Typologies of postnatal support and breastfeeding at two months in the UK: Response to comments by Harpur & Haddon

We welcome the comments by Harpur and Haddon (2020) on our paper on the typologies of social support and its associations with breastfeeding at two months in a UK sample. We share their concerns around the under-acknowledged costs of breastfeeding, and the need for a truly family-centred approach to breastfeeding support. However, they are mistaken to assume we do not view breastfeeding problems as an important cost of breastfeeding: We explicitly comment on breastfeeding challenges within our paper, and such challenges are theoretically incorporated into the “costs of breastfeeding” following an evolutionary anthropological framework. They are also incorrect in their statement that we recommend breastfeeding promotion messages to wider family members. In fact, we outline in our manuscript that breastfeeding promotional messages can have negative consequences for mothers, and are unlikely to be supportive. What we do suggest is a family-centred approach that recognises that women interact with, and may be supported by, a wide range of individuals (including fathers and grandmothers); and the importance of taking a nuanced approach to support without assuming that all types of support necessarily leads to “more breastfeeding.” We hope our response is useful in clarifying the key points of our paper

Direct investment by stepfathers can mitigate effects on educational outcomes but does not improve behavioural difficulties

In contemporary developed populations, stepfather presence has been associated with detrimental effects on child development. However, the proximate mechanisms behind such effects are yet to be fully explored. From a behavioural ecological perspective, the negative effects associated with stepfathers may be due to the reduced quantity and quality of investments children receive within stepfather households. Here, we build on previous studies by investigating whether the effects of stepfather presence on child outcomes are driven by differences in maternal and partner (i.e., father or stepfather) direct investments. We use data from the Avon Longitudinal Study of Parents and Children to explore stepfather effects on children's educational achievement and behavioural difficulties at age 7. Our results indicate that, for educational achievement, stepfather effects are due to the lower levels of direct investments children receive. For behavioural difficulty, stepfather effects are due to multiple factors whereby stepfather presence is associated with greater difficulties independent of investment levels, and direct investments from stepfathers are ineffective. Our results suggest that the negative effects of stepfathers on child outcomes can be explained, in part, by the reduced quantity and the ineffectiveness of direct investments children receive from stepfathers. Furthermore, the effects of stepfather direct investments seem to vary between child outcomes. © 2014 The Authors

Teen Views on Adolescence: Findings from a One Day Workshop.

What is 'adolescence'? This is a question we put to 28 teenagers aged 14-18 this summer. On the 28th of June 2018, a group of teenagers and researchers came together at a workshop at UCL to share their views and opinions about what adolescence means to them. The result was a day of likely conversations, brilliant ideas and stimulating reflections. This summary report outlines the key views and opinions shared with us during the workshop, focusing on two themes: Meanings of 'Adolescence' and Communicating Adolescence

Communication Across Maternal Social Networks During England’s First National Lockdown and Its Association With Postnatal Depressive Symptoms

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother’s social network related to her experience of postnatal depressive symptoms during the first “lockdown” in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still “takes a village” to raise children in high-income populations and mothers are struggling in its absence

Allomaternal Investments and Child Outcomes in the United Kingdom

Due to the fact that human mothers often have multiple, vulnerable offspring with long periods of dependency, it is argued that mothers need assistance from allomothers to successfully provide and care for their children. Cross-cultural observations and quantitative research converge on support for the idea that mothers in high fertility, high mortality populations need assistance from other individuals for successful childrearing. It is also clear within the literature that there is variation across populations in terms of who matters: who provides the help, how they help, and how much impact they have on childrearing. The current thesis extends from previous studies by exploring the effects of allomothers on childrearing in a contemporary developed context: With economic development and the demographic transition, questions arise regarding the importance of allomothers for successful childrearing, and whether humans in these settings still operate as cooperative breeders. This thesis specifically focuses on quantitatively investigating the effects of fathers, stepfathers and grandparents on child development in the UK. First, using the Avon Longitudinal Study of Parents and Children, I investigate how direct investments from fathers and stepfathers affect multiple child outcomes. Second, using the UK Millennium Cohort Study, I investigate how direct and indirect investments from maternal and paternal grandparents affect parental investment levels, as well as multiple child outcomes. Taken together, my findings suggest that allomothers do indeed impact child development in the UK. However, the important allomothers seem to be those within the nuclear household. This is in contrast with many high-fertility, high mortality populations where grandmothers, especially maternal grandmothers, are often the most important allomothers regarding child survival, and fathers less so. Within its limits, the current thesis highlights who matters for childrearing in the UK today

The Support Provided to Young Carers in England

This lightning review suggests local authorities are failing to care for a substantial number of young carers. Many of the approximately 130,000 children who are missing out on support are likely to have substantial caring duties. This review poses questions for local authorities on their pathways for identifying, assessing and supporting young carers. In order to measure the prevalence of young carers known to local authorities, a survey was used to ask how many young carers were referred for an assessment, how many were assessed and deemed in need of support, and how many were in receipt of support in 2015/16

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

Background: Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0–5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers. / Methods: We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017–2018 retrospective online survey on social support and infant feeding. / Results: Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive. / Conclusions: Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK

The differential role of practical and emotional support in infant feeding experience in the UK.

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'