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Meta-Analysis
. 2016 Nov 9;11(11):CD001688.
doi: 10.1002/14651858.CD001688.pub3.

Interventions for promoting the initiation of breastfeeding

Olukunmi O Balogun  1 , Elizabeth J O'Sullivan, Alison McFadden, Erika Ota, Anna Gavine, Christine D Garner, Mary J Renfrew, Stephen MacGillivray
Affiliations
Meta-Analysis

Interventions for promoting the initiation of breastfeeding

Olukunmi O Balogun et al. Cochrane Database Syst Rev. .

Abstract

Background: Despite the widely documented risks of not breastfeeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower-income groups. In low- and middle-income countries, many women do not follow World Health Organization (WHO) recommendations to initiate breastfeeding within the first hour after birth. This is an update of a Cochrane Review, first published in 2005.

Objectives: To identify and describe health promotion activities intended to increase the initiation rate of breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding early (within one hour after birth).

Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and scanned reference lists of all articles obtained.

Selection criteria: Randomised controlled trials (RCTs), 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: Two review authors independently assessed trial reports for inclusion, extracted data and assessed trial quality. Discrepancies were resolved through discussion and a third review author was involved when necessary. We contacted investigators to obtain missing information.

Main results: Twenty-eight trials involving 107,362 women in seven countries are included in this updated review. Five studies involving 3,124 women did not contribute outcome data and we excluded them from the analyses. The methodological quality of the included trials was mixed, with significant numbers of studies at high or unclear risk of bias due to: inadequate allocation concealment (N = 20); lack of blinding of outcome assessment (N = 20); incomplete outcome data (N = 19); selective reporting (N = 22) and bias from other potential sources (N = 17). Healthcare professional-led breastfeeding education and support versus standard care The studies pooled here compare professional health workers delivering breastfeeding education and support during the prenatal and postpartum periods with standard care. Interventions included promotion campaigns and counselling, and all took place in a formal setting. There was evidence from five trials involving 564 women for improved rates ofbreastfeeding initiation among women who received healthcare professional-led breastfeeding education and support (average risk ratio (RR) 1.43, 95% confidence interval (CI) 1.07 to 1.92; Tau² = 0.07, I² = 62%, low-quality evidence) compared to those women who received standard care. We downgraded evidence due to design limitations and heterogeneity. The outcome of early initiation of breastfeeding was not reported in the studies under this comparison. Non-healthcare professional-led breastfeeding education and support versus standard care There was evidence from eight trials of 5712 women for improved rates of breastfeeding initiation among women who received interventions from non-healthcare professional counsellors and support groups (average RR 1.22, 95% CI 1.06 to 1.40; Tau² = 0.02, I² = 86%, low-quality evidence) compared to women who received standard care. In three trials of 76,373 women, there was no clear difference between groups in terms of the number of women practicing early initiation of breastfeeding (average RR 1.70, 95% CI 0.98 to 2.95; Tau² = 0.18, I² = 78%, very low-quality evidence). We downgraded the evidence for a combination of design limitations, heterogeneity and imprecision (wide confidence intervals crossing the line of no effect). Other comparisonsOther comparisons in this review also looked at the rates of initiation of breastfeeding and there were no clear differences between groups for the following comparisons of combined healthcare professional-led education with peer support or community educator versus standard care (2 studies, 1371 women) or attention control (1 study, 237 women), breastfeeding education using multimedia (a self-help manual or a video) versus routine care (2 studies, 497 women); early mother-infant contact versus standard care (2 studies, 309 women); and community-based breastfeeding groups versus no breastfeeding groups (1 study, 18,603 women). None of these comparisons reported data on early initiation of breastfeeding.

Authors' conclusions: This review found low-quality evidence that healthcare professional-led breastfeeding education and non-healthcare professional-led counselling and peer support interventions can result in some improvements in the number of women beginning to breastfeed. The majority of the trials were conducted in the USA, among women on low incomes and who varied in ethnicity and feeding intention, thus limiting the generalisability of these results to other settings.Future studies would ideally be conducted in a range of low- and high-income settings, with data on breastfeeding rates over various timeframes, and explore the effectiveness of interventions that are initiated prior to conception or during pregnancy. These might include well-described interventions, including health education, early and continuing mother-infant contact, and initiatives to help mothers overcome societal barriers to breastfeeding, all with clearly defined outcome measures.

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Conflict of interest statement

Olukunmi O Balogun: none known.

Elizabeth J O'Sullivan: none known.

Alison McFadden: none known.

Erika Ota: none known.

Anna Gavine: none known.

Christine D Garner: none known.

Mary J Renfrew: none known.

Stephen MacGillivray: none known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Sensitivity analysis (excluding high attrition bias studies) of forest plot of comparison: 2 Non‐healthcare professional‐led breastfeeding education and support versus standard care, outcome: 2.1 Initiation of breastfeeding.
1.1
1.1. Analysis
Comparison 1 Healthcare professional‐led breastfeeding education and support versus standard care, Outcome 1 Initiation of breastfeeding.
2.1
2.1. Analysis
Comparison 2 Non‐healthcare professional‐led breastfeeding education and support versus standard care, Outcome 1 Initiation of breastfeeding.
2.2
2.2. Analysis
Comparison 2 Non‐healthcare professional‐led breastfeeding education and support versus standard care, Outcome 2 Early initiation of breastfeeding.
3.1
3.1. Analysis
Comparison 3 Healthcare professional‐led breastfeeding education with non‐healthcare professional support versus standard care, Outcome 1 Initiation of breastfeeding.
4.1
4.1. Analysis
Comparison 4 Healthcare professional‐led breastfeeding education with peer support versus attention control, Outcome 1 Initiation of breastfeeding.
5.1
5.1. Analysis
Comparison 5 Breastfeeding education using multimedia versus routine care, Outcome 1 Initiation of breastfeeding.
6.1
6.1. Analysis
Comparison 6 Early mother‐infant contact versus standard care, Outcome 1 Initiation of breastfeeding.
7.1
7.1. Analysis
Comparison 7 Community‐based breastfeeding groups versus no breastfeeding groups, Outcome 1 Breastfeeding rate at birth.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Henderson 2001 {published data only}
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NCT00393640 {published data only}
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NCT01916603 {published data only}
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NCT02162498 {published data only}
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References to studies awaiting assessment

Bakhshi 2015 {published data only}
    1. Bakhshi M, Kordi M, Esmaeeli H. The effect of continuous support during labor on the onset of lactogenesis stage II in primiparas. Journal of Mazandaran University of Medical Sciences 2015;25(130):153‐8.
Samieizadeh 2011 {published data only}
    1. Samieizadeh T, Sereshti M, Dashipur AR, Mohammadinia N, Arzani A. The effect of supportive companionship on Length of labor and desire to breastfeed in primiparous Women. Journal of Urmia Nursing & Midwifery Faculty 2011;9(4):1‐9.

References to ongoing studies

ISRCTN23019866 {published data only}
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