Excerpt from The WHO Reproductive Health Library Published by Update Software Ltd.

Interventions for promoting the initiation of breastfeeding

Information, education and communication (IEC) activities can help promote the initiation and successful continuation of breastfeeding. Information packs provided by commercial companies to pregnant mothers to encourage breastfeeding appear to have no benefit. There is a need to conduct large trials on this subject in under-resourced settings.

RHL Commentary by Atanu Kumar Jana

EVIDENCE SUMMARY

This review aimed to evaluate the effectiveness of interventions to increase the rate of initiation of breastfeeding. Three types health education interventions designed to increase the rate of initiation of breastfeeding were evaluated in the seven trials (1388 women) included in the review: breastfeeding promotion packs, early mother–infant contact, and population-based programmes. Six of the seven trials had been conducted among low-income women in the USA and one in Nicaragua. Pooled together, five small trial (involving 582 women) showed a significant beneficial effect on breastfeeding initiation rates with the use of breastfeeding promotion packs, irrespective of the type of package used (relative risk [RR] 1.53; 95% confidence interval [CI] 1.25 to 1.88). In another trial, postnatal support provided by specialists in addition to prenatal health education had additional benefits of increasing initiation rates (RR 2.18; CI 1.40 to 3.40) and the median duration of breastfeeding (Intervention: 84 days, Control: 33 days). Finally, the seventh was a study of 547 women that compared breastfeeding initiation rates using promotion packages prepared by noncommercial bodies with that produced by a formula milk company. The trial included a third intervention group which evaluated early rooming-in of 259 mother–infant pairs followed by prolonged separation during the rest of their hospital stay. These two interventions had no effect on improving breastfeeding initiation rates.

The trials were identified and retrieved using the Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane Central Register of Controlled Trials and a comprehensive search up to October 2002 of databases such as MEDLINE, EMBASE, ERIC and CINAHL, the “grey literature” and relevant journals. Trials that focused on promotion of exclusive breastfeeding or prolonging its duration were excluded.

The quality and validity of the trials was evaluated independently and cross-checked. The effect of each type of intervention was calculated using individual and pooled relative risk estimates with 95% confidence intervals. Contrary to the convention of Cochrane reviews, in this review a relative risk of more than one indicates that the intervention has a more favorable effect on initiation rates than controls. Subgroup analysis was not possible because of paucity of studies and differences in the types of interventions.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References

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This document should be cited as: Atanu Kumar Jana. Interventions for promoting the initiation of breastfeeding: RHL commentary (last revised: 20 February 2006). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com