Breastfeeding support groups in Ireland: a mixed methods investigation from a cultural historical activity theory perspective

Abstract

Background: Irish breastfeeding initiation rates remain the lowest in the OECD and few women are breastfeeding exclusively to six months. Breastfeeding support groups are deemed effective in promoting breastfeeding initiation and duration, but women’s views are not well reported with further research recommended to identify the most effective aspects of breastfeeding support. In Ireland support groups are facilitated by two main breastfeeding support groups (BSGs), La Leche League Ireland (LLL) and Cuidiú alongside smaller organisations such as Friends of Breastfeeding (FoBF). The Health Service Executive (HSE) also has BSGs run by Public Health Nurses (PHNs).

Aim: This study was designed to investigate the role and impact of BSGs from the mothers’ perspective. It also aimed to explore women’s experiences of BSGs and determine their knowledge and use of BSGs alongside assessing their Breastfeeding Self-Efficacy (BSE).

Methods: A Sequential Explanatory Mixed Methods Design is used along with Cultural Historical Activity Theory (CHAT) as the theoretical framework. Data collection took place using an online survey in July, 2015 at Phase 1 (N=978) and follow-up at Phase 2 in October, 2015 (Time 2, N=412). The survey included the BSES-SF and matched responses from Phase 1 and Phase 2 (N=232) to assess if BSE changed over time. Phase 3 included semi-structured interviews (N=15) and the data was analysed using thematic analysis.

Results/Findings: The majority of mothers first contact a BSG to ‘meet other mothers’ (n=247, 29.8%), not necessarily for a problem (n=196, 23.6%). They continue attending to ‘meet other mothers’ (34%), get support (33%), share experiences (25%), and help other mothers (24%) and considered knowledge of breastfeeding extremely important in breastfeeding counsellors (n-597, 71%). There was a small, positive correlation between current breastfeeding length and continuing to attend BSGs for ‘mothering support’, rs =.09, n=620, p=.025, and ‘help other mothers’ rs =.15, n=627, p < .01. Participants had high BSE at Phase 1 (58.1) which did not increase over time z=-1.296, p=.195, effect size (r=-0.06), however, there was a small, positive correlation between current breastfeeding length and BSE, rs =.24, n=722, p < .01.

This study demonstrates that BSGs assist in normalising mothers’ experiences in Ireland where they perceive a non-breastfeeding culture. Mothers felt duty bound to be role models and ‘pass on’ their knowledge and experiences to others. Taken together, findings highlight that BSGs provide a social outlet to meet other breastfeeding mothers and foster inclusion, with sharing of ‘food and refreshments’ extremely important. Personal breastfeeding experience and training is highly valued with health professionals perceived as having insufficient experience, training, and knowledge. Women interact with many formats of BSGs, transitioning from PHNs to voluntary BSGs. Key junctures in the breastfeeding ‘journey’ are supported by BSGs, such as returning to work. Online Breastfeeding support is highly utilised but supplements, rather than replaces, face-to-face BSGs and has its own complex ‘sub-culture’.

Conclusion: Mothers attend BSGs to ‘meet other mothers’ and enjoy the social aspect of sharing food and refreshments, along with experiences, which fosters inclusion and friendships. Skilled support and practical help from breastfeeding supporters can lead to mothers achieving, and exceeding, their own goals with supporters acting as role models and passing on their knowledge and experiences to others. Due to the perceived non-breastfeeding culture in Ireland, it is possible that women may need to be determined and highly self-efficacious, in order to meet their breastfeeding goals.