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Breastfeeding shouldn’t face protest.
M-SUR/Shutterstock

Amy Brown, Swansea University

Health promotion messages rarely work when they simply tell people what to do. We all know what a healthy diet looks like, yet that knowledge doesn’t prevent us from ordering another takeaway. Instead our behaviour is driven by the environment in which we live: public attitudes, financial constraints, and support from others all affect our confidence and ability to act.

The same is true for breastfeeding. Despite increasing breastfeeding rates being a strategic priority globally, the involvement of many governments often only goes so far as unhelpful messages extolling women to breastfeed. These don’t work because they don’t change the environment in which women are trying to breastfeed. They might tell women breastfeeding is important but they don’t offer practical support, change negative public attitudes, or help women delay going back to work. All of this pushes many women to stop breastfeeding before they are ready.

Rather than focusing on telling women to breastfeed, governments must recognise their wider public health responsibility, and work to create an environment that actually supports breastfeeding. It shouldn’t be left to charities and volunteers alone. Support should be part and parcel of society – and implementing a new strategy is not as difficult as you might think.

1. Education and support

Good quality education, rather than simply a list of reasons why women should breastfeed, is key to success here. Before the birth, mothers should be offered information on how breastfeeding works, challenges that might arise and who they can get support from. Peer supporter schemes are a highly valued source of practical and emotional help for new mothers, but in many places are absent or have had their funding cut.

But this is not just about teaching mothers, ongoing breastfeeding education is crucial for all who support them, including GPs and childcare staff, so that women get consistent, high quality advice. However, this education is not much use unless staff are also given the time to work with mothers after birth.

2. Public acceptance

Breastfeeding promotion should not just target mothers, but the wider population. A mother may want to breastfeed but if those close to her do not understand why, or how to help, her experience will be more challenging.

Support from day one.
Tyler Olson/Shutterstock

The public need to know why it is important to support breastfeeding, and that it has legal protection too. Breastfeeding Welcome schemes – participating organisations display signs saying they are supportive of breastfeeding – can play an important role here to reassure mothers, and also send a strong signal to potential critics.

Public acceptance is not just an issue for adults: children should also learn about the breast, and its role in nutrition, health and reproduction, just as they would any other body part. Doing this would mean that the next generation would not even think to question breastfeeding.

3. Maternal legal rights

Countries, like Sweden, that have longer, well-paid maternity leave and flexible working rights also have the highest breastfeeding rates. However, in the UK for example, statutory maternity pay drops to just £140 a week after six weeks, and in the US it is non-existent – meaning many mothers return to work weeks after the birth.

When they return, many struggle to continue breastfeeding due to poor facilities – despite research showing that when women have private, paid breaks to express, this leads to continued breastfeeding and happier staff. Some simple changes here would not only enable women to breastfeed for longer, but show that society values mothering.

4. Mental health

Caring for a baby invariably leaves new mothers feeling exhausted. In many cultures, childcare is not down to one mother, but a whole village. However, in the West, new mothers are often isolated, lonely and exhausted, which can make breastfeeding feel insurmountable.

In the absence of a village, professional support is again vital. Research has shown that enabling health visitors to spend more time with new mothers, even just to simply talk about they are feeling, can help mothers’ mental health immensely. Community support networks are also vital, to reduce feelings of isolation, but these need encouragement to be set up and thrive.

5. Formula control

Formula milk is lifesaving for babies who cannot be breastfed but advertising these products is simply not necessary. Many of the claims made have already been challenged by health bodies as misleading or unnecessary – but numerous countries, including Britain, still need to stop companies from putting promotions out altogether.

In countries that have implemented these five elements, there have been clear increases in breastfeeding rates. In Norway, for example, both mothers and fathers have extended, well-paid leave after the birth, while laws are upheld, and adverts for infant formula are regulated. Brazil has had success too, following similar changes and investing in over 200 breast milk banks.

The ConversationWe are happy to invest in other health interventions – such as laws around smoking in public places and banning lead paint – so why not extend this public health approach to supporting how babies are fed? If we want to give women the best possible chance of breastfeeding, governments – not mothers – must take responsibility for creating an environment that supports, protects and enables them to do so.

Amy Brown, Associate Professor of Child Public Health, Swansea University

This article was originally published on The Conversation. Read the original article.

Media & childbirth in Nepal

Much of the academic literature about the mass  media,  ‘old’ (press, radio, television) or ‘new’ (Facebook, Twitter, Snapchat and the like) has focused on high-income countries.  There is a growing literature on the effect on aspects of health and health care of the media in low-income countries.  In an overview article published yesterday we looked at the media, health and health promotion in Nepal as a two-way process [1].  Health promoters need to media to get their messages across to their audiences.  Thus the media offer a vital outlet for health promotion advice and information . Both the general public and health care workers learn about health and medical issues through the mass media.For example,  the mass media are used to increase the uptake of antenatal care among women in rural Nepal [2], or women can get information through YouTube clips [3].

img_6447Much of the academic literature about the mass  media,  ‘old’ (press, radio, television) or ‘new’ (Facebook, Twitter, Snapchat and the like) has focused on high-income countries.  There is a growing literature on the effect on aspects of health and health care of the media in low-income countries.  In an overview article published yesterday we looked at the media, health and health promotion in Nepal as a two-way process [1].  Health promoters need to media to get their messages across to their audiences.  Thus the media offer a vital outlet for health promotion advice and information . Both the general public and health care workers learn about health and medical issues through the mass media.For example,  the mass media are used to increase the uptake of antenatal care among women in rural Nepal [2], or women can get information through YouTube clips [3].

