Exploring infant & young child feeding (IYCF) practices & perceptions in the London Borough of Tower Hamlets

Abstract

Introduction: The aim of the research was to gain a greater understanding of infant and young child feeding perceptions and practices in the London Borough of Tower Hamlets and the role of early years’ providers in supporting healthy feeding practices. The research was used to feed into ongoing commissioning and resource allocation priorities, taking into consideration continuing budget restrictions, to achieve nutrition outcomes through effective early years’ public health interventions.
 Methodology: A qualitative methodology was applied. The target groups were mothers with children under five years old, early years ‘service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. In total 18 focus group discussions, 36 interviews and 3 direct observation sessions were carried out with 144 participants across the borough.
 Findings: There was generally widespread knowledge that breastfeeding is best for infants, however, there was less clarity on the best time for introducing complementary food and drinks to infants. Mothers trust health providers for information, but most used the internet, family and friends for information as it was easier to access. Some mothers reported mixed messages, pain, and pressure from the media, families and friends as the main reasons for changing from exclusive breastfeeding to mixed feeding. Some mothers reported lack of support postnatally and inconsistent advice such as service providers giving mixed messages, especially regarding feeding in public, mixed feeding and when to introduce other fluids and foods. The borough’s infant and young child feeding support workers were valued, but not all mothers knew about the service. Certain groups, such as those with English as a second language, teenage mothers and mothers without childcare reported not using services routinely. 
 Conclusions: Following presentation of the key findings, and a discussion with early years’ service providers, the Tower Hamlets Public Health Division suggested practice changes which were adopted by the LBTH council. The council committed to continue supporting the Infant Feeding & Wellbeing Service (known as the Baby Feeding Service) to continue to improve infant and young child feeding practices. Health visitors are encouraged to use their new 3-4 month contact with post-natal mothers, in addition to the five mandated universal contacts, as an opportunity to offer nutrition support to mothers. The council also approved increased nutrition capacity within the Health Visiting and Public Health team. More information is now available on the Tower Hamlets website to support mothers with clear nutrition and infant feeding information with details of the many services mothers can access in the borough.

A qualitative analysis of factors influencing infant and young children feeding perceptions and practices, of working mothers, in London Borough of Ealing

“…McAndrew et al (2012) explored the reasons for the low breastfeeding rates, discovering that early breastfeeding termination was unplanned: 80% of mothers said they would prefer to continue breastfeeding for the first six months, often citing difficulty in feeding and lack of support. According to Keith et al (2019) the most common reasons for early breastfeeding termination reported by mothers were associated with the inability to latch on, pain, mixed messages, perceived inadequate milk supply, lack of support and going back to work. These findings supported the Infant Feeding Surveillance report (Infant Feeding Surveillance System, 2017), which revealed that early formula introduction was associated with concerns related to low milk supply, latching problems and medical complications.…”

“…These findings supported the Infant Feeding Surveillance report (Infant Feeding Surveillance System, 2017), which revealed that early formula introduction was associated with concerns related to low milk supply, latching problems and medical complications. Despite all health staff, in Tower Hamlets, being trained in the UNICEF Ten Steps for successful breastfeeding, Keith et al (2019) discovered many health workers gave incorrect messages, such as 'one bottle is ok', 'do not feed in public' and 'you do not have enough milk' to mothers. These mixed messages created confusion in mothers, resulting in early introduction of mixed feeding practices, which often led to early cessation of breastfeeding (Keith et al, 2019).…”

“…Despite all health staff, in Tower Hamlets, being trained in the UNICEF Ten Steps for successful breastfeeding, Keith et al (2019) discovered many health workers gave incorrect messages, such as 'one bottle is ok', 'do not feed in public' and 'you do not have enough milk' to mothers. These mixed messages created confusion in mothers, resulting in early introduction of mixed feeding practices, which often led to early cessation of breastfeeding (Keith et al, 2019). Mothers and health workers are not always aware that a newborn stomach capacity allows it to hold only 20 ml of fluid (Bergman, 2013).…”

“…Mothers and health workers are not always aware that a newborn stomach capacity allows it to hold only 20 ml of fluid (Bergman, 2013). Even when health workers support breastfeeding, the cuts in staffing and health resources in the last ten years in the UK have resulted in many supporting services being overly stretched, including community infant feeding support groups (Keith et al, 2019); language and service integration and coordination were also significant barriers. Although the UK does support the ILO's (International Labour Organization) guidance of four months of paid maternity leave, extending this to six months paid leave in most government roles, many mothers still need to return to work within this essential period.…”

“…Research in Tower Hamlets, in London, indicated that mothers were getting mixed messages regarding infant feeding from health workers and family members; mothers were also unsure who they should ask for support, as many local services had seen dramatic funding cuts in the last ten years (Keith et al, 2019). The provision of face-to-face support, from trained personnel, during the prenatal and postnatal period has been effective in helping mothers achieve their desired breastfeeding goals (Radzyminski and Callister, 2016;Keith et al, 2019).…”