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Young, white, working class and breastfeeding in Leeds:

My influences, my choices.

About Womens Health Matters

Womens Health Matters (WHM) is an independent voluntary sector

organisation and a registered charity, run by women for women in

Leeds.

Established in 1987, the organisation prioritises work with women in

disadvantaged areas of the city and women who face additional

disadvantage because of race, disability, class or sexual orientation.

WHM is committed to a community development approach: an active

involvement of women in the issues which affect their lives which is

based on sharing power, skills, knowledge and experience. We give

women the opportunity to decide their own health priorities and create

their own solutions, to challenge inequalities and involve those who are

normally excluded from resources or service planning.

WHM believes it is essential to listen to the concerns of women and to

recognise that women are experts on their own bodies and health.

We believe that health is affected by many things and that emotional

wellbeing, social issues and physical health are equally important.

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Teenage Pregnancy work

Since 2001 Womens Health Matters has run the Include project which

provides one to one support with teenage mums and pregnant young

women. The project was initially funded by the Government as part of

their nationwide Sure Start Plus pilot programme.

This pilot was to see what impact one to one, individually planned

support would have on the outcomes for young mums and their children

with the aim to:

Improve the social and emotional wellbeing of pregnant young women, young parents and their children.

Strengthen the families and communities of pregnant young women and young parents.

Improve the learning of pregnant young women, young parents and their children.

Improve the health of pregnant young women, young parents and their children.

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Although this pilot scheme ended March 2006, the work in Leeds has

continued and is currently funded by Leeds City Council, Children’s

Services.

The project works city wide and supports on average 125 young women

each year.

Yums – Young mum’s group, Middleton

Womens Health Matters also runs the Yums group, a group for young

mums and pregnant young women in Middleton, South Leeds.

The group came about after some research carried out by the PCT

around breastfeeding and young white working class women, as part of

the city’s breastfeeding strategy in 2010.

The findings from this report showed that the main issue for this group

was isolation in their local community, that there wasn’t anywhere that

they could go to meet other young women in situations similar to their

own.

The outcome from this research was the creation of the Yums group, a

group to help mitigate the isolation experienced by so many of the young

women who took part in the initial research.

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The group is primarily a social group, aiming to overcome social isolation

and the problems that arise out of this isolation, with aims similar to

those already identified by the Include project:

Improving the social and emotional wellbeing of pregnant young women, young parents and their children.

Strengthening the families and communities of pregnant young women and young parents.

Improving the health of pregnant young women, young parents and their children – including promoting the positive message of breastfeeding to the attendees

Improving the learning of pregnant young women, young parents and their children

Alongside this, the group provides support, education and advice on issues

that the group members identify as wanting support with. It also seeks to

strengthen the young women’s relationships with other professionals they

come across such as health visitors, doctors, careers advice etc.

The group is a breastfeeding friendly environment, and there have been a

number of group members who have breastfed within the group. There

have been several young women who have done “extended feeding” with

their children, feeding until their children turned two years old.

What was the research about?

Research shows that the women most likely to decide to breastfeed their

babies are: Infant Feeding Survey, 2010 – NHS Information Centre

Age 30+,

From BME communities;

Those who stayed in education until at least age 18;

From managerial or professional occupations or living in the least

deprived areas.

The research was to focus on what were the factors which led to those

young women who were outside of these demographics to decide to

breastfeed as opposed to bottle feed their babies, with the hope of

finding common factors which could be used to support and encourage

other young women to think about breastfeeding in future.

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Method:

As Womens Health Matters already had contact and a relationship with

young, white working class mums from South Leeds through the Yums

group, these young women formed the basis of the research.

The young women who attend the group were initially given

questionnaires about their influences around their feeding choices; those

who breastfed were given one questionnaire and those who bottle fed

were given another.

The young women who mix fed were also given the breastfeeding form

as the research was around choosing to breastfeed and not exclusivity

of breast feeding.

We asked similar questions to both sets of young women so that we

could compare and contrast backgrounds, experience, support and

opinions.

As well as completing the questionnaires, the young women were invited

to attend one of two sessions at Womens Health Matters so that some of

these questions could be investigated further with the hope of gaining a

deeper understanding of their influences through discussion.

