An exploratory analysis of enablers of exclusive breastfeeding in England: Positive deviance in practice

Abstract

BackgroundBreastfeeding is an impactful public health intervention, playing an important role in short and long-term infant health, cognitive development and maternal health, and reducing strain on health services. Worldwide, we are approaching the Global Nutrition Target of 50 percent of infants exclusively breastfed at six months. However, the rate in the United Kingdom is only one percent.ObjectiveThis research explored exclusive breastfeeding in England, through interviews with mothers who practiced positive deviance by exclusively breastfeeding, alongside midwives and breastfeeding advocates, who facilitated the practice, to inform future policy and practice change.MethodsA qualitative study was undertaken to explore exclusive breastfeeding practices and perceptions. Semi-structured face-to-face interviews took place with twelve mothers who had exclusively breastfed and two advocates; additionally, a focus group using participatory reflection tools was conducted with six midwives. Data were analysed using Reflexive Thematic Analysis, generating three themes and nine subthemes. Findings were analysed through a power lens.ResultsBreastfeeding does not have a prominent position in society, and an improved breastfeeding culture is essential. Support from professionals, peers and partners is instrumental in successful breastfeeding, as are the time and financial resources required. Maternal agency, a breastfeeding mindset and the ability to self-advocate are contributing factors, alongside transparent information on infant feeding.ConclusionsRobust maternity protection and increased marketing restrictions for the breast milk substitute industry are vital for increasing exclusive breastfeeding rates. Systemic support mechanisms and appropriate resourcing give power to the mother. Promotion of breastfeeding and availability of transparent information on infant feeding allows informed choices to be made and supports a breastfeeding mindset, enabling power within. A societal commitment to breastfeeding and an integrated breastfeeding culture is required to facilitate these changes, utilising the collective power of multiple actors and enabling factors. These elements are necessary for displacing commercial power and tackling ineffectual governance and leadership.