Evaluation of the Holding Time project, Cheshire and Merseyside 2022-23

Contents

1	Introduction	1.1	Breastfeeding: A global, national and local picture
2	The Holding Time project
3	Methodology	3.1	Aim
		3.2	Data collection
		3.3	Data analysis
		3.4	Ethical Approval
4	Findings
4.1	General Public	4.1.1	Knowledge of Holding Time project/reasons for attending
		4.1.2	Benefits for mothers attending the Holding Time project
		4.1.3	Influences of Holding Time on personal attitudes towards breastfeeding
		4.1.4	Influence of Holding Time on community towards breastfeeding
		4.1.5	How Holding Time can be improved in influencing breastfeeding
4.2	Mothers	4.2.1	Background to mothers who participated in Holding Time
		4.2.2	Mothers’ participation in Holding Time by stage
		4.2.3	Breastfeeding challenges experienced by mothers
		4.2.4	The impact of Covid and lockdowns on new mothers
		4.2.5	Taking part: an opportunity to share experiences in a unique setting
		4.2.6	Storytelling – cathartic and healing
		4.2.7	The interview – real stories of breastfeeding
		4.2.8	The portrait- a memory of my breastfeeding journey
		4.2.9	Attending the Open Eye Gallery – a unique event
		4.2.10	The impact of Holding Time – looking back
		4.2.11	Recommendations for future Holding Time projects
		4.2.12	Key messages from mothers participating in the Holding Time project
5	Recommendations
6	Conclusion
7	References
8	Appendix	1	Interview schedule general public
		2	Interview schedule mothers
		3	Social media analytics for Holding Time Cheshire and Merseyside

1. Introduction

1.1 Breastfeeding: A global, national and local picture

Breastfeeding has proven short and long term benefits to mothers, babies and the environment (Victora et al 2016), yet the recent Lancet 2023 Breastfeeding series https://www.thelancet.com/series/breastfeeding-2023 describes how less than 50% of babies are breastfed worldwide. The Lancet series also cites the aggressive marketing of formula milks as having a significant impact on the low numbers of babies being breastfed globally (https://www.thelancet.com/series/breastfeeding-2023) .

In England in 2021/22 72.3% of babies received breastmilk for their first feed, a decrease from 75% in 2019/2020. By 6-8 weeks 49.3% of babies received any breastmilk, a slight increase from 2019/20 (Nuffield Trust, 2023). Breastfeeding data for Cheshire and Merseyside is incomplete, however when broken down into wards, breastfeeding rates are lower at initiation feed and 6-8 weeks than the national average (ONS 2022). The National picture for exclusive breastfeeding at 6 months in England, advocated by the WHO (2018), is <1%.

Why mothers don’t initiate breastfeeding or discontinue one commenced is complex, and in the UK in particular it is influenced by socio-cultural, psychological, physical and political factors. In response to the decline in breastfeeding, various initiatives have been undertaken, notably the UNICEF Baby Friendly Initiative (BFI) https://www.unicef.org.uk/babyfriendly/ which aims to protect and promote breastfeeding, supporting pregnant women and mothers in their infant feeding decisions. In spite of efforts to drive up and improve breastfeeding rates, they continue to stagnate at best. In response to this, novel approaches to supporting and promoting breastfeeding are being sought, particularly those that focus on changing the socio-cultural narrative around breastfeeding, one of these key initiatives is ‘Holding Time’ which has been commissioned by NHS Cheshire and Merseyside’s Women’s Health and Maternity (WHaM) programme https://holdingtime.org/ to address these very issues

2. The Holding Time Project

Holding Time is a seven-year, ongoing socially – engaged Feminist art project produced by Lisa Creagh artist/director and a collective of freelance creatives.

