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Support for breastfeeding mothers

  1. Cathryn Britton2,
  2. Felicia M McCormick1,*,
  3. Mary J Renfrew1,
  4. Angela Wade3,
  5. Sarah E King1

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 8 NOV 2006

DOI: 10.1002/14651858.CD001141.pub3

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How to Cite

Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub3.

Author Information

  1. 1

    University of York, Mother and Infant Research Unit, Department of Health Sciences, York, UK

  2. 2

    University of York, Department of Health Sciences, York, UK

  3. 3

    Institute of Child Health, Centre for Paediatric Epidemiology and Biostatistics, London, UK

*Felicia M McCormick, Mother and Infant Research Unit, Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. fm510@york.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

There is extensive evidence of short-term and long-term health benefits of breastfeeding for infants and mothers. Early benefits include reduced mortality in preterm infants (Lucas 1990a), reduced infant morbidity from gastro-intestinal, respiratory, urinary tract and middle-ear infections and less atopic illness (Aniansson 1994; Cesar 1999; Howie 1990; Kramer 2001; Lucas 1990b; Marild 2004). There is some evidence that exclusive breastfeeding is associated with the lowest rates of these illnesses in the first six months of life (Kramer 2002; Raisler 1999).

Breastfeeding offers some protection against the development of childhood diseases such as juvenile onset insulin dependant diabetes mellitus (Sadauskaite 2004; Virtanen 1991); raised blood pressure (Taittonen 1996; Wilson 1998; Singhal 2001); obesity (Fewtrell 2004; Gillman 2001) and the development of diseases in later life such as atopic disease (Fewtrell 2004) and raised blood pressure (Fewtrell 2004; Martin 2004). Breastfeeding has also been associated with significantly higher scores for cognitive development (Anderson 1999; Fewtrell 2004).

As well as health benefits to infants, breastfeeding has an impact on maternal health too (Labbock 2001). Studies have demonstrated a lower incidence of breast cancer (Beral 2002; Newcombe 1994), ovarian cancer (Gwinn 1990; Rosenblatt 1993) and hip fractures (Cumming 1993) in those women who have breastfed.

The established health benefits of breastfeeding to a nation have resulted in global and national support for encouraging the commencement and continuation of breastfeeding. In 2003 the World Health Organization recommended that, wherever possible, infants should be fed exclusively on breast milk until six months of age (WHO 2003). In England two aims are to raise the breastfeeding initiation rate by two percentage points per year (DoH 2002) and to support the World Health Organization recommendation (WHO 2003) of exclusive breastfeeding for the first six months of life (DoH 2003).

Despite the established benefits of breastfeeding, breastfeeding rates in many developed countries continue to be resistant to change. In the UK, the breastfeeding initiation rate was 69% in 2000 (Hamlyn 2002). A similar figure is reported in the US (USDoHHS 2005). However, in both the UK and USA there is a marked decline in breastfeeding within the first few weeks after initiation, and exclusive breastfeeding is rare. Conversely, some other European countries, such as Scandinavia and Germany (Cattaneo 2003), have high initiation and continuation breastfeeding rates (Nicoll 2002).

There are many factors that might influence the early cessation of breastfeeding. In developed countries, young mothers and those in low-income groups or those who ceased full-time education at an early age are least likely to either start breastfeeding or continue for a period of time sufficient to confer health gain (Hamlyn 2002). Enkin notes that industrial societies, on the whole, do not provide women with the opportunity to observe other breastfeeding women before they attempt breastfeeding themselves (Enkin 2000). In such societies, women are at risk of lack of support to breastfeed their babies. Paradoxically, in poorer countries, more affluent groups may have lower breastfeeding rates (Chhabra 1998; Rogers 1997). This is particularly important as there is a protective effect when breastfeeding continues for long periods of time, resulting in reduced infant mortality and child mortality in the second year of life in less developed countries (WHO 2000).

Although some women will choose to breastfeed their infant for a limited amount of time, or not at all, there is evidence that many women are disappointed that they have not been successful in breastfeeding for longer. Hamlyn 2002 reports that 87% of mothers who ceased breastfeeding within six weeks of birth would have liked to breastfeed for longer. For those mothers who breastfed for at least six months, 37% would have preferred to continue for longer.

Clearly there is a need to review the support mothers receive when breastfeeding to determine what might be effective in helping women continue to breastfeed. The purpose of this review was to examine interventions which provide extra support for mothers who wish to breastfeed; and to assess their impact on breastfeeding duration and exclusivity and, where recorded, on health outcomes and maternal satisfaction. Specific objectives of the review were to describe forms of support which have been evaluated in controlled studies, and the settings in which they have been used. It was also of interest to examine the effectiveness of different modes of offering similar supportive interventions (for example, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone. We also planned to examine the effectiveness of different care providers and training programmes and the effect of baseline breastfeeding prevalence (where known) on the effectiveness of supportive interventions.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

(1) To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.

(2) To examine the effectiveness of comparable interventions and compare effectiveness in low- and high-income groups where possible.

(3) To examine the effectiveness of different modes of offering similar supportive interventions (for example, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.

(4) To compare the effectiveness of different care providers and training.

(5) To explore the interaction between baseline breastfeeding prevalence (where known) and effectiveness of support.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Criteria for considering studies for this review

 

Types of studies

All randomised or quasi-randomised controlled trials, with or without blinding, and with a minimum of 75% follow up.

 

Types of participants

Participants were pregnant women intending to breastfeed, postpartum women intending to breastfeed and women breastfeeding their babies.

 

Types of interventions

Contact with an individual or individuals (either professional or volunteer) offering support which is supplementary to standard care (in the form of, for example, appropriate guidance and encouragement) with the purpose of facilitating continued breastfeeding. Studies were included if the intervention occurred in the postnatal period alone or also included an antenatal component. Interventions taking place in the antenatal period alone were excluded from this review, as were interventions described as solely educational in nature.

 

Types of outcome measures

The main outcome measure was the effect of the interventions on duration of any breastfeeding to specified points in time. Outcomes were recorded for stopping feeding before four to six weeks and two, three, four, six, nine and 12 months. Other outcomes of interest were exclusive breastfeeding, measures of neonatal and infant morbidity (where available) and measures of maternal satisfaction with care or feeding method.

 

Search methods for identification of studies

 

Electronic searches

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register by contacting the Trials Search Co-ordinator (January 2006).

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 27 July 2009 and added the results to Studies awaiting classification.

The Cochrane Pregnancy and Childbirth Group’s Trials Register is maintained by the Trials Search Co-ordinator and contains trials identified from: 

  1. quarterly searches of the Cochrane Central Register of Controlled Trials (CENTRAL);
  2. weekly searches of MEDLINE;
  3. handsearches of 30 journals and the proceedings of major conferences;
  4. weekly current awareness alerts for a further 44 journals plus monthly BioMed Central email alerts.

Details of the search strategies for CENTRAL and MEDLINE, the list of handsearched journals and conference proceedings, and the list of journals reviewed via the current awareness service can be found in the ‘Specialized Register’ section within the editorial information about the Cochrane Pregnancy and Childbirth Group. 

Trials identified through the searching activities described above are each assigned to a review topic (or topics). The Trials Search Co-ordinator searches the register for each review using the topic list rather than keywords. 

Trials identified through the searching activities described above are given a code (or codes) depending on the topic. The codes are linked to review topics. The Trials Search Co-ordinator searches the register for each review using these codes rather than keywords.

In addition, we searched MEDLINE (1966 to November 2005), EMBASE (1974 to November 2005) and handsearched Midwives Information and Resource Service (MIDIRS) quarterly Digest from 1991 to September 2005. We scanned secondary references and obtained relevant studies. Details of the search strategies can be obtained from the review authors.

We did not apply any language restrictions.

 

Data collection and analysis

Titles and abstracts of the electronic searches were assessed for inclusion by a review author and a research assistant (Felicia McCormick (FM), Natasha Danson). All the included trials offered an intervention to breastfeeding women with the purpose of encouraging continued breastfeeding. All articles identified were available in English. Two review authors independently read articles identified via the search strategy to determine inclusion or exclusion (Cathryn Britton (CB), FM). Any differences in opinion were resolved in consultation with a third author (Mary Renfrew). When information regarding the study was unclear, we attempted to contact authors of original reports to provide further details. Angie Wade and Sarah King provided statistical advice and review.

We designed a data extraction form. Two authors (CB, FM) used data extraction forms and quality appraisal forms independently. One author extracted and the second author checked the data. Disagreements were resolved through discussion between the authors. We identified 34 randomised or quasi-randomised controlled trials from 14 countries as eligible for inclusion in this review. We extracted the following study characteristics and entered them in the table of included studies: country, setting, demographic data on study group and controls, study design, randomisation procedure, intervention package, length and completeness of follow up, description of withdrawals and drop-outs, blinding of assessors and outcome measures. We used Review Manager software (RevMan 2003) to double enter all the data.

We assessed the method of allocation concealment used in each study using criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2005). We categorised studies according to whether the method of allocation concealment reported was judged to have been adequate (A), unclear (B) inadequate (C), or if allocation was not concealed (D). We also checked study reports for clear descriptions of inclusion and exclusion criteria; randomisation methods; withdrawals and drop-outs; statistical analysis used; blinding of outcome assessment; and intention-to-treat analysis. Methods used for generation of the randomisation sequence are described in the 'Characteristics of included studies' table. Included trials had a minimum of 75% initial follow up. When included trials reported data at more than one time point and follow-up rates fell, we included only data from time points where follow-up rates were at least 75% in the analysis.

We carried out statistical analysis using RevMan 2003. We analysed data on an intention-to-treat basis whenever possible, even if intention-to-treat analysis had not been used in the study report. When cluster-randomised trials were incorporated, we calculated effective sample sizes and entered these into the meta-analyses. We determined effective sample sizes via calculation of the intraclass correlation coefficient, where the data were available, or through consideration of the relative sizes of the confidence intervals obtained from analyses which did and did not correct for clustering of the outcomes.

We calculated relative risk as the preferred estimate of treatment effect. We preferred random-effects models to perform all meta-analyses since studies were clinically heterogeneous. We also undertook subgroup analyses of all studies offering support compared with those that had adequate allocation concealment; studies in settings with high, medium and low baseline breastfeeding initiation rates; support offered by professional, lay or a combination of professional and lay supporters; face-to-face, phone or balanced telephone and face-to-face contact; and postnatal support alone or support with an antenatal component.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

For this review update, we identified 354 new references. After screening, we selected 14 new trials for inclusion. (Seventy-nine reports from an updated search in July 2009 have been added to Characteristics of studies awaiting classification.)