At the sessions, the young women were invited to be filmed, one to one,

to delve further into their opinions, influences and thoughts around

breastfeeding.

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Why breastfeed?

Leeds has just launched its citywide breastfeeding strategy, “Food for

Life 2010 – 2015”, with the aim of “increasing the numbers of mothers

choosing, initiating and continuing to breastfeed, and to further develop

the services, culture and environment in Leeds to fully support parents to

breastfeed their babies”. It is understood that increasing initiation of

breastfeeding is the first step in improving the health and wellbeing of

mothers and babies and reducing health inequalities across the city.

There is much worldwide research that shows that breastfeeding is good

for mother’s and child’s health (NHS, Infant Feeding Profiles, 2010 – 11)

with many benefits, including:

Less chance of diarrhoea and vomiting for baby,

Antibodies in breast milk are good for the baby’s immune system

and so can provide protection from infectious diseases

Less chance of baby developing eczema.

Fewer chest and ear infections and having to go to hospital as a result

Breastfeeding is free

Breastfeeding is convenient

Breast milk is always at the right temperature for baby and is

constantly adapting to meet baby’s needs

Breastfeeding burns around 500 calories a day

Breastfeeding lowers a woman’s chance of getting ovarian and

breast cancer

Breastfeeding can help deepen the bond between mother and

baby

Breastfeeding can delay the return of a woman’s period

Long term, breastfeeding has been seen to reduce the incidence

of obesity in later life

Everyone knows about the benefits breastfeeding. Expectant mothers

are given this information throughout their pregnancy by all the health

professionals they will meet. The message is loud and clear.

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Even famous women are now shouting loud and proud about their own

breastfeeding - Pink, Beyonce, Kate Middleton, Gwen Stefani, Angelina

Jolie breastfed her twins. They have all spoken publicly about their pride

in breastfeeding their children.

So, if some of the world’s most successful and visible women in the

world are telling us how amazing breastfeeding is, how come they aren’t

convincing young women to breastfeed too? If there’s one thing that

people feel about young people, it’s that they are susceptible to being

influenced by what they see in the media – advertising, music videos,

and celebrity’s life styles. And yet the thing they seem not to be taking

up, despite the proliferation of messages and now images of the famous

breastfeeding, is breastfeeding.

Whilst much research is carried out on a negative outcome i.e. why don’t

younger mums breastfeed, it was felt that it might more useful to ask

why some young women break with convention and expectation and

instead choose to breastfeed.

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Breastfeeding rates in England, the region and Leeds

The rates for initiation of breastfeeding across England have risen

overall, rising from 66.2% in 2005/06 to 73.9% in quarter 4 of 2012/2013.

This rise hasn’t been completely straight forward however, with rates

also falling over this period, hitting a high of 74.3% in quarter 1 of

2011/12 The rates have stayed resolutely in the low 70s (Department of

Health, Indicators on Breastfeeding).

However, these figures hide a much more complicated story of

breastfeeding rates across England, and with huge differences among

the different demographic groups.

In 2007/08, the initiation of breastfeeding rates across England was

71.7% with Yorkshire and the Humber’s rates falling below the average

at 68.8%. Within that Leeds fell even further below the average at

64.2%, the average for the region being brought up by Calderdale and

Sheffield at 76.6% and 74.1% respectively. Out of the fourteen areas

within the region, Leeds ranked sixth, with Rotherham at the bottom at

just 48.1%

By 2012/13 Leeds rates had increased a little to 68.2%, but once again,

this wasn’t a linear rise and the rates between these periods had risen

as high as 72.2% in 2010/11, just a little behind the rate for England as a

whole at 73.7%

The NHS produces a report on Infant Feeding every five years, the last

one dated 2010.This report found that the highest rates of breastfeeding

were among:

Mother’s aged 30 + 87%

BME communities:

Chinese and other ethnicities 97%

Black 96%

Asian 95%

Those who stayed in education until at least age 18 91%

Those in managerial or professional occupations 90%

Those living in the least deprived areas 89%

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So where do these statistics leave white, working class teenage mums?

Based on the above statistics, these mothers are those who would be

least expected to initiate breastfeeding.

Middleton and South Leeds

The majority of the young women who were involved with the research

currently live in Middleton (LS10). Those who don’t live in Middleton live

in the adjacent areas of Belle Isle and Beeston. They all had their first

babies between the ages of 15 and 20.

