Olukunmi Omobolanle Balogun|Elizabeth O’Sullivan|Alison McFadden|Erika Ota|Anna Gavine|Christine D Garner|Mary J Renfrew|Stephen MacGillivray
Interventions for promoting the initiation of breastfeeding
National Center For Child Health and Development|University College Dublin|University of Dundee|St. Luke's International University|University of Dundee|Cornell University|University of Dundee|University of Dundee
despite widely documented risks breastfeeding initiation rates remain relatively low many highincome countries particularly among women lowerincome groups low middleincome countries many women follow world health organization recommendations initiate breastfeeding within first hour birth update cochrane review first published 2005to identify describe health promotion activities intended increase initiation rate breastfeedingto evaluate effectiveness different types breastfeeding promotion activities terms changing number women initiate breastfeedingto evaluate effectiveness different types breastfeeding promotion activities terms changing number women initiate breastfeeding early within one hour birthwe searched cochrane pregnancy childbirths trials register 29 february 2016 scanned reference lists articles obtainedrandomised controlled trials rcts without blinding breastfeeding promotion intervention population group except women infants specific health problemtwo review authors independently assessed trial reports inclusion extracted data assessed trial quality discrepancies resolved discussion third review author involved necessary contacted investigators obtain missing informationtwentyeight trials involving 107362 women seven countries included updated review five studies involving 3124 women contribute outcome data excluded analyses methodological quality included trials mixed significant numbers studies high unclear risk bias due inadequate allocation concealment n 20 lack blinding outcome assessment n 20 incomplete outcome data n 19 selective reporting n 22 bias potential sources n 17 healthcare professionalled breastfeeding education support versus standard care studies pooled compare professional health workers delivering breastfeeding education support prenatal postpartum periods standard care interventions included promotion campaigns counselling took place formal setting evidence five trials involving 564 women improved rates ofbreastfeeding initiation among women received healthcare professionalled breastfeeding education support average risk ratio rr 143 95 confidence interval ci 107 192 tau 007 62 lowquality evidence compared women received standard care downgraded evidence due design limitations heterogeneity outcome early initiation breastfeeding reported studies comparison nonhealthcare professionalled breastfeeding education support versus standard care evidence eight trials 5712 women improved rates breastfeeding initiation among women received interventions nonhealthcare professional counsellors support groups average rr 122 95 ci 106 140 tau 002 86 lowquality evidence compared women received standard care three trials 76373 women clear difference groups terms number women practicing early initiation breastfeeding average rr 170 95 ci 098 295 tau 018 78 lowquality evidence downgraded evidence combination design limitations heterogeneity imprecision wide confidence intervals crossing line effect comparisonsother comparisons review also looked rates initiation breastfeeding clear differences groups following comparisons combined healthcare professionalled education peer support community educator versus standard care 2 studies 1371 women attention control 1 study 237 women breastfeeding education using multimedia selfhelp manual video versus routine care 2 studies 497 women early motherinfant contact versus standard care 2 studies 309 women communitybased breastfeeding groups versus breastfeeding groups 1 study 18603 women none comparisons reported data early initiation breastfeedingthis review found lowquality evidence healthcare professionalled breastfeeding education nonhealthcare professionalled counselling peer support interventions result improvements number women beginning breastfeed majority trials conducted usa among women low incomes varied ethnicity feeding intention thus limiting generalisability results settingsfuture studies would ideally conducted range low highincome settings data breastfeeding rates various timeframes explore effectiveness interventions initiated prior conception pregnancy might include welldescribed interventions including health education early continuing motherinfant contact initiatives help mothers overcome societal barriers breastfeeding clearly defined outcome measures