Health Promotion in Breastfeeding

Introduction

BreastFeeding is referred to the action of feeding newborns and young children with milk from mother's breast. This is an important activity to be done as breast milk contains vital nutrients in proper proportions for baby to help them to be protected against sickness, allergies, diseases and others (Victora et al. 2016). In this assignment, history regarding the involvement of the UK government in breastfeeding and the rates of breastfeeding rate in the country is to be discussed. The health promotion concepts along with theories regarding Start4life Breastfeeding program is to be explained. A breastfeeding promotion plan for the local area is to be established and the process of its evaluation is to be described. For students seeking further support, resources like healthcare dissertation help can provide valuable guidance throughout this process.

Question 1:

Describing the history regarding involvement of the government in breastfeeding programs as a means of health promotion of mothers and babies in England

The contribution of the UK government to promote breastfeeding rates in the UK is seen to have a long history. The Baby Friendly Initiative (BFI) was initially launched by the UK government in 1994 which acted as framework for implementing best practices required by the NHS trust team for supporting breastfeeding among mothers. The best practice in framework was mentioned by delineating ten key steps to breastfeeding which are to be followed within healthcare environment so that effective promotion of the breastfeeding among the mothers is established (Fallon et al. 2019; unicef.org.uk, 2020). In 1998, this BFI is extended by the UK government to cover community healthcare services that is the Seven Point Plan for Protection, Support and Promotion of Breastfeeding in the community healthcare settings in the UK. This is done with the initiative to make each facility in the UK community offering maternity and newborn services be able to effectively improve breastfeeding rate among the mothers and babies in the UK (unicef.org.uk, 2020). The UK government further in 2006 with the help of the National Institution for Health and Clinical Excellence (NICE) ensured implementation of the UNICEF BFI in both the community as well as hospital healthcare settings. In addition, it ensured one of the six key main suggestions of the UNICEF BFI be implemented in the Clinical Postnatal Care Guidelines (NICE, 2006; unicef.org.uk, 2017). This is because BFI by the UNICEF was found to be clinically efficient and cost-effective intervention for improving the healthcare-related to breastfeeding. In 2008, the UK government later implemented second NICE guidelines regarding the management of nutrition of the mother, babies and pregnant women with the establishment of BFI in the healthcare settings (NICE, 2006). In 2006, the UK government to improve the breastfeeding rates in the UK developed the Breastfeeding Manifesto Coalition in the UK that was composed of more than forty organisations such as Obstetricians and Gynaecologists, Royal Colleges of Paediatrics and Child Health, General Practitioners and others. The inclusion of the organisations is done with the intention that the manifesto which mentions seven key objectives to be implemented for the different strategies and goals outlines in breastfeeding national strategies is supported by all the UK health professional for its success (breastfeedingmanifesto.org.uk, 2006).

The Breastfeeding Manifesto was an effective approach by the UK government to raise the rate of breastfeeding level in the UK as it has developed the objective through which inclusion of education for breastfeeding is to be made in the curriculum in nursery as well as in primary and secondary level. This is going to allow the young people while growing develop the idea regarding the benefits of breastfeeding of children in early years (breastfeedingmanifesto.org.uk, 2006). Thus, it would lead the young people while being adults and acting as mothers to be involved in breastfeeding their child, in turn, allowing improving the scenario of breastfeeding of babies in the UK. In 2013, the UK government is seen to publish a 14-page document named Accommodating Breastfeeding in the Workplace to inform regarding the laws and practices to be followed in the workplace to allow women breastfeed their child (maternityaction.org.uk, 2013). The development of the law was an effective approach by the UK government as it is seen that many working mothers due to lack of guidance and legislative support are unable to breastfeed their babies at the workplace. This, in turn, would often make the working mothers though start breastfeeding their babies but show inability to continue for long-term creating negative impact on the health management of the babies (maternityaction.org.uk, 2013). The UK government through the use of Equality Act 2010 have mentioned that no women are to be discriminated in any way for being involved publicly breastfeeding their babies (assets.publishing.service.gov.uk, 2010). It was an effective initiative by the government to improve breastfeeding rates as it allowed the mothers in the UK to be avoided by the public or cafe owners or others to move away or refuse or cover for breastfeeding of the babies. Thus, the mothers were made to feel free under the act to breastfeed their babies in the public. In the UK, the Public Health England (PHE) under the Delivering Better Oral Health mentions that breast milk is the main and only food to be provided to babies for nearly six months and the formula milk is to be introduced only after the six months as an alternative of the breast milk. In addition, it informs that babies are to be introduced to free-flow bottles at the age of six months and to be discouraged from drinking by use of bottles from 12 months of age (gov.uk, 2019). This indicates that the UK government has developed effective recommendations to be followed by the mothers to ensure they breastfeed their babies properly. However, wide differences and falling rates of breastfeeding in the UK are seen even after the effective involvement of the UK government to promote the act over the years.