The previous version of this review (Sikorski 2002) identified one trial of lay support in progress in Scotland. Further information about this trial was not available in time for this update; however, it has since been published (Muirhead 2006). The completed trial of trained lay breastfeeding counsellors in London identified by Sikorski (Sikorski 2002) has since been published and is included in this review as Graffy 2004. The study by Dennis included in Sikorski 2002, using data from Dennis's thesis, has since been published, and we have made this publication the primary reference for this study in this review (Dennis 2002).

This review has a total of 34 included studies which come from 14 countries. Six studies were conducted in each of the following countries: Canada (Dennis 2002; Gagnon 2002; Lynch 1986; Mongeon 1995; Pinelli 2001; Porteous 2000); USA (Brent 1995; Chapman 2004; Frank 1987; Grossman 1990; Pugh 2002; Wrenn 1997); UK (Graffy 2004; Jenner 1988; Jones 1985; Moore 1985; Morrell 2000; Winterburn 2003). Four studies were conducted in Brazil (Albernaz 2003; Barros 1994; Leite 1998; Santiago 2003); two studies were conducted in Bangladesh (Haider 1996; Haider 2000) and Australia (McDonald 2003; Quinlivan 2003). Single studies came from India (Bhandari 2003), Nigeria (Davies-Adetugbo 1997), Italy (Di Napoli 2004), Iran (Froozani 1999), the Netherlands (Kools 2005), Belarus (Kramer 2001), Mexico (Morrow 1999) and Sweden (Sjolin 1979).

The total number of mother-infant pairs included is 29,385.

There were 42 excluded studies. The main reasons for exclusion were high loss to follow up, evaluation of an educational intervention and lack of data. Full details are available in the 'Characteristics of excluded studies' table.

The main purpose of this review was to analyse the impact of the intervention, extra breastfeeding support, with the purpose of facilitating continued breastfeeding. We included studies if the intervention occurred in the postnatal period alone or also included an antenatal component. We excluded interventions taking place in the antenatal period alone, as well as interventions described as solely educational in nature.

The main outcome measure was the effect of the intervention on duration of breastfeeding to specified points in time. Outcomes were recorded for stopping feeding before four to six weeks and two, three, four, six, nine and 12 months. Other outcomes of interest were exclusive breastfeeding, measures of neonatal and infant morbidity (where available) and measures of maternal satisfaction with care or feeding method.

Personnel and training
The included studies evaluated support provided by a variety of medical, nursing and allied professionals (for example, nutritionists) as well as lay people. Lay support was either voluntary or remunerated. In previous editions of this review, support has been categorised as either 'professional' or 'lay'. A new category, 'lay and professional', has been devised for this update. Nineteen studies used professionals for support (Albernaz 2003; Davies-Adetugbo 1997; Di Napoli 2004; Frank 1987; Froozani 1999; Gagnon 2002; Grossman 1990; Jones 1985; Kools 2005; Kramer 2001; Lynch 1986; McDonald 2003; Moore 1985; Pinelli 2001; Porteous 2000; Quinlivan 2003; Santiago 2003; Sjolin 1979; Wrenn 1997). Nine studies used lay people for support (Chapman 2004; Dennis 2002; Graffy 2004; Haider 2000; Jenner 1988; Leite 1998; Mongeon 1995; Morrell 2000; Morrow 1999) and six studies used a combination of both professional and lay people (Barros 1994; Bhandari 2003; Brent 1995; Haider 1996; Pugh 2002; Winterburn 2003).

Details of those involved in providing support and the interventions used are given in the table of 'Characteristics of included studies'. Eight studies (Albernaz 2003; Davies-Adetugbo 1997; Di Napoli 2004; Froozani 1999; Haider 1996; Haider 2000; Kramer 2001; Leite 1998) used either the 18-hour or 40-hour WHO/UNICEF breastfeeding counselling/lactation management courses as the basis for the training of breastfeeding supporters. A further nine studies reported providing the supporter with extra formal training in breastfeeding support prior to the intervention (Bhandari 2003; Chapman 2004; Dennis 2002; Gagnon 2002; Graffy 2004; Morrell 2000; Mongeon 1995; Morrow 1999; Santiago 2003). Where the length of additional training was reported, this ranged from sessions lasting 2.5 hours to 40 hours.

We also subdivided the studies into broad categories to examine aspects of the interventions, as discussed in the Methods section.

Comparison groups
In the majority of studies, the comparison group was reported to have received 'usual postnatal care', which varies both between and within countries. The care at the time of the trials may also differ from that which is offered at the present time. Wherever there were individual study details on care received by the comparison groups, these are given in the 'Characteristics of included studies' table.

Outcomes
Breastfeeding was usually reported as being either partial or exclusive, with no further definitional refinement. Few studies reported both partial and exclusive rates at all time points. Reporting of health outcomes was scanty and inconsistent, allowing little joint analysis. The timing of outcome assessments varied considerably between studies, ranging from two weeks to one year postnatally. Several studies took repeated measurements of breastfeeding rates, and some reported mean duration.

Differences in groups studied
Support was usually offered to women intending to breastfeed, but in three studies (Brent 1995; Morrell 2000; Quinlivan 2003) intention to formula-feed was not an exclusion criterion. In the small study by Porteous (Porteous 2000), support was only offered to those breastfeeding women who identified themselves as unsupported on a self-report questionnaire. In two studies the intervention was targeted at low-income women (Chapman 2004; Pugh 2002), whereas the intervention was only offered to women under the age of 18 years in another (Quinlivan 2003).

In one study (Moore 1985), only women with a personal or partner history of asthma or eczema were selected. Two further trials (Davies-Adetugbo 1997; Haider 1996) studied the effect of support for mothers of sick infants with moderate diarrhoeal disease. One trial (Bhandari 2003) studied the effect of breastfeeding support delivered to communities and included diarrhoea prevalence outcomes. In another trial (Pinelli 2001), the focus of the study was the effect of breastfeeding support to parents of very low birthweight babies.

 

Risk of bias in included studies

Each trial was assessed for quality as outlined in the Methods section. Fifteen of the 34 trials used an approach to allocation concealment considered adequate (A). In 12 trials the approach used was unclear (B), and seven used an approach considered inadequate (C). These assessments are among the details reported in the 'Characteristics of included studies' table of this review. For one trial (McDonald 2003), only the abstract of the study was available to review and this scored B.

 

Effects of interventions

The initial searches of MEDLINE and EMBASE identified 327 references. Twenty-seven references not identified by previous editions of the review were identified by a search of the Cochrane Pregnancy and Childbirth Group Trials Register. Fourteen new trials were finally added to the 20 that featured in Sikorski 2002. The 34 studies included in this review are from 14 countries and include 29,385 mother-infant pairs.

Some studies used professional or lay individuals, or a combination of both. Data were collected regarding the effect of the intervention on breastfeeding duration. Some studies reported exclusive breastfeeding rates, but others were ambiguous and it was difficult to ascertain whether the infant was fed breast milk alone. We collected data on the effect of the interventions on any form of breastfeeding to assess the impact of interventions to enable women to continue breastfeeding.

Types of outcome measures
The main outcome measure was the effect of the interventions on duration of breastfeeding to specified points in time. Outcomes were recorded for stopping feeding before four to six weeks and two, three, four, six, nine and 12 months. Other outcomes of interest were exclusive breastfeeding, measures of neonatal and infant morbidity (where available) and measures of maternal satisfaction with care or feeding method.

Overall effect on any breastfeeding
The main summary outcome measure was breastfeeding at the time of the last study assessment up to six months. There continues to be a beneficial effect on the duration of any breastfeeding up to six months with the implementation of any form of extra support (relative risk (RR) 0.91, 95% confidence interval (CI) 0.86 to 0.96). However, it is noted that there was significant heterogeneity (I2 = 53.6%). Sensitivity analysis using only studies with adequate allocation concealment demonstrated a similar result (RR 0.90, 95% CI 0.83 to 0.98, I2 62.4%).

In order to explore any differential effect of support conditional on the baseline prevalence of breastfeeding in the area in which the trial was conducted, we divided the trials into three categories denoted by high (greater than 80%), intermediate (60% to 80%) or low (less than 40%) initiation rates in the local area. Analysis of the trials conducted in settings with intermediate breastfeeding initiation (Chapman 2004; Dennis 2002; Di Napoli 2004; Gagnon 2002; Graffy 2004; Jones 1985; Lynch 1986; Mongeon 1995; Morrell 2000; Pinelli 2001; Porteous 2000; Pugh 2002; Winterburn 2003; Wrenn 1997) demonstrated all forms of support had a significant benefit on breastfeeding (RR 0.92, 95% CI 0.85 to 0.98), whereas there was no significant effect where there were high rates of breastfeeding (RR 0.91, 95% CI 0.81 to 1.01) (Albernaz 2003; Barros 1994; Bhandari 2003, Froozani 1999; Kramer 2001; Kools 2005; Leite 1998; McDonald 2003; Morrow 1999; Quinlivan 2003). There was no significant effect in areas with low initiation rates (RR 0.88, 95% CI 0.69 to 1.12) (Brent 1995; Frank 1987; Grossman 1990).

Analysis of results at different periods of follow up presented some challenges in interpreting the data. There was variability between the studies regarding the time points when data were collected, therefore caution has to be exercised when interpreting the trends. However, analysis of results at different periods of follow up suggested that the benefit of all forms of support was present at all time points up to nine months.

Overall effect on exclusive breastfeeding
The effect of any support on mothers exclusively breastfeeding is greater than on women continuing any form of breastfeeding (RR 0.81, 95% CI 0.74 to 0.89) (Albernaz 2003; Bhandari 2003; Frank 1987; Froozani 1999; Gagnon 2002; Graffy 2004; Haider 2000; Jenner 1988; Kools 2005; Kramer 2001; Leite 1998; McDonald 2003; Moore 1985; Morrell 2000; Morrow 1999; Porteous 2000; Pugh 2002; Santiago 2003; Sjolin 1979; Wrenn 1997). There is significant heterogeneity in this group of 20 trials (I2 = 92.2%). Those women who receive any form of support are less likely to give up exclusive breastfeeding before five months.

Professional support
Trials comparing an intervention of extra professional support to usual care in preventing the cessation of any breastfeeding showed professional support to be effective at four months but not at other time points (RR for stopping any breastfeeding before four months in five trials 0.78, 95% CI 0.67 to 0.91) (Albernaz 2003; Frank 1987; Froozani 1999; Quinlivan 2003; Sjolin 1979). However, the overall effect of extra professional support on stopping any breastfeeding did not reach statistical significance (RR for stopping any breastfeeding before last study assessment up to six months in 16 trials 0.94, 95% CI 0.87 to 1.01) (Albernaz 2003; Frank 1987; Froozani 1999; Gagnon 2002; Grossman 1990; Di Napoli 2004; Jones 1985; Kools 2005; Kramer 2001; Lynch 1986; McDonald 2003; Pinelli 2001; Porteous 2000; Quinlivan 2003; Sjolin 1979; Wrenn 1997). There was heterogeneity present among the 16 trials (I2 = 49.8%).

