1. Unmet Needs: Breastfeeding Pilot Project Kim Fraser Breastfeeding Project Leader

2. Unmet Needs Pilot Project 3 NHS boards with highest deprivation Demonstrate a link with deprivation and health gain Evidence based Innovative, sustainable, partnership working

3. ‘ Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health and continue up to two years of age or beyond.’ (WHO 2003)

4. 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)

5. Breastfeeding by Postcode

6. Evidence Systematic Review NICE 2005 Successful interventions Include both antenatal and postnatal periods One to one interventions Need further evidence especially deprived areas

7. Evidence Baby’s age when stopped % who would have liked BF longer <1 week90 1-2 weeks93 2-6 weeks87 6 weeks-4 months69 4-6 months48 >6 months37 Source: Hamlyn et al 2002 Mothers Who Would Have Liked to Breastfeed Longer

8. Evidence : Variables Health care factors Partner and family support Lactation knowledge and understanding Workplace environment oYears of education oParity oAge oIncome Source: Higginson 2001

9. Evidence Use 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

10. Summary Evidence Mothers wishing to breastfeed longer Mothers wish more support Initiatives that cover both the antenatal and postnatal periods are more effective Use of healthcare assistants has been successful Some factors are modifiable

11. 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

12. 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

13. 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

14. 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

15. 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

16. Results ( July to December) Source ISD 2006 Source ISD May 2006

17. Results (July to March) 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

18. Breastfeeding in Tayside at 6-8 weeks Source ISD 2006

19. Results first 6 months

20. Results

22. 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

23. Qualitative data Focus Groups Breastfeeding Support Workers Midwives Health Visitors In-depth Interviews Mothers-12

24. 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

25. Future Integrate model into mainstream practice Expand throughout Tayside Disseminate information to other health board areas

26. 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.