As per recent reported released regarding breastfeeding in the UK in 2018, it is reported that one in ten mothers that equals to 42.7% breastfeed their babies till 6-8 weeks after birth. However, this rate of breastfeeding babies was 43.1% in 2015-16 and 43.8% in 2014-15 indicating there has been a fall in the breastfeeding rates at 6-8 weeks of the birth of the babies in the UK (unicef.org.uk, 2019). This indicates that there is fall in the breastfeeding rate among mothers who are dedicated to continue the action until six months as suggested by the WHO. In respect to local area considerations in the UK, it is revealed that 8 out of 10 babies in the Tower Hamlets region were breastfed till 6-8 weeks of their birth whereas only 1 in 5 babies that amount of 18.9% babies being breastfed by their mothers till 6-8 weeks of birth in Knowsley, Merseyside (theguardian.com, 2018). The Public Health England latest published data regarding breastfeeding from 66 communities informs that the percentage of breastfeeding at six to eight weeks of birth is 20.4% to 78.7% in different localities (assets.publishing.service.gov.uk, 2019). This informs that breastfeeding prevalence rates in the UK are still widely diverse in different areas and more effective contribution of the UK government is required to improve the situation.

Question 2:

Discussing health promotion concept and theories which influenced Start4life Breast-Feeding Campaign and discussing ways in which the strategy is to be communicated to stakeholder

The Start4Life Campaign is developed by the UK government to support the better initiation of life for the infants from their birth by offering healthcare professionals with available, concise information regarding the suggestion for breastfeeding, the effective introduction of solid foods as well as active play for the individuals. The campaign is targeted for pregnant women, new mothers and their partners along with the influencers and supporters such as the siblings, grandparents and others (nhs.uk, 2019). The Start4Life Campaign has been created by the government by considering health promotion theories and models such as Transtheoretical Model, Beattie’s Health Promotion Model, Tones and Tilford’s Health Promotion Model and Pender’s health promotion theory. The Transtheoretical Model is nature of behaviour change model which assess the readiness of individual to act regarding a certain behaviour and inform strategies or process to be followed for guiding the change in the behaviour of the individual (Ibrahim et al. 2017). Thus the UK government assessed the readiness of the UK women towards breastfeeding and identified that many of the new mothers and pregnant women are not ready to accept the approach. This is because it is found that they lack effective information regarding the way to breastfeed the new babies due to which the rates of breastfeeding in the country is also low. This is evident from the study of Fox et al. (2015) where it is informed that 80% of the women who mentioned to stop breastfeeding their babies even after initiating citied the cause of lack of education regarding the way to continue breastfeed and inappropriate support from the partners and society. In addition, it is found the family members and partners acting to provide support to the mothers in caring for the child lack information and education regarding the way breastfeeding if the child is to be supported till six months of the birth (Lok et al. 2017). This is evident as out of the 300 women surveyed by the Elizabeth Duff for writing her book, it was seen that 60% of them mentioned lack of support from the family and 80% mentioned pain and difficulty to breastfeed as the reason for withdrawal of breastfeeding the babies by the mothers (theguardian.com, 2016).