Professional support resulted in a beneficial effect on exclusive breastfeeding (RR 0.91, 95% CI 0.84 to 0.98) (Albernaz 2003; Frank 1987; Froozani 1999; Gagnon 2002; Kools 2005; Kramer 2001; Lynch 1986; McDonald 2003; Moore 1985; Porteous 2000; Sjolin 1979; Wrenn 1997). This is apparent in the first few months (RR before four to six weeks 0.69, 95% CI 0.51 to 0.92; RR before two months 0.76, 95% CI 0.61 to 0.94; RR before three months 0.84, 95% CI 0.72 to 0.99).

Lay support
Trials that used lay people to deliver the intervention demonstrated a significant reduction in breastfeeding cessation at the time of the last study assessment (RR 0.86, 95% CI 0.76 to 0.98) (Chapman 2004; Dennis 2002; Graffy 2004; Leite 1998; Mongeon 1995; Morrell 2000; Morrow 1999). Significant heterogeneity was present among these studies (I2 = 75.6%). Further subgroup analysis did not reveal a statistically significant effect at any time point up to four months. However, in the studies of lay support which reported exclusive breastfeeding, there was a marked reduction in the cessation of exclusive breastfeeding before the last study assessment (RR 0.72, 95% CI 0.57 to 0.90) (Graffy 2004; Haider 2000; Jenner 1988; Leite 1998; Morrell 2000; Morrow 1999). There was heterogeneity among these studies (I2 = 96.3%). Further subgroup analysis indicated that this effect was significant within the first three months (RR before four to six weeks 0.66, 95% 0.46 to 0.96; RR before two months 0.44, 95% CI 0.26 to 0.73; RR before three months 0.42, 95% CI 0.31 to 0.57).

Combined professional and lay support
Five studies compared combined lay and professional support with usual care (Barros 1994; Bhandari 2003; Brent 1995; Pugh 2002; Winterburn 2003). Overall these showed a significant reduction in cessation of any breastfeeding (RR 0.84, 95% CI 0.77 to 0.92, I2 = 55.7%), especially in the first two months (RR before four to six weeks 0.65, 95% 0.51 to 0.82; RR before two months 0.74, 95% CI 0.66 to 0.83). Two studies (Bhandari 2003; Pugh 2002) demonstrated a significant reduction in cessation of exclusive breastfeeding (RR 0.62, 95% CI 0.50 to 0.77, I2 = 82.2%). However, these results should be viewed with caution as the numbers analysed are small, and there was only one high-quality trial included in this section (Bhandari 2003).

We performed subgroup analyses to test formally for significant differences between the groups offering professional support, lay support and combined professional and lay support. For stopping any breastfeeding there was no evidence of difference between subgroups except for borderline difference at two months (p=0.0468), where the tendency was for combined support to be most effective. For stopping exclusive breastfeeding, there were significant differences for all times tested (three months, four months, six months), and at each time point either lay or combined lay and professional support was most effective.

Differing modes and timing of support
The studies that offered face-to face support showed a statistically significant benefit (RR for giving up any breastfeeding 0.85, 95% CI 0.79 to 0.92) (Albernaz 2003; Barros 1994; Bhandari 2003; Brent 1995; Chapman 2004; Froozani 1999; Jones 1985; Kramer 2001; Leite 1998; Morrell 2000; Morrow 1999; Pinelli 2001; Quinlivan 2003; Winterburn 2003). The overall test for heterogeneity was I2 = 57.4%. In those studies where telephone support was offered, no significant effect was demonstrated (RR 0.92, 95% 0.78 to 1.08) (Dennis 2002; Frank 1987; Grossman 1990; Lynch 1986; Mongeon 1995). Where both telephone and face-to-face support were provided, there was no significant improvement in breastfeeding continuance (RR 1.00, 95% CI 0.91 to 1.09) (Di Napoli 2004; Gagnon 2002; Graffy 2004; Kools 2005; McDonald 2003; Porteous 2000; Pugh 2002; Sjolin 1979; Wrenn 1997).

The effect on stopping any breastfeeding at last study assessment before six months that was measured in studies of interventions containing an antenatal element to breastfeeding support (RR 0.92, 95% CI 0.83 to 1.02) was not significant, whereas the effect in those studies offering postnatal support alone did achieve statistical significance (RR 0.89, 95% CI 0.84 to 0.96). However, effect estimates were similar and the difference between the effect of interventions containing an antenatal element and the effect of interventions offering postnatal support alone was not statistically significant.

Health outcomes
There was a highly significant beneficial effect on exclusive breastfeeding two to three weeks after discharge from a healthcare facility in the two studies of support for mothers with sick infants (RR for stopping exclusive breastfeeding before two to three weeks after discharge 8.32, 95% CI 4.94 to 14.01, I2 = 0%) (Haider 1996; Davies-Adetugbo 1997). Three studies (Bhandari 2003; Davies-Adetugbo 1997; Haider 1996) reported on recurrence of diarrhoea. There was a marked short-term reduction in the recurrence of diarrhoea in these trials (RR for recurrence before two to three weeks follow-up (RR 0.70, 95% CI 0.54 to 0.9). There was statistical heterogeneity among these three studies (I2 = 53.8%). In the study by Haider (Haider 1996), eight babies in the control group and two babies in the intervention group had died two weeks after discharge from hospital. The difference in the populations in these trials, when compared to the healthy mother-infant dyads included in other studies, led to their exclusion from the main meta-analysis.

Few trials reported health outcomes and it was not possible to combine these statistically. The PROBIT study (Kramer 2001) found a significant reduction in the risk of one or more gastrointestinal infections and of atopic eczema in the group receiving care from health professionals who had received the WHO/UNICEF Baby Friendly Initiative training. There was no significant reduction in respiratory tract infection. Frank 1987 found no difference in breastfeeding rates in those infants rehospitalised during their study while Froozani 1999 observed a significant reduction in the mean number of days of gastrointestinal illness in the group receiving support but no significant difference in respiratory illness.

Measures of satisfaction
Satisfaction measures were poorly reported. Jones 1985 reported satisfaction with the amount of help received, both at home and in hospital, and found this to be greater in the intervention group. Two studies reported maternal satisfaction with infant feeding. Dennis (Dennis 2002) found no significant differences between the peer and control groups' mean scores on the Maternal Breastfeeding Evaluation Scale (mean scores 53.81 (standard deviation (SD) 5.69) versus 52.98 (SD 5.94), P = 0.26) (Leff 1994). However, significantly more mothers in the control group reported overall dissatisfaction with their infant feeding method. Graffy 2004 reported no difference between intervention group and control group on most measures but found the intervention group were less likely to believe they were not making enough milk.

Socially disadvantaged groups
One study (Jones 1985) reported effects of the supportive intervention in different social groups. In this study, the greatest difference in the proportion of women still breastfeeding at four weeks was in social classes IV and V (86% of social classes IV and V in the intervention group breastfeeding at four weeks versus 58% in social classes IV and V in the control group, P < 0.01). In the UK people are classified into social groupings according to their (or their partner's) occupation, for example, social class IV and V includes women with partners in manual or unskilled occupations.

In two further studies, low-income women from the US were included (Chapman 2004; Pugh 2002), and in another study (Quinlivan 2003) women under the age of 18 years were recruited.

Effect of differing training programmes
Eight trials (Albernaz 2003; Davies-Adetugbo 1997; Di Napoli 2004; Froozani 1999; Haider 1996; Haider 2000; Kramer 2001; Leite 1998) reported using either the 18- or 40-hour WHO/UNICEF breastfeeding training courses. Another trial (Bhandari 2003) used a course based on an adaptation of the WHO Integrated Management of Childhood Illness Training Manual on Breastfeeding Counselling (WHO 1997). Meta-analysis of the six trials using WHO/UNICEF training (Albernaz 2003; Bhandari 2003; Froozani 1999; Haider 2000; Kramer 2001; Leite 1998) showed significant benefit in prolonging exclusive breastfeeding (RR 0.69, 95% CI 0.52 to 0.91) but the trials were statistically heterogeneous (I2 = 97.9%).

Two trials (Chapman 2004; Morrow 1999) used the peer counsellor programme developed by La Leche League, the international lay breastfeeding support organisation and in Graffy 2004 the counsellors were trained by the National Childbirth Trust, a UK-based childbirth and breastfeeding advocacy organisation.

The length of training offered to lay supporters varied from 2.5 hours (Dennis 2002) to 40 hours (Albernaz 2003; Haider 2000). Other studies reported providing some extra training in breastfeeding support prior to the intervention (Dennis 2002; Gagnon 2002; Mongeon 1995; Morrell 2000; Santiago 2003).

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

This review adds several trials to its predecessor (Sikorski 2002). The reporting of these studies was often not comprehensive - lacking, for example, in terms of details of the training and qualifications of the supporters, the definitions used of the extent of breastfeeding and in the description of adherence to the support protocol. There was also a failure to present details of the informational element of the interventions and of the care received by the comparison groups. Nevertheless, the studies included in the review are of a higher overall quality than its predecessor, with 15 of the 34 trials using an approach to allocation concealment considered adequate.

These factors, together with the diversity of supportive interventions and the widely differing timing of study end-points, should urge some caution in the interpretation of the analysis of pooled data.

Despite this caution, the overall benefit found from all forms of supportive intervention has been explored with subgroup analysis and is moderately robust following exclusion of the methodologically weaker trials. It has been noted that the greatest effect of support interventions on breastfeeding women occurred in communities with intermediate levels of breastfeeding initiation.

While the effect size of support interventions on reducing the cessation of any breastfeeding is modest, there is evidence of a greater effect on the prolongation of exclusive breastfeeding. There was a marked reduction in the cessation of exclusive breastfeeding within the first three months when lay support was used. Professional support, lay support and combinations of lay and professional support did not differ significantly in their effect on the continuance of any breastfeeding, though there was a tendency for combined professional and lay support to be more effective. For continuance of exclusive breastfeeding, lay support and combinations of lay and professional support were more effective than professional support alone. These effects are also well illustrated in the studies of sick children, where the attendant short-term health benefits of exclusive breastfeeding are demonstrated.

It would appear that strategies that depend mainly on face-to-face support appear more effective than those that rely primarily on telephone contact.

Our attempts to determine the most helpful elements of support strategies should be treated with some caution as there is inconsistent reporting due to variations in the timing of outcome assessments.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

 

Implications for practice

Consideration should be given to providing supplementary breastfeeding support as part of routine health service provision. There is evidence for the effectiveness of additional professional support in prolonging exclusive breastfeeding. WHO/UNICEF training courses appear to be an effective model for professional training. Lay support is effective in promoting exclusive breastfeeding and any breastfeeding. Support offered by professionals and lay people together can be effective in prolonging any breastfeeding, especially within the first two months.

