Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

This article is part of the supplement: The Lives Saved Tool in 2013: new capabilities and applications

Open Access Highly Accessed Review

Breastfeeding promotion interventions and breastfeeding practices: a systematic review

Sarah Haroon1, Jai K Das1, Rehana A Salam1, Aamer Imdad1 and Zulfiqar A Bhutta12*

Author affiliations

1 Division of Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan

2 Global Child Health and Policy, Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada

For all author emails, please log on.

Citation and License

BMC Public Health 2013, 13(Suppl 3):S20  doi:10.1186/1471-2458-13-S3-S20

Published: 17 September 2013

Abstract

Introduction

Exclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months. Breastfeeding has been shown to have a protective effect against gastrointestinal infections, among other benefits. Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence, especially EBF, up to recommended standards and also to decrease infant morbidity.

Methods

A systematic literature search was conducted for RCTs and quasi-experimental studies comparing breastfeeding education or support to routine care. The effect of interventions was observed for exclusive, predominant, partial and no breastfeeding rates. The time intervals of interest were day 1, <1 month, and 1 to 5 months. Outcome-specific evidence was graded according to the Child Health Epidemiology Reference Group (CHERG) rules using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria and recommendations were made from studies in developing countries for inclusion into the Lives Saved Tool (LiST) model.

Results

After reviewing 4600 abstracts, 372 studies were selected for full text screening and 110 of these studies were finally included. Statistically significant increases in EBF rates as a result of breastfeeding promotion interventions were observed: 43% at day 1, 30% at <1 month, and 90% at 1-5 months. Rates of ‘no breastfeeding’ reduced by 32% at 1 day, 30% at <1 month, and 18% at 1-5 months. The effect of interventions on the rates of predominant and partial breastfeeding were non-significant.

Conclusion

Breastfeeding education and/or support increased EBF rates and decreased no breastfeeding rates at birth, <1 month and 1-5 months. Combined individual and group counseling appeared to be superior to individual or group counseling alone. Interventions in developing countries had a greater impact than those in developed countries.