The Start4Life campaign then based on the assessment determined that their target group is to be not only mothers but also their family member and accordingly developed strategies such as educating all regarding the steps to be followed to breastfeed a baby and offer support to mothers. The Transtheoretical Model has six stages which include pre-contemplation, contemplation, preparation, action, maintenance and termination (Smith et al. 2018). In the pre-contemplation stage, the individuals do not show intention to show change in behaviour (Smith et al. 2018). During the initiation of Start4Life, the government found this nature of attitude and behaviour among the mothers where they were seen to avoid showing change to continue breastfeeding for their babies. In the contemplation stage, the people are made to recognise the problem in their behaviour and are lead to develop the intention to act for creating change (Silva et al. 2016). The Start4Life Campaign by following this stage initially tried to aware the hindrances caused as a result of lack of breastfeeding and the benefits to be faced by following it to make the individuals targeted through the campaign develop intention to create change in the behaviour. In the preparation stage, people develop the intention to make and actions are informed to them to be taken to create change in behaviour (Lyons et al. 2018). Thus, following this stage, the government in Start4Life campaign informed and educated the actions and strategies to be taken by the target individuals to prepare them to make change in behaviour. At the action stage, the people are seen to execute change in the behaviour based on information provided and in maintenance stage the actions are ensured to be sustained (Lyons et al. 2018). Thus, to follow the aspect of the stages, the continued education regarding breastfeeding to the new mothers and their supportive family members along with partners are provided online in the Start4Life campaign. Therefore, it is seen that Start4Life was developed based on the Transtheoretical model as it has followed the steps accordingly to frame and implement it. The Beattie's Health Promotion Model is also followed to develop Start4Life campaign. The Beattie’s Health Promotion Model mentions four activities to be followed to improve health conditions which are personal counselling, health persuasion, legal action and community development. The Health persuasion is done through proper delivery of information by maintaining continuity and commitment along with providing social proof to individuals to promote health (Whitehead, 2018). In Start4Life campaign, it is seen that the government provided various information regarding the way breastfeeding is to be done to persuade the target individual adopt the practices to breastfeed babies, in turn, acting to improve the growth and quality life of the babies.

The Tones and Tilford’s Health Promotion Model mentions that there are mainly two ways for promoting health which is development and implementation of health policy in public manner and providing health education to the people to make them empowered to take action in controlling their life in a better way (Deehan and Wylie, 2018). The Start4Life campaign is seen to have considered the second ideas provided by the model. This is evident as following the strategy they have developed educational initiatives with the help of different health professionals to inform target individuals regarding the way to manage and execute breastfeeding activity and access support regarding it from family members to ensure its successful completion of the babies till six months of birth. The Pender’s Health Promotion theory informs that for promoting health three areas are to be focused which is individual characteristics and experiences, behaviour outcomes and behaviour-specific cognition (Cangöl and Şahin, 2017). The Start4Life has been developed by following the theory as before its formation the individual characteristics and experiences of the target individuals which are new mothers and their family members are assessed to determine the way their subsequent actions regarding avoiding breastfeeding are showcased. The behaviour specific knowledge of the individuals is also assessed to determine the reason mothers are avoiding breastfeeding. On the basis of the information, the strategies in the campaign are developed to make change in behaviour of new mothers that are creating increased rates of breastfeeding. In the Start4Life campaign, the agencies of the government who are involved in the breast-feeding strategic campaign include Department of Health, Department of Education, National Health Services (NHS) and the Public Health England (PHE). The PHE in the initiative has the key role as they are allocated to manage run the program successfully so that overall rates of breastfeeding is increased within the UK which is presently at a concerning low level. They have the role ensure proper management of the health professionals along with have to determine all the sources are being properly used so that the target population can be influenced to make change in their behaviour and ensure the promotion of breastfeeding in the country (campaignresources.phe.gov.uk, 2019).

The Department of Health in the StartLife campaign has the role to provide proper funds required in its management. The health department of the UK also have a role in the campaign to monitor the success of the program and accordingly suggested PHE to make changes so that it can be accomplished (campaignresources.phe.gov.uk, 2019). The NHS has the role to provide support to PHE is making the information presented in the campaign to reach wider individuals in the country so that all the people within the population can be able to understand the importance of breastfeeding and get involved in the activity to promote the health of their infants (campaignresources.phe.gov.uk, 2019). The Department of Education has the role to support PHE to develop proper instructions and strategies in the right format so that they are able to effectively educate the target individuals to involve in breastfeeding and ensure quality health of their child as well as for themselves (campaignresources.phe.gov.uk, 2019). The audio-visual communication strategy is to be used in the community where a breast-feeding campaign is to be organised. The audio-visual communication is referred to making interaction by using sounds as well as visual component to provide information to the target individuals in a campaign (Grigsby et al. 2017). As mentioned by Adam et al. (2019), audio-visual communication strategy in health campaign assist to get effective attention of the target individuals or group. This is because visual images are seen to create lasting impact on the minds of the individuals making them easily remember the instructions provided regarding health issues. Thus, the use of audio-visual interaction would assist to educate the target group in the local community with the help of pictures regarding the way they are to hold their baby and position themselves so that breastfeeding can be done properly. The audio-visual instruction in healthcare helps to allow easy flow of information. This is because explanation of visual images and video with audio leads individuals to understand the true meaning of the information (Miranda and Chao, 2017). Thus, the audio-visual communication is to be used as it is going to assist the new mother understand easily the rules to be followed in breastfeeding along with their parameters and family members to understand the way they are to support the new mothers so that effective breastfeeding of the child can be established.

