An exploration of how third sector breastfeeding support organisations have developed their services for delivery in areas of socio-economic deprivation

Inequalities in UK breastfeeding initiation and continuation rates exist whereby socio-economically advantaged mothers are most likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and consequently third sector breastfeeding organisations are commissioned to deliver UK BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, and a key evidential gap concerns understanding interaction between context and intervention. This study explored how and why these organisations have developed BPS services within socio-economically deprived contexts. The study was completed in two phases. During phase one an exercise was undertaken to establish background information about the four main UK breastfeeding organisations. Semi-structured interviews with BPS organisation strategists and representatives (n=7) were undertaken, complemented by a meta-synthesis of published literature. Phase two constituted case studies of two BPS services in different areas of deprivation in England. Semi-structured interviews were undertaken with: mothers who had (n=10) and had not engaged (n=9) with the BPS services, peer supporters (PSs) (n=9), community health professionals (n=5), infant feeding co-ordinators (n=2), third sector organisation managers (n=3), and public health commissioners (n=2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse data. One over-arching theme and four main themes were constructed. The over-arching theme ‘the transcending influence of society’ explains how the combination of funding availability and data sharing arrangements, determined service operation and PSs access to women. Although commissioners required that more support be given to the target group of women, this was not always achieved. The acceptability of the peer support role, operating at the individual, social group, and community levels was captured by ‘the role’ main theme. The second main theme, ‘access,’ concerns developments to improve the access of target women. The third main theme, ‘embedding’ describes the community-professional connections for supporting access. The final main theme, ‘service management’ captures issues of funding and the relationship with time, communication, and reporting. Findings suggest that organisational practices do not facilitate the discussion, collection, and use of contextual knowledge to inform ongoing development of BPS services. Recommendations include development of a theoretical tool to facilitate the use of contextual knowledge.