Taking a holistic view of the interconnections of cultural, structural and physical/psychological barriers, the project is wide in scope and ambitious in aims. The aim is to understand and highlight the complexity of issues surrounding the low breastfeeding rates in the UK, by creating a platform for mothers with lived experience of infant feeding. Working closely with a core group of mothers, this cultural intervention celebrates breastfeeding-positive achievements, normalised infant feeding issues and is designed to be both educational and inspiring for the whole community who support new families locally.

Each iteration of the project begins with lead artist/producer approaching grassroots community groups, health practitioners and academics to form a small network in each area. In the Cheshire and Merseyside project, the Collaborative Research group created by Liverpool University School of Psychology provided a useful propagation opportunity and an initial presentation to representatives from Improving Me, Public Health, Bambis Infant Feeding team was the starting point of the project in January 2020.

Improving Me, Cheshire & Merseyside’s Women’s Health and Maternity – a group of 27 organisations dedicated to raising health outcomes for women in the area –  provided funding for the project and this initial investment was doubled by the Holding Time Project lead, enabling a two year project to develop across multiple channels, attracting many new partners and future collaborations for both organisations. These included Northern Rail, National Museums Liverpool, The Liverpool Foundation Hospital Trust, John Lewis, both cathedrals, BBC Merseyside, Liverpool Libraries, Writewell and others.

Other innovative local projects, such as Cradle to Career in Birkenhead were consulted in the initial stages. Leading researchers in PND/postnatal anxiety and infant feeding issues at Liverpool University and researchers in the faculty of Health at Wolverhampton, helped to draw up and gain ethical approval for the project.

A core group of 20 mothers were recruited via the local infant feeding teams, grassroots networks such as Koalas, Maternity Voices and the Holding Time social media manager  – the project used a social media campaign to target new mothers who were least likely to breastfeed in the area. This was determined by the academics and health professionals to be White British/young and working class. The cohort of mothers was assessed by postcode to check that it was demographically representative of the area.

Mothers were invited initially to participate in ‘Storytelling Workshops’ with the writing workshop lead from Creative Lives. These culminated in a live event at Open Eye Gallery, and a broadcast on BBC Radio Merseyside.

Video interviews and portrait photographs created with the lead artist, resulted in a bank of imagery, audio and transcripts which were then formed into podcasts, VLOGS, animated installations and social media flags. Working across multiple digital channels – a project website with BLOG, social media blasts for key awareness dates, a steady flow of Youtube releases – the work is widely disseminated and receives a steadily building audience of approximately 5 – 10,000 per month.

Exhibitions, an ‘Audio Tour’ of mothers’ portraits/narratives across Liverpool and various live events further amplify and build awareness of the project across sixteen cultural, community and health venues including the Tate Gallery, the Cathedrals, local museums, hospitals and libraries.

3. Methodology

3.1 Aim

The aim of this evaluation was to explore the impact of the Holding Time Breastfeeding project on participating mothers from Cheshire and Merseyside and the general public. The evaluation was undertaken between the months of October 2022 and February 2023 with Liverpool John Moores University (LJMU) commissioned to undertake the evaluation.

3.2 Data Collection

The aim of this evaluation was to explore the impact of the Holding Time Breastfeeding project on participating mothers from Cheshire and Merseyside and the general public. The evaluation was undertaken between the months of October 2022 and February 2023 with Liverpool John Moores University (LJMU) commissioned to undertake the evaluation.

3.3 Data Analysis

Quantitative data was analysed numerically and displayed in tabular format. Qualitative data was analysed using a thematic analysis which looks for patterns to form themes. Findings were presented using verbatim comments and a word cloud. Where possible local and national benchmark data was used to compare with the Holding Time project data.

3.4 Ethical Approval

Ethical approval was applied for and gained from Liverpool John Moores University; UREC reference: 22/NAH/039

4. Findings

The following section presents the findings from the evaluation of the Holding Time project with both the general public and participants.

