A grounded theory study to elicit the reasons why women who initiate breastfeeding do not access peer support provision. Situating self in a dichotomised discourse of infant feeding.

Abstract

Breastfeeding is recognised globally as an important health issue. The positive health outcomes for both mothers and babies associated with breastfeeding mean governments are keen to increase rates. One of the ways this has been attempted in the UK is via the establishment of peer support programmes. Uptake of this form of support is problematic however, and the aim of this study has been to construct, with participants, an integrated theory of non-access.

This study has explored the reasons why some women who initiate breastfeeding do not access local peer support provision. A constructionist grounded theory method was adopted and women, health professionals and peer supporters were interviewed in Cornwall, South West England. Thirteen women, fourteen peer supporters and six health professionals participated in twenty four semi-structured interviews. Open coding,constant comparison and focussed coding were used to analyse data and enable the construction of one core category and five main themes to explicate non access of peer support.

Dichotomies in the language pertaining to infant feeding were intertwined throughout the themes, requiring women to place themselves and their experiences within a divided landscape. A background of pressure, moral judgement and a dearth of breastfeeding knowledge form the core category, and the five main themes are situated within this milieu. The first main theme, ‘place and space of support’, explains how during the early postnatal period the group environment was not considered an appropriate place for support, and some women had stopped breastfeeding before they felt able to access a group environment. The second main theme, ‘one way or no way’, details the techno-medical rules-based model of breastfeeding adopted by many health professionals. Here breastfeeding is seen as a bodily function divorced from all social, familial and cultural concerns. Women anticipated that peer supporters would adopt the same model and this impacted upon access. The third main theme, ‘lack of clarity of aims and ethos’, outlines how health professionals and peer supporters lacked a clear sense of both the aims and the ethos of the service, and also of why women might like to access. The fourth main theme, ‘not like me’, explains how when women struggled to follow ‘the rules’ they often felt like ‘a failure’ and simultaneously viewed other women as ‘successes’, which inhibited access. The final theme, ‘practicalities’, explains how practical concerns like group timings and venues were considered to be less important factors in whether or not services are accessed.

Recommendations for practice include re-evaluation by the peer support service of its aims and underpinning values. Revised aims could be embedded and overtly articulated throughout the service. Health professionals could reflect anew upon their own approaches to support. The development of close working partnerships amongst health professionals and peer supporters and a re-consideration of the manner in which peer support is provided is suggested. Future research could include a study focusing on knowledge implementation in this area. An ethnographic study employing discourse analysis could facilitate both a better understanding of women’s support needs in the early postnatal period, and also insights into the verbal and non-verbal interactions that create feelings of pressure and judgement.