Question 3:

Planning a Breast Feeding Campaign in local authority and evaluating it

The rates of breastfeeding made by individuals differ by increasing statistics in different localities in the UK. The breastfeeding percentage of babies till 6-8 weeks of birth in Herefordshire is seen to be 58.1% whereas in Tower Hamlets it is 81.6%, Reading it is 61.8% and Oxfordshire it is 61% (towerhamletstogether.com, 2019). This indicates that the rates of breastfeeding in Herefordshire are quite low compared to other adjacent localities in the UK. As mentioned by Pérez‐Escamilla et al. (2016), breastfeeding helps the babies to avail the ideal nutrition required for their proper growth. This is because the colostrum present in the breast milk assists the digestive tract of the babies to get developed. However, in the Herefordshire, it is seen that lower breastfeeding rates are leading many babies in the locality to face gastrointestinal issues as their digestive tract is not able to be well-developed due to lack of intake of milk in early years of birth (herefordshireccg.nhs.uk, 2017). As argued by Zingone et al. (2017), breast milk is seen to contain high amount of immunoglobulin A (IgA) and other antibodies allowing the babies to gain improved immunity from diseases. This is because the antibodies present in the breast milk develops protective covering on the nose, throat and digestive system of the babies to protect them from diseases whose personal immunity system is still growing. However, the lower breastfeeding rates in Herefordshire is going to impact most of the babies to have hindered immunity, in turn, making them get easily affected by diseases.

The improved breastfeeding rates are seen to impact on proper regulation of the bodyweight of the babies as the required nutrition in the early years are effectively got by their babies through the intake of breast milk. This is because in the early years the babies are unable to have any solid food apart from milk to gain nutrition and maintain their weight (Prell and Koletzko, 2016). Thus, the lower breastfeeding rates in the Herefordshire may create weight issues among the babies as an impact. As commented by Cooklin et al. (2018), women who breastfeed mentions that they face back pain as they have remained in sitting position and hold the weight of the babies for longer time on each interval to feed them. Moreover, breastfeeding leads the mothers to face bruising on the breast as the babies during feeding may squeeze or pinch on them (Feenstra et al. 2018). In Herefordshire, though exact statistics are not available yet mothers are seen to report that issues faced due to breastfeeding such as back pain, bruising and cramping are leading them to continue the activity for longer time (herefordshireccg.nhs.uk, 2017). Therefore, a breastfeeding improvement for the locality is to be planned to resolve issues faced due to lower rates of breastfeeding among the babies and make new mothers more actively participate in the process by effective management of the negative impact experienced by them. The Health Promotion Campaign to be organised in Herefordshire has the key aim to improve the breastfeeding rates in the area for the better health condition of the babies and their mothers.

Topic: Increase Breastfeeding activity among new mothers to improve the baby's health

Target group: The target group for the campaign would be the new mothers who are involved or not involved in breastfeeding activity, pregnant women, the family members and partners of the new mothers and pregnant women who are intended to support them during caring of the babies.

Needs of the target group: The target group is needed to be made aware of the benefits of breastfeeding for the babies as well as themselves. They are also required to be informed regarding the steps to be followed to ensure proper breastfeeding. The new mothers are to be informed regarding the way they are to breastfeed the babies so that the negative impacts perceived by them on the body due to the activity can be properly managed and avoided.