4.1 General Public

A data capture exercise was undertaken in November 2022 during the Holding Time portrait launch at the Open Eye Gallery, Liverpool. Two researchers from LJMU undertook opportunistic snap shot interviews (lasting up to 15 minutes) with members of the general public who were in attendance at the gallery during the launch and who had visited the Holding Time exhibition. Twenty members of the public were interviewed using an interview schedule developed by the research team and the Holding Time project lead (appendix 1). Those interviewed were mainly: white British, worked in ONS occupation groups 1-3, identified as female, were aged between 20-39 and from the North West (see table 1 for demographics).

4.1.1. Knowledge of Holding Time project/reasons for attending

Half (10) of these interviewed had no knowledge of the Holding Time project and were either ‘passing through’ or attended the gallery regularly. They indicated that they were interested in art galleries per se and were keen to see any exhibitions that were currently showing, in essence they were exposed to Holding Time opportunistically.

Nine interviewees were invited to the event as they were either friends, relatives, or partners of the Holding Time participants.One interviewee had seen the event advertised through their local Maternity Voice Partnership. The interviewees described their reasons for attending as;

wanting to see Holding Time in action, in its entirety’ (Aunty)

‘to see people’s reactions, to be involved’ (grandmother)

‘to show how proud I am of her’ (partner)

Table 1: General Public Demographic

Demographic	Classification	N=20
Gender	Male	5
	Female	15
Age	0-19	0
	20-29	7
	30-39	8
	40-49	1
	50-59	2
	60-69	1
	70+	1
Ethnic Group	White	15
	Mixed/Multiple Ethic Groups	3
	Asian/Asian British	2
	Black/African/Caribbean	0
	Black British	0
	Chinese	0
Postcode	Northwest	17
	West Midlands	2
	South West	1
Occupation	ONS 1-3*	13
	ONS 4-6**	2
	ONS 7-9***	1
	Student	2
	Retired	2

4.1.2 Benefits for mothers attending the Holding Time project

Interviewees were asked what they saw as the potential benefits of the Holding Time project for mothers. For those who were unfamiliar with the project, the elements of the project were described by the researchers.  Interviewees described the project benefits in terms of how it could personally help mothers who took part;

‘enables mothers to share experiences’

‘can be cathartic for mothers’

‘provides acceptance in a non-judgemental space’

‘makes memories’

‘shows the special bonding’

The interviewees also described the benefits for mothers in terms of how it could influence the wider remit of breastfeeding from a cultural perspective;

‘normalise breastfeeding’

‘increases awareness of breastfeeding’

‘to see breastfeeding happening’

‘breastfeeding shame can be diluted or eradicated’

‘opinions on breastfeeding are challenged’

‘ could influence men’s’ views’

‘seeing others doing it can empower more to do it’

4.1.3 Influences of Holding Time on personal attitudes towards breastfeeding

Interviewees were asked how the Holding Time project had influenced their own attitude towards breastfeeding. Overwhelmingly they described how it made them realise/recognise/validated current opinions that ‘breastfeeding is normal’ and this was verbalised by both those who were invited to the event and thus knew participants on the project’, and also by those who were non-invitees. In association with the normalising of breastfeeding interviewees also described how Holding Time;

‘opened my eyes to the fact that not all people see breastfeeding as the norm’

‘made me see breastfeeding is a thing of beauty’

‘made me look back on my own feeding journey’

‘I’m pro breastfeeding but this [Holding Time] made me realise the reality of trauma attached to breastfeeding, opened my eyes to others’ experiences’

Some of the interviewees who were ‘passing through’ described how breastfeeding was not something on their agenda and that the project had changed this;

‘its not something I’ve paid attention to in the past’

‘this caught me by surprise, made me think about it [breastfeeding]’

‘Its not something I’ve ever seen… you don’t see it often anyway you only’

‘see the negatives, this is a nice thing’

4.1.4 Influence of Holding Time on community towards breastfeeding

Interviewees were asked how they felt the Holding Time project could influence the wider community. Again, the overwhelming message was that Holding Time could show how ‘normal’breastfeeding was. Interviewees described how the project was a catalyst for debate and dialogue around breastfeeding;

