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A submission was written to nominate the Australian Breastfeeding Association (ABA) as a worthy recipient of a national health volunteer award. The awards were being offered by the National Health and Medical Research Councill. There was to be no monetary reward but the nomination provided an opportunity to highlight the massive number of hours ABA members volunteer for their wide-reaching work.
CATEGORY TO BE NOMINATED IN: Health Promotion / Prevention
TYPE OF AWARD: Metropolitan and Rural
Brief description of the volunteer services provided:
The Australian Breastfeeding Association (ABA) is a not-for-profit organisation that primarily exists to empower and assist women to breastfeed. It is one of the largest women's organisations in Australia. Trained voluntary breastfeeding counsellors receive over 260 000 counselling contacts either face-to-face or through the free Breastfeeding Helpline each year.
Trained voluntary community educators offer a further host of services to the community in promoting a wider awareness of ABA and breastfeeding. Typical community education activities include local displays, school talks, pre-school bath and feed demonstrations, ante-natal talks and hospital visits.
Regular group discussion meetings are held in various locations within the 370 groups around Australia, both metropolitan and rural. Nearly 50% of ABA's membership resides outside the metropolitan area; nearly 50% of counselling contacts are received from rural and regional areas. Telephone and email allows rural and remote mothers access to counselling.
The Australian Breastfeeding Association offers a unique blend of mother-to-mother support, accurate and up-to-date breastfeeding information and counselling about breastfeeding and its management. ABA was established in 1964 to encourage and support breastfeeding mothers, while creating in the community an awareness of the importance of human milk.
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Duration of service provided: 37 years
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How many volunteers are/were involved: ABA currently has approximately 12 000 members, 1400 breastfeeding counsellors and 230 community educators.
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Brief overview of how the nomination has contributed to health care activities ie qualitative evidence of the impact on individuals and the community:
Taken from personal messages received by a breastfeeding counsellor:
"Thanks for your listening ear, your kindness, your understanding and willingness to help. Thankyou."
"Thank you so much for your encouragement and support over the last few weeks, it has been very much appreciated. I think things have improved and I am having more often pain-free feeds. Baby is still battling with wind at times but generally is much better. Thankyou again."
"Thank you so much for teaching baby and I how to express. Our evening out went really well with baby being the model baby. Mum and I really appreciated your support, knowledge and encouragement. We are so lucky to have you in our district. Once again thank you for your wonderful help."
Taken from letters published in ABA's bi-monthly magazine:
"I would like to take this opportunity to thank ABA for the following: the counsellors who checked my attachment; the meetings I have been able to attend which were informative, well run and confidence building; the hire of the electric breast pump. I am in love with it."
"I didn't think I could do it either, but I had the wonderful support of my local ABA group and counsellors who helped when I had doubts or questions."
" As a father of two delightful and healthy breastfed children, I would like to thank ABA for encouraging and supporting our family."
" Before I returned to work I looked for information I could use to explain to my supervisor and colleagues about what I needed from the workplace to successfully express and store breastmilk during the day. I was surprised to find no industrial guide and so relied on the guidelines recently published by the Australian Breastfeeding Association."
Taken from entries in the guestbook, from ABA's website:
"Hi! I'm very thankful to ABA for the support and meetings I have been able to attend after the birth of my first baby a year ago. My second baby is due soon, and I can't believe how easy, cheap and rewarding breastfeeding is. It's nice to know you have support and backup when required. Thanks."
"I wish I had found this months ago. Australia is lucky to have this group!! I struggled with nursing my newborn with Down Syndrome and had to stop by the time he was only a few weeks old because he was not gaining weight. I wish I had someone to work with me and help us through." US mother
"I just subscribed to ABA today and am looking forward to receiving my magazine. I have received some very good support from ABA counsellors as I have been ready to wean several times, they have helped me to understand what is happening to me and my baby and helped me feel confident that I'm a good mum, no matter what."
Qualitative evidence for the quality of our training scheme: (In reference to the IBLCE examination)
"My peers were very generous with sharing their knowledge and I've learnt from every mother I've spoken to. I know that other exam candidates found ABA information to be a good foundation for their exam preparation. ABA literature reflects a great understanding of what breastfeeding mothers experience and is backed up by recent research."
"We have found that ABA counsellors tend to be over-represented in the international top scorers."
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Brief description of how the volunteering initiative is innovative:
Mothers experienced in breastfeeding are trained so that they can help other mothers to breastfeed.
