Laura J Brown writes about the results of her first PhD study.
We all know that “Breast is Best”, yet the UK has some of the lowest breastfeeding rates in the world. Our bottle-feeding culture makes successful breastfeeding very difficult for UK mums, perforating its way through many aspects of parenting advice and discourse, leaving women confused and inadequately supported to breastfeed their babies.
Breastfeeding is associated with so many health benefits, both for mother and baby, such as reduced cancer risk for mums and reduced infections for babies – but breastfeeding isn’t just good for individuals, it’s good for society too. One of the ways in which society benefits is through reduced expenditure on formula feeding products and the associated reduction in environmental costs imposed by their manufacture and distribution. Breastfeeding also reduces absenteeism as less time off is needed to care for sick infants and therefore also benefits the economy. It can also lead to reduced NHS costs due to its protection against infant hospital admissions. Breastfeeding is a societal issue – an issue we need to tackle together. UNICEF recently made a call to action, urging health ministers to create a supportive, enabling environment for women to breastfeed by removing the societal barriers to breastfeeding in the UK. My research looks at the subtler barriers behind these breastfeeding-specific barriers.
The Millennium Cohort Study follows around 19,000 babies born between 2000 and 2002 to find out information on almost every aspect of their lives. The data has been used by scientists to answer a whole range of research questions in health and the social sciences. Thinking about the links between breastfeeding, environmental quality and environmental perception, I was interested in data from the earlier sweeps of the study which took place when the millennium babies were 9 months and 3 years old. I combined mothers’ opinions about their neighbourhoods concerning both physical aspects such as levels of litter, and sociocultural aspects such as how safe they felt in their area to give an overall individualised score for environmental perception. Objective environmental quality was instead derived from observations made by independent neighbourhood assessors. Assessors walked along the street where each mother lived and noted the quality of the physical environment by checking for burnt out cars and graffiti and the like (and even the presence of dog mess on the pavement!), while also paying attention to more sociocultural aspects such as whether they could see anyone arguing or fighting on the street. These two indicators of environmental quality – one subjective, and one objective – were then put to the test to see whether they had any link with women’s breastfeeding behaviours.
I found that women’s chances of initiating and maintaining breastfeeding increased as their objective environmental quality increased. Even after controlling for infant and maternal characteristics, family socioeconomic status, larger-scale environmental factors (like ward-level deprivation and ethnic composition), for each unit increase in objective environmental quality, mothers were around 1.5 times more likely to initiate breastfeeding and around 10% less likely to stop breastfeeding sooner. Perception on the other hand, was only found to be important in low objective quality environments. But aren’t some women better able to protect themselves from the environment than others? Surely an individual’s resources as indicated by their socioeconomic status – their wealth, status and education – would be important in off-setting the impact of the local environment on their health and behaviour? I looked at this too and indeed, family socioeconomic status did buffer against low environmental quality, with those with higher income and higher job status being more likely to breastfeed. Ok, so higher socioeconomic status mothers seem to be relatively immune to environmental issues, but that also means that low socioeconomic status mothers are particularly vulnerable. We can see how women who live in dirty streets or where antisocial behaviour is rife, and who have low income, job status and education can experience a double jeopardy when it comes to breastfeeding.
But why does any of this matter? What is the point of knowing if or how aspects of the environment affect breastfeeding? Well, we live in a society that puts up so many barriers to breastfeeding as it is, something that UNICEF have made apparent in their recent call to action. But, if there are also barriers behind these breastfeeding-specific barriers, then there is a bigger problem. The good news is that we can focus on environmental interventions to help alleviate these barriers. Breastfeeding is such an emotional issue in this country, and with so many women giving up before they’d like to, it’s also important that we don’t just blame individuals. By focusing on environmental improvement, for example by cleaning up our streets and reducing pollution, we have the opportunity to improve environmental health with positive consequences for both mother and child – with a bonus positive impact for the rest of the neighbourhood too.