Rurality and Breastfeeding: What is the Relationship?

1. Rurality and Breastfeeding: What is the Relationship? Lucy Denvir StR Public Health NHS Dumfries and Galloway November 2011

2. Background • Evidence for positive health benefits of breastfeeding • Local interest in urban / rural health issues • National priority agenda (has been HEAT target) • Local priority – Breastfeeding Strategy

5. Aims • Explore and appraise current knowledge in this area • Analyse available relevant local data • Assess implications and provide any recommendations for policy, practice and future research

6. Literature Search • Ovid Medline database via ‘The Knowledge Network’ • English language articles 1999-2010 • Search terms: ‘breastfeeding and (urban or rural*)’ • 59 initial articles, 4 left after inclusion and exclusion criteria applied

7. Findings • Very limited transferable knowledge in this area - most studies based outside UK in developing countries • Whether urban or rural, important factors are: -Access to information, services and support -Targeting of areas with lowest rates -Whole community approach • Relationship with deprivation unclear

8. Data Methodology • Data from Child Health Systems Programme Pre-School System via ISD. • 3 years 07-08, 08-09, 09-10. • Dumfries and Galloway - 4463 cases. • Individual level data: 6-fold urban/rural indicator, SIMD 09 quintile, maternal age, feeding method first visit, feeding method 6-8 week review. • Analysis using SPSS.

9. Results • 6-Fold Urban/Rural Classification can be condensed into 2-Fold Categories 1-4 = Urban, 5 and 6 = Rural. • There are no areas in Urban/Rural category 1 (large urban) in D+G • Cross-tabulation and chi-square test for difference in proportions: Chi-square test results all had P-value <0.001 ie probability that these results due to chance is less than 1/1000

10. Urban Rural

13. Urban Rural

14. Urban Rural

15. Results so far! • Relationship between urban-rural indicator and feeding method at first visit and 6-8 week review – rural mothers more likely to breastfeed. • Relationship between deprivation and feeding method – most deprived SIMD 09 quintiles 1 and 2 least likely to breastfeed. • Relationship between maternal age and feeding method – mothers age >30 more likely to breastfeed.

16. Results contd BUT: • More rural mothers aged >40 and fewer aged <25. • Deprivation relationship less clear, biggest difference between SIMD 09 quintiles 2 and 3. So urban-rural mothers have a different age and deprivation profile – further analysis required!

17. Multiple Logistic Regression: • Cases with missing data excluded leaving 4030 for analysis • Reference categories: Youngest age group (<20 years) SIMD 09 Quintile 1 (most deprived) Urban/Rural category 2 (other urban areas)

21. Results • Maternal age and deprivation are significant and independent predictors of breastfeeding at first visit and 6-8 week review • Most marked increase in odds of breastfeeding in mothers age >30 and mothers in SIMD 09 quintile 4 • Odds of breastfeeding increased in rural category areas 5/6 in relation to urban areas • Some evidence of rurality as an independent and significant predictor of breastfeeding but this is less certain particularly at 6-8 week review

22. Conclusions • Good sample size, relatively accurate and complete data • Does not include other important variables eg educational attainment, parity • Some evidence that rurality may be an important predictor of breastfeeding independent of maternal age and deprivation • Breastfeeding determinants are complex and multifactorial and issues such as rural deprivation contribute to the difficulty in identifying vulnerable communities and individuals

23. Recommendations • Target areas with lowest rates • Flexible and individualised but whole community approach • Replicate study in other areas • Include analysis of other variables • More research on cultural, attitudinal and behavioural differences between urban and rural areas

24. Acknowledgements: Carolyn Hunter-Rowe (Snr Health Intelligence Analyst) Dr Andrew Carnon (CPHM) Claire Nolan (Information Analyst ISD) Thanks for listening! Any comments / questions? ☺