Breastfeeding is an important public health issue. To really make a difference to breastfeeding rates, it is not enough to educate mothers and treat individual breastfeeding problems. It is vital to have a multidisciplined approach, and it is essential that all those involved in helping women breastfeed are proactive in their promotion of breastfeeding in the community. The Australian Breastfeeding Association has been credited by many for the vital role its volunteers have played in Australia's breastfeeding rates being better than a number of other countries.
Health promotion is a key concept. The strategies of health promotion, as outlined in the World Health Organization's Ottawa Charter of Health Promotion provide a good framework for a multifaceted approach for breastfeeding (Croker 1999). The association utilises the full range of these health promotion strategies.
Through the energy and commitment of the nation-wide network of ABA volunteers, many significant breastfeeding initiatives have been achieved over the past few years:
Strengthening community action
- Development of the Community Relations Kit, a community education resource
- Fact Sheets available in other languages
- Leadership training for, and resources supporting, local group discussions
Developing personal skills
- Breastfeeding Management in Australia: A Reference and Study Guide published and revised
- Teenage outreach video produced
- Publication of Breastfeeding... naturally, a book for new parents.
- Release of an audiocassette tape Breastfeeding ... Right From the Start
- Establishment of ABA website and Internet groups for counsellors, community educators and trainees
- Successful tender to the Commonwealth Department of Health for breastfeeding promotion. Materials were developed to reach areas of the population that were traditionally hard to access - young parents, fathers, parents from lower socio-economic background and whose first language was other than English. Materials included a poster, a series of 'tip cards', a cartoon booklet and a simple to read picture booklet.
- Successful submission for funding from the Commonwealth Department of Health to be used for an information booklet about the most common queries to our breastfeeding helplines aimed at parents of infants in the 0-3 month age range, training of breastfeeding counsellors and continuing education for breastfeeding counsellors.
- The release of two new booklets: Breastfeeding Higher Order Multiples and Gastro-Oesophageal Reflux and the Breastfed Baby.
Reorienting health services
- International breastfeeding conference held in Brisbane
- Joint WHO/UNICEF initiative to develop guidelines for Baby Friendly Hospitals
- Hospital Resource Booklet established to assist with the development of breastfeeding protocols
- Successful tender to the Commonwealth Department of Health aimed at providing a resource kit and breastfeeding education especially designed for Australia's health professionals including general practitioners, paediatricians, child health centres and pharmacies. Each group received a Best Practice Guide to Common Breastfeeding Problems, a Lactation Resource Directory and a continuing breastfeeding education module
- Ongoing production of Breastfeeding Review, a journal for health professionals and those interested in breastfeeding research
- Mary Paton Research Award, encouraging research into breastfeeding and critical reviews of current literature on breastfeeding
Building healthy public policy
- An Australian agreement covering the aspects of the WHO Code of Marketing of Breastmilk Substitutes which apply to infant formula manufacturers was signed
- Presentation of a detailed Five Year Plan for breastfeeding promotion to the Commonwealth Department of Health outlining a number of strategies designed to develop a holistic approach to increasing breastfeeding rates in Australia. Areas targeted are Infrastructures and Barriers, Antenatal and Postnatal.
- Participation in discussion with the National Health and Medical Research Council regarding the review of the Dietary Guidelines for Australians. ABA's comments recommended a revision of the guidelines to include a recommendation for exclusive breastfeeding for 6 months.
- Lobbying of health funds regarding rebates for ABA subscriptions.
Creating supportive environments
- Ongoing presentation of Mother-Friendly Workplace Awards to employers who meet criteria for providing conditions to facilitate breastfeeding in the workplace. There are now 75 recipients of this award throughout Australia.
- The successful launch of the 'Breastfeeding mothers welcome here' stickers in conjunction with World Breastfeeding Week and Breastfeeding Awareness Month theme of Breastfeeding : It's Your Right.
- Baby Care Room accreditation to over 550 rooms across Australia
- Maintaining a 'breastfeeding presence' in the community to provide support for breastfeeding being portrayed as the physiological and social norm of infant feeding.
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Brief description regarding how volunteers are managed within the program:
The Australian Breastfeeding Association is managed by an elected board of (voluntary) directors. The association is administered by a small paid staff based at our office in Melbourne in conjunction with the board and seven units. Each unit is responsible for carrying out the work of the association in their own areas of administration, breastfeeding information, community education, finance, publications, public relations, and training. The units are responsible for the national coordination of ABA's activities and the provision of resources. A number of working groups comprise each unit; each led by a coordinator and with members throughout Australia. The working groups undertake specific tasks to ensure the ongoing functioning of the association and the maintenance of a high standard of service to the community. All work within the units is voluntary.
