Why are 'hard-to-reach' women not engaging in a breastfeeding peer support programme?

ABSTRACT Increasing breastfeeding rates is one way of reducing health inequality and breastfeeding peer support is seen an effective method to improve breastfeeding rates in low-income areas. Local quantitative data indicated a poor uptake of breastfeeding peer support in two deprived areas in a south-east London borough. This evaluation set out to investigate in more depth why the uptake was poor. Using semi-structured interviews, 11 women were interviewed, eight of whom declined the support and three embraced it. The findings indicate insurmountable barriers for the respondents in initiating and sustaining breastfeeding in a sometimes undermining formula-feeding community. They also show that early support and a good start were crucial for women to be able to withstand these barriers, with many women surreptitiously breastfeeding unbeknown to those caring for them. The respondents were wary of asking for help, knew little of the peer support programme, were distrustful as to what a peer supporter did and what she could do for them, and consequently some endured pain without recourse to support.