Breastfeeding improving most among mums from disadvantaged backgrounds

Mothers who breastfeed are managing to breastfeed for longer, a trend particularly noticeable among mothers from disadvantaged backgrounds. Dr Valeria Skafida used data from the Growing Up in Scotland to investigate whether rates of breastfeeding amongst mothers in Scotland between 2004 and 2011 may have been influenced by public health policy. Here she talks us through the key findings.

The findings are based on Growing Up in Scotland (GUS) data of more than 5000 mothers, which assessed their breastfeeding habits in the first 10 months of their babies’ lives. It compared results from 2004 and 2011.

• Mothers from more advantaged backgrounds are far more likely to try breastfeeding at least once, when compared to mothers from disadvantaged backgrounds.
• While the total number of women who breastfed their babies at least once increased by only 3% between 2004 and 2011, those who did breastfeed are feeding for longer.
• Mothers who gave birth in 2011 and who managed to breastfeed beyond the first month had a 25% higher chance of breastfeeding for longer compared with mothers in 2004. 
• This was far more pronounced among mothers from disadvantaged backgrounds. Mothers with few or no educational qualifications had a 150% higher chance of continuing to breastfeed for between 6 and 10 months in 2011 than their peers did in 2004.
• The study also found that mothers in households where a language other than English was spoken had a four times higher chance to breastfeed their child compared with mothers where only English was spoken.
• There remains a significant proportion of women who stop breastfeeding within the first month. Not having enough milk was the most commonly given reason for stopping so early.

In the past decade, the Scottish Government has been at the forefront of public health policies among developed nations in terms of breastfeeding promotion. Changes have occurred at policy level, in national legislation, in hospitals and in health care staff training. One of the key shifts since 2005, in health services aimed at children has been the recognition that families assessed as being more vulnerable would benefit from being offered more intensive support. These findings, by comparing the lives and habits of families before and after the policies were introduced, have the potential to demonstrate the value of policies to tackle health-related issues among disadvantaged populations.

For more information:
CRFR briefing 71: Changes in Scottish infant feeding policy and breastfeeding habits between 2004 and 2011.

Skafida, V. (2014) Change in breastfeeding patterns in Scotland between 2004 and 2011 and the role of health policy. European Journal of Public Health.

They study has already attracted keen interest from the Scottish Government and public health analysts. Acting Chief Medical Officer, Dr Aileen Keel, welcomed the research, particularly noting the encouraging trend among mums from disadvantaged backgrounds. Similarly Minister for Public Health Micheal Matheson was  pleased to see a rise in the number of mothers from disadvantaged backgrounds who have breastfed for longer, especially in light of the longlasting health benefits this brings and evidence to suggest that breastfed babies are less likely to use NHS services in later life.

The impact of domestic abuse on women’s relationships with their babies

Dr Fiona Buchanan writes about her research on women’s perspectives on how domestic violence affected their relationship with their babies

At a seminar organised by the CRFR at the end of June I was delighted that the audience of committed and active workers from agencies all over Scotland and beyond found my research thought provoking and - hopefully - useful.

I was grateful for the opportunity to get research from Australia out to inform practice in Scotland, and so I’m also using the CRFR blog to take the discussion further. This is what I presented.

Feminists have long argued that services for women and children who have survived domestic abuse need to be informed by the every-day experiences of women and children.

However, in the growing field of early intervention it is attachment theory, based in expert opinion informed by clinical testing, observation and classification, that is guiding many workers. With this approach women and their babies are the focus for identifying and treating problems.
But, in basing practice in theory formed from expert opinion, women’s voices about how they think domestic abuse affects the relationships with their babies are overlooked.  Instead the focus is on fixing problems.
Having worked in South Australia rolling out new early intervention services based on attachment theory I was concerned that we were missing what was really going on for women and their babies in domestic abuse.

That’s why I undertook research to find out: "How knowledge of relationships between women and their babies can be informed by focusing on the lived experiences, including the emotional experiences, of women who have birthed and mothered babies in domestic abuse".

