Summary of main results
This substantively updated review provides evidence that breastfeeding
support interventions increase the number of women continuing
to breastfeed, and the number of women continuing to
exclusively breastfeed, at up to six months and at up to four to six
weeks. The size of the treatment effects varied considerably in different
trials, and average treatment effects may not be applicable
in different settings. The subgroup analysis suggested that faceto-
face support was associated with a greater treatment effect than
telephone support for exclusive breastfeeding, and that interventions
had an increased effect on exclusive breastfeeding in areas
where background breastfeeding initiation was high.
The 52 trials included span the years from 1979 to 2011, with 37
(71%) having been published since 2000. They were conducted
in 21 countries, with 37 (55% of participants) being conducted
in high-income countries, two in low-income countries (one in
Bangladesh, one in Burkino Faso, Uganda and South Africa) and
the remainder in low-to-middle income countries. These numbers
indicate that the challenge of supporting women to breastfeed is
both longstanding and international; this is also reflected in the
continuing low rates of duration and exclusivity of breastfeeding
in many countries, despite increasing availability of good quality
evidence of the scale of its public health impact.
A striking aspect of this updated review is the heterogeneity of
the support interventions, and the diversity of setting and of standard
care. Interventions deemed by researchers to be ‘supportive’
included some where it was difficult to see how women might
actually feel supported, especially when the support service provided
was one they had to ask for, or travel a distance to get to
(e.g. Graffy 2004; Hoddinott 2009), or where there was only one
scheduled contact with the support person. Having said that, this
updated review has shown that the effect of supportive interventions
is robust across settings and population groups, and results
from a wide range of interventions.