‘will open people’s eyes’

‘conversation starter ’

‘spark for discussion’

‘plants a seed’

‘opens the dialogue’

‘makes it normal, at the moment this [breastfeeding being normal] is silenced’

The photographs were described by some interviewees as ‘so subtle’, ‘non-gratuitous’ and as ‘real images of real mothers’. Conversely, it was describedby others as ‘nicely in your face’ and ‘dramatic’. Interviewees discussed how seeing the photographs could impact on views, opinions and thoughts around breastfeeding;

‘reduces objectification of breasts’

‘Drip feeds into people’s brains’

‘changes thoughts’

‘views can be changed’

In addition, the interviewees described how by seeing the photographs this could influence those who were breastfeeding at the time or who had not decided on their method of feeding;

‘can influence those on the fence’

‘could encourage those that might be on the fence’

‘the normalising might help [breastfeeding mothers] to carry on breastfeeding’

‘gives power to continue’ [breastfeeding]

‘helps with reservations and addresses any misconceptions’

Furthermore, interviewees described how Holding Time could overturn the current socio-cultural negativity associated with breastfeeding in the UK;

‘Where it’s seen, less will stare, it reduces self-consciousness

‘health is a big thing, breastfeeding isn’t a joke, this helps with that’

‘exposure makes it [breastfeeding] the norm’

‘Can encourage breastfeeding it reduces the stigma…its helped by the positive images’

Finally, some interviewees focused on how Holding Time showed that breastfeeding can be challenging, giving a realistic but positive picture of this;

4.1.5.How Holding Time can be improved in influencing breastfeeding

The interviewees were asked how Holding Time could be improved in terms of influencing positive attitudes towards breastfeeding. Overwhelmingly, the interviewees said the project required ‘more exposure’;

‘Needs more advertisements’

‘Needs to be in more public places’

‘Needs to be more wide spread’

‘Needs expansion’

‘wider scope’

‘Advertising needed outside of those already interested’

‘take the project out to the public’

‘The gallery is good but it limits attendance’

However, some interviewees discussed how the project in its current form was beneficial to ensure its success;

‘needs to be small scale at first, too big and quick and people will push back’

‘even if it helps 1 or 2 at the moment it’s a good thing’

‘this is the back door to changing attitudes’

‘Just one image can change your mind completely’

4.2 Mothers

Twenty-five  mothers from Cheshire and Merseyside took part in the Holding Time project between September 2021 – November 2022. Data was supplied by the Holding Time project lead regarding participant demographics and feeding methods, project attendance and the challenges the mothers experienced when breastfeeding. Not all mothers supplied this data which is reflected in the tables. Mothers consented to the use of this data for the evaluation.

Ten mothers take part in an online interview around their experiences of taking part in the Holding Time Project, undertaken by the researchers. An interview schedule (appendix 2) was developed by the research team with input from the Holding Timer project lead. Interviews were held online via MS Teams, were video recorded and lasted between 20-60 minutes. MS teams transcriptions were ‘cleaned’ and then thematically analysed using the interview schedule and aim of the evaluation as central concepts.

4.2.1 Background to mothers who participated in Holding Time

The participants interviewed (23 of 36 total) were mostly White British. Approximately half were employed in ONS groups 1-3 and half 4-9. All the participants lived in Liverpool or Cheshire, except one mother based in Wales (see table 2 for demographics).

The participants were almost exclusively White British, employed in ONS groups 1-3 and lived in Liverpool or Cheshire, one mother was based in Wales (see table 2 for demographics ). It is difficult to compare the demographics of the Holding Time participants with a national picture of breastfeeding mothers due to limited data captured in some categories. However, the postcodes and occupations indicate that these mothers are not likely to be experiencing high levels of social deprivation and will have been educated to Higher Education level, both characteristics of mothers most likely to breastfeed in England (McAndrew et al 2012). All of the mothers were breastfeeding or had breastfed, with 13 also having expressed breastmilk giving this either by bottle, cup and/or syringe.