Of course, we  are all aware that the media can misrepresent health issues, for example, mess up health statistics and exaggerate health scares. Such misrepresentation is partly through selective reporting and partly through sensationalising issues and focusing on negative effects. Our paper reminds health promoters (and health workers or policy makers) that good news is often ‘not’ interesting enough, they need something that will answer the most basic of questions that the media asks: Who? What? When? Where? Why? and How? Who is this story happening to? What has happened (the event)? Where has it taken place? Why is it happening now and how has this all come about. If health promoters can answer those questions going into any conversation with the media, then there is a chance that a reasonably factually correct stories will appear in the media.

jmmihs-2016We also remind the readers that many politicians are avid media followers, especially if they are named or their party is linked to a public health story. The same is true for multi-national corporations, large public bodies and charities working in the health field. Many such organisations keep a close eye on the media, not just the news, to keep track of how they are portrayed and perceived by the general public, potential customers and even suppliers. Those working in public health should be aware of this and use this knowledge when designing public health messages and campaigns.

 

References:

  1. van Teijlingen, E., Simkhada, P., Luce, A., Hundley, V. (2016) Media, Health and Health Promotion in Nepal, Journal of Manmohan Memorial Institute of Health Sciences 2(1): 70-75. http://www.nepjol.info/index.php/JMMIHS/article/view/15799/12744
  2. Acharya, D., Khanal, V., Singh, J.K., Adhikari, M., Gautam, S. (2015) Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal. BMC Research Notes 8:4–9 http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-1312-8
  3. Global Health Media Project (no date) Giving good care during labour (Nepali) – Childbirth Series https://www.youtube.com/watch?v=Jjb6mbzaU7Y

 

Presentation Prof. Vanora Hundley

Dr. Julie Roberts, Research Fellow at the University of Nottingham, leads a Wellcome Trust Seed Award on ‘Televising Childbirth: Understanding media impacts on perceptions of risk, women’s choices and health’. This project investigates the relationship between reality TV and women’s experiences of pregnancy and labour. The project brings together perspectives from midwifery, sociology, television studies and health humanities. It seeks the views of service users, activists and the media industry. The objective is to develop a new approach to questions about the role of TV in shaping women’s perceptions of risk, autonomy and choice during labour.wellcome-nottingham

As part of this project Prof. Vanora Hundley at University of Bournemouth (BU) will be speaking on Dec. 14th 2016 about ‘Changing the Narrative around Birth: Midwives Views of Working with the Media’. Prof. Hundley is a co-author on a study with colleagues at Bournemouth University and the University of Stirling with the title: “Is it realistic?” the portrayal of pregnancy and childbirth in the media’ [1]. luce-bmc-pregnancy-childbirthThe lead-author of this paper, Dr. Ann Luce is based in the Faculty of Media & Communication (BU), her co-authors Dr. Catherine Angell, Prof. Vanora Hundley, Prof. Edwin van Teijlingen and Dr. Marilyn Cash are all associated with the Faculty of Health & Social Sciences (BU), whilst Prof. Helen Cheyne is based at the University of Stirling. Previous publications around childbirth and the media by Prof. Hundley focused on fear in childbirth [2] and the question whether midwives need to engage more actively with the mass media [3].

 

References:

  1. Luce, A., Cash, M., Hundley, V., Cheyne, H., van Teijlingen, E., Angell, C. (2016) “Is it realistic?” the portrayal of pregnancy and childbirth in the media BMC Pregnancy & Childbirth 16: 40
  2. Hundley, V., Duff, E., Dewberry, J., Luce, A., van Teijlingen, E. (2014) Fear in childbirth: are the media responsible? MIDIRS Midwifery Digest 24(4): 444-447.
  3. Hundley, V., Luce, A., van Teijlingen, E. (2015) Do midwives need to be more media savvy? MIDIRS Midwifery Digest 25(1):5-10.

The sad media stories about childbirth

two headed boyThere are many types of childbirth stories in the media. We all have seen stories about celebrities’ pregnancies, stories about the first baby born on Christmas day, stories about breast-feeding mother being told to leave a restaurant or public transport. There are also more factual statistical stories about birth rates and improving maternal mortality ratios. Today I came across a story of a deformed baby being born in Nepal. The English-language daily paper The Himalayan Times in Nepal carried a story of a woman who gave birth to a baby with two heads at the Hanumannagar Health Post of Saptari district two days ago. Unfortunately, the paper gave the woman’s name and age so little respect for the mother’s privacy.

Saptari woman gives birth to two-headed baby boy

Prof. Edwin van Teijlingen
CMMPH, Bournemouth University

Interesting article in The Kathmandu Post today (31 July 2016)

Laxmi Tamang KTM POST 2016Laxmi Tamang makes a very good point in her article ‘Unkindest cut’ published in The Kathmandu Post (today 31 July 2016) about the lack of midwifery in Nepal. Midwifery is a profession independent from nursing, whereas nursing overwhelmingly deals with sick patients, midwifery deals with predominantly healthy pregnant women and women in labour. Pregnancy and childbirth are not an illness! We stated a few years ago that: ‘Nepal needs midwifery’ (see http://www.nepjol.info/index.php/JMMIHS/article/view/9907).

Nepal needs midwifery

Prof. Edwin Roland van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, UK

Fear in childbirth and the Media

My first post of this dedicated ‘Media & Midwifery’ WordPress site. It was established to address issues around the role and influence of the media on societal attitudes and views on pregnancy, childbirth and other issues around new mothers.  This site is hosted by students and staff based at Bournemouth University (UK).   The hosts include members of the Centre for Midwifery, Maternal & Perinatal Health and the Journalism & Communication Academic Group at Bournemouth University.

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