Face-to-face support appears to be more effective than support by telephone but there is as yet no evidence to suggest that the duration of breastfeeding is improved by routine antenatal contact. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breastfed infants.

 
Implications for research

There are several areas which require further study in the light of the results of this review.

  • Further trials are required to assess the effectiveness of lay, professional and combined support in different settings - in particular in those communities with low rates of breastfeeding initiation.
  • Trials should test the effectiveness of different training programmes (which should be well-defined and reproducible) and should attempt to address impact on both exclusive and any breastfeeding where possible.
  • Prospective economic analyses are required to accompany trials to establish the cost-effectiveness of different interventions.
  • Implementation of the Baby Friendly Initiative should be accompanied by the continued monitoring of breastfeeding rates to explore whether its effect is similar in countries with differing rates of initiation and prevalence of breastfeeding.
  • Further probing of the components of support interventions that are effective or ineffective should be encouraged, together with consideration of the significance of the timing and delivery of the support intervention.
  • Further trials to investigate appropriate strategies for supporting women who wish to breastfeed longer than two months are required.
  • Further exploration of maternal satisfaction should be included in future trials as this element is consistently poorly evaluated.

[Note: The 79 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

The review authors wish to thank the following study authors who were very helpful in responding to queries: Dr A Di Napoli and Professor MK Bhan. Thanks to Natasha Danson who contributed to trawling, pre-screening and contacting authors, and to James Thomas who set up a database for data extracted from the included papers. Thanks are also due to Sonja Henderson, Cochrane Pregnancy and Childbirth Review Group Co-ordinator, and Rebecca Smyth, Cochrane Pregnancy and Childbirth Review Editorial Assistant (Technical Editing).

As part of the pre-publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team), one or more members of the Pregnancy and Childbirth Group's international panel of consumers and the Group's Statistical Adviser.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
Download statistical data

 
Comparison 1. All forms of support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding before last study assessment up to 6 months28Risk Ratio (M-H, Random, 95% CI)Subtotals only
    1.1 All trials
289997Risk Ratio (M-H, Random, 95% CI)0.91 [0.86, 0.96]
    1.2 Studies with adequate allocation concealment
145632Risk Ratio (M-H, Random, 95% CI)0.90 [0.83, 0.98]
    1.3 Trials in settings with low breastfeeding initiation
3555Risk Ratio (M-H, Random, 95% CI)0.88 [0.69, 1.12]
    1.4 Trials in settings with intermediate breastfeeding initiation
144489Risk Ratio (M-H, Random, 95% CI)0.92 [0.85, 0.98]
    1.5 Trials in settings with high breastfeeding initiation
104797Risk Ratio (M-H, Random, 95% CI)0.91 [0.81, 1.01]

 
Comparison 2. All forms of support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping exclusive breastfeeding before last study assessment207668Risk Ratio (M-H, Random, 95% CI)0.81 [0.74, 0.89]

 
Comparison 3. All forms of support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding at different times27Risk Ratio (M-H, Random, 95% CI)Subtotals only
    1.1 Before 4 to 6 weeks
144728Risk Ratio (M-H, Random, 95% CI)0.88 [0.78, 1.00]
    1.2 Before 2 months
82372Risk Ratio (M-H, Random, 95% CI)0.83 [0.69, 0.99]
    1.3 Before 3 months
144635Risk Ratio (M-H, Random, 95% CI)0.88 [0.80, 0.98]
    1.4 Before 4 months
93780Risk Ratio (M-H, Random, 95% CI)0.86 [0.77, 0.96]
    1.5 Before 6 months
123804Risk Ratio (M-H, Random, 95% CI)0.94 [0.90, 0.99]
    1.6 Before 9 months
2688Risk Ratio (M-H, Random, 95% CI)0.90 [0.81, 0.99]
    1.7 Before 12 months
31640Risk Ratio (M-H, Random, 95% CI)0.99 [0.90, 1.08]
 2 Stopping exclusive breastfeeding at different times20Risk Ratio (M-H, Random, 95% CI)Subtotals only
    2.1 Before 4 to 6 weeks
103475Risk Ratio (M-H, Random, 95% CI)0.67 [0.54, 0.84]
    2.2 Before 2 months
51308Risk Ratio (M-H, Random, 95% CI)0.59 [0.38, 0.92]
    2.3 Before 3 months
112993Risk Ratio (M-H, Random, 95% CI)0.67 [0.53, 0.84]
    2.4 Before 4 months
82900Risk Ratio (M-H, Random, 95% CI)0.64 [0.48, 0.86]
    2.5 Before 5 months
1590Risk Ratio (M-H, Random, 95% CI)0.47 [0.40, 0.54]
    2.6 Before 6 months
62583Risk Ratio (M-H, Random, 95% CI)0.90 [0.81, 1.00]

 
Comparison 4. Professional support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding before last study assessment up to 6 months165380Risk Ratio (M-H, Random, 95% CI)0.94 [0.87, 1.01]
 2 Stopping exclusive breastfeeding before last study assessment124133Risk Ratio (M-H, Random, 95% CI)0.91 [0.84, 0.98]

 
Comparison 5. Lay support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding before last study assessment73079Risk Ratio (M-H, Random, 95% CI)0.86 [0.76, 0.98]
 2 Stopping exclusive breastfeeding before last study assessment63084Risk Ratio (M-H, Random, 95% CI)0.72 [0.57, 0.90]

 
Comparison 6. Professional support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding at different times16Risk Ratio (M-H, Random, 95% CI)Subtotals only
    1.1 Before 4 to 6 weeks
92529Risk Ratio (M-H, Random, 95% CI)0.85 [0.70, 1.02]
    1.2 Before 2 months
3897Risk Ratio (M-H, Random, 95% CI)0.89 [0.67, 1.19]
    1.3 Before 3 months
82690Risk Ratio (M-H, Random, 95% CI)0.90 [0.77, 1.04]
    1.4 Before 4 months
5957Risk Ratio (M-H, Random, 95% CI)0.78 [0.67, 0.91]
    1.6 Before 6 months
82779Risk Ratio (M-H, Random, 95% CI)0.94 [0.86, 1.03]
    1.7 Before 9 months
1552Risk Ratio (M-H, Random, 95% CI)0.87 [0.78, 0.97]
    1.8 Before 12 months
31640Risk Ratio (M-H, Random, 95% CI)0.99 [0.90, 1.08]
 2 Stopping exclusive breastfeeding at different times12Risk Ratio (M-H, Random, 95% CI)Subtotals only
    2.1 Before 4 to 6 weeks
61457Risk Ratio (M-H, Random, 95% CI)0.69 [0.51, 0.92]
    2.2 Before 2 months
3633Risk Ratio (M-H, Random, 95% CI)0.76 [0.61, 0.94]
    2.3 Before 3 months
61829Risk Ratio (M-H, Random, 95% CI)0.84 [0.72, 0.99]
    2.4 Before 4 months
5922Risk Ratio (M-H, Random, 95% CI)0.69 [0.47, 1.02]
    2.6 Before 6 months
31509Risk Ratio (M-H, Random, 95% CI)0.95 [0.91, 0.98]

 
Comparison 7. Lay support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding at different times7Risk Ratio (M-H, Random, 95% CI)Subtotals only
    1.1 Before 4 to 6 weeks
51966Risk Ratio (M-H, Random, 95% CI)0.91 [0.73, 1.14]
    1.2 Before 2 months
2458Risk Ratio (M-H, Random, 95% CI)0.86 [0.41, 1.78]
    1.3 Before 3 months
4733Risk Ratio (M-H, Random, 95% CI)0.76 [0.54, 1.09]
    1.4 Before 4 months
31923Risk Ratio (M-H, Random, 95% CI)0.92 [0.74, 1.14]
    1.6 Before 6 months
3933Risk Ratio (M-H, Random, 95% CI)0.98 [0.92, 1.04]
 2 Stopping exclusive breastfeeding at different times6Risk Ratio (M-H, Random, 95% CI)Subtotals only
    2.1 Before 4 to 6 weeks
42018Risk Ratio (M-H, Random, 95% CI)0.66 [0.46, 0.96]
    2.2 Before 2 months
2675Risk Ratio (M-H, Random, 95% CI)0.44 [0.26, 0.73]
    2.3 Before 3 months
3713Risk Ratio (M-H, Random, 95% CI)0.42 [0.31, 0.57]
    2.4 Before 4 months
21568Risk Ratio (M-H, Random, 95% CI)0.62 [0.25, 1.53]
    2.5 Before 5 months
1590Risk Ratio (M-H, Random, 95% CI)0.47 [0.40, 0.54]
    2.6 Before 6 months
1623Risk Ratio (M-H, Random, 95% CI)0.98 [0.93, 1.03]

 
Comparison 8. Differing modes of support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding before last study assessment up to 6 months289997Risk Ratio (M-H, Random, 95% CI)0.91 [0.86, 0.96]
    1.1 Predominant telephone support
51168Risk Ratio (M-H, Random, 95% CI)0.92 [0.78, 1.08]
    1.2 Predominant face-to-face contact
145127Risk Ratio (M-H, Random, 95% CI)0.85 [0.79, 0.92]
    1.3 Balanced telephone and face-to-face support
93702Risk Ratio (M-H, Random, 95% CI)1.00 [0.91, 1.09]

 
Comparison 9. Differing timings of support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding at last study assessment up to 6 months289997Risk Ratio (M-H, Random, 95% CI)0.91 [0.86, 0.96]
    1.1 Postnatal support alone
207259Risk Ratio (M-H, Random, 95% CI)0.89 [0.84, 0.96]
    1.2 Antenatal component to support
82738Risk Ratio (M-H, Random, 95% CI)0.92 [0.83, 1.02]

 
Comparison 10. Differing training versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping exclusive breastfeeding before last study assessment7Risk Ratio (M-H, Random, 95% CI)Subtotals only
    1.1 WHO/UNICEF courses versus usual care
62829Risk Ratio (M-H, Random, 95% CI)0.69 [0.52, 0.91]
    1.2 La Leche League training versus usual care
1110Risk Ratio (M-H, Random, 95% CI)0.52 [0.39, 0.69]

 
Comparison 11. Support of mothers with sick children
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Exclusive breastfeeding 2 to 3 weeks after discharge from healthcare facility2419Risk Ratio (M-H, Fixed, 95% CI)8.32 [4.94, 14.01]
 2 Recurrence of diarrhoea 2 to 3 weeks after discharge from healthcare facility3829Risk Ratio (M-H, Fixed, 95% CI)0.70 [0.54, 0.90]

 
Comparison 12. Lay support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Maternal satisfaction with infant feeding1251Mean Difference (IV, Fixed, 95% CI)0.83 [-0.61, 2.27]

 
Comparison 13. Lactation nurse versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Sufficient help received with breastfeeding problems1Risk Ratio (M-H, Fixed, 95% CI)Subtotals only
    1.1 In hospital
1583Risk Ratio (M-H, Fixed, 95% CI)2.05 [1.52, 2.77]
    1.2 At home
1583Risk Ratio (M-H, Fixed, 95% CI)1.83 [1.39, 2.42]

 
Comparison 14. Combination of lay and professional support versus usual care
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Stopping any breastfeeding at different times55210Risk Ratio (M-H, Random, 95% CI)0.84 [0.77, 0.92]
    1.1 Before 4 to 6 weeks
1900Risk Ratio (M-H, Random, 95% CI)0.65 [0.51, 0.82]
    1.2 Before 2 months
31087Risk Ratio (M-H, Random, 95% CI)0.74 [0.66, 0.83]
    1.3 Before 3 months
31382Risk Ratio (M-H, Random, 95% CI)0.90 [0.80, 1.00]
    1.4 Before 4 months
1900Risk Ratio (M-H, Random, 95% CI)0.95 [0.85, 1.06]
    1.6 Before 6 months
2941Risk Ratio (M-H, Random, 95% CI)0.95 [0.86, 1.05]
 2 Stopping exclusive breastfeeding at different times21312Risk Ratio (M-H, Random, 95% CI)0.62 [0.50, 0.77]
    2.1 Before 3 months
2451Risk Ratio (M-H, Random, 95% CI)0.60 [0.43, 0.86]
    2.2 Before 4 months
1410Risk Ratio (M-H, Random, 95% CI)0.47 [0.40, 0.55]
    2.3 Before 6 months
2451Risk Ratio (M-H, Random, 95% CI)0.71 [0.59, 0.86]

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

Last assessed as up-to-date: 8 November 2006.