Participant	Occupation	Postcode	Feeding Method
1	Unknown
2	Teaching Assistant	CW8	Mainly BF, some EBM
3	Student Midwife	L19	BF and EBM
4	Police Officer	CH60	BF and EBM
5	Charity Worker	CH44	BF
6	Forensic Nurse	L21	BF and EBM
7	Civil Servant	WA7	BF and EBM
8	Nurse	CH62	BF
9	Full time mother	L31	BF
10	Doctor	L17	BF and formula top ups
11	Health Visitor	L21	BF and cup fed EBM
12	Nurse	CH63	BF and EBM & donor milk
13	Teacher	CH3	BF
14	Full time mother	WA12	BF
15	Antenatal teacher	CH42	BF
16	Academic	CH61	BF (twins)
17	Full time mother	CH43	BF and EBM
18	Self employed	CH49	BF and cup and syringe fed EBM
19	Unknown	CW1	BF

4.2.2. Mothers participation in Holding Time by stage

Holding Time Project Activity	Participants, N=25
Storytelling workshop	23
Interview with Holding Time Project lead	23
Project Launch with live readings	22
Photo shoot in professional studio	18
Performing at Open Eye Gallery	8
Listening to the audio/interview for approval	23
Looking at the portraits/animations/exhibition	25

4.2.3 Breastfeeding challenges experienced by mothers

Mothers gave examples of the challenges they had faced when breastfeeding (see table 4). The challenges encompass a variety of socio-cultural and physical factors and align with current literature around barriers and challenges to breastfeeding (Patil et al 2020). In addition, the impact of the pandemic and subsequent lockdowns on breastfeeding is highlighted, again something that is consistent with current literature (Brown and Shenker 2021).

Challenges to breastfeeding reported by Holding Time project participants
Mum has Raynaud’s disease
Baby had tongue tie, thrush, mum had postnatal depression and not feeling attachment with my baby
Found breastfeeding hard, baby lost weight, low milk supply
Negative attitudes from others towards breastfeeding, single mum
Babies in Neonatal Intensive Care Unit / small for gestational age babies
Caring for dying mother whilst establishing breastfeeding
Baby has tongue tie and cows protein milk allergy – mum had to eliminate certain foods from own diet
Conflicting information, difficult to access support during lockdown, psychological and physical struggles
Lack of support due to covid, tongue tie diagnosed at 5 months
Feeling less supported after child turned 1
Daughter has congenital heart disease required open heart surgery, stay in NICU
Breastfeeding for first time during a pandemic, baby had tongue tie
Breastfeeding twins
Neurodiversity and breastfeeding
Baby lost weight and was put on a feeding plan. Trauma of watching forced feeding led to PND

4.2.4 The impact of covid and lockdowns on new mothers

Mothers were asked about their family and home lives, including mechanisms of support from family/friend/community etc. Overwhelmingly the mothers described the negative impact Covid and subsequent lockdowns had had on themselves and their baby. The mothers described feeling isolated, not being able to access support when they needed it, which including support with breastfeeding. In addition, the lack of events and groups they could attend led them to be concerned regarding the impact this would have on their baby’s socialisation;

‘we were in and out of lockdowns so I didn’t really meet anyone else until this [Holding Time]’

‘It was really difficult as I didn’t have any family near me and it was covid’

4.2.5 Taking part – an opportunity to share experiences in a uniques setting

The mothers discussed how they had heard about Holding Time and their reasons for taking part in the project. The mothers heard about the project through various sources including: Facebook, friends, a health visitor and breastfeeding support groups. Some mothers could not pinpoint  how they had come to take part. In terms of reasons to take part, many of the mothers described the project giving them ‘the space to share breastfeeding experiences’ with the majority of the mothers having experienced challenges during their breastfeeding journey. In addition, the prospect of ‘doing something very different’ and ‘unique’ which would provide an ‘everlasting memory’ appealed to most of the mothers. Mothers also described how being part of the project would be something for themselves as well as their baby,