Although not all of the young women were brought up in this area, they

all now live there with their children.

Most houses in Middleton are in the lowest-rated Council Tax bands A and B.

In April 2012, 1493 people were claiming Jobseekers Allowance which at 8.3% was nearly double the Leeds' average. *

Of the 10,649 households in Middleton, 1,201 are households with dependent children and no adult in employment, which is almost 1 in 9 households *

Of the 1,410 of lone-parent households with dependent children in the area, most were women (1,307) and most had no job **

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In 2012, at the Foundation Stage (3 to 5 years) 51.6% of children have a good level of achievement

By the end of Key Stage 2 (11 years) 69.6% of pupils achieved Level 4 or better.

However by the age of 16, this had dropped to 32.8% of pupils achieving five or more A-C grades including English and Maths in GCSEs - this is lower than the Leeds average of 53.4%

In secondary education, 16.5% of pupils are persistent absentees missing 15% or more sessions during the school year and 12.4% of 16 – 18-year olds are not in employment, education or training ***

* Leeds Profile (Wards & Administrative Areas) Selection: Middleton Park Ward Geo-type:

2004 Wards

** Office for National Statistics, Neighbourhood Profiles, Middleton Ward

*** Education & Skills, West Yorkshire Observatory

In 2008/09 the LS10 area of Leeds had the second lowest rate of

breastfeeding initiation across the city, which is in keeping with areas of

low breastfeeding rates being in the areas of highest deprivation (Leeds

Breastfeeding Strategy, Food for Life).

Given all this information, statistically, the young mums in the area are

very unlikely to decide to breastfeed their children.

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Research Method:

The questionnaires were designed to ascertain:

Who were the main sources of influence around feeding choices

What experience they had of seeing people around them

breastfeeding when they were growing up

What images of breastfeeding they saw – in the media, in

campaigns etc

What part the attitude of professionals played in their decision

making

What support they were offered and what difference this might

have made

If anything they have seen or heard since having their children

may influence their choice of feeding for subsequent children.

16 questionnaires were given out – 7 breastfeeding forms and 9

bottle feeding forms

6 bottle feeding mums attended the session and 7 breastfeeding

mums.

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Findings: What the young women told us

Decision Time

We grow up in a world where dolls are given to little girls to play with,

complete with bottles for feeding. Play is a recognised source of

socialisation, and teaches us much about the rules of the world and the

way our society works. However, hopefully as we grow and learn, we

are exposed to new experiences which can change and influence some

of these early set ideas. Of the seven young women who breastfed,

three of them decided during their pregnancies to breastfeed, four had

always thought that they would breastfeed their children when they had

them.

Five never considered bottle feeding as a way of feeding their children;

they only considered breastfeeding when thinking about feeding their

children.

They wanted to breastfeed their babies because:

“It felt natural”

“Saw people at Yums breastfeeding”

“Nobody around me did, I wanted to be different, be the first”

“Sister did it, had discussions with her”

“Mum did it, she knew what to do”

“It was cheaper!”

“Health benefits for me and baby”

“Empowerment”

“Didn’t want to have to bother with bottles”

“Everyone in my family breastfed, it was just normal, it would have

been weird if I didn’t”

“I was breastfed, I wanted the same for my baby”

“I wanted to make my mum proud”

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Of the seven young women who attended the formula feeding session,

five of them had wanted to breastfeed their children and only decided to

formula feed after they had their babies. The reason they changed was

because:

Baby born premature, baby was fed NutriPrem formula through a

tube, breastfeeding wasn’t an option. Some help with expressing

was given at the hospital.

“No help when I got home, I breastfed for three days then couldn’t

do it anymore”

“Baby didn’t latch on and there wasn’t anyone at home to help”

“Midwife wasn’t helpful”

“No milk – and no help with this”

“Really painful breasts and no one to help”

“I had to keep buzzing for help, I just gave up after a while”

Family Support

The levels of support felt by the young women from family, friends and

partners was generally very positive. Even in those situations where

there was no one previously in the home who had breastfed, there was a

lot of support and encouragement. There was an acknowledgment that

if a young woman’s own mother hadn’t breastfed herself, it made it

difficult for her to provide much information herself as she wouldn’t have

any personal experience to draw upon. However this didn’t stop them

from being “happy”, “supportive”, “encouraging,” “encourage me to carry

on,” “as supportive as they could be with the knowledge and experience

they had themselves”.