Goals of the campaign

To inform steps to the target group regarding the way breastfeeding of the babies is to be properly made

To deliver data regarding the way issues in breastfeeding faced by new mothers for which they avoid the activity are to be resolved

To dispense knowledge regarding the way family members or partners can support new mothers in breastfeeding of the babies

To dispense information regarding the benefits of breastfeeding on the mother and the child

Resources needed for the Breastfeeding Campaign:

The successful accomplishment of the campaign would require resources such as visual images to explain the steps of breastfeeding, presentation of videos to explain the way to breastfeed and benefits related to it and leaflets which inform steps and benefits of breastfeeding to be provided to the new mothers. The visual images and videos are to be used for the campaign as it going to assist the target group effectively process the information in the brain making them aware regarding the way breastfeeding is to be made and its related benefits (Macnab and Mukisa, 2019).

Campaign Activity Method:

The Breastfeeding Campaign is to be organised by delivering the information through PowerPoint presentation of images and videos at the community centres. In addition, leaflets are to be provided to the target group so that they have written information about the benefits and impacts of breastfeeding as well as way to execute it can be delivered to them. This is because all the points mentioned in the campaign may not be able to be remembered by the target group which would make them face confusion. Therefore, presence of written information through leaflets would help to make refer it during need to ensure proper breastfeeding activities are performed by them as well as negative effects perceived to be faced due to the activity are avoided and controlled.

Agencies and Professionals to be involved in the campaign:

The campaign is to be organised with the help of local Clinical Commissioning Groups (CCGs), local healthcare council, health professionals and nurses, NHS and others. This is because in the way experienced individuals who are able to deliver appropriate information regarding breastfeeding in the campaign could be involved to ensure greater success of the activity.

Ways to examine the success of the Breastfeeding campaign

The evaluation of the Breastfeeding campaign is to be executed using different evaluation tools and techniques. The questionnaires are to be used for accessing feedback from the target group. The access of feedback regarding healthcare campaign from the target group is required as it assists the campaign organisers to have effective information regarding the strength and drawbacks of their actions (Davies, 2019). This is because respondents inform the aspects they liked and disliked in the campaign based on which the organisers would determine the changes to be made next to ensure better delivery of healthcare information. Therefore, by using questionnaire the feedback from the individuals in the target group in Breastfeeding campaign is to be gathered which are then to be analysed to evaluate the success of the campaign. The observation is another method to be used for evaluating the success of the campaign. In the process, the breastfeeding activities of the new mothers are to be monitored after the campaign in the locality to determine the number of them is influenced by the campaign to remain engaged in breastfeeding their babies above 6-8weeks from their birth. The interview of the target group before and after the campaign is to be organised to evaluate the success of the campaign. The benefit of using interview is that it allows the interviewer to understand the feelings and expressions of the respondents regarding a certain topic (McIsaac et al. 2017). Thus, the interview evaluation process is to be used as it is going to lead the organisers to understand to what extent the campaign was successful in changing the attitudes and beliefs of the target group to improve breastfeeding rates in the locality. In addition, the interview evaluation process would also help the organisers to examine the success of the modes of delivering the information in the campaign regarding breastfeeding. A survey is to be made before and after the execution of the campaign to evaluate its success. This is because through the survey it can be determine the number of new mothers involved in breastfeeding activities before and after the campaign. The more new mothers involved in breastfeeding after the campaign compared to the number availed before the beginning of the campaign would lead to evaluate that the campaign is successful as the rates of breastfeeding which the key aim of the campaign has been accomplished.

Conclusion

The UK government is seen over the years developed the Baby Friendly Initiative, National Institution for Health and Clinical Excellence (NICE), Breastfeeding Manifesto Coalition, Equality Act 2010, Public Health England (PHE) and others to improve the rates of breastfeeding. It is also seen that before the publication of the breastfeeding laws in the UK, many of the restaurant owners along with publics as well as managers at the workplace criticised and discriminated women for breastfeeding their babies in public or at home. The Transtheoretical Model, Beattie's Health Promotion Model, Tones and Tilford's Health Promotion Model and Pender’s health promotion theory are the theories and models that influenced the development of the Start4Life campaign. The audio-visual communication strategy is to be used for organising local campaign regarding breastfeeding. A plan regarding the development of campaign for improvement of breastfeeding in Herefordshire is to be developed and evaluation tools to be used for determining the success of the campaign include feedback assessment, survey, interview and observation.

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