Evaluation of the effectiveness of a structured breast-feeding promotion program integrated into a Maternal and Child Health service in Jerusalem

Abstract

A community program for promotion of breast-feeding integrated into the Maternal and Child Health (MCH) services is presented and evaluated, using two quasi-experimental designs, comparison groups and time trends. The program, which began in 1981, included guidance from the 7th month of pregnancy to 6 months post-delivery. An increase in the percentage of breast-feeding mothers and the duration of breast-feeding was noted in the post-intervention cohorts (1981-82 and 1985) compared with the preintervention cohorts (1979-81). The comparison of the breast-feeding pattern of the 1985 birth cohort from the MCH service exposed to the program with a similar group receiving routine MCH care indicated that the percentage of mothers breast-feeding fully or partially was consistently higher among the intervention group compared with the control group at 4, 13 and 26 weeks (P = 0.0045), and the mean duration of full breast-feeding was 9.3 weeks compared with 7.0 weeks (P = 0.028). The program had a greater effect on mothers with a lower educational standard, thus closing the gap in the breast-feeding pattern by educational level in the intervention group. The evaluation indicates that a structured breast-feeding promotion program is more effective than the routine guidance received in the MCH service.

PIP: 2 quasi-experimental designs (comparison groups and time trends) were used to evaluate a breastfeeding promotion program in Jerusalem that was integrated into the maternal-child health service. The program, which was incorporated into the maternal-health program in 1981, sought to increase the percentage of women breastfeeding and prolong its duration. The intervention group consisted of 118 consecutive births that took place in 1985, while the control group was comprised of 192 births also occurring in 1985 registered at a maternal-child health service of an adjacent neighborhood where promotion of breastfeeding was not part of the program. Consistent and significant differences were found between these 2 groups in the percent breastfeeding. In the intervention group, 80% initiated breastfeeding and 29% were still breastfeeding at 26 weeks; among controls, these percentages were 75% and 12%, respectively. At 13 weeks postpartum, 29% of inventions in the intervention group were being fully breastfed and at 26 weeks, 5% were in this category; among controls, these statistics were 18% and 2%. Educational status exerted a significant effect on breastfeeding in the control group. Among mothers with under 13 years of schooling, 65% started breastfeeding, 20% were still nursing at 13 weeks, and 3% were breastfeeding at 26 weeks; in contrast, among controls with 13 or more years of education, these percentages were 85%, 50%, and 25%, respectively. No differences in breastfeeding were noted by educational level in the intervention group. Among mothers who did not return to outside employment, a higher percentage in the intervention group breastfed at each age than nonworking mothers in the control group. Multiple regression analysis identified 4 independent variables that had a significant effect on the duration of full and total breast-feeding: education, previous experience, younger maternal age, and program exposure. Finally, time trend analysis indicated a marked change in percent of women breastfeeding at 26 weeks, from 10% in the preintervention period to 16% during the program's 1st year, to 29% in the 1985 birth cohort.