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Could artificial intelligence assist mothers with breastfeeding?

02 April 2018
3 min read
Volume 26 · Issue 4


Public Health England is using Amazon's Alexa to complement the work of professionals and provide support for breastfeeding mothers at all hours

As midwives, nurses and health visitors are well aware, there is a wealth of information and research about the importance of breastfeeding. Benefits to babies include reduced incidence of gastrointestinal and respiratory illness, and for mothers reduced risk of breast cancer (and possibly ovarian cancer, too). An increase in breastfeeding rates could therefore improve health outcomes and translate into cost savings across the NHS.

In the UK, breastfeeding rates are lower than most comparable countries—and much lower than in less affluent countries. Public Health England (PHE) (2017a) annual data show that, while almost three-quarters of women start breastfeeding when their child is born, by 6-8 weeks, this figure drops to just 44%, and to less than 1% at 1 year.

Research (PHE and UNICEF, 2016) has identified a number of reasons why women are not starting or sustaining breastfeeding, including a belief that breastfeeding does not have significant benefits over formula, embarrassment, and stigma—for example being made to feel uncomfortable when feeding in public and in unwelcoming environments. According to PHE research (2017b), the key breastfeeding challenges and barriers experienced by women included: pain, bleeding, issues over feeding patterns, concerns about the amount of milk their baby was getting, lack of preparation before breastfeeding and uncertainty about how long to continue.

Devices such as Amazon's ‘Alexa’ and Facebook chatbots could provide answers

It is important to acknowledge these challenges and provide advice in an effort to raise breastfeeding rates across England. As health professionals, we must continue to support women with these often unanticipated difficulties as they arise. Breastfeeding, while natural, is something that mothers and babies learn together, and, when starting out, they can incur setbacks. Midwives know the importance of being able to provide support to women, particularly first-time mothers, to start and sustain breastfeeding, and to help more women to breastfeed for longer.

Equally, it can be beneficial to help expectant mothers to mentally prepare for setbacks when they first start breastfeeding, in a way that is not daunting or scaremongering, particularly for young mothers. A survey conducted by PHE (2018) among 1000 mothers of young children found that, in hindsight, 24% wished that they had read about and were more prepared for breastfeeding, and 26% wished they had realised that asking for help could make a difference. Midwives and maternity support workers can significantly alter a woman's confidence, and it is important that women feel able to ask questions and share their concerns. The evidence would suggest that being more prepared and knowledgeable will help young mothers anticipate and overcome challenges they may face, and may help them to continue breastfeeding for longer.

Getting partners involved can also make a difference. Some partners report feeling excluded from discussions during pregnancy and the early days after birth, and it is important to describe the value of the practical assistance they can provide, and to discuss the potential to express breast milk for bottle-feeding (once breastfeeding is established).

Health professionals do an excellent job of caring for new mothers, but one of the key difficulties lies in the fact that it is not possible to provide support 24/7, and problems with breastfeeding can often occur during the small hours (indeed, Google Trends (2018) shows that this is when online searches for ‘breastfeeding help’ peak). During these tired, stressful and emotional moments is when many women decide to give up breastfeeding.

In an effort to tackle this problem, Start4Life, PHE's programme that helps parents-to-be and parents to adopt healthy behaviours, has launched a new 24/7 Breastfeeding Friend—a ‘skill’ available on Amazon's Alexa voice service. Users can ask Alexa a variety of questions about breastfeeding, with answers tailored to the age of the baby. The new service is in addition to the interactive Start4life Breastfeeding Friend chatbot, accessed through Facebook Messenger, the Start4Life website and the Off to the Best Start leaflet. The information provided by all the Start4Life services is NHS-approved and the Alexa skill and the chatbot are independent of Amazon and Facebook.

The Breastfeeding Friend from Start4Life launched after it was revealed by a new survey of 1000 mothers of young children (commissioned by Public Health England) that 64% felt access to 24/7 breastfeeding support, such as a phoneline, website or chatbot, would make new mothers more likely to have a positive experience of breastfeeding, as well as more likely to decide to try breastfeeding (59%) and breastfeed for longer (58%). It was also revealed that, of those who ever gave breastmilk to their first child, younger mothers were more likely than older mothers to use online sources when researching or starting to breastfeed (42% of 18-34 year olds versus 30% of 35-50s). These results show that mothers are using online sources and digital tools more than ever to help improve their breastfeeding experience. We hope that the Breastfeeding Friend will provide support for these women and their breastfeeding journey.

With the range of support tools available to parents to complement the excellent work being done by midwives, nurses, health visitors and other health professionals, I hope that we can encourage more women to decide to breastfeed and, once they start, to carry on breastfeeding for longer so that more babies are exclusively breastfed for the first 6 months, and receive the best start in life.