Kaunaonen et al. (2012) systematic review of peer support interventions for breastfeeding in developed countries is both timely and welcome as such strategies are becoming more widely implemented and have been associated with increased rates of initiation and longer duration of lactation among childbearing women (Britten et al. 2006). Peer support schemes also resonate with the ‘Big Society’ ethos of the incumbent UK coalition government (Clark 2010). Studies have also identified positive benefits for breastfeeding peer supporters, particularly those from deprived populations. These include personal empowerment, increased self-esteem, educational opportunity and a sense of external validation: for some, this has catalysed other positively construed transformations in their lives such as commencement of further education (Raine 2003, Britten et al. 2006, Hoddinott et al. 2006).
This was a comprehensive and ambitious review of peer support interventions in breastfeeding, with strong methodology, using well-defined inclusion criteria. It is limited to developed nations, utilising evidence from quantitative and qualitative studies. Kaunaonen et al. (2012) sought to identify the categories of peer supporters; their training needs; the nature of interventions used; and their effectiveness in supporting breastfeeding.
One interesting finding was the diverse ways in which ‘peer supporters’ are defined across these studies. A definition of ‘peers’ such as that of Britten et al. (2006: 12), as people who,
‘…share similar characteristics…and experiential knowledge of a specific behaviour with the target population’ might seem intuitive.
This would suggest that breastfeeding peer supporters might be women who have successfully breastfed, with or without additional training; however, the review yielded broader definitions. Spouses, grandmothers and adoptive mothers, with or without training, for whom there is either no guarantee or sometimes no possibility of shared experiential knowledge, were included. Whilst this might seem to stretch the boundaries of the meaning of ‘shared experiential knowledge’ arguably, it is a stroke of genius to include fathers and grandmothers as peer supporters, in acknowledgement of their powerful influence over women's infant feeding decisions.
Another interesting finding in this review was the wide variation in the duration and focus of training. Some training schemes were in depth, whilst others were non-existent. Some emphasised the mechanics of breastfeeding and dealing with problems, whilst others placed more stress on appropriate communication and counselling skills. This could well reflect the diverse array of intervention types offered, from antenatal and postnatal groups to one-to-one facilitation and telephone counselling. Other factors such as the necessity for both antenatal and postnatal intervention, the duration of intervention and the culture of infant feeding in maternity units were also shown to impact upon initiation rates and duration of lactation.
The inclusion of qualitative studies is valuable as it incorporates maternal satisfaction and description of peer supporters’ experiences as findings. This is all important data in terms of understanding what makes these interventions effective and sustainable. The findings of this review could be used to guide the development of future peer and professional breastfeeding support programmes, drawing on the demonstrable effectiveness of different approaches to recruitment, training, type and duration of interventions used. It might also provide justification for continuing to train and commission the more narrowly defined groups of breastfeeding peer supporters – women who have previously breastfed successfully – if these are shown to be the most effective.