Sixteen incredibly honest, open and insightful women who had mothered babies in domestic abuse took part in the research.  They spoke of how, in domestic abuse, their partners focused ongoing hostility towards the developing mother/baby relationship.  The women gave many examples of how they responded to this by thinking, feeling and, where possible, acting to protect their babies.  They did this whether or not they felt attached to their babies.  It seemed that protection came first and took priority over attachment.

Enduring sustained hostility, protecting babies and finding space to relate
Women protected in many ways we don’t recognise as protection, for instance trying to make sure the baby was always quiet, the house was always spotless and their partners’ lifestyle was not disrupted in any way.
They did all this to appease their partners so that they would not find fault and create a scene.  But as one woman put it: “there is no routine in that crazy life-style; you never know when the next eruption is going to happen”.

Women also described some heart wrenching situations where they put themselves in danger to make sure their babies were not physically hurt. Most of the women never told friends and family these details because of the distress it would cause. Counsellors had not enquired about the impact of abuse on the relationship with their baby or their efforts to protect their baby.

The women did their best to protect their babies but found that the time it took to try to‘keep the peace’ meant they had little time to get to know their babies.  As one woman said:

“ … I didn’t get to spend the time that I wanted to with Chris (the baby), cuddling him and didn’t get to sit down and read books to him when he was really little, and, you know, do all those little things you want to, spend the time playing on the floor, and that, was always having to do other things to prevent problems...”
However, women were creative about finding at least some space to relate to their baby. They did this during breastfeeding, by co-sleeping and one woman spent time with her baby at childcare.

What should we do?
There is a lot to learn from these women’s stories and three things that workers could take on board:
• Ask about and listen to women’s experience of sustained hostility directed towards the mother/baby relationship
• Ask about, acknowledge and respect women’s protective feelings, thoughts and actions towards their babies.
• Applaud women’s efforts to find a safe space where they could relate to their babies and when women have no safe space, help them to access some.

Of course, when living with domestic abuse women are not always able to protect their babies, especially when they cannot protect themselves, but let’s stop seeing them as the problem.  By learning from women who have formed relationships with babies in domestic abuse, workers can act with understanding of context to promote women’s protection of their babies.

For more information about my research

View Fiona’s presentation that accompanied her talk in Edinburgh.

“Domestic Violence and the Place of Fear in Mother/Baby Relationships: “What Was I Afraid Of ? Of Making It Worse?” Journal of Interpersonal Violence June 2013 vol. 28 no. 9 1817-1838

Fiona Buchanan, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia

Read other CRFR blogs on gender-based violence

'I felt so guilty': emotion and mothers’ experiences of caring for their young children

Guilty, frazzled, tired and upset. How does it feel to be a mother caring for her baby in the first days and weeks, and then months and years, of her baby’s life?

In the last decade, the policy context of health visiting practice has shifted the focus of health work with new parents from working with all families to working with those who it is felt are the most vulnerable.  This, however, poses a tricky dilemma as we try to understand what vulnerability is, and, how it is experienced by different parents.  

Caroline King, in a seminar on 15 May, as part of CRFR’s emotions series, will consider what the study of emotion can tell us about mothers’ experiences of caring for their children. She will explore the accounts of 20 mothers who took part in her PhD study.  She will also draw on her own experience as a mother and consider whether at times she was vulnerable after the birth of her children.  In doing so, she will consider the role of emotion and emotion work in both uncovering and covering the tracks of vulnerability.  Can vulnerability, she will ask, be experienced by any mother?   If so, what role do personal resources play, for example, a mother’s education or income, in how we frame, manage and categorise vulnerability?

In her analysis Caroline will consider the particular role of class in opening up and closing down what is recognised as vulnerability and the implications of this for mothers and their children.

An introduction to the topic of vulnerability in the contexts of mothering and health visiting practices can be found by viewing a short film made in collaboration with artist Rosie Gibson (previously CRFR artist in residence), and based on Caroline’s PhD findings,  https://vimeo.com/62327287.

This experimental piece considers issues around framing and managing vulnerability.  It draws on the narratives of mothers and health visitors to consider the most dominant ways in which vulnerability is couched through professional practice. In doing so, it aims to open up discussion about what it means to be vulnerable and the ways in which meaningful support can be provided.

To book a place at the seminar at CRFR in Edinburgh email Brenda Saetta. Places are funded and free to delegate but numbers are limited.