Influencing trends in breastfeeding: A critical examination of contemporary approaches to health promotion

The aim of this dissertation is to examine critically whether contemporary approaches to health promotion have the potential to influence trends in breastfeeding. A selection of data relating to the practice of breastfeeding and current health promotion activity, in conjunction with a literature review forms the basis for this analysis. A comprehensive understanding of the activity of breastfeeding is achieved by analysing the scientific evidence relating to breastfeeding, identifying the patterns of breastfeeding and determining the factors that affect the activity. This analysis provides the basis for further investigation. Using the WHO/Ottawa Charter (1986) framework of health promotion both the current concept of health promotion, and current health promotion activity are examined in relation to the practice of breastfeeding The analysis reveals that, paradoxically, fewer women are breastfeeding at a time when scientific evidence is increasingly supportive of breastfeeding. Social factors (such as work and family support), the availability of infant formula and inadequate health professional support have all affected breastfeeding trends. The issue of empowerment as the 'key principle' of all health promotion activity has important implications for the health promoter in that it requires him/her to work in a fundamentally different way. Examining the proposed strategies in the Ottawa Charter (1986) demonstrates that he/she needs different skills, while the implications that empowering strategies would not necessarily increase the number of women who breastfeed, when targets have been set to increase their number to 75%, provide an additional complication. The incongruity of the WHO linking targets to the Ottawa Charter (1986) when empowerment itself is not the measured goal, is identified as potentially damaging for health promotion in practice. In practice at both national and local level, although the current rhetoric of health promotion is used, there is little evidence that practice is empowering in its effect. As anticipated, the use of target setting appears to encourage a coercive as opposed to empowering approach with health professionals adhering more towards a traditional educational model of health promotion. At national level the 'unwillingness1 of government and the infant food manufacturers to create a more supportive environment for breastfeeding demonstrates their lack of commitment to the principle of empowerment, with evidence suggesting they would both contest the validity of the concept. At local level, one study identifies health promotion that is empowering. This demonstrates that breastfeeding trends can be influenced (4% increase in 3 years-Study in Hillingdon 1995). Nevertheless without a more supportive environment, by providing longer maternity leave and work placed nurseries, for example, it appears unlikely there will be a significant change in the trends. The need to measure health promotion activity through empowerment rather than the number of women who breastfeed could provide a more accurate assessment of health promotion activity, encouraging the health promoter to adopt more empowering strategies. Target setting, if it is necessary, needs to reflect empowerment with the trends in breastfeeding monitored. This would achieve a more comprehensive understanding of trends in breastfeeding and the influence of health promotion