Informing breastfeeding policy, guidelines and training, as well as direct interventions to improve the experience for nursing mothers
Submitting InstitutionBournemouth University
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Nursing, Public Health and Health Services
Summary of the impact
Bournemouth University (BU) research into the obstacles to and
facilitators for breastfeeding has generated impacts for a wide range of
beneficiaries at a local, national and international level. Research has
influenced and informed policy and guidelines in the UK and Australia. It
has informed research-based training modules for midwives, lactation
consultants and other related professionals. The research-based online
resources produced by BU are regularly used by around 1,500 breastfeeding
mothers from across the globe every month. This level of breastfeeding
promotion and support presents an opportunity to improve individual
well-being, lessen health inequalities and reduce health care costs.
Breastfed babies experience fewer health problems during the first year
of life. No manufactured substitute equates to breast milk but in the UK
many infants never receive it. BU has been conducting both practice-driven
and theoretically-based research projects on breastfeeding since 1998.
Projects have examined the moral conflicts women go through, the value of
peer support, the effectiveness of current National Health Service (NHS)
policy and how midwives' and lactation consultants' practice can be
altered to better support breastfeeding mothers.
In 2003 Alexander (BU 2000 to present) undertook a research project to
evaluate the effectiveness of peer support groups for breastfeeding
mothers. The research team established a `Bosom Buddies' group in a
deprived area of Salisbury and ran a weekly drop-in centre attended by a
midwife and breast-feeding counsellor. Peer-supporters were trained. The
research showed the group was highly successful in supporting women to
continue to breast feed for at least six weeks following their first
attendance. In addition there was evidence of significant psycho-social
benefits including increased confidence and greater satisfaction with
their experience (P1). Further information about the effectiveness of the
group is detailed in the impact section. A similar evaluation was carried
out at the West Howe breastfeeding support group in Bournemouth at the
Sure Start Centre in 2005, with equally positive results.
By 2006, following a grant (G2), researchers were conducting extensive
qualitative research. They recorded detailed video interviews with 49
women about their breastfeeding experiences. The women were aged 19-40
years and came from a range of occupational, ethnic, religious and
regional backgrounds. Key themes were identified from the material,
including sore nipples, going home with a breastfed baby, dealing with
difficult times, cultural aspects of breastfeeding and breastfeeding and
working, among others. These themes were used to develop the breastfeeding
pages of HealthTalkOnline, as well as forming the basis for two subsequent
The material was used by Ryan (BU 2005-2010) to examine the `moral
process' women go through in relation to feeding their baby (P3). Moral
work refers to how and why we identify ourselves and justify our actions.
Four key areas were identified:
- Maintaining one's identity as a breastfeeding mother in society;
- Identifying oneself as and coping with being a new mother;
- Doing what is good for the baby;
- Educating others about the benefits of breastfeeding.
The purpose of this work was to understand and acknowledge the variety of
moral positions women find themselves when breastfeeding. This is in
contrast to the very limited positions of `success' or `failure' as set
out by the medical profession (P3).
In 2012 Taylor (BU 2005 to present) and Hutchings (BU 1985 to present)
evaluated how the videos of breastfeeding mothers' stories had impacted on
midwives' attitudes to breastfeeding (P5). Six key themes emerged which
have since informed professional development for midwives and lactation
consultants. The themes are as follows: Listening and learning from real
women's experiences; Generation of emotions; Acquisition of new knowledge
and learning; Reflection on practice; Promotion of independent learning;
Sharing learning and ideas with peers. The research found that listening
and learning from women's experiences of breastfeeding has the potential
to change midwives' attitudes towards breastfeeding (P5).
References to the research
P1. Alexander, J., Anderson, T., Grant, M., Sanghera, J. and
Jackson, D. (2003) An
evaluation of a support group for breast-feeding women in Salisbury, UK.
Midwifery, 19(3), 215-220. DOI:
P2. Ryan, K., Team, V., Alexander, J. and Faircloth, C. (In press)
Theorising breast milk expression. Medical Anthropology.
P3. Ryan, K., Bissell, P. and Alexander, J., (2010) Moral work in
women's narratives of breastfeeding. Social Science & Medicine,
70(6), 951-958. DOI:10.1016/j.socscimed.2009.11.023
P4. Ryan, K., Alexander, J. and Todres, L. (2011) Calling,
permission and fulfilment: The interembodied experience of breastfeeding.
Qualitative Health Research 21(6), 731-42. DOI:
P5. Taylor, A. and Hutchings, M. (2012) Using video narratives of
women's lived experience of breastfeeding in midwifery education:
exploring its impact on midwives' attitudes to breastfeeding. Maternal
and Child Nutrition 8(1), 88-10. DOI:
G1. April 2008-February 2010. Best Beginnings (Department of
Health for England, NHS Scotland, The Welsh Assembly Government, the
Health Promotion Agency of Northern Ireland and the Tedworth Charitable
Trust), Breastfeeding DVD Evaluation. £116,500.
G2. September 2005-May 2007. Bournemouth University Research
Capacity-Building Grant, HealthTalkOnline (DIPEx) module
on UK women's experiences of breastfeeding — qualitative research project
and web publication. £160,000.
Details of the impact
BU's work has benefited a range of research users on a local, national
and international scale. It has shaped breastfeeding policy and
guidelines, training for midwives and lactation consultants, and has been
applied to direct intervention for breastfeeding mothers through the
Policy and best practice guidelines
Internationally, BU's peer support research informed the Australian
Breastfeeding Association in their submission to the Parliamentary
Inquiry into the Health Benefits of Breastfeeding. When referencing
BU's research the report states: "It has been found that a large part of
the reason why women find peer-to-peer groups helpful is due to the
psychosocial support they provide, resulting in increased confidence in
breastfeeding for the women and greater satisfaction with their
breastfeeding experience" (R1). The Inquiry led to the Australian
National Breastfeeding Strategy 2010-2015, which is employing a
range of methods to contribute to improving the health, nutrition and
well-being of infants and the health and wellbeing of mothers by
protecting, promoting, supporting and monitoring breastfeeding (R2).
