Unmet Needs: Breastfeeding Pilot Project

Kim FraserBreastfeeding Project Leader

Unmet Needs• Pilot Project

• 3 NHS boards with highest deprivation

• Demonstrate a link with deprivation and health gain

• Evidence based

• Innovative, sustainable, partnership working

Inequalities

• Disadvantaged areas-50% less likely B/F

• 1990- highest rates social class 1-3(Dundee Infant Feeding Study)

• 2000’s :• most affluent : 68.2% • Most disadvantaged: 29.4%

(Health Inequalities Strategy)

0

20

40

60

80

100

120

DD11

DD12

DD13

DD14

DD15

DD23

DD24

DD30

DD36

DD37

DD39

DD40

DD46

DD48

DD49

%

Birth

Discharge

1st visit

6-8 weeks

Breastfeeding by Postcode

Evidence

Systematic Review NICE 2005

Successful interventions • Include both antenatal and postnatal

periods• One to one interventions

Need further evidence especially deprived areas

Evidence

Baby’s age when stopped

% who would have liked BF longer

<1 week 90

1-2 weeks 93

2-6 weeks 87

6 weeks-4 months 69

4-6 months 48

>6 months 37

Source: Hamlyn et al 2002

Mothers Who Would Have Liked to Breastfeed Longer

Evidence : Variables

Health care factorsPartner and family supportLactation knowledge and understandingWorkplace environment

oYears of educationoParityoAgeoIncome

Source: Higginson 2001

EvidenceUse of Healthcare Assistants

• DOH report on evaluation breastfeeding between 1999 and 2002

• 3 projects which explored the role of health care assistants providing extra support to breastfeeding mothers

• Qualitative evidence from these indicated that it was a successful way of working

AIMS

• To provide women on low incomes in Dundee with additional information and support by breastfeeding support workers to improve breastfeeding initiation and duration rates

Objectives

• Recruit and train BSW’s

• Identify mothers living in deprived areas from postcode areas

• Provide additional support , information and practical skills in the antenatal and postnatal periods

• Evaluate effectiveness

Design

• Non- randomised experimental design

• Intervention group Depcat 5,6 and 7 areas of Dundee

• 2 control groups

• Inclusion Criteria- All pregnant women living in the designated postcode areas

• Exclusion Criteria- none

Recruitment

• System that allows information to be obtained

• Information when collect hand held notes

• Contacted by BSW

• Rate 1 in 4 initially increased to 40%

• Not persuading

Intervention

• Provided by Breastfeeding Support Workers

• Make contact in the antenatal period

• Continues postnatally in hospital and home

• Up to 6 weeks post discharge

• Additional support

• Not problem solving

Results (July to March)

% Change in Breastfeeding Rates (July04-March 05 and July05-March06)

-15

-10

-5

0

5

10

15

Birth Discharge 1st visit 6-8 weeks

Time period

%

Intervention Control deprived Control Affluent

Source ISD September 2006

Intervention 9% increase (CI 4.7-13.3)Control increase 1.8%(CI -8.8- +12.4)

All points of examination statistically significant difference p<0.001

Results first 6 months

0

10

20

30

40

50

60

70

80

90

100

Intention before birth

Birth Discharge 11 Days 6 weeks

Mixed feeding

ExclusiveBreastfeeding

Results

Length of Visits

0

5

10

15

20

25

30

35

40

0-14mins

15-29mins

30-44mins

45-59mins

60-89mins

90-119mins

over 120mins

wastevisit

Time

%

Qualitative Data

Maternal Satisfaction Questionnaires• 76% response rates• High levels of satisfaction

Emerging themes• Enabled establishment and continuation

of breastfeeding• Knowledge and Information• Supportive role• Increased confidence

Qualitative dataFocus Groups• Breastfeeding Support Workers• Midwives• Health Visitors

In-depth Interviews• Mothers-12

Continuation• In May NHS Tayside Executive

Team extended project until end March 2007 further data collection

• September- Executive Team agreed to non-recurring funding for 3wte breastfeeding Support Workers for further 2 years

Conclusion

This is a project which has taken the limited evidence around breastfeeding and deprivation and through a research process has demonstrated an effective model of working that can improve breastfeeding rates for those living in deprived communities that can be used to inform future practice.