Reflections on the Process of Implementing Change: Highlights from the 2016 MAINN Conference

Guest Blogger: Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc.*

Dalarna Univ_MAINN
Dalarna University, Falun, Sweden

Last week a small team of Healthy Children Project (HCP) faculty members travelled to participate in the Nutrition and Nurture in Infancy and Childhood: Biocultural Perspectives conference in Falun, Sweden. This conference, which is sponsored annually by the University of Central Lancashire (UK) Maternal and Infant Nutrition and Nurture (MAINN) Unit led by the brilliant Fiona Dykes, is held on alternating years in England, or at a different co-sponsoring university. The Reproductive, Infant and Child Health (RICH) unit of Dalarna University hosted the conference, in the shadow of a giant ski jump perched atop the hill over the university campus in rural central Sweden. The conference was attended by more than 150 individuals from 17 countries.

Conference Convenor Renée Flacking

After a warm welcome from the effervescent conference convenor, Renée Flacking, Dalarna University Prov Vice Chancellor Marie Klingberg-Allvin spoke of the university, known for net-based learning as well as traditional classroom instruction.

Dr. Klingberg-Allvin highlighted a Dalarna University collaboration with Somaliland Universities to offer graduate degree program to midwives in Somalia and Somaliland, where mothers and infants die at one of the one of the highest rates in the world. The potential impact of this work on infant and maternal mortality is immense, and is the subject of a brief, moving video.

Lars Wallin

First keynote presenter and Dalarna professor Lars Wallin spoke about the NeoKIP (Neonatal Knowledge into Practice) study, which examined a community-based “bottom-up” strategy for reducing infant mortality in 44 Vietnamese communities. This project identified and trained community-based facilitators who were members of the Women’s Union. The facilitators worked with focus groups of health professionals in every targeted community to identify barriers and design and employ strategies to address key barriers using a Plan, Do, Study, Act approach. A lovely descriptive video may be found here.

Kajsa Brimdyr

During her keynote presentation, HCP faculty member Kajsa Brimdyr CLC, PhD spoke on the topic of Implementing Practice Change Immediately after Birth: An ethnographic approach. Trained as an ethnographer, one who studies cultural practices, Kajsa introduced an ethnographic research frame in the research work conducted by HCP, a midwifery team from Karolinska Institute in Sweden, and the Egyptian Lactation Consultant Association, to study hospital practice around skin-to-skin immediately after birth. Kajsa’s experience, and that of other ethnographic research teams, are also presented in the recently published book edited by MAINN team members Fiona Dykes and Renée Flacking: Ethnographic Research in Infant and Child Health.


Fatuomo Osman

Fatumo Osman, a doctoral student at Karolinska Institute, shared lessons from the Ladnaan Project. Ladnaan is a Somali word for “a sense of health and well-being). This project explored the parenting support needs of Somali refugees living in Sweden. Introducing a theme that resonated through several conference presentations, Ms. Osman highlighted the importance of involving members of the target population in identifying needs, and designing and evaluating programs to address needs.




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Anna Blair

Anna Blair of the Healthy Children Project spoke on the topic of maternal identity, social stigma, and social justice in maternal child health.





Drs. Flacking & Brimdyr introduce Happy Birth Day

On the first evening of the conference, an evening reception at the lovely modern Dalarna University library included entertainment by a musical group, a juggler, and a screening of a segment of Healthy Children’s Happy Birth Day series focusing on gentle, low-intervention birth stories.



Karin Cindy MAINN
Karin and Cindy

Karin Cadwell and I presented a crash course on the role of breastfeeding in epigenetics, sharing knowledge about the several ways that human milk (as well as other substances ingested) may signal the expression of the infant’s genetic code.



Drs. Cadwell & Brimdyr also spoke about research they’ve conducted with Swedish-American teams exploring the impact of epidural medications and synthetic oxytocin on the expression of the primitive neonatal reflexes. (Click the links to view the article and video describing the outcomes regarding epidurals.)

We enjoyed so many other thought-provoking presentations, including these and others:

  • Ragnhild Maastrup of Denmark, sharing results of her study examining the progression of preterm infants to the breast, and factors associated with earlier breastfeeding proficiency in these little ones.
  • Schmied _ MAINN
    Virginia Schmied

    Elaine Burns and Virginia Schmied of Australia exploring the impact of professional, peer counselor and mother support on feeding outcomes. The appreciative inquiry approach of one study was particularly interesting.

  • Doctoral student Victoria Fallon of England, presenting “’Bottled Up’: The emotional and practical experiences of formula feeding mothers.” One of her most striking findings was that a very high percentage of mothers in the study reported feeling guilt, stigma, and the need to defend their infant feeding plans, regardless of how they intended to feed. The impact of these experiences on maternal emotional health could be detrimental.
  • Hannula_MAINN
    Leena Hannula

    Leena Hannula of Finland presenting about the Neo-BFHI initiative, an initiative developed by a Scandinavian and Canadian team of researchers; recommendations of the Neo-BFHI group can be found here. Later Dr. Hannula presented fascinating findings from a survey of “Adolescents’ breastfeeding intentions in five countries: the influence of attitudes, social norms and shared-parenting beliefs.”

Gill Thomson
  • Gill Thomson of the University of Central Lancashire (UK) tackling the thorny topic, “Shame if you do, shame if you don’t: women’s experiences of infant feeding.” The potentially devastating impact of shame on maternal self-image is a powerful force to consider in designing campaigns and interventions.



  • Doctoral student Nicole Bridges of Australia presented “The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online,” a study model utilizing Facebook for research.
  • Cartwright_MAINN
    Angela Cartwright

    Graduate student Angela Cartwright of England, presenting findings of a qualitative study of “Mothers’ experiences of feeding infants with Down Syndrome.” The themes emerging from this study indicate that much more support is needed by mothers tackling the task of feeding babies born with his challenge.

  • Dr. Elizabeth O’Sullivan of Ireland sharing quantitative findings of her research into human milk feeding strategies, intriguing findings to pair with the qualitative findings described earlier by her team.
Silke Mader

On the final day of the conference, Silke Mader spoke eloquently about her experience as a mother of twins born at 25 weeks gestation in the late 1990s in a presentation entitled Improving the Empowerment of Parents – What do parents need to take over care? The lack of emotional and physical support her family received during her emergency medical treatment, the death of her infant daughter, and the several month long NICU hospitalization of her infant son led eventually to the creation of the European Foundation for the Care of Newborn Infants (EFCNI), which works across Europe to strengthen parent support, and drive the implementation of evidence-based neonatal practice through endeavors such as benchmarking care NICU support and care practices. She reminded the group to seek parental support, and drew special attention to the needs of fathers as well as mothers, as their needs are often invisible to the health care system.

Drs. Flacking & Dykes closing MAINN 2016


Our time at this conference reinforced our belief that people-centered change in supporting birth, infant and child health, and the development of the parent-child bond is possible; in fact, it is happening throughout the world! It was wonderful to be surrounded by so many individuals questing for a better beginning for our families. We left Sweden full of gratitude for the passionate, curious, and innovative hearts and minds that are hard at work to understand the challenges and fuel progress in this crucial field.

Group at Dinner_MAINN
Celebrating MAINN 2016 at the conference dinner Back row: Flacking, Blair & Thomson Front Row: Turner-Maffei, Maastrup & Brimdyr


*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)

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