding strategies.
How to encourage breastfeeding
Develop a communications campaign designed to: inform the public of the benefits of breastfeeding; support breastfeeding in public; help build mothers' confidence; encourage respect for breastfeeding mothers.
Provide education in schools to normalise breastfeeding.
Offer training for support groups and health professionals including informing them of women's thoughts and feelings generated from research; raising their awareness of the perceived and real barriers to breastfeeding; helping them teach women how to feed discreetly.
Show positive young role models from different socioeconomic groups breastfeeding in public.
Inform businesses and employers of the benefits to them of facilitating breastfeeding.
Create facilities for feeding or changing where fathers are also welcome.
Create more mixed age feeding facilities, for example where toddlers can play while baby feeds.
Create accessible facilities in commercial areas.
Create feeding facilities that are not situated in toilets or baby changing rooms.
Signpost (in print and online) breastfeeding-friendly establishments.
Provide training for mothers (in partnership with support groups, peer support workers and other professionals) demonstrating how to feed discreetly, and helping mothers develop confidence.
Ensure all materials produced tie in with and assist national breastfeeding campaigns, rather than compete with them.
Support, engage and encourage partners and other key influencers of breastfeeding mothers.