‘…to achieve something for myself that he [baby] could be involved in whilst I was doing it… it [Holding Time] was very inclusive in that respect’

4.2.6 Storytelling – cathartic and healing

Mothers were asked about their experiences and opinions concerning all aspects of the Holding Time project that they attended (see table 5 for stages). Some mothers voiced initial apprehension regarding the story telling stage due to it focusing on a difficult and sometimes traumatic period in their breastfeeding journey and lives. However, all mothers described the benefits of undertaking it. The majority of mothers described the story telling in terms of being ‘cathartic’, ‘healing’ and ‘therapeutic’, and all described the positive impact they could see it had on other mothers who listened to their stories. The mothers also described how they felt empowered to share stories with ‘like-minded’ people which gave them confidence to do so;

‘It was good in terms of an outlet for your feelings, your thoughts and …I think it definitely helped me come to terms with a lot of things that had happened during that time [post partum] ..I had massive anxiety …it just came at the right time [Holding Time]… it was like, oh, but these people are listening to me. So it was like, it was a really good. It was a really useful outlet for me in that in that respect’.

‘So I think that was the most kind of valuable thing for me. That was the thing that I got the most out of… Yeah, I think just sort of having the opportunity to sort of tell, tell your story and process it and hear other people’s stories was incredibly valuable and…because you don’t hear those stories, you don’t hear those stories really anywhere’.

4.2.7 The Interview – real stories of breastfeeding

Mothers were asked to discuss their experience of being interviewed by the Holding Time project lead, an interview which was subsequently uploaded to YouTube. Viewings of the interviews at the time of this evaluation range from 62 – > 2000 (see appendix 3 for screen grabs of social media analytics). The majority of mothers enjoyed undertaking the interview with some describing it as an extremely emotional experience when they revisited their breastfeeding journey. Again, the mothers described it in therapeutic terms, and were glad to be able to ‘tell their story’, hoping that it would help other mothers see breastfeeding ‘as it is’ and ‘in real terms’. The difficulties the mothers had experienced were viewed as being positive for other mothers to hear. This was due to the videos presenting a realistic picture of the difficulties mothers can experience when breastfeeding, which could prepare other mothers for the realities and make them realise they were not alone if things did not go to plan.

‘Yeah, it was really good [interview]. And I remember listening back to it and thinking, wow, like that’s really quite impacting and like impactful. I hate that word. But you know, it has a high impact’.

‘if it only helps one other mum’ listening to my story’ then I’d be so chuffed, that’s what its about isn’t it?’

4.2.8 The portrait – a memory of my breastfeeding journey

All of the mothers interviewed had taken part in the photo shoot. A number of the mothers described the anxiety they experienced in case their baby decided not to breastfeed during the shoot, as some babies where only breastfeeding intermittently at that stage. However, their anxieties were dispelled as all of the babies did breastfeed. The mothers described the finished portrait as ‘very special’ of feeling ‘proud’ that they had a record of their breastfeeding and that this was a ‘memory of my breastfeeding journey’. This appeared to be important in terms of depicting a positive picture of their breastfeeding, given that many of the mothers had experienced challenges and found breastfeeding difficult. All of the mothers described how the photo shot was natural and relaxed, this being cultivated by the photographer who was the lead for the Holding Time project.

I was nervous because again, not something I do…So I was a bit like what? God. What’s it gonna be like? But it was so relaxing because she was just having a conversation and just snap, snap, snap. It didn’t feel like that’s a pose or anything like that

So the photoshoot I was actually really nervous about the photoshoot. I hate having my photos taken and it was so relaxed and so lovely. it was just nice and the photos are just natural, like they’re not staged….they’re so raw… this is feeding, this is breastfeeding and its so lovely.

