Best Fed BabiesRuth Campbell

Public Health Nutritionist

Area Profile

• North Hamilton/Blantyre Social Inclusion Partnership status April 1999, Community Regeneration April 2005

• 25% pupils eligible for FSM (SL 20%)• 38% pupils eligible for clothing grant

(SL 31%)• Unemployment rate 7.8% (SL 4.5%)

Baseline Health Indicators

• Low birth weight babies (<2.5kg) in area 11.1%, compared to 6.4% in Lanarkshire

• Breastfeeding rate at 6 weeks 12.4% in area, compared to 22.7% in Lanarkshire

Acheson Report: Inequalities in Health (1998)“We recommend further reductions

in poverty in women of childbearing age, expectant mothers, young children & older people should be made by increasing benefits in cash or in kind to them.”

Best Fed Babies• Partnership between SIP/Community

Regeneration, NHS Lanarkshire & Asda (2 stores), launched Oct ‘01

• Grocery vouchers provided to value of £50 per month for expectant mothers for maximum of 6 months

• If mother chooses to breastfeed, vouchers continue for additional 3 months

Best Fed Babies: The Aim

• To maximise the health potential for both mother & baby, addressing the social inequalities associated with low birth weight babies

Objectives• A reduction in the number of low birth

weight babies in the area• An increase in the number of women

breastfeeding in the area• An increased maternal awareness of the

factors influencing health in pregnancy• Client empowerment through informed

decision making

Best Fed Babies: The Process• Expectant mothers living in

designated area recruited at booking appointment with midwife, followed up postnatally by health visitor

• Info also collected on smoking, alcohol, medication/drugs

• Photographic ID card issued to be presented at checkout with vouchers

Best Fed Babies: The Process• Booklet containing information on

scheme, healthy eating, smoking cessation services, breastfeeding support groups & Community Mothers peer support programme

• ‘Healthy eating’ groceries emphasised (no alcohol, tobacco, clothing or audio/visual goods)

• Asda staff trained on scheme & to ‘police’ to a degree

Best Fed Babies: Post Natal• Notification of birth & feeding method

by midwife to regeneration office• If breastfeeding, 1st payment sent• Feeding update form at first visit by

health visitor which triggers 2nd payment

• Feeding update form at 6/8 weeks triggers 3rd payment

Best Fed Babies: To Date

• 1514 women on programme so far • 1358 births• 8.2% babies born with low birth

weight (compared to 11.1% in ’99)• 27.8% babies on programme

breastfed at 6 weeks v 21.6% in regen area (compared to 12.4% in ’99)

Evaluation of first year

• Quantitative: questionnaire sent to approx 200 mothers, 53% (n=93) response

• No. of children, shopping habits, food habits e.g. changes in food purchases, did these continue, impact on rest of family, feeding method, influences on chosen method, impact of vouchers on feeding decision

Evaluation: Qualitative

• Mothers: 4 focus groups (n=16) plus 10 face to face interviews

• Health professionals• Retailer• Health Development Officer

SIP/Regeneration Partnership

Survey FindingsThe Vouchers• 53% received vouchers antenatally, with

42% receiving them both antenatally & postnatally

• Vast majority received their vouchers each month (91%), with 90% reporting no problems in using them at the 2 stores

Shopping Habits• 92% already shopped at the 2 stores

Survey Findings: Eating Habits• Vast majority (99%) bought more of the

same foods (fruit & veg, followed by meat, dairy & fish)

• Just under two thirds bought less of same foods (sweets, chocolate, crisps, ready made, processed frozen meals)

• 43% added foods in (fruit, new “more expensive, healthier” foods they hadn’t tried before)

• Just over a third left some foods out (foods not allowed during pregnancy & crisps, sweets etc

Survey Findings: Eating Habits 2• Although positive changes to eating

habits made, some said they “always eat more fruit & veg when pregnant”

• 42% of mothers who had a previous pregnancy said they had changed their eating habits this time. The vouchers had allowed them to “afford more fresh fruit” & one mum wrote “If you have more money to spend on healthier foods, you’ll buy them”

Survey Findings: Eating Habits 3• 58% had continued with some of the food

changes since having their baby, although 24% had returned to their previous habit

• Just over half said others in the household had changed their eating habits during the scheme. Majority was husband/partner, although changes were also reported in children (32%) “the kids eat more fruit instead of crisps and sweets”

Survey Findings: Feeding Choice• 51% chose to breastfeed, within this

group, more were first time mothers• Main influence on feeding came from

midwife & previous experience• Availability of the vouchers influenced

22% of mothers• 46% of mothers who breastfed, did so

for up to 12 weeks• Of those who breastfed, almost all

would do again

Survey Findings: Overall EffectsMothers• Ability to eat healthier food, raised

awareness “It showed me how to choose the best foods for me & my family”, benefit to household budget

Health• Weight, sleep, less financial worries,

varied & higher quality diet

Survey Findings: Overall EffectsBaby• “Nourishment”, “goodness” while in the

womb• Effect as having delivered “a healthy

baby” which for many meant a good weight “As a result of the vouchers I think it made my daughter more healthier as I was 4 weeks early & she was 5lb 4oz”

Family• Financial boost, encouraging healthy

eating

Recommendations for further development• Improving targeting criteria• Empowering a healthy food culture• Fine tuning nutrition information for

mothers• Increasing scheme’s visibility in store• Developing breastfeeding• Beyond Best Fed Babies

Where are we now?• Means testing introduced Jan ’06• Broader ‘early intervention programme’

includes introduction of nutrition education to BFB, peer support for breastfeeding, breastfeeding support groups, healthy weaning initiative, Health promoting Nursery Award scheme

• Further evaluation planned summer/autumn