Whilst those partners who were around could sometimes feel left out,

“partner felt upset that he couldn’t be involved”, they still offered support

“but still supportive”.

When asked directly about who (or what) had made an influence on

their decision to breastfeed, the people closest to them were cited as

being very influential, though supportive professionals also played their

part:

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“Mum, my family”

“Sister”

“Mum breastfed me until I was 3”

“Family Nurse Partnership was really good, I could text her if I

needed any help”

“I had a home birth, the Family Nurse helped with everything”

“Birth and Beyond class was great”

“Getting tips on how to feed under two tops so I didn’t show

anything!”

“From birth to 5 – useful, diagrams”

A number of the young women recognised that they really needed

continuity to have the chance to build a relationship with professionals

for the influence to work, so for those young women who kept seeing

different midwives, this never occurred.

In stark contrast to the young women who breastfed, none of the young

women who bottle fed felt like they had anyone supporting them with

their feeding choices, and they felt there was even the expectation that

they would bottle feed. They also mentioned issues like

Peer pressure

Cultural influences

Role as mum vs. role of girlfriend

Someone to help with feeds

Couldn’t take my baby into school with me

Didn’t want to stop going to work, going out, drinking coffee or

alcohol

Nowhere private at home to feed my baby

Given information when it was too late, hospital gave me information

when I was leaving the hospital after I’d had my baby

All of these issues could have been discussed by professionals had the

relationship been better and information provided as part of a discussion

rather than just being given leaflets.

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None of the young women who bottle fed had anyone at home who

breastfed, or knew of anyone who had breastfed and a number of them

said that the first time they had been around anyone who breastfed was

in the Yums group. They were surprised at how easy it looked, and after

initial embarrassment, how normal it seemed. It was nice to have

someone they could ask about breastfeeding, somewhere where it was

so open.

Images of breastfeeding and campaigns

We learn from what we see, and if we see images of women feeding

their babies in different ways, it hopefully opens up more options for

women to choose from. Three of the young women who breastfed had

never seen anyone around them breastfeeding. However, all except one

of these young women, said that they still were supported and

encouraged by the people around them, be it by family, friends or

professionals.

None of the young women recalled any specific breastfeeding

campaigns that they saw when they were in the decision stage. One

was aware of the baby cafe in her local area.

Of the young women who recalled seeing things in the media, one was

particularly struck by the negative images that she saw in the media –

stories about women being challenged for feeding in public; she found

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this very worrying and was really concerned that this might happen to

her, causing her anxiety when she had to go out in public and breastfeed

herself.

Another young woman made use of YouTube and pregnancy and

feeding blogs. She felt a part of an online community which was very

supportive and encouraging, and gave lots of really positive messages

and information. This is the same young woman who didn’t get any

support at home around breastfeeding, so for her this was a very

welcome source of information and support. She went on to breastfeed

both of her children.

Professionals and information

All the young women had conversations with the professionals they saw

during their pregnancies about breastfeeding. However, the quality of

this varied. Some reported midwifes simply asking if they were going to

breastfeed or not, appearing to only gather information instead of

providing discussion space to share information and advice about

breastfeeding.

The young women spoke of information being given in leaflet form which

were just handed over with a lot of other leaflets. Some professionals

didn’t go through the information in the leaflet to discuss the points or

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see if the young women had any questions. One young woman

explained that she struggled with reading and so leaflets were of no use

to her. Her midwife never asked her if she could read or needed any

help with reading any of the information she gave her.

They also stated that it was hard to remember specific leaflets that they

were given as they were given so many, and it was suggested that it

would have been better if the leaflets that were given were more tailored

to their individuals needs. So rather than just being given a big pile of

leaflets, to be given leaflets on issues that were relevant to them.

They used words like “bundles of leaflets”, “something with a lot of

reading involved” which then in turn became useless as a source of

information.

The one thing that did have a positive influence was the 0 – 5 booklet

that was given out.

