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Abstract

Background: There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economicallydisadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions arerecommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services inareas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledgeabout the interaction between context and intervention and how this affects women’s experiences.Methods: This interpretive study used a case study methodology to explore how and why two BPS services developedtheir services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS servicedevelopment. Data collected across both cases comprised; observation (n = 1), and semi-structured interviews with:mothers who had (n = 10) and had not (n = 9) engaged with the BPS services, peer supporters (PSs) (n= 9), communityhealth professionals (n = 5), infant feeding co-ordinators (n = 2), non-profit organisation managers (n =3), and publichealth commissioners (n = 2). Inductive grounded theory analytic techniques of open coding and constant comparisons,followed by cross case comparisons, were used to analyse the data.Results: The over-arching theme - ‘the transcending influence of society’ – offers insights into the underlying context anddrivers impacting service development. It reflects how funding and data sharing arrangements determined serviceoperation and the peer’s access to women. Four underpinning themes explain how: peer supporters were resourceful inadapting their services (‘adapting and modifying the support’); BPS organisations worked to enable women’s access tosupportive breastfeeding environments, but did not necessarily focus service development on the needs of women livingin areas of deprivation (‘supporting women’s journeys to access’); the BPS-professional connections for supporting accessand how BPS could result in more supportive community environments (‘embedding within healthcare practice’); and howmanagement practices precluded meaningful use of data to provide context led service development (‘ways of usingknowledge’).Conclusions: Findings suggest that while PSs are commissioned to focus on those most in need, there is limiteddiscussion, collection, or use of knowledge about women’s lives to develop needs-led service delivery. The keyrecommendation is the development of a social ecological tool to facilitate the use and application of contextualknowledge.

DOI

10.1186/s12939-021-01393-7

Publication Date

2021-03-20

Publication Title

International Journal for Equity in Health

Volume

20

Issue

1

ISSN

1475-9276

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