4.2.9 Attending the Open Eye Gallery – a unique event

The mothers were asked to recount their experiences of attending the gallery exhibition of their portraits. Some of the mothers found this ‘moving’ and ‘emotional’, particularly as they had invited family and friends to attend. Others found it ‘exciting’ and again felt very ‘proud’ that they and their baby were on display in such a public arena. The mothers also enjoyed meeting the other mothers who had participated, for some this was the first time this had occurred due to lockdowns and much of the project being online;

I loved it. Seeing all the women there [Open Eye Gallery], everybody breastfeeding. All with the babies. And meeting them after being online with them. It was brilliant and I really enjoyed it, going on my own, knowing that that they were my friends, you know, seeing some of the husbands there as well. It was so nice.

The event was described in terms of its uniqueness, with some mothers commenting on its ability to reach a different set of people from those who would usually be around breastfeeding mothers;

…it was just so lovely to see so many different age ranges and people coming in…

 In addition, mothers commented on the positive impact the exhibition had on their partners;

‘…my partner really found it beneficial and he kept saying …’I actually really enjoyed today I actually enjoyed today’. And when we first got there, I thought this is not gonna be for him. This is not gonna be for him… he just kept saying ‘I’m so proud, I’m so proud’

4.2.10 The impact of the Holding Time Project – looking back

Mothers were asked to focus on the impact Holding Time had had on themselves and those supporting them. All of the mothers found it had exceeded their expectations and met their original objectives of being able to voice and share their breastfeeding experiences. Mothers described how it had had a positive impact on their breastfeeding, in some cases encouraging them to breastfeed for longer and for one mother it having a positive impact on breastfeeding a subsequent baby. In addition, number of the mothers reiterated how the project had been a ‘healing, cathartic and therapeutic’ experience for them;

‘It was just… I’m getting goosebumps thinking about it. It was just so powerful…’

‘It might be difficult emotionally at times, but the support was amazing, so I definitely got more out of it than I could have expected.’

‘I just really enjoyed it, it just helped me loads’

4.2.11 Recommendations for future Holding Time projects

The mothers were invited to discuss how Holding Time could be improved and what messages they would give to mothers thinking about taking part. All of the mothers discussed the need for Holding Time to be available for more mothers, that it required expansion with some of the mothers describing a need for it on the NHS as part of integral maternity care provision. They urged other mothers to take part in Holding Time, reiterating the benefits they had received from it.

Mothers were asked about the delivery of the project which due to the UK just coming out of various lockdowns was mainly online. Responses were mixed, some mothers felt the online delivery was convenient and without it they could not have participated. However, others felt a face to face format would have enabled them to make greater connections with the other mothers which would have benefitted both themselves and their babies. In addition, some mothers described a ‘hybrid’ format, including both online and face to face meetings would be most beneficial;

‘Online, I think as well when you’ve got a group of women, you can’t just kind of turn to another mum and have a conversation. Do you know when you do have that break? It’s literally got to be one person of the group talking on the zoom meeting or whatever. But when you’re in person, you can all break off and get to meet other mums and have that authentic chit chat’.

‘I wouldn’t have been able to do this [Holding Time] if it was face to face, so online was great’

‘I think the story telling was so emotional that being online was good, you could go and have a breather after it…’

All of the mothers described gaining ongoing support via the Holding Time WhatsApp group that was set up as part of the project. Support was ‘24/7’ from other mothers. All of the mothers had remained in the group beyond their active participation in Holding Time, with some consulting it during their subsequent pregnancies and breastfeeding.

‘It was at the support network that you needed and I’m still in the group on WhatsApp and it’s just really nice to check in with all the girls’

Similar to comments from the general public, some of the mothers discussed that Holding Time needed to reach a wider audience, sometimes giving suggestions of how this could occur;

‘But I think the problem is the people she’s [Holding Time project lead] already reaching are the ones that don’t need to know because they already know, its trying to get it out there into the wider world. Like I don’t whether to see if we could do a documentary on Radio 4 or something like that, you know…’

They also discussed the audio tour, which was seen as a positive and the scaling up of their portraits which would be shown in areas such as hospitals, giving greater exposure. One mother also suggested their portraits being shown on the sides of building in order to capture as many people’s attention as possible;

Yeah and if they [portraits] were projected on the sides of building then they couldn’t be missed and more people would see them and maybe talk about them.’

