Interventions for promoting the initiation of breastfeeding

 

Abstract

Background

Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups.

Objectives

To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained.

Selection criteria

Randomised controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem.

Data collection and analysis

One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information.

Main results

Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001).

Authors' conclusions

This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.

 

Plain language summary

Interventions for encouraging women to start breastfeeding

The World Health Organization recommends that all infants should be fed exclusively on breast milk from birth to six months of age. Breastfeeding is supported by extensive evidence for short-term and long-term health benefits, for both mother and baby. Babies who are not fully breastfed for the first three to four months are more likely to suffer health problems such as gastroenteritis, respiratory and ear infections, urinary tract infections, allergies and diabetes mellitus. Practical benefits include savings on buying artificial formulas, particularly where they are not subsidised. Yet many women choose to bottle feed their babies. Reasons include personal and social biases against breastfeeding such as attitudes of family and close friends, attitudes to breastfeeding in public and employment practices.

This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Studies were of low-income women in the USA, where baseline breastfeeding rates are typically low.

Eleven randomised controlled trials were included. Eight trials involving 1553 women contributed to the data. Five studies with 582 women on low incomes in the USA showed breastfeeding education clearly increased breastfeeding rates compared to providing routine care. One trial with 165 women showed peer support for women considering breastfeeding also increased breastfeeding rates. Needs-based, one-to-one, informal education or support sessions, delivered either before or before and after the birth by a trained breastfeeding professional or peer counsellor, was the most effective intervention among women of different ethnicity and feeding intention in three studies. The one evaluation of hospital breastfeeding promotion packs compared to formula-company produced materials about infant feeding showed this intervention to be ineffective. Approximately 40% of women in both groups reported receipt of formula company promotion items from sources other than their obstetric provider.

 

摘要

背景

促進啟動母乳哺餵的相關措施

儘管哺餵母乳對健康的好處已被廣泛記載,在許多高收入國家啟動率仍然相對較低,特別是在低收入群體的婦女。

目標

依據開始哺餵母乳的婦女數目上的變化,評估鼓勵婦女哺乳相關措施的成效。

搜尋策略

在我們搜群了the Cochrane Pregnancy and Childbirth Group's Trials Register (2006年五月30日), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2003年刊號1)以及後續從開始到2002年10月的資料庫: MEDLINE, CINAHL, ERIC, Applied Social Sciences, PsychLIT, EMBASE, British Nursing Index, BIDS, EPIcentre.我們也搜尋了在2002年10月之後的灰色文學: 'SIGLE, DHSS Data, and Dissertation Abstracts. 我們還搜尋了從開始到1998年10月的the Journal of Human Lactation, Health Promotion International and Health Education Quarterly。 我們還檢視了所有獲得文章的參考

選擇標準

選入的研究包括所有隨機對照試驗,不論有或沒有致盲設計,也包括在任何人口族群的任何母乳哺育的促進措施,但是排除婦女和小孩有特殊的健康問題者。

資料收集與分析

ㄧ位審查作者單獨提取資料和評估試驗的品質,再由第二位作者檢查。我們與研究者取得聯繫去獲得失落的信息。

主要結論

七個試驗包含了1388位婦女。其中五個試驗包含了582位在美國低收入婦女的分析發現提供母乳哺育相關教育比起僅提供一般照顧能明顯增加起始哺育率。(RR 1.53, 95% CI 1.25 to 1.88)

作者結論

從這篇文章得到的證據顯示各種形式的母乳哺育教育可以有效提高美國低收入婦女的母乳哺餵起始率。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)林孝祖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

各種形式的母乳哺育教育是可以有效提高美國低收入婦女支母乳哺餵起始率。哺餵母乳對嬰兒和母親兩者的健康都是有好處是廣為人知的。儘管這樣，許多婦女選擇不進行母乳哺育自己的嬰兒,特別是婦女生活在母乳哺育並不普遍的國家或社區。本篇文章目的是評估哪些母乳哺育的促進方案成功地提升婦女開始哺育母乳的人數。有找出五個方案全顯示出成功地提升在美國的貧窮婦女開始以母乳哺育他們的嬰兒。