Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Educational Material, Group Education, Home Visits, Telephone Support

Intervention Description: Evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants.

Intervention Results: Significant differences in the percentage of women initiating breastfeeding in the video (50%), peer counselor (62%), and video + peer counselor (52%) groups vs control group (26%)

Conclusion: Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.

Study Design: Cluster RCT

Setting: 4 WIC clinics in Baltimore, MD

Population of Focus: WIC eligible African American women starting prenatal care < 24 GA, with a singleton pregnancy, planning to keep the baby and stay in the clinic’s catchment area

Data Source: Mother self-report

Sample Size: Video (n=64) • Peer Counselor (n=55) • Video + Peer Counselor (n=66) • Control (n=57)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education

Intervention Description: The intervention consisted of breastfeeding education delivered by a trained counselor, along with incentive marketing using a truth or myth activity in a small group format, followed by instruction, discussion, and informational handouts. Specific incentives included an enhanced food package valued at over $50 per month and extended program eligibility for women who exclusively breastfed or did not receive formula. Additionally, mothers in the study who exclusively breastfed for at least 2 months were eligible for a $25 mall gift certificate. The control group received the standard prenatal education on the general benefits and barriers to breastfeeding, and clients in both groups were provided with educational materials and support.

Intervention Results: The results of the intervention showed mixed outcomes. While there was no significant difference in breastfeeding initiation rates between the intervention and control groups, the intervention group had a significantly higher percentage of women who exclusively breastfed (P=.025) and breastfed for a longer duration than the control group. The intervention also had a significant positive effect on breastfeeding knowledge and beliefs among participants. Although the intervention did not significantly impact total breastfeeding duration, the exclusive breastfeeding duration was significantly longer for the intervention group.

Conclusion: The study concluded that exposure to a single breastfeeding intervention with incentives had significant positive effects on exclusive breastfeeding rates and duration, as well as on breastfeeding attitudes and perceptions. The authors suggest that interventions plus incentives should be considered by dietitians and lactation educators to increase breastfeeding exclusivity and duration among WIC populations. However, the study had limitations, such as a high dropout rate in the intervention group, which may have led to confounding factors influencing the results.

Study Design: RCT

Setting: Western NY

Population of Focus: Women participating in WIC who spoke English, were pregnant, and HIV negative

Data Source: Mother self-report

Sample Size: Intervention (n=30/19)3 Control (n=30/29)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Midwife, Group Education

Intervention Description: This study aimed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding.

Intervention Results: Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299).

Conclusion: In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.

Study Design: RCT

Setting: Royal Women’s Hospital in Melbourne

Population of Focus: Women who were public patients, having a first child, between 16- 24 weeks GA when recruited, and able to speak, read, and write English

Data Source: Mother self-report

Sample Size: Randomized • Practical Skills (n=327) • Attitudes (n=327) • Control (n=328) 6-Month Follow-Up • Practical Skills (n=297) • Attitudes (n=293) • Control (n=299)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, Incentives, Professional Support, COMMUNITY, Individual Supports,

Intervention Description: The Canada Prenatal Nutrition Program (CPNP) aims to improve birth outcomes and promote and support breastfeeding among vulnerable women. Using charitable donations, the Parkdale Parents' Primary Prevention Project (5Ps) CPNP provides postnatal lactation support to its clients in addition to standard prenatal services (group education workshops, individualized support from public health nurses and dieticians, community referrals, snacks, two public transit tokens, grocery store gift card, self-serve food bank, and childcare). This lactation support program was designed and implemented by 5Ps CPNP staff and includes three components: 1) gift package of breastfeeding and infant care supplies; 2) IBCLC visits within 48 h of referral; and 3) double electric breast pump.

Intervention Results: Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump.

Conclusion: This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women.

Study Design: Evaluation data

Setting: A Canada Prenatal Nutrition Program site in Toronto

Population of Focus: Pregnant women in the catchment area

Sample Size: 199 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, COMMUNITY, Other (Communities), POPULATION-BASED SYSTEMS

Intervention Description: To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.

Intervention Results: The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found.

Conclusion: A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.

Study Design: Pragmatic cluster RCT

Setting: 14 clusters of general practices

Population of Focus: Clusters of general practices that collected breastfeeding data through the Child Health Surveillance Program of the National Health Service Scotland from Oct 2002 forward

Data Source: Child Health Surveillance Programme

Sample Size: Intervention (n=7) Control (n=7) N=Clusters

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education

Intervention Description: The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice.

Intervention Results: Group education is an instrument used by professionals in primary care that favors the acquisition of skills and modification of already-acquired behavior, all making it a potential method of choice to improve rates of exclusive breastfeeding in this period.

Conclusion: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO.

