Best Fed Babies Ruth Campbell Public Health Nutritionist

Area Profile North Hamilton/Blantyre Social Inclusion Partnership status April 1999, Community Regeneration April % 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, 1 st payment sent Feeding update form at first visit by health visitor which triggers 2 nd payment Feeding update form at 6/8 weeks triggers 3 rd 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 Findings The 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 hadnt 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, youll 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 Effects Mothers 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 Effects Baby 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 schemes 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