DateEventDescription
27 July 2009AmendedSearch updated, 65 reports added to Studies awaiting classification.


 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

Protocol first published: Issue 3, 1998
Review first published: Issue 1, 1999

DateEventDescription
6 November 2008AmendedConverted to new review format.
30 January 2006New search has been performedSearches updated. We have included fourteen new studies and excluded an additional 30 studies.
30 January 2006New citation required and conclusions have changedNew review team prepared this update.

Previous versions of this review categorised support as 'professional' or 'lay'. This edition introduces a new category: combined lay and professional support. Studies in this category demonstrated a significant effect on duration of any breastfeeding, especially in the first two months.


 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

This update is based on the previous Cochrane review 'Support for breastfeeding mothers' by Sikorski J, Renfrew MJ, Pindoria S, Wade A.

Felicia McCormick co-ordinated the update, undertook the searches and, with Natasha Danson, screened the search results and obtained papers.
Cathryn Britton and Felicia McCormick data extracted and quality appraised papers with Mary Renfrew.
Felicia McCormick, with Natasha Danson, wrote to authors for additional information.
Cathryn Britton and Felicia McCormick entered the data into Review Manager.
Angie Wade provided statistical advice about including cluster-randomised trials in the analyses.
Sarah King advised on the interpretation of the data, particularly on heterogeneity.
Cathryn Britton drafted the review; Mary Renfrew, Felicia McCormick, Angie Wade and Sarah King commented, and Cathryn Britton incorporated these comments.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

None declared.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. What's new
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Internal sources

  • No sources of support supplied

 