The exception to this were the nurses from the Family Nurse Partnership

who gave helpful, individually relevant information about breastfeeding

throughout their contact with the young women. They appeared to be

much more proactive with information, engaging with an ongoing

dialogue rather than what felt like just asking the question for the sake of

it. They revisited the issue of breastfeeding at various points throughout

the pregnancies, which seemed to be a better way for the young women

to retain the information given.

One young woman mentioned the breastfeeding DVD, but didn’t feel this

was useful by itself, but if it had been watched with a professional, and

used as a tool for discussion, it might have been different.

Hospital Support:

The support given by the hospital at the time of birth can be invaluable.

It’s a really crucial time in breastfeeding, as a bad initial experience of

breastfeeding after birth can completely alter a mother’s choice of

feeding. Not only has a woman just given birth – a very physically and

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emotionally demanding experience, but she also has to really quickly

learn the fine art of breastfeeding. This can be the make or break time

for a woman in her choice of feeding her child.

One young woman had a very positive experience in the hospital with

breastfeeding support “every time I had trouble, they assisted and

showed me different techniques of feeding”. However, not everyone’s

experience was so positive. “The hospital weren’t very supportive, just

show their face now and again”, “I was given no support by the hospital

or the midwives/health visitor once home”, “no help at all, was left by the

midwives and did not offer any help”.

It was generally felt that the staff were more interested in supporting

those women on the wards who were statistically more likely to

breastfeed.

The young women admitted that they were hesitant to speak up and ask

for help when they needed it. They already felt judged by being

“teenage mums” not necessarily by the staff at the hospital, but in

general, which meant that they had very little confidence to ask for help.

The young woman who spoke glowingly about the staff at the hospital

didn’t feel that she had to ask for help, it was routinely offered. This

meant that she didn’t feel any stigma in getting help. When asked, the

young women said that regularly being offered help at the hospital, and

afterwards at home, would have made a huge difference to them,

instead of being expected to approach staff for help when it was

required.

It would have been helpful not only for the information and support but

also it would have improved their relationship with the midwives/hospital

staff which would have in turn increased their confidence to be able to

ask for help in the future by building a good, supportive relationship.

One young woman who had her first baby out of the area said that the

LGI was much better than where she had her first baby, and found the

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staff much more approachable. She is currently breastfeeding her

daughter, so this clearly made a difference.

None of the young women who bottle fed felt that there was any real

support provided when they were at the hospital. They were told to try it,

and then if you need help to ask. They would have liked someone to

show them and been more proactive in the support available. There

was a feeling again that the staff we more interested in helping and

supporting the other mums on the ward.

Barriers vs. Actual Problems:

The worries about breastfeeding that younger mums have are the same

as all mums, however young mothers have much less power and control

in their lives to overcome the problems, be they real or perceived

problems.

They were very concerned about:

Feeding in public – what would be people’s attitudes be?

That they would be tired after being up all night feeding

Felt weird about feeding in front of their friends – a change in their

status, now mothers and not just a teenage girl!

Feeding in front of grandma and granddad – young mums often

live with family and extended family rather than having their own

homes. There is less chance of privacy to get used to and be

confident about breastfeeding

And for them there was the added issue of not knowing other

young women who were breastfeeding.

A number of the young women said that they really wanted to talk

to other mums like themselves who were breastfeeding.

One young woman found her community of support from the

internet forums that she was part of, but generally it was the

isolation that was a problem for them.

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Once again, the actual problems were the same as all mums –

Positioning,

Attachment,

Latching,

Mastitis

Leakage

Finding somewhere in public they could feed

Partner felt neglected

Not being able to go anywhere, stuck at home breastfeeding

Ugly bras

People expecting us to bottle feed, being shocked when we

breastfed!

But the issue of isolation remained. They still didn’t know other young

women who were breastfeeding, so the source of support and

information that many other breastfeeding mothers rely upon - other

mums - wasn’t available to them.

The places that they got their support and advice from were:

Family and friends

Partner

Family Nurse

Baby café

YouTube

Yums – some said that they might have fed for longer had they

been able to access Yums (a breastfeeding friendly, young mums

group) sooner.

All the young women who breastfed in the Yums group talked about a

feeling of belonging and relief at finally finding somewhere not only could

they breastfeed their baby, but somewhere that they could meet other

mums like themselves (i.e. younger mums) who were breastfeeding.

