The Peer Counsellor Programme in Great Britain
From: LEAVEN, Vol. 37 No. 2, April-May 2001, pp. 46-7
In 1990, my local Health Authority asked me to help increase breastfeeding rates in Nottingham, my home town. The Health Authority is the local part of the National Health Service, the British state-run health service which gives free health care to all. I offered the La Leche League Peer Counsellor Programme, wrote a costing-proposal, and contacted Mary Lofton, with whom I had discussed the PCP when I met her at an LLLI Conference.
To our surprise we were awarded money to bring Mary over to introduce us to the programme and fund the first training programme. This proved such a success that Nottingham Health wrote one new programme each year into their budget.
Health professionals in other parts of Britain heard about the PCP and began to ask us to organise programmes for them. We only approve the setting up of PCPs in areas of disadvantage. We run the programme under license and keep control of what is happening to ensure it still belongs to La Leche League.
In 1994 we were pressed for a PCP in Ramsgate - they had funding. We had no Leaders close so I wrote a five day training course for LLL to train health professionals who can train mothers in their areas as Peer Counsellors. Local Leaders used to train PCs but we now actively discourage this. Programmes are much more successful when LLL supports the health professionals to train PCs.
We help the health professionals to set up ongoing support for PCs-usually monthly but often more. We continue to support the health professionals.
The health professionals' training starts with debriefing and introductions. Then the trainer goes through LLLI philosophy, explaining what is and is not part of the philosophy - for example, Leaders are not required to eat muesli and have their babies in bed! Each participating health professional receives a BREASTFEEDING ANSWER BOOK, a WOMANLY ART OF BREASTFEEDING, and a folder of leaflets, including one of each tear-off sheet. Each Peer Counsellor Programme gets a small library of books and leaflets - including the rest of the tear-off pad. This library includes BREASTFFEDING PURE AND SIMPLE, Becoming a Father, Breastfeeding Special Care Babies by Sandra Lang, other useful books, and a subscription to BREASTFEEDING ABSTRACTS.
The Peer Counsellors receive and use the basic LLL leaflets. We find the tear-off pads especially useful. We use mainly LLL produced leaflets, but also some produced by Baby Friendly UK and a midwives research and information service. The Peer Counsellor Programme in GB is developing its own weaning leaflet-written and reviewed in Great Britain - to meet a particular cultural need.
Anne Jobling remarks, "Peer Counsellors sometimes feel angry when they realise that they have received inaccurate breastfeeding information when they were nursing their babies. It is helpful if the training course provides time for them to share their feelings and work through them; the trainer can help them to see why they made those decisions and realize that they did the best they could with the information that they had at the time. Anger can be channelled into determination to make sure that such an experience never happens to another mother."
Recently, the Department of Health offered 115,000 grants to areas of disadvantage to raise breastfeeding rates. Of the 31 grants awarded, six were for LLL Peer Counsellor programmes. The progress and growth of the PCP has increased from one or two programmes per year to one or two per month over the last ten years. Our biggest problem has always been juggling meeting demand with keeping proper control.
At present we have approximately 120 Peer Counsellors active around Great Britain. We established an active span of three years for PCs, which allows them to move on to other things. Jill Dye notes, "We find that once mothers are empowered, they tend to move on to employment or study." We have playworkers, health care assistants, midwives, and one Leader Applicant among our former PCs. Some programmes use the term "Peer Supporter" since in Britain professional counsellors like to make a distinction between their profession and those who support breastfeeding mothers.
Our evaluation has shown that where there is a programme mothers are more than twice as likely to breastfeed ("Evaluation of the La Leche Peer Counsellor Support Programme in Nottinghamshire," by Janet Glencross; dissertation presented to the Nottingham School of Public Health, University of Nottingham, 1998). We expect the progress of improvement to take three steps. First we raise awareness of breastfeeding in the area. Then a slight rise in duration is followed by an increase in incidence.
The PCP is part of the Professional Liaison Department in Great Britain. Currently four Leaders are trained to teach the health professionals' course: Anne Jobling, Jill Dye, Catherine Pardoe, and myself, and more Leaders are interested. Leaders involved receive fees and are specially trained for the work.
Funding has come from the National Lottery, from Health Authorities, the government Department of Health, another charity, and Primary Care Groups (a new subdivision of the National Health Service). Sure Start, a government initiative for deprived areas, has funded Peer Counsellor Programmes in some parts of Britain. Developing the Peer Counsellor Programme has driven me over the last 10 years and I love it. Although it is not part of a Leader's basic work, it really is one of the most rewarding things I have ever been involved with.
[Editor's Note: "The Peer Counsellor Programme in Great Britain" is one of a series of articles on the LLLI Peer Counseling Program in countries including Africa and Guatemala. Edited and compiled by Rachel O'Leary, the articles will bring readers close up and personal to the PCP in starkly different environments, all unified by breastfeeding mothers and babies.]
One Peer Counsellor's story:
My first baby was born in Nigeria. I breastfed her, but weaned her at three months of age because of family pressure. I married and came to Britain, and when I was expecting my second child a midwife looked at my breasts and told me that I would not be able to were too flat. I bottle-fed my second and third children. When I was expecting my third baby I returned to Nigeria for the birth because I was so determined to breastfeed this time. I pleaded with my Mum to show me how to breastfeed. She thought I should bottle-feed because that is what people do in Britain. But when my baby was born, Mum helped me to sit up, hold my baby, and get her well latched on to my breast. When I returned to Sheffield, England, I saw advertisements for women to train as Peer Counsellors and I wanted to do it because I knew that other women don't have their mums to help them.
--Contributed by Anne Jobling