External sources

  • UK Medical Research Council, UK.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
  21. References to other published versions of this review
Albernaz 2003 {published data only}
  • Albernaz E, Victora C. Impact of face-to-face counselling on duration of exclusive breastfeeding: a review. Pan American Journal of Public Health 2003;14(1):17-24.
  • Albernaz E, Victora CG, Haisma H, Wright A, Coward WA. Lactation counseling increases breast-feeding duration but not breast milk intake as measured by isotopic methods. Journal of Nutrition 2003;133(1):205-10.
Barros 1994 {published data only}
  • Barros FC, Halpern R, Victora CG, Teixera AM, Beria J. A randomised intervention study to increase breastfeeding prevalence in southern Brazil. Revista de Saude Publica 1994;28(4):277-83.
Bhandari 2003 {published data only}
  • Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK, et al. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet 2003;361:1418-23.
  • Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, Bhan MK, et al. An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. Journal of Nutrition 2004;134(9):2342-8.
  • Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, Bhan MK, et al. Use of multiple opportunities for improving feeding practices in under-twos within child health programmes. Health Policy and Planning 2005;20(5):328-36.
Brent 1995 {published data only}
Chapman 2004 {published data only}
  • Chapman D, Damio G, Young S, Perez-Escamilla R. Association of degree and timing of exposure to breastfeeding peer counseling services with breastfeeding duration. Advances in Experimental Medicine and Biology 2004;554:303-6.
  • Chapman DJ, Damio G, Perez-Escamilla R. Differential response to breastfeeding peer counseling within a low-Income, predominantly Latina population. Journal of Human Lactation 2004;20(4):389-96.
  • Chapman DJ, Damio GD, Young S, Perez-Escamilla R. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population. Archives of Pediatric and Adolescent Medicine 2004;158(9):897-902.
Davies-Adetugbo 1997 {published data only}
  • Davies-Adetugbo AA, Adetugbo K, Orewole Y, Fabiyi AK. Breast-feeding promotion in a diarrhoea programme in rural communities. Journal of Diarrhoeal Diseases Research 1997;15(3):161-6.
Dennis 2002 {published and unpublished data}
  • Dennis CL. A randomized controlled trial evaluating the effect of peer (mother-to-mother) support on breastfeeding duration among primiparous women [PhD dissertation]. Toronto, Ontario, Canada: University of Toronto, 1999.
  • Dennis CL. Breastfeeding peer support: maternal and volunteer perceptions from a randomised controlled trial. Birth 2002;29:169-76.
    Direct Link:
  • Dennis CL, Hodnett E, Gallop R, Chalmers B. The effect of peer support on breastfeeding duration among primiparous women: a randomized controlled trial. Canadian Medical Association Journal 2002;166(1):21-8.
Di Napoli 2004 {published and unpublished data}
  • Di Napoli A, Di Lallo D, Fortes C, Franceschelli C, Armeni E, Guasticchi G. Home breastfeeding support by health professionals: findings of a randomised controlled trial in a population of Italian women. Acta Paediatrica 2004;93:1108-14.
    Direct Link:
Frank 1987 {published data only}
  • Frank DA, Wirtz SJ, Sorensen JR, Heeren T. Commercial hospital discharge packs and breastfeeding counseling: effects on infant feeding practices in a randomized trial. Pediatrics 1987;80(6):845-54.
Froozani 1999 {published data only}
  • Froozani MD, Permehzadeh K, Motlagh AR, Golestan B. Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran. Bulletin of the World Health Organization 1999;77(5):381-5.
Gagnon 2002 {published data only}
Graffy 2004 {published data only}
Grossman 1990 {published data only}
  • Grossman LK, Harter C, Kay A. The effect of postpartum lactation counseling on the duration of breastfeeding in low-income women. American Journal of Diseases in Childhood 1990;144(4):471-4.
Haider 1996 {published data only}
  • Haider R, Islam A, Hamadani J, Amin NJ, Kabir I, Malek MA, et al. Breast-feeding counseling in a diarrhoeal disease hospital. Revista Panamericana De Salud Publica/Pan American Journal of Public Health 1997;1:355-61.
  • Haider R, Islam A, Hamadani J, Amin NJ, Kabir I, Malek MA, et al. Breastfeeding counselling in a diarrhoeal disease hospital. Bulletin of the World Health Organization 1996;74(2):173-9.
Haider 2000 {published data only}
  • Haider R, Ashworth A, Kabir I, Huttly S. Effects of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000;356:1643-7.
  • Haider R, Kabir I, Huttley SRA, Ashworth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. Journal of Human Lactation 2002;18(1):7-12.
Jenner 1988 {published data only}
  • Jenner S. The influence of additional information, advice and support on the success of breast feeding in working class primiparas. Child Care, Health and Development 1988;14(5):319-28.
    Direct Link:
Jones 1985 {published data only}
Kools 2005 {published data only}
  • Kools EJ, Thijs C, Kester ADM, van den Brandt PA, de Vries H. A breast-feeding promotion and support program a randomized trial in the Netherlands. Preventive Medicine 2005;40:60-70.
Kramer 2001 {published and unpublished data}
  • Kramer MS, Chalmers B, Hodnett E, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001;285(4):413-20.
  • Lawrence RA. Promotion of Breastfeeding Intervention Trial (PROBIT) a randomized trial in the Republic of Belarus. Journal of Pediatrics 2001;139(1):164-5.
Leite 1998 {published data only}
  • Leite AJM, Puccini R, Atallah A, Cunha A, Machado M, Capiberibe A, et al. Impact on breastfeeding practices promoted by lay counselors: a randomized and controlled clinical trial. Journal of Clinical Epidemiology 1998;51(Suppl 1):S10.
Lynch 1986 {published data only}
  • Lynch SA, Koch AM, Hislop TG, Coldman AJ. Evaluating the effect of a breastfeeding consultant on the duration of breastfeeding. Canadian Journal of Public Health 1986;77(3):190-5.
McDonald 2003 {published data only}
  • McDonald SJ, Henderson JJ, Evans SF, Faulkner S, Hagan R. Effect of an extended midwifery support program on the duration of breastfeeding: a randomised controlled trial. [abstract]. Perinatal Society of Australia and New Zealand 7th Annual Congress; 2003 March 9-12; Tasmania, Australia. 2003:A68.
Mongeon 1995 {published data only}
  • Mongeon M, Allard R. A controlled study with regular telephonic support given by volunteers on the progress and outcome of breast-feeding [Essai controle d'un soutien telephonique regulier donne par une benevole sur le deroulment et l'issus de l'allaitment]. Revue Canadienne de Sante Publique 1995;86(2):124-7.
Moore 1985 {published data only}
Morrell 2000 {published data only}
Morrow 1999 {published data only}
  • Morrow AL, Lourdes Guerrero M. From bio-active substances to research on breastfeeding promotion. In: Newburg editor(s). Bioactive components of human milk. New York: Kluwer Academic/Plenum Publishers, 2001:447-55.
  • Morrow AL, Lourdes Guerrero M, Shults J, Calva JJ, Lutter C, Ruiz-Palacios GM, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999;353(9160):1226-31.
Pinelli 2001 {published data only}
  • Pinelli J, Atkinson SA, Saigal S. Randomized trial of breastfeeding support in very low-birth-weight infants. Archives of Pediatric and Adolescent Medicine 2001;155(5):548-53.
Porteous 2000 {published data only}
  • Porteous R, Kaufman K, Rush J. The effect of individualized professional support on duration of breastfeeding: a randomized controlled trial. Journal of Human Lactation 2000;16(4):303-8.
Pugh 2002 {published data only}
  • Pugh L, Milligan R, Frick K, Spatz D, Bronner Y. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth 2002;29(2):95-100.
    Direct Link:
Quinlivan 2003 {published data only}
Santiago 2003 {published data only}
  • Santiago LB, Bettiol H, Barbieri MA, Guttierrez MRP, Del Ciampo LA. Promotion of breastfeeding: the importance of pediatricians with specific training [Incentivo ao aleitamento materno: a importancia do pediatra com treinamento especifico]. Jornal de Pediatria 2003;79(6):504-12.
Sjolin 1979 {published data only}
  • Sjolin S, Hofvander Y, Hillervik C. A prospective study of individual courses of breastfeeding. Acta Paediatrica Scandinavica 1979;68(4):521-9.
    Direct Link:
Winterburn 2003 {published and unpublished data}
  • Winterburn S, Moyez J, Thompson J. Maternal grandmothers and support for breastfeeding. Journal of Community Nursing 2003;17(12):4-9.
Wrenn 1997 {published data only}
  • Wrenn SE. Effects of a model-based intervention on breastfeeding attrition [dissertation]. San Antonio: University of Texas, 1997.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
  21. References to other published versions of this review
Barnet 2002 {published data only}
  • Barnet B, Duggan AK, Devoe M, Burrell L. The effect of volunteer home visitation for adolescent mothers on parenting and mental health outcomes: a randomized trial. Archives of Pediatric and Adolescent Medicine 2002;156:1216-22.
Black 2001 {published data only}
Bloom 1982 {published data only}
  • Bloom K, Goldbloom RB, Robinson SC, Stevens FE. II. Factors affecting the continuance of breast feeding. Acta Paediatrica Scandinavica 1982;71(Suppl 300):9-14.
    Direct Link:
Bolam 1998 {published data only}
  • Bolam A, Manandhar DS, Shrestha P, Ellis M, Costello AM. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial. BMJ 1998;316(7134):805-11.
Cattaneo 2001 {published data only}
Chen 1993 {published data only}
  • Chen CH. Effects of home visits and telephone contacts on breastfeeding compliance in Taiwan. Maternal-Child Nursing Journal 1993;21(3):82-90.
Davies-Adetugbo 1996 {published data only}
  • Davies-Adetugbo AA. Promotion of breastfeeding in the community: impact of health education programme in rural communities in Nigeria. Journal of Diarrhoeal Disease Research 1996;14(1):5-11.
Ellis 1984 {published data only}
Forster 2004 {published data only}
  • Forster D, McLachlan H, Lumley J, Beanland C, Waldenstrom U, Amir L. Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. Birth 2004;31(3):176-82.
    Direct Link:
  • Forster D, McLachlan H, Lumley J, Beanland C, Waldenstrom U, Harris H, et al. ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial. BMC Pregnancy and Childbirth 2003;3(1):5.
  • Forster DA, McLachlan HL, Lumley J, Beanland CJ, Waldenstrom U, Short RV, et al. ABFAB: attachment to the breast and family attitudes towards breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the duration of breastfeeding: a randomised controlled trial [abstract]. Perinatal Society of Australia and New Zealand 7th Annual Congress; 2003 March 9-12; Tasmania, Australia. 2003:A70.
Gagnon 1997 {published data only}
  • Gagnon AJ, Edgar L, Kramer MS, Papageorgiou A, Waghorn K, Klein MC. A randomized trial of a program of early postpartum discharge with nurse visitation. American Journal of Obstetrics and Gynecology 1997;176:205-11.
Gross 1998 {published data only}
  • Gross SM, Caulfield LE, Bentley ME, Bronner Y, Kessler L, Jensen J, et al. Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. Journal of the American Dietetic Association 1998;98:143-8.
Grossman 1987 {published data only}
  • Grossman LK, Harter C, Kay A. Postpartum lactation counseling for low-income women. American Journal of Diseases of Children 1987;141:375.
Guise 2003 {published data only}
  • Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA, et al. The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force. Annals of Family Medicine 2003;1(2):70-8.
Hall 1978 {published data only}
  • Hall JM. Influencing breastfeeding success. Journal of Obstetric, Gynecologic and Neonatal Nursing 1978;7:28-32.
    Direct Link:
Hauck 1994 {published data only}
  • Hauck YL, Dimmock JE. Evaluation of an information booklet on breastfeeding duration: a clinical trial. Journal of Advanced Nursing 1994;20(5):836-43.
    Direct Link:
Henderson 2001 {published data only}
Kistin 1994 {published data only}
  • Kistin N, Abramson R, Dublin P. Effect of peer-counsellors on breastfeeding initiation, exclusivity and duration among low-income women. Journal of Human Lactation 1994;10(1):11-5.
Labarere 2003 {published data only}
  • Labarere J, Bellin V, Fourny M, Gagnaire JC, Francois P, Pons JC. Assessment of a structured in-hospital educational intervention addressing breastfeeding: a prospective randomised open trial. BJOG: an international journal of obstetrics and gynaecology 2003;110:847-52.
    Direct Link:
Lavender 2004 {published data only}
  • Lavender T. Breastfeeding: expectations versus reality. 10th International Conference of Maternity Care Researchers; 2004 June 13-16; Lund, Sweden. 2004:12.
  • Lavender T, Baker L, Smyth R, Collins S, Spofforth A, Dey P. Breastfeeding expectations versus reality: a cluster randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2005;112:1047-53.
    Direct Link:
Lieu 2000 {published data only}
  • Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Pediatrics 2000;105:1058-65.
MacArthur 2002 {published data only}
  • MacArthur C, Winter HR, Bick DE, Knowles H, Lilford R, Henderson C, et al. Effects of redesigned community postnatal care on women's health 4 months after birth: a cluster randomised trial. Lancet 2002;359:378-85.
Mattar 2003 {published data only}
McInnes 2000 {published data only}
McKeever 2002 {published data only}
  • McKeever P, Stevens B, Miller KL, MacDonell K, Gibbins S, Guerriere D, et al. Home versus hospital breastfeeding support for newborns: a randomized controlled trial. Birth 2002;29(4):258-65.
    Direct Link:
  • Stevens B, McKeever P, Coyte P, Daub S, Dunn M, Gibbins S, et al. The impact of home versus hospital support of breastfeeding on neonatal outcomes. Pediatric Research 2001;49 Suppl(4):261A.
Neyzi 1991 {published data only}
  • Neyzi O, Gulecyuz M, Dincer Z, Olgun P, Kutluay T, Uzel N, et al. An educational intervention on promotion of breast feeding complemented by continuing support. Paediatric and Perinatal Epidemiology 1991;5:299-303.
Pascali-Bonaro 2004 {published data only}
  • Pascali-Bonaro D, Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. Journal of Midwifery & Women's Health 2004;49(4 Suppl 1):19-27.
    Direct Link:
Perez-Escamilla 1992 {published data only}
  • Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey K. Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Early Human Development 1992;31(1):25-40.
Ratner 1999 {published data only}
Rea 1999 {published data only}
  • Rea MF, Venancio SI, Martines JC, Savage F. Counselling on breastfeeding: assessing knowledge and skills. Bulletin of the World Health Organization 1999;77(6):492-8.
Redman 1995 {published data only}
  • Redman S, Watkins J, Evans L, Lloyd D. Evaluation of an Australian intervention to encourage breast feeding in primiparous women. Health Promotion International 1995;10(2):101-13.
Reeve 2004 {published data only}
  • Reeve JR, Gull SE, Johnson MH, Hunter S, Streather M. A preliminary study on the use of experiential learning to support women's choices about infant feeding. European Journal of Obstetrics & Gynecology and Reproductive Biology 2004;113:199-203.
Rowe 1990 {published data only}
  • Rowe L, Hartmann PE. Comparison of two methods of breast feeding management. Proceedings of 6th Congress of the Federation of the Asia-Oceania Perinatal Societies; 1990; Perth, Western Australia. 1990:236.
Rush 1991 {published data only}
  • Rush JP, Kitch TL. A randomized, controlled trial to measure the frequency of use of a hospital telephone line for new parents. Birth 1991;18:193-7.
    Direct Link:
Schy 1996 {published data only}
  • Schy DS, Maglaya CF, Mendelson SG, Race KEH, Ludwig-Beymer P. The effects of in-hospital lactation education on breastfeeding practice. Journal of Human Lactation 1996;12(2):117-22.
Sciacca 1995 {published data only}
  • Sciacca JP, Dube DA, Phipps BL, Ratliff MI. A breast feeding education and promotion program: effects on knowledge, attitudes, and support for breast feeding. Journal of Community Health 1995;20(6):473-89.
  • Sciacca JP, Phipps B, Dube D, Ratliff MI. Influences on breast-feeding by lower-income women: an incentive, partner-supported educational program. Journal of the American Dietetic Association 1995;95(3):323-8.
Segura-Millan 1994 {published data only}
  • Segura-Millan S, Dewey KG, Perez-Escamilla R. Factors associated with perceived insufficient milk in a low-income urban population in Mexico. Journal of Nutrition 1994;124(2):202-12.
Serafino-Cross 1992 {published data only}
  • Serafino-Cross P, Donovan P. Effectiveness of professional breastfeeding home-support. Society for Nutrition Education 1992;24(3):117-22.
Steel O'Connor 2003 {published data only}
  • Steel O'Connor KO, Mowat DL, Scott HM, Carr PA, Dorland JL, Young Tai KF. A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services. Canadian Journal of Public Health 2003;94(2):98-103.
Valdes 2000 {published data only}
  • Valdes V, Pugin E, Schooley J, Catalan S, Aravena R. Clinical support can make the difference in exclusive breastfeeding success among working women. Journal of Tropical Pediatrics 2000;46(3):149-54.
Westphal 1995 {published data only}
  • Taddei JA, Westphal MF, Venancio S, Bogus C, Souza S. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. Sao Paulo Medical Journal 2000;118:185-91.
  • Westphal MF, Taddei JAC, Venancio SI, Bogus CM. Breast-feeding training for health professionals and resultant institutional changes. Bulletin of the World Health Organization 1995;73(4):461-8.
Wiggins 2005 {published data only}
  • Wiggins M, Oakley A, Roberts I, Turner H, Rajan L, Austerberry H, et al. Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial. Journal of Epidemiology & Community Health 2005;59(4):288-95.
Wolfberg 2004 {published data only}
  • Wolfberg AJ, Michels KB, Shields W, O'Campo P, Bronner Y, Bienstock J. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. American Journal of Obstetrics and Gynecology 2004;191:708-12.

