Wednesday, November 9, 2016

Interventions for encouraging women to start breastfeeding

Cochrane: International rates of breastfeeding initiation are extremely variable both between and within countries. Low- and middle-income countries generally have high rates of women starting breastfeeding, and the challenge is for breastfeeding to begin within one hour of birth. High-income countries have a much greater variation in the number of women who start breastfeeding, with more highly educated and more well-off women likely to start.

The World Health Organization recommends that breastfeeding should start within the first hour after giving birth, that all infants should be exclusively breastfed from birth to six months of age, and that breastfeeding should continue until 2 years or beyond. We know that breastfeeding is good for the health of women and babies. Babies who are not fully breastfed for the first three to four months of life are more likely to suffer from infections of the stomach and intestines, air passages and lungs, or develop ear infections. Babies who are not breastfed are more likely to be overweight or have diabetes later in life, and mothers who do not breastfeed have increased risks of breast and ovarian cancer. Other practical benefits of breastfeeding include saving money on buying breast milk substitutes and, for society, on treating illness. Yet many women feed their babies with infant formula.
Why is this important?
We want to have a better understanding of what works to promote breastfeeding, for women, their families, the health system and society. Women face many barriers to breastfeeding, including lack of public spaces where women can breastfeed without feeling embarrassment; lack of flexible working days for breastfeeding women at work; widespread advertising of breast milk substitutes; and public policy that ignores the needs of breastfeeding women. New ways to promote breastfeeding are needed.
What evidence did we find?
We searched for evidence on 29 February 2016. This updated review now includes 28 randomised controlled studies involving 107,362 women. Twenty studies involving 27,865 women looked at interventions to increase the number of women who started breastfeeding, in three high-income countries (Australia, 1 study; UK, 4 studies; and USA, 14 studies) and one lower middle-income country (Nicaragua, 1 study). Three studies investigated the effect of an intervention to increase the number of women who started breastfeeding early, within one hour after birth. These involved 76,373 women from Malawi, Nigeria and Ghana. The study from Malawi was large, with 55,931 participants.
Health education delivered by doctors and nurses and counselling and peer support by trained volunteers improved the number of women who began breastfeeding their babies. Five studies involving 564 women reported that women who received breastfeeding education and support from doctors or nurses were more likely to start breastfeeding compared to women who received standard care. Four of these studies were conducted in low-income or amongst minority ethnic women in the USA, where baseline breastfeeding rates are typically low. Eight studies involving 5712 women showed improved rates of starting breastfeeding with trained volunteer-delivered interventions and support groups compared to the women who received standard care.
Breastfeeding education provided by trained volunteers could also improve the rates of early initiation of breastfeeding, within one hour of giving birth, in low-income countries.
We assessed all the evidence in this review to be low-quality because of limitations in study design and variations in the interventions, to whom, when, where, and how an intervention was delivered. Standard care also differed and could include some breastfeeding support, for example, in the UK.
We found too little evidence to say whether strategies with multimedia, early mother-infant contact, or community-based breastfeeding groups were able to improve breastfeeding initiation.
What does this mean?
Doctors, nurses, and trained volunteers can deliver education sessions and provide counselling and peer support to increase the number of women who start breastfeeding their babies. High-quality research is needed to understand which interventions are likely to be effective in different population groups. More studies are needed in low- and middle-income countries to find out which strategies will encourage women to start breastfeeding just after giving birth.