The structure of the association includes seven branches in line with the seven states of Australia, and these geographical areas are further broken down into regions and local groups. Across Australia there are approximately 370 groups whose regular activities include discussion meetings, social gatherings, breastfeeding education classes, breast pump hire, fundraising and community education activities. The day-to-day activities of the association are carried out by a large volunteer workforce of breastfeeding counsellors, trainee breastfeeding counsellors, community educators and members throughout Australia. Apart from an office administrator in some branches, all work in branches is undertaken in a voluntary capacity.
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What education and training is/was provided to volunteers:
The association's 1400 voluntary breastfeeding counsellors are all mothers who have breastfed their baby for at least nine months. They undergo an 18 month training period consisting of assignments, training meetings and involvement in their local group. After qualifying they are expected to maintain their standard of breastfeeding knowledge by regular reading of association publications and attending in-service activities and conferences. The association provides extensive resources to ensure that its counsellors are providing accurate and up-to-date information. These include a counsellor's manual, regular information updates and counsellors' magazine. All counsellors agree to abide by a Code of Ethics to safeguard themselves and the association.
Community educators undertake a shorter period of training, involving two workshops, two assignments and an assessed presentation, and are qualified to make community education presentations on behalf of the association. These qualifications are updated every two years.
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What recognition do volunteers receive:
By far the most recognition ABA volunteers receive is at a very individual, personal level - the satisfaction of sharing the new-found happiness of a mother and baby, witnessing a resolved problem, clarifying an issue with an informed health professional or receiving a small message of grateful thanks.
On a wider level, it is encouraging too when ABA receives recognition within the community - positive press coverage, the affirmative outcome of a lengthy grant submission or the invitation to contribute to coalition health groups or community advisory projects.
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Brief description of the use of financial resources:
Our main source of income is subscriptions. Income is also derived from fundraising at the national, branch and group levels, national sponsorship and endorsement, and some government grants.
The Lactation Resource Centre (LRC) is based at our office in Melbourne and has a collection of more than 15 700 references on breastfeeding and lactation. Funds help to staff the centre with experts in the field of human lactation. The LRC provides services to many local and international individuals and organizations and is regularly consulted by government and world agencies.
Mothers Direct is a wholly owned subsidiary of the association which specializes in mail order products for parents of new babies, including our own products such as the Meh Tai baby sling and our own publications such as our 26 booklets on a range of breastfeeding topics.
General funds are managed carefully to maintain the efficient running and wide promotion of the association. Key areas of expenditure are the training of breastfeeding counsellors and community educators, inservice materials for counsellors and community educators, publications about breastfeeding including a bi-monthly magazine for subscribers and community education materials.
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Brief description of personal barriers:
We often work to overcome barriers to breastfeeding and the further expansion of our services.
ABA is aware of the importance of addressing social and institutional barriers in the promotion of breastfeeding. Research suggests that maternal age, level of education and the support of the father for breastfeeding have a strong association with the decision to breastfeed. Among the barriers to breastfeeding are maternal discomfort with breastfeeding in public, the support required for breastfeeding, the convenience of bottle feeding and the mother's return to the paid workforce. (McIntyre E, Hiller J & Turnbull D Breastfeeding Review 2001 9(1): 13-24.)
A number of recent initiatives have tried to address some of these factors targeting the mother's support network, groups with lower breastfeeding rates - teenage mothers, indigenous communities and some ethnic groups - and health professionals.
Volunteer time and energy is precious and highly valued, but is increasingly impinged upon by strong social and community pressures. Much has been achieved by so many wonderful women over the past 37 years, and we trust we can maintain the passion, commitment and relevance for many years to come.
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Concluding Appendix
The average ABA counsellor:
- Receives 3.5 counselling contacts per week
- Spends 18.7 minutes in each counselling contact
- Spends the majority of her time in non-counselling activities that include training other mothers to become breastfeeding counsellors and community educators; administration of groups and branches; networking with mothers at a local level; and contributing to the initiatives of the association .
A number of counsellors carry out their volunteer work despite personal challenges eg visually impaired, isolated. 54% of counsellors are in the paid workforce, and 20% are studying.
(Results of the Breastfeeding Counsellor Survey conducted October 1998 and the Counsellor Activity Survey conducted May 1998 by the ABA Statistics Working Group.)
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Post script:
Congratulations to the Australian Breastfeeding Association on being awarded the Gold National Health Volunteer Award in the category of health promotion / prevention.
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