4.2.12 Key messages from mothers participating in the Holding Time project

Figure 1 depicts a word cloud which captures the overall feelings mothers described about the Holding Time project. This data was extracted from the mothers’ answers regarding comments or key messages they would give to describe their experience of the project.

5. Recommendations

More complete data to be collected on the demographics of the mothers taking part in Holding Time. This can used in various ways; to compare with national benchmark data, to use in future funding applications, to give a profile of who takes part in the project and to expose gaps in terms of those who do not.

Evaluations with mothers to be undertaken at key stages of Holding Time. This will ensure ‘live’ data is captured and reduce any impact of memory recall that retrospective data collection may have. In addition, findings can be responded to in a timely manner.

The potential of a ‘diary’ be explored which mothers undergoing the project can complete. This could provide the live data the project would benefit from.

Data to continue to be collected at designated points regarding attendance/engagement at all stages and events of Holding Time to include; one off events pertaining to Holding time in pubic venues, engagement with stakeholders and providers, YouTube video views, other social media platforms (views on Twitter etc). This can be used to show the ‘reach’ of the project, any gaps in the project and included in future funding applications. Liaison and communication with venues where Holding Time is held to reiterate the importance of capturing this data.

Continue to scope opportunities to collect data from the general public regarding Holding Time – this has previously been undertaken by University of Wolverhampton. This is a valuable exercise and findings can be used to move the project forward in its aim to break down cultural barriers around breastfeeding.

Canvassing of mothers in terms of how the project should be delivered. Findings from this evaluation are mixed with some mothers preferring a face to face format, some online and others a ‘hybrid’ approach with a mix of face to face and online.

Continue to find ways of advertising the project to people outside of those who are already invested/committed to breastfeeding.

Dissemination of the project at National and International outlets to include; conferences – i.e. Royal College of Midwives, Institute of Health Visiting, Infant feeding Conference UCLAN, journal articles – targeting international journals focusing on Infant feeding i.e. Maternal and Child Nutrition, Breastfeeding Medicine, Journal of Human Lactation, awards – i.e. Royal College of Midwives, Webinars – i.e. Maternity and Midwifery hour.

6. Conclusion

This evaluation has provided a picture of the impact of the Holding Time project on the mothers from Cheshire and Merseyside who participated in it and the general public. Findings point to a unique project that has impacted positively on mothers and the general public. Upscaling, expansion and capturing a wider more diverse audience are required to realise the true potential of Holding Time. With expansion, the project has the potential to reduce cultural barriers to breastfeeding, whist supporting those mothers who do breastfeed in the UK’s currently challenging environment.

7. References

Brown, A., Shenker, N. (2020). Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Maternal and Child Nutrition, 17(1) available: https://doi.org/10.1111/mcn.13088

Lancet (2023) Breastfeeding, available at: https://www.who.int/health-topics/breastfeeding#tab=tab_2

Nuffield Trust (2023), Breastfeeding, available at: https://www.nuffieldtrust.org.uk/resource/breastfeeding

ONS (2022) Breastfeeding statistics, available at: https://www.gov.uk/government/statistics/breastfeeding-at-6-to-8-weeks-after-birth-quarterly-data-for-2021-to-2022

Patil DS, Pundir P, Dhyani VS, et al. (2020) A mixed-methods systematic review on barriers to exclusive breastfeeding (2020). Nutrition and Health. 26(4):323-346, available: https://doi.org/10.1177/0260106020942967

Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/s0140-6736

WHO (2018) Breastfeeding, available at:  https://www.who.int/health-topics/breastfeeding#tab=tab_2

Appendix

1. Social media analytics for Holding Time Project Cheshire and Merseyside