Interventions for promoting the initiation of breastfeeding

Abstract

BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE: To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. METHODS: Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained. Selection criteria: Randomized controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem. Data collection and analysis: One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needsbased, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001). AUTHORS' CONCLUSIONS: This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.

Effects of a Prenatal Intervention on Breastfeeding Initiation Rates in a Latina Immigrant Sample

“…The results of this RCT demonstrate that exposure to a culturally competent, HFA model prenatal intervention can significantly increase mother-reported EBF during the first week postpartum in an urban, Latina, predominantly immigrant population. Our finding of increased EBF is consistent with the results of previous RCTs of health education programs targeting breastfeeding initiation in non-Hispanic, low-income populations, 20 and with findings from a RCT of a peer counseling intervention conducted with women of Puerto Rican origin in Hartford, CT. 18 Maternal report of ABF was not significantly associated with exposure to the prenatal intervention in the present study. The high rate of ABF in our sample (82.4%) may have worked against our finding an intervention effect for ABF as it was defined in the present study (and as previous investigators have defined it).…”

Effects of a Prenatal Intervention on Breastfeeding Initiation Rates in a Latina Immigrant Sample

“…The results of this RCT demonstrate that exposure to a culturally competent, HFA model prenatal intervention can significantly increase mother-reported EBF during the first week postpartum in an urban, Latina, predominantly immigrant population. Our finding of increased EBF is consistent with the results of previous RCTs of health education programs targeting breastfeeding initiation in non-Hispanic, low-income populations, 20 and with findings from a RCT of a peer counseling intervention conducted with women of Puerto Rican origin in Hartford, CT. 18 Maternal report of ABF was not significantly associated with exposure to the prenatal intervention in the present study. The high rate of ABF in our sample (82.4%) may have worked against our finding an intervention effect for ABF as it was defined in the present study (and as previous investigators have defined it).…”

Psychometric Testing of the Breastfeeding Self-Efficacy Scale-Short Form Among Adolescents

“…However, the finding that adolescents who attended prenatal classes had higher breast-feeding self-efficacy than those who did not provides evidence that antenatal breastfeeding education targeting adolescents may improve infant feeding outcomes. These results also support the findings of a Cochrane systematic review that showed that antenatal breastfeeding education had a significant effect on increasing initiation rates as compared with routine care [38]. Finally, adolescents who were breast-fed themselves had higher breast-feeding selfefficacy postnatally than those who were not, and this has been found to be consistent with previous research with both adolescent and adult mothers [19,39].…”

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006–2016)

“…The current paper presents information comparing the rates of breast-feeding in Europe in mothers of different SES, defined by level of maternal education. The results confirm what other authors have stressed concerning the need for standardized methods to monitor breast-feeding rates in Europe to allow comparison between countries and recommendations to reduce inequalities ( 75 , 76 ) .…”

Effects of a Prenatal Intervention on Breastfeeding Initiation Rates in a Latina Immigrant Sample

“…The results of this RCT demonstrate that exposure to a culturally competent, HFA model prenatal intervention can significantly increase mother-reported EBF during the first week postpartum in an urban, Latina, predominantly immigrant population. Our finding of increased EBF is consistent with the results of previous RCTs of health education programs targeting breastfeeding initiation in non-Hispanic, low-income populations, 20 and with findings from a RCT of a peer counseling intervention conducted with women of Puerto Rican origin in Hartford, CT. 18 Maternal report of ABF was not significantly associated with exposure to the prenatal intervention in the present study. The high rate of ABF in our sample (82.4%) may have worked against our finding an intervention effect for ABF as it was defined in the present study (and as previous investigators have defined it).…”

Psychometric Testing of the Breastfeeding Self-Efficacy Scale-Short Form Among Adolescents

“…However, the finding that adolescents who attended prenatal classes had higher breast-feeding self-efficacy than those who did not provides evidence that antenatal breastfeeding education targeting adolescents may improve infant feeding outcomes. These results also support the findings of a Cochrane systematic review that showed that antenatal breastfeeding education had a significant effect on increasing initiation rates as compared with routine care [38]. Finally, adolescents who were breast-fed themselves had higher breast-feeding selfefficacy postnatally than those who were not, and this has been found to be consistent with previous research with both adolescent and adult mothers [19,39].…”

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006–2016)

“…The current paper presents information comparing the rates of breast-feeding in Europe in mothers of different SES, defined by level of maternal education. The results confirm what other authors have stressed concerning the need for standardized methods to monitor breast-feeding rates in Europe to allow comparison between countries and recommendations to reduce inequalities ( 75 , 76 ) .…”

Effects of a Prenatal Intervention on Breastfeeding Initiation Rates in a Latina Immigrant Sample

“…The results of this RCT demonstrate that exposure to a culturally competent, HFA model prenatal intervention can significantly increase mother-reported EBF during the first week postpartum in an urban, Latina, predominantly immigrant population. Our finding of increased EBF is consistent with the results of previous RCTs of health education programs targeting breastfeeding initiation in non-Hispanic, low-income populations, 20 and with findings from a RCT of a peer counseling intervention conducted with women of Puerto Rican origin in Hartford, CT. 18 Maternal report of ABF was not significantly associated with exposure to the prenatal intervention in the present study. The high rate of ABF in our sample (82.4%) may have worked against our finding an intervention effect for ABF as it was defined in the present study (and as previous investigators have defined it).…”

Psychometric Testing of the Breastfeeding Self-Efficacy Scale-Short Form Among Adolescents

“…However, the finding that adolescents who attended prenatal classes had higher breast-feeding self-efficacy than those who did not provides evidence that antenatal breastfeeding education targeting adolescents may improve infant feeding outcomes. These results also support the findings of a Cochrane systematic review that showed that antenatal breastfeeding education had a significant effect on increasing initiation rates as compared with routine care [38]. Finally, adolescents who were breast-fed themselves had higher breast-feeding selfefficacy postnatally than those who were not, and this has been found to be consistent with previous research with both adolescent and adult mothers [19,39].…”

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006–2016)

“…The current paper presents information comparing the rates of breast-feeding in Europe in mothers of different SES, defined by level of maternal education. The results confirm what other authors have stressed concerning the need for standardized methods to monitor breast-feeding rates in Europe to allow comparison between countries and recommendations to reduce inequalities ( 75 , 76 ) .…”