Study Design: community-based cluster randomised trial

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, NATIONAL, Policy/Guideline (National),

Intervention Description: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. This study is one of the few studies to include and measure access to breastfeeding support such as breast pumps, worksite programs, educational materials, support groups, lactation consultants, and workplace policies. To meet the 6 month recommendation, employers can provide additional resources (i.e. lactation consultants and support groups) to help mothers transition back to work and continue breastfeeding. The ACA was an important first step for establishing minimum resources to support breastfeeding mothers; however, it needs to be expanded to cover all employer and workers.

Intervention Results: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups.

Conclusion: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.

Study Design: Online, cross sectional survey

Setting: Policy

Population of Focus: Working mothers between the ages of 18 and 50 years old who gave birth in the previous two years

Sample Size: 52 women

Age Range: 18-50 year old women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Educational Material, Group Education, Telephone Support

Intervention Description: The aim of this study was to evaluate the effectiveness of a multiphased midwifery intervention called the 'Milky Way' on any breastfeeding rates until six months.

Intervention Results: There were no significant differences in the antenatal baseline data between the groups. Compared to standard care, women in the Milky Way group had higher rates of breast feeding at one (83.7%, n=144 versus 61.3%, n=119, p<0.001), four (64.5%, n=111 versus 37.1%, n=72, p<0.001) and six months (54.3%, n=94 versus 31.4%, n=61 p<0.001).

Conclusion: Assignment to the Milky Way intervention was associated with significantly higher rates of breastfeeding compared with assignment to standard care only.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Tertiary hospital in South Western Sydney Area Health Services

Population of Focus: Nulliparous women ≥19 years old with basic English literacy

Data Source: Mother self-report

Sample Size: Enrolled • Intervention (n=172) • Control (n=194) 6-Month Follow-Up • Intervention (n=149) • Control (n=189)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Group Education

Intervention Description: The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam. To counteract this trend, a language and culture specific education program was developed.

Intervention Results: Results suggested that the education program had significant effects on knowledge, attitudes, planned and actual behaviour towards breastfeeding. However, the effect did not sustain until 6 months postpartum.

Conclusion: Implications for nursing practice and further research are discussed.

Study Design: QE: non-equivalent control group

Setting: Western and South Western Sydney, New South Wales

Population of Focus: Vietnamese women who were at least 12 weeks pregnant

Data Source: Mother self-report

Sample Size: Intervention (n=108) Control (n=86)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Group Education

Intervention Description: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women.

Intervention Results: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times.

Conclusion: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Study Design: QE: non-equivalent control group

Setting: 2 WIC clinics in Flagstaff, AZ

Population of Focus: Primiparous women with an expected due date between May and Dec 1992

Data Source: Mother self-report

Sample Size: Intervention (n=26) Control (n=26)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Educational Material, Group Education, Incentives,

Intervention Description: The AMEN (originally "Avondale Moms Empowered to Nurse;" remaned to "All Moms Empowered to Nurse") project was the first Peer-to-Peer (Mom-to-Mom) breastfeeding education and support project in Avondale, a neighborhood in Hamilton County, Ohio. AMEN was designed to provide Peer-to-Peer (Mom-to-Mom) breastfeeding education and support, specifically for African American mothers living in neighborhoods of poverty, to increase breastfeeding initiation and duration. The peer support group typically met one to two times per month with the provision of childcare, transportation, refreshments, and grocery gift card incentives. Group activities included sharing of a breastfeeding topic of interest by Champion moms, various interactive activities (e.g., breastfeeding Jeopardy), and faciliated sharing by attendees, in addition to special guest presentations. With the COVID-19 pandemic, the group pivoted to the virtual world (Zoom) allowing even more mothers to join.

Intervention Results: Since May 2017, 67 AMEN support meetings have included 158 participants, with average attendance of 10 (range 5–19) per meeting. In addition to 8 Champions, 110 moms have attended, including 24% expecting mothers. Additional attendees include 13 family support persons, 23 guest speakers, and 12 from community outreach programs. Qualitative feedback from participants has been uniformly positive. Breastfeeding initiation rates have increased 12% in the initial neighborhood.

Conclusion: Harnessing strength within the local community, Champion Breastfeeding Moms have successfully launched AMEN breastfeeding support groups in under-resourced African American urban neighborhoods, helping more mothers reach their breastfeeding goals.

Study Design: Mixed methods

Setting: Home visitation program, Every Child Succeeds, at Carmel Presbyterian Church in partnership with the Cincinnati Children's Hospital Medical Center in the Avondale neighborhood

Population of Focus: Participants in the AMEN peer support program

Sample Size: 67 support meetings with a total of 158 participants (8 champions, 110 mothers, 13 family support persons, 23 guest speakers, and 12 from community outreach programs)

Age Range: Not reported