References to studies awaiting assessment

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
  21. References to other published versions of this review
Agrasada 2005 {published data only}
  • Agrasada GV, Gustafsson J, Kylberg E, Ewald U. Postnatal peer counselling on exclusive breastfeeding or low-birthweight infants: a randomised, controlled trial. Acta Paediatrica 2005;94:1109-15.
Ahmed 2008 {published data only}
  • Ahmed AH. Breastfeeding preterm infants: an educational program to support mothers of preterm infants in Cairo, Egypt. Pediatric Nursing 2008;34(2):125-30.
Aidam 2005 {published data only}
Anderson 2005 {published data only}
  • Anderson AK, Damio G, Young S, Chapman DJ, Perez-Escamilla R. A randomised trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Archives of Pediatric and Adolescent Medicine 2005;159(9):836-41.
Anderson 2007 {published data only}
  • Anderson AK, Damio G, Chapman DJ, Perez-Escamilla R. Differential response to an exclusive breastfeeding peer counseling intervention: the role of ethnicity. Journal of Human Lactation 2007;23(1):16-23.
Baqui 2008 {published data only}
  • Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, et al. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 2008;371(9628):1936-44.
Barlow 2006 {published data only}
  • Barlow A, Varipatis-Baker E, Speakman K, Ginsburg G, Friberg I, Goklish N, et al. Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial. Archives of Pediatrics and Adolescent Medicine 2006;160(11):1101-7.
Bashour 2008 {published data only}
  • Bashour HN, Kharouf MH, Abdulsalam AA, El Asmar K, Tabbaa MA, Cheikha SA. Effect of postnatal home visits on maternal/infant outcomes in syria: a randomized controlled trial. Public Health Nursing 2008;25(2):115-25.
    Direct Link:
Bhandari 2007 {published data only}
  • Bhandari N. Promotion and consequences of exclusive breastfeeding in India [abstract]. Journal of Human Lactation 2007;23(1):75.
Bonuck 2005 {published data only}
  • Bonuck KA, Trombley M, Freeman K, McKee D. Randomized, controlled trial of a prenatal and postnatal lactation consultant intervention on duration and intensity of breastfeeding up to 12 months. Pediatrics 2005;116(6):1413-26.
Bonuck 2006 {published data only}
  • Bonuck KA, Freeman K, Trombley M. Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. Archives of Pediatrics & Adolescent Medicine 2006;160(9):953-60.
Bonuck 2008 {published data only}
  • Bonuck KA. Boosting breastfeeding in low-income, multi-ethnic women: a primary care based RCT (BINGO). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 9 April 2008) 2008.
Brown 2008 {published data only}
  • Brown LP. Breastfeeding services for LBW infants - outcomes and cost. CRISP (http://crisp.cit.nih.gov) (accessed 17 June 2008) 2008.
Bunik 2007 {published data only}
  • Bunik M, Beaty B, Dickinson M, Shobe P, Kempe A, O'Connor ME. Early formula supplementation in breastfeeding mothers: how much is too much for BF duration success?. Breastfeeding Medicine 2007;2(3):184.
Bunik 2007a {published data only}
  • Bunik M, Shobe P, Crane L, Kempe A. Low-income Latina mothers' perspectives on breastfeeding issues and participation in a telephone based support intervention. Breastfeeding Medicine 2007;2(3):184.
Bunik 2007b {published data only}
  • Bunik M, Shobe P, O'Connor ME, Beaty B, Langendoerfer S, Crane L, et al. Randomized controlled trial to evaluate a telephone support intervention for breastfeeding in low-income Latina mothers. Breastfeeding Medicine 2007;2(3):183.
Caldeira 2008 {published data only}
  • Caldeira AP, Fagundes GC, de Aguiar GN. Educational intervention on breastfeeding promotion to the Family Health Program team [Intervencao educacional em equipes de Programa de Saude de Familia para promocao da amamentacao]. Revista de Saude Publica 2008;42(6):1027-33.
Caulfield 1998 {published data only}
  • Caulfield LE, Gross SM, Bentley ME, Bronner Y, Kessler L, Jensen J, et al. WIC-based interventions to promote breastfeeding among African-American women in Baltimore: effects on breastfeeding initiation and continuation. Journal of Human Lactation 1998;14(1):15-22.
Coutinho 2005 {published data only}
  • Bechara Coutinho S, Cabral de Lira P, de Carvalho Lima M, Ashworth A. Comparison of the effects of two systems for the promotion of exclusive breastfeeding. Lancet 2005;366:1094-100.
de Oliveira 2006 {published data only}
  • de Oliveira LD, Giugliani ER, do Espirito Santo LC, Franca MC, Weigert EM, Kohler CV, et al. Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems. Journal of Human Lactation 2006;22(3):315-21.
Ebbeling 2007 {published data only}
  • Ebbeling CB, Pearson MN, Sorensen G, Levine RA, Hebert JR, Salkeld JA, et al. Conceptualization and development of a theory-based healthful eating and physical activity intervention for postpartum women who are low income. Health Promotion Practice 2007;8(1):50-9.
Ekstrom 2006 {published data only}
Ekstrom 2006a {published data only}
Eneroth 2007 {published data only}
  • Eneroth H, el Arifeen S, Kabir I, Persson LA, Lonnerdal B, Hossain MB, et al. Exclusive breastfeeding and infant iron and zinc status, the MINIMat study Bangladesh [abstract]. Journal of Human Lactation 2007;23(1):79-80.
Ferrara 2008 {published data only}
  • Ferrara A. Diet, exercise and breastfeeding intervention program for women with gestational diabetes (DEBI Trial). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008) 2008.
Finch 2002 {published data only}
  • Finch C, Daniel EL. Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the American Dietetic Association 2002;102(7):981-4.
Forster 2006 {published data only}
  • Forster DA, McLachlan HL, Lumley J. Risk factors for early cessation of breastfeeding: results from a randomised controlled trial. Perinatal Society of Australia and New Zealand 10th Annual Congress; 2006 April 3-6; Perth, Australia. 2006:149.
Garcia-Montrone 1996 {published data only}
  • Garcia-Montrone V, de Rose JC. An education experience for promoting breast-feeding and infant stimulation by low-income women: a preliminary study. Cadernos de Saude Publica 1996;12(1):61-8.
Gijsbers 2006 {published data only}
  • Gijsbers B, Mesters I, Knottnerus JA, Kester ADM, Van Schayck CP. The success of an educational program to promote exclusive breastfeeding for 6 months in families with a history of asthma: a randomized controlled trial. Pediatric Asthma 2006;19(4):214-22.
Gijsbers 2006a {published data only}
  • Gijsbers B, Mesters I, Knottnerus JA, Van Schayck CP. Factors associated with the initiation of breastfeeding in asthmatic families: the attitude-social influence-self-efficacy model. Breastfeeding Medicine 2006;1(4):236-46.
Gijsbers 2008 {published data only}
  • Gijsbers B, Mesters I, Knottnerus JA, van Schayck CP. Factors associated with the duration of exclusive breast-feeding in asthmatic families. Health Education Research 2008;23(1):158-69.
Hall 2007 {published data only}
Hoddinott 2006 {published data only}
  • Hoddinott P. A randomised controlled trial to evaluate the clinical and cost effectiveness of breasfeeding peer support groups in improving breastfeeding initiation, duration and satisfaction. National Research Register (www.nrr.nhs.uk) (accessed 6 July 2006) 2006.
Hoddinott 2009 {published data only}
  • Hoddinott P, Britten J, Prescott GJ, Tappin D, Ludbrook A, Godden DJ. Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial. BMJ 2009;338:a3026.
Inch 2003 {published data only}
  • Inch S, Law S, Wallace L. Hands off! The breastfeeding best start project (2). Practising Midwife 2003;6(11):24-5.
Isselmann 2006 {published data only}
  • Isselmann KF, Collins B, McCoy A. A prospective efficacy trial of a brief breastfeeding promotion intervention to prevent postpartum smoking relapse. American Public Health Association 134th Annual Meeting & Exposition 2006 Nov 4-8; Boston, MA. 2006.
Jakobsen 2008 {published data only}
  • Jakobsen MS, Sodemann M, Biai S, Nielsen J, Aaby P. Promotion of exclusive breastfeeding is not likely to be cost effective in West Africa. A randomized intervention study from Guinea-Bissau. Acta Paediatrica 2008;97:68-75.
    Direct Link:
Jang 2008 {published data only}
  • Jang GJ, Kim SH, Jeong KS. Effect of postpartum breast-feeding support by nurse on the breast-feeding prevalence. Taehan Kanho Hakhoe chi 2008;38(1):172-9.
Johnston 2001 {published data only}
  • Johnston BD, Thompson RS, Huebner CE, Barlow WE, Tyll L. Expanded well-child care with a pre-natal component: early results from the group health evaluation of "healthy steps" [abstract]. Pediatric Research 2001;49(4):132A.
Jones 2004 {published data only}
  • Jones E, Jones P, Spencer A. Breastfeeding and returning to work. Practising Midwife 2004;7(11):17-8, 20, 22.
Junior 2007 {published data only}
  • Junior WS, Martinez FE. Effect of intervention on the rates of breastfeeding of very low birth weight newborns. Jornal de Pediatria 2007;83(6):541-6.
Kramer 2007 {published data only}
  • Kramer MS, Matush L, Vanilovich I, Platt R, Bogdanovich N, Sevkovskaya Z, et al. Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial. BMJ 2007;335(7624):815.
Kramer 2007a {published data only}
  • Kramer MS, Vanilovich I, Matush L, Bogdanovich N, Zhang X, Shishko G, et al. The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children. New evidence from a large randomized trial. Caries Research 2007;41(6):484-8.
Kramer 2008 {published data only}
  • Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Archives of General Psychiatry 2008;65(5):578-84.
Kramer 2008a {published data only}
  • Kramer MS, Fombonne E, Igumnov S, Vanilovich I, Matush L, Mironova E, et al. Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial. Pediatrics 2008;121(3):e435-40.
Kramer 2009 {published data only}
  • Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z, et al. A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus. Journal of Nutrition 2009;139(2):417S-21S.
Kronborg 2007 {published data only}
  • Kronborg H, Vaeth M, Olsen J, Iversen L, Harder I. Effect of early postnatal breastfeeding support: a cluster-randomized community based trial. Acta Paediatrica 2007;96(7):1064-70.
    Direct Link:
Kronborg 2008 {published data only}
  • Kronborg H, Vaeth M, Olsen J, Harder I. Health visitors and breastfeeding support: influence of knowledge and self-efficacy. European Journal of Public Health 2008;18(3):283-8.
Labarere 2005 {published data only}
  • Labarere J, Gelbert-Baudino N, Ayral AS, Duc C, Berchotteau M, Bouchon N, et al. Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Pediatrics 2005;115(2):e139-46.
Leite 2005 {published data only}
  • Leite AJ, Puccini RF, Atallah AN, Alves da Cunha AL, Machado MT. Effectiveness of home-based peer counselling to promote breastfeeding in the northeast of Brazil: a randomised clinical trial. Acta Paediatrica 2005;94:741-6.
Lewin 2005 {published data only}
  • Lewin SA, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B, et al. Lay health workers in primary and community health care. Cochrane Database of Systematic Reviews 2005, Issue 1. [Art. No.: CD004015. DOI: ]
MacArthur 2009 {published data only}
  • MacArthur C, Jolly K, Ingram L, Freemantle N, Dennis CL, Hamburger R, et al. Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial. BMJ 2009;338:b131.
Mannan 2008 {published data only}
  • Mannan I, Rahman SM, Sania A, Seraji HR, Arifeen SE, Winch PJ, et al. Can early postpartum home visits by trained community health workers improve breastfeeding of newborns?. Journal of Perinatology 2008;28(9):632-40.
Memmott 2006 {published data only}
Merewood 2005 {published data only}
  • Merewood A, Philipp BL, Chamberlain LB, Malone KL, Cook JT, Bauchner H. Using peer support to improve breastfeeding rates among premature infants: an RCT [abstract]. Pediatric Academic Societies Annual Meeting; 2005 May 14-17; Washington DC, USA. 2005:Abstract no: 2342.
Merewood 2006 {published data only}
  • Merewood A, Chamberlain LB, Cook JT, Philipp BL, Malone K, Bauchner H. The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 2006;160(7):681-5.
Moore 2007 {published data only}
  • Moore SE, Prentice AM, Coward WA, Wright A, Frongillo EA, Fulford AJ, et al. Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling. American Journal of Clinical Nutrition 2007;85(4):1075-82.
Moreno-Manzanares 1997 {published data only}
  • Moreno-Manzanares L, Cabrera-Sanz MT, Garcia-Lopez L. Breast feeding [Lactancia materna]. Revista Rol de Enfermeria 1997;20(227-228):79-84.
Muirhead 2006 {published data only}
  • Muirhead PE, Butcher G, Rankin J, Munley A. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. British Journal of General Practice 2006;56(524):191-7.
Noel-Weiss 2006 {published data only}
  • Noel-Weiss J, Rupp A, Cragg B, Bassett V, Woodend AK. Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. Journal of Obstetric, Gynecologic and Neonatal Nursing 2006;35(5):616-24.
    Direct Link:
Peterson 2002 {published data only}
  • Peterson KE, Sorensen G, Pearson M, Hebert JR, Gottlieb BR, McCormick MC. Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. Health Education Research 2002;17(5):531-40.
Petrova 2009 {published data only}
  • Petrova A, Ayers C, Stechna S, Gerling JA, Mehta R. Effectiveness of exclusive breastfeeding promotion in low-income mothers: a randomized controlled study. Breastfeeding Medicine 2009;4(2):63-9.
Philipp 2004 {published data only}
  • Philipp BL, Merewood A, Malone KL, Chamberlain LB, Cook JT, Bauchner H. Effect of NICU-based peer counselors on breastfeeding duration among premature infants [abstract]. Pediatric Research 2004;55 Suppl:73.
Pugh 1998 {published data only}
Pugh 2007 {published data only}
  • Pugh LC, Nanda JP, Frick KD, Sharps PW, Spatz DL, Serwint JR, et al. A randomized controlled community-based trial to improve breastfeeding among urban low-income mothers. Pediatric Academic Societies Annual Meeting; 2007 May 5-8; Toronto, Canada 2007.
Ransjo-Arvidson 1998 {published data only}
  • Ransjo-Arvidson AB, Chintu K, Ng'andu N, Eriksson B, Susu B, Christensson K, et al. Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia. Journal of Epidemiology & Community Health 1998;52:385-91.
Rossiter 1994 {published data only}
Sakha 2008 {published data only}
Sinclair 2007 {published data only}
  • Sinclair M. Successful breastfeeding promotion: a motivational instructional model applied and tested. Current Controlled Trials (www.controlled-trials.com/) (accessed 30 October 2007) 2007.
Sisk 2006 {published data only}
  • Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birthweight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics 2006;117(1):E67-E75.
Stevens 2006 {published data only}
  • Stevens B, Guerriere D, McKeever P, Croxford R, Miller KL, Watson-MacDonell J, et al. Economics of home vs. hospital breastfeeding support for newborns. Journal of Advanced Nursing 2006;53(2):233-43.
    Direct Link:
Su 2007 {published data only}
  • Su LL, Chong YS, Chan YH, Chan YS, Fok D, Tun KT, et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. BMJ 2007;335(7620):596.
Susin 2008 {published data only}
Thussanasupap 2006 {published data only}
  • Thussanasupap B. The effects of systematic instructional program on breastfeeding self-efficacy, nipple pain, nipple skin changes and incision pain of cesarean mothers [abstract]. Care, Concern and Cure in Perinatal Health. 14th Congress of the Federation of Asia-Oceania Perinatal Societies; 2006 Oct 1-5; Bangkok, Thailand. 2006:138.
Tylleskar 2008 {published data only}
  • Tylleskar T. PROMISE EBF: safety and efficacy of exclusive breastfeeding promotion in the era of HIV in sub-Saharan Africa. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008) 2008.
Wallace 2006 {published data only}
  • Wallace LM, Dunn OM, Alder EM, Inch S, Hills RK, Law SM. A randomised-controlled trial in england of a postnatal midwifery intervention on breast-feeding duration. Midwifery 2006;22:262-73.
Wambach 2006 {published data only}
  • Wambach K. Kansas University Teen Mothers Project (ongoing trial). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 21 March 2006) 2006.
Wambach 2009 {published data only}
  • Wambach K, Rojjanasrirat W, Williams Domian E, Aaronson L, Breedlove G, Yeh HW. Effects of a peer counselor and lactation consultant on breastfeeding initiation and duration. Journal of Human Lactation 2009;25(1):101-2.
Zukowsky 2007 {published data only}
  • Zukowsky K. Breast-fed low-birth-weight premature neonates: developmental assessment and nutritional intake in the first 6 months of life. Journal of Perinatal & Neonatal Nursing 2007;21(3):242-9.