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One of the young women did go to the local baby cafe and spoke very

highly of the support from the staff there. However, young mums have a

very different experience of being a mum, with attitudes of professionals

and other parents often being very negative. They all were very happy

to be somewhere where their situation and experiences were seen as

being “normal”.

All but one of the young women who breastfed their own babies would

recommend breastfeeding to other young mums, and indeed have done.

They said that they would tell them first and foremost that it is their

choice, but highlight the benefits for mum and baby and talk about their

own experiences – both good and bad so that they were more prepared.

They would tell them about the things that they really benefited from:

“The convenience”

“The bond, the closeness”

“Being your baby’s No.1”

“Health benefits”

“Can’t run out”

“Gave me energy”

“Your time with your baby”

“Weight loss”

“Save money”

“Comfort for baby”

“On tap”

All the young women felt that more support from professionals would

have made a huge difference to them. Those who had support from the

Family Nurse Partnership team all thought that this level of support

would make a big difference to the number of young mums who choose

to breastfeed, due to the ongoing, individually tailored support provided

by this project. They appreciated that any information that was given in

a leaflet was read through and discussed, so it was a tool for giving

information rather than just being the source of information. The leaflet

then became something that they could refer to at a later date if they

needed to and so provided some lasting benefit.

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The young women didn’t feel that they were given much information

about what support might be available to them in the community, so

whilst one young woman had a very positive experience of using the

baby cafes, the other young women said that they hadn’t been made

aware of the cafes themselves.

When asked what they felt would make an ideal support system they

said:

“Good relationship”

“Continuity of care from professionals”

“Information on discreet feeding”

“Someone to go through leaflets/info with you”

“Knowing there’s someone you can call”

“More groups like Yums”

“A good breastfeeding group where you felt welcome”

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Outcomes:

The key message coming from the young woman is that support and

accessible information are the most important factors when deciding to

breastfeeding.

Whilst for many young women, this information and support comes from

the family home, for those who don’t have this at home, professionals

play a vital role.

When planning breastfeeding support services for younger mums, the

following issues are key:

Timely information – keep discussion going throughout the

pregnancy

Discussion instead of relying on giving leaflets

Involve everyone in the home with the support and information

given so that they can offer support too

Information provided in an accessible format – don’t assume high

levels of reading ability

Leaflets can be used for giving information – but don’t just give

leaflets to share information, read through them together so that

they are understood and can then be referred back to

When designing leaflets, use plenty of images as well as text

Images of younger women breastfeeding to be used in

information and publications

Consistent support gives the chance to build good and positive

relationships with professionals

Proactive support – don’t just say help is available, offer it, take it

to the young women. Please don’t wait for young women to ask

for help.

Ask questions about the young women’s concerns or worries

More information about breastfeeding friendly places and baby

cafes

More information about discreet feeding

Advice on what partners and family members could do to help

when not helping with feeding to ensure inclusion

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Much more proactive support in the hospital, staff not to make

assumptions about young mum’s feeding choices. Don’t take a

lack of asking for help as a sign they aren’t interested, they may

just feel nervous about asking for help and support

Advice on other sources of information i.e. social media,

YouTube etc.

Referrals to young parents groups so that they can find support

from other similar age parents

Learn from the Family Nurse Partnership model about the way

they engage with young women about breastfeeding

Young mums want what is best for their children in the same way that all

mothers do. However, because of their lack of confidence in dealing

with professionals or asking questions, they may not be as vocal in

asking for help and guidance as older mothers. This doesn’t mean that

they don’t have questions and that they aren’t interested in

breastfeeding their babies. The key to helping young women open up is

consistency and building up good relationships.

We need to offer more proactive services that don’t rely on initial contact

being made by the young women themselves. Due to many younger

mums living in the family home, it is a good idea to try and involve other

members of the household when discussing breastfeeding and support

as they may be their only other source of support. All but one of the

young women who didn’t breastfeed said that being in a group where

other young mums were breastfeeding has made a huge difference to

their feelings about breastfeeding. It has normalised it for them, and they

would try and breastfeed themselves if they have any more children.

Seeing breastfeeding at first hand, hearing about its benefits and being

more aware of the support available has made them feel that

breastfeeding is something that they can do too.