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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.