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
  21. References to other published versions of this review
Anderson 1999
Aniansson 1994
  • Aniansson G, Alm B, Andersson B, Hakansson A, Larsson P, Nylen O, et al. A prospective cohort study on breast-feeding and otitis media in Swedish infants. Pediatric Infectious Disease Journal 1994;13:183-8.
Beral 2002
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Cattaneo 2003
  • Cattaneo A. Protection, promotion and support of breastfeeding in Europe: current situation. Trieste, Italy: Unit for Health Services Research and International Health, WHO Collaborating Centre for Maternal and Child Health, 2003.
Cesar 1999
  • Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. BMJ 1999;318:1316-22.
Chhabra 1998
  • Chhabra P, Grover VL, Aggerwal OP, Dubey KK. Breast feeding patterns in an urban resettlement colony of Delhi. Indian Journal of Pediatrics 1998;65(6):867-72.
Cumming 1993
DoH 2002
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DoH 2003
  • Department of Health. New recommendation offers mothers support to mark National Breastfeeding Awareness Week (Press release). http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices. 12 May 2003 (accessed 22 May 2006).
Enkin 2000
  • Enkin M, Keirse MJNC, Neilson JP, Crowther C, Duley L, Hodnett E, Hofmeyr GJ. A guide to effective care in pregnancy and childbirth. Third Edition. Oxford: Oxford University Press, 2000.
Fewtrell 2004
  • Fewtrell MS. The long-term benefits of having been breast-fed. Current Paediatrics 2004;14:97-103.
Gillman 2001
Gwinn 1990
Hamlyn 2002
  • Hamlyn B, Brooker S, Oleinikova K, Wands S. Infant Feeding 2000. A survey conducted on behalf of the Department of Health, the Scottish Executive, the National Assembly for Wales and the Department of Health, Social Services and Public Safety in Northern Ireland. London: The Stationery Office, 2002. [: ISBN 0113225709]
Higgins 2005
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Howie 1990
Kramer 2002
  • Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2002, Issue 1. [Art. No.: CD003517. DOI: ]
Labbock 2001
Leff 1994
  • Leff EW, Jefferis C, Gagne MP. The development of the Maternal Breastfeeding Evaluation Scale. Journal of Human Lactation 1994;10(2):105-11.
Lucas 1990a
Lucas 1990b
Marild 2004
  • Marild S, Hansson S, Jodal U, Oden A, Svedberg K. Protective effect of breastfeeding against urinary tract infection. Acta Paediatrica 2004;93:164-8.
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Martin 2004
  • Martin RM, Ness AR, Gunnell D, Emmett P, Davey Smith G, ALSPAC Study Team. Does breast-feeding in infancy lower blood pressure in childhood?. Circulation 2004;109:1259-66.
Newcombe 1994
Nicoll 2002
  • Nicoll A, Thayaparan B, Newell ML, Rundall P. Breast feeding policy, promotion and practice in Europe. Results of a survey with non-governmental organizations. Journal of Nutritional & Environmental Medicine 2002;12(3):255-64.
Raisler 1999
RevMan 2003
  • Oxford, England: The Cochrane Collaboration. Review Manager (RevMan). Version 4.2 for Windows. Oxford, England: The Cochrane Collaboration, 2003.
Rogers 1997
Rosenblatt 1993
  • Rosenblatt KA, Thomas DB, WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Lactation and the risk of epithelial ovarian cancer. International Journal of Epidemiology 1993;22(2):192-7.
Sadauskaite 2004
  • Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samulesson U. Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood. Diabetes/Metabolism Research and Reviews 2004;20:150-7.
    Direct Link:
Singhal 2001
Taittonen 1996
  • Taittonen L, Nuutinen M, Turtinen J, Uhari M. Prenatal and postnatal factors in predicting later blood pressure among children: cardiovascular risk in young Finns. Pediatric Research 1996;41(4):627-32.
USDoHHS 2005
  • US Department of Health and Human Services, Health Resources and Services Administration. Women's Health USA. Rockville, Maryland: US Department of Health and Human Services, 2005.
Virtanen 1991
  • Virtanen SM, Rasanen L, Aro A, Lindstrom J, Sippola H, Lounamaa R, et al. Infant feeding in Finnish children less than 7 yr of age with newly diagnosed IDDM. Childhood Diabetes in Finland Study Group. Diabetes Care 1991;14(5):415-7.
WHO 1997
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WHO 2003
  • World Health Organization. Global strategy for infant and young child feeding. Geneva, Switzerland: World Health Organization, 2003.
Wilson 1998
  • Wilson AC, Stewart Forsyth J, Greene SA, Irvine L, Au C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998;316:21-5.

References to other published versions of this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
  21. References to other published versions of this review
Renfrew 1995
  • Renfrew MJ. Postnatal support for breastfeeding mothers. [revised May 1994]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Sikorski 1999
  • Sikorski J, Renfrew MJ. Support for breastfeeding mothers (Cochrane Review). In: The Cochrane Library, Issue 1, 1999. Oxford: Update Software.
Sikorski 2002
  • Sikorski J, Renfrew MJ, Pindoria P, Wade A. Support for breastfeeding mothers. Cochrane Database of Systematic Reviews 2002, Issue 1. [Art. No.: CD001141. DOI: ]
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