Flexible shared parental leave: Shaping infant-feeding decisions in the UK - A longitudinal explanatory sequential internet-mediated mixed methods study

Abstract

Infant feeding is an enduring public health issue. The changes made to parental leave entitlement which came into effect in April 2015 in the United Kingdom (UK) have the potential to impact infant-feeding decisions. The introduction of flexible shared parental leave (SPL) remodelled maternity and paternity (or adoption) entitlement, enabling parents to share up to 50 weeks’ leave. The discourse has not yet considered this policy shift fully, nor has research comprehensively examined whether it will influence parental feeding decisions. The research design was informed by a narrative literature review followed and a systematic review of the literature, which indicated that few studies consider both infant feeding and parental leave. The systematic review found that focus of the discourses tended towards breastfeeding and maternity leave. In light of the interdisciplinary nature of the topic, a longitudinal explanatory sequential mixed methods design was selected to comprehensively address all strands of the research questions. The research was framed by a theoretical framework meta-model derived from Belsky's (1984) process model of the determinants of parenting, set within Bronfenbrenner's (1977, 1979) ecology of human development (later termed the bioecological systems model (2005)) and informed by a pragmatist lens. A sample of parents of infants born in April 2015 (the first eligible for shared parental leave) were surveyed via online questionnaire. At three points over the course of 12 months, the parents were asked to detail how their infants were fed and about leave decisions. Following on from this, a subset of parents were interviewed to illuminate the decision-making process further. The study aimed to baseline behaviour at the point of policy implementation and record attitudes towards shared leave. The outcome of the research is an initial evidence base documenting infant feeding patterns in the UK in 2015, in the context of a potential future shift stemming from the introduction of shared parental leave. In line with expected projections (BIS, 2013), take-up of shared parental leave was low within the sample of parents who took part. Of interest, the small number that did opt for shared parental leave reflected the wider sample tendency towards breastfeeding at 24-hours, yet mixed feeding to 6 months. Nevertheless, the parents that took part did not shy away from revisiting feeding decisions made in light of day-to-day practicalities, any issues they faced and the development of their infant. The study provides insight into the approach of parents opting for mixed feeding i.e., selecting the feeding mode(s) and/or substance(s) or mode(s)/substance(s) seen as most appropriate at the time. It is atypical (contrasted with conventional definitions applied within the research discourse) in disaggregating breastfeeding and breast milk feeding. Finally, the research further evidences the complexity of the narrative in parental decision-making. In view of the findings, further research is needed to document shared parental leave take-up and how parents are choosing to apportion it. A reconsideration of infant feeding definitions by the relevant agencies, to further the granularity of research data in relation to breastfeeding, breast milk feeding and mixed feeding (mixed mode, mixed substance or mixed method - mode and substance - feeding) would be welcome to improve research outcomes. Moreover, as a result of the discontinuation of the quinquennial Infant Feeding Survey series, there is a need for systematic, low cost research at regular intervals to supplement the modest infant feeding data collected via the Personal Child Health Record programme. Without this research, the significance of the impact of the parental leave policy reform in the UK on infant-feeding decisions may be overlooked.