Interventions Designed to Promote Exclusive Breastfeeding in High-Income Countries: A Systematic Review Update

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to 1 year post-partum. However, it is currently unclear whether these findings extend to specific countries with resource-rich environments. This mixedmethods systematic review aims to (a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the United Kingdom (UK) and (b) explore the experiences and views of women receiving BFI-compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Two quantitative studies indicate that Baby Friendly Hospital Initiative implementation has a positive impact on breastfeeding outcomes up to 1 week post-partum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (n = 3) on breastfeeding up to 8 weeks post-partum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer term breastfeeding and wider maternal and infant health outcomes in the UK. A meta-synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI-compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource-rich settings.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review

Fallon

Harrold

Chisholm

2019

“…The factors influencing breast and formula feeding in this population group are poorly understood. Evidence indicate that maternal breastfeeding intention, knowledge, attitude and cultural factors are important determinants to exclusive breastfeeding (Skouteris et al, 2017). This study aims to investigate the psychosocial and cultural predictors of exclusive breastfeeding and formula feeding among Chinese…”

Section: School Of Psychology University Of Liverpool Englandmentioning

confidence: 99%

Abstracts

Raftery

Tosh

Siebelt

et al. 2020

Malnutrition in women and children in Bangladesh is one of the highest in the world with 33% of <5 children underweight and 36% stunted (NIPORT 2014). Imbalanced diet and inappropriate feeding practices are the major determinants of child undernutrition. Poverty, low income, and price hikes restrict poor families from accessing sufficient and diversified nutritious foods, which leads to their food and nutrition insecurity (Ghose 2014). To generate positive impacts on nutritional outcomes, agricultural interventions require more focus on nutrition and need to be linked to nutrition specific interventions (Haselow et al 2016). Improving homestead fruit and vegetable production integrating with enhanced communications about nutrition would lead to improved dietary diversity and nutritional status of children (Mulmi 2017). Combining agriculture with behaviour change communication and nutrition-sensitive interventions would improve diet and feeding quality to reduce child undernutrition. Such integrated intervention requires rigorous design and implementation strategy to generate an impact.This study aims to assess the feasibility and acceptability of an intervention package that combines nutrition-specific (nutrition counselling) and nutrition-sensitive (counselling and support for agriculture, and unconditional cash transfers) delivered on a mobile phone platform for improving maternal and child feeding behaviours among low-income families in rural Bangladesh. We conducted a mixed-methods feasibility study. The intervention included counselling on homestead gardening techniques and infant feeding by agriculture and nutrition workers using smartphone apps. Women received weekly individual counselling at home and group counselling fortnightly. Each participating woman received an unconditional monthly incentive of BDT 1200 cash transfer through a mobile banking system called bKash. The intervention took place for 6 months. We collected data through in-depth interviews and a cross sectional surveys of the participants and their family members.The women were interested in both agriculture and nutrition counselling and understood the messages clearly.They established homestead garden of seasonal vegetables successfully that included preparing beds, planting seedlings, nurturing the plans, and harvesting. Seasonal rainfall and damage by hens and ducks were major challenges but most of the families were able to find a solution. Most of the women preferred to consume own produced vegetables and spending the cash provided on purchasing nutritious foods such as fruits, egg, and milk for their children as advised in the counselling. The project implementation staff and the bKash agent did not report any difficulties in using the mobile banking system for cash transfer. Combining nutrition-specific and nutrition-sensitive interventions is a feasible and acceptable approach to the community to improve maternal and infant feeding practices. Using mobile phone technologies can provide additional benefit for the intervention to rea...

“…Moreover, psycho‐social factors such as little breastfeeding knowledge, low intention to breastfeed, no support, and low breastfeeding self‐efficacy (BSE) are associated with shorter breastfeeding duration (de Jager, Skouteris, Broadbent, Amir, & Mellor, ). Yet, these determinants are modifiable compared with socio‐demographic factors (Skouteris et al, ). A recent review concludes that interventions, which include Bandura's concept of self‐efficacy, are found to be effective to increase breastfeeding duration (Skouteris et al, ).…”

Section: Introductionmentioning

confidence: 99%

The significance of early breastfeeding experiences on breastfeeding self‐efficacy one week postpartum

Nilsson

Kronborg

Rahbek³

et al. 2020

Many new mothers do not reach their breastfeeding goals. Breastfeeding self‐efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self‐efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self‐efficacy in the first week postpartum, and drop in self‐efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self‐efficacy, and 26% drop in self‐efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin‐to‐skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self‐efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self‐efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self‐efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self‐efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.