On a regional level NHS Devon and Devon County Council used the work in
their guidelines as recently as 2012. Best Practice for Breastfeeding
Peer Support was designed to show what a good quality, effective
breastfeeding peer support initiative should include, providing details of
the pitfalls and examples of best practice. BU's research formed part of
the evidence base for the benefits of peer support services (point 4.1) in
the section `Peer Support — The Evidence Base' (R3).
Improved practice for midwives, lactation consultants and other
One of the key findings from P5 was that listening to and learning from
women's experiences has the potential to change midwives' attitudes
towards breastfeeding. This acted as a trigger to promote midwives'
critical thinking around practice-based issues involving personal
reflection and self-awareness. The video narratives chronicled between
2005 and 2007 (G2) informed the development of two training units. Both
units are aimed at health professionals and peer support workers and
require participants to identify and reflect on their own attitudes
towards infant feeding, to enhance their understanding of breastfeeding
and encourage critical reflection on practice.
The first, Supporting Breastfeeding Mothers, is a distance
learning continuing professional development unit. Since its establishment
in 2010 it has been delivered to 27 midwives, nurses, health visitors and
other allied health professionals.
The second, BU Resource Package Infant Feeding (BURP), was originally
developed for Winchester and Eastleigh Healthcare NHS Trust in 2011. It
has since been sold to Princess Anne Hospital, Southampton for £7,500. An
estimated 600 staff are trained using this package. When compared with the
standard breastfeeding training course cost of £250 per staff member from
an external provider, this package saves an estimated £142,500 per NHS
Trust. A midwife at Princess Anne Hospital, Southampton, who completed the
unit in January 2013, confirms it is not just cheaper but is a very
effective learning tool. "I really do think it will help in practice," she
said. "I think it is a fantastic way to learn, read a bit, watch a bit, do
a few quizzes. Well done for all your hard work" (R4).
Improved experience for breastfeeding mothers
BU research has been providing direct support to breastfeeding mothers
via HealthTalkOnline; a website run by the charity Dipex and in
association with the University of Oxford. The site covers a wide range of
health issues and BU researchers used the video interviews and emerging
themes from G2 to compile and produce the breastfeeding pages (R5). The
website was selected as the best communications channel because it would
be accessible across the globe at all hours.
Since the pages were launched in 2007 the number of visitors has risen
steadily. In February 2013, the webmaster reported an average of 37,000
page views on BU's breastfeeding pages from 1,500 unique users each month
(R6). While it can be difficult to demonstrate how web use constitutes
impact, there is strong evidence that users are immersing themselves in
the content rather than simply browsing the pages with no effect.
HealthTalkOnline data shows 44% of page visits are for over three minutes,
with 8% over thirty minutes (R7).
The findings from Dipex's online evaluative questionnaire reinforce this
assertion. Results indicated that most users were very positive about the
quality and coverage of the information on the breastfeeding webpages.
Nearly all (97.4%) considered the webpages helpful. Most importantly
though, responses demonstrated changes in users' behaviour or attitudes,
with 7.7% of respondents deciding to continue breastfeeding or start
breastfeeding after visiting the HealthTalkOnline website (R8).
The HealthTalkOnline breastfeeding pages developed by BU are used across
the globe. Dipex's evaluative questionnaire showed the resource is used in
Australia, New Zealand, the USA and Canada (R8). Location information
taken from IP addresses shows over half of visitors are from overseas,
including South Africa, Philippines and India among other countries (R9).
These webpages are an invaluable resource for breastfeeding mothers
because they provide round the clock, consistent advice from an
evidence-based and trustworthy source. Unlike many evidence-based sources,
which make dry and sometimes difficult reading, the BU breastfeeding pages
on HealthTalkOnline present information through real relatable stories.
The website has an excellent reputation through its connection with the
University of Oxford. The continuity of the website medium means the
impact of this work will continue. This is one example of the longevity of
The BU team continue to study the obstacles to and facilitators for
breastfeeding and it is hoped that impacts will extend to further
beneficiaries in the future, improving the experience for breastfeeding
mothers and helping to achieve the best possible levels of care by
midwives and lactation consultants. As recently as September 2013, the
United Nations Children's Fund (UNICEF) drew from BU research in its Baby
Friendly Initiative standards (R10), which demonstrates the continuing
impacts arising from this work.
Sources to corroborate the impact
R1. Australian Breastfeeding Association. Parliamentary
Inquiry into the Health Benefits of Breastfeeding. 2007.
National Breastfeeding Strategy 2010-2015.
R3. Grant, M. and Ogden, M. Best
Practice for Breastfeeding Peer Support: A practical guide for those
purchasing breastfeeding support services. 2012.
R4. Midwife at Princess Anne Hospital, Southampton. Communication
by personal email, January 2013 (available on request).
R5. Credits to Bournemouth University staff and BU research listed
R6. Website statistics for HealthTalkOnline breastfeeding pages,
provided by DIPEx Webmaster. Communication by personal email, February
2012 (available on request).
R7. Graph showing monthly page impressions and page depth (time
spent) for HealthTalkOnline (available on request).
R8. Results of questionnaire assessing the impact of DIPEX
breastfeeding webpages presented to the Royal College of Midwives,
November 2013 (available on request).
R9. Graph showing location from IP addresses visiting
HealthTalkOnline (available on request).
evidence and rationale for the UNICEF UK Baby Friendly Initiative