Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Lactation Consultant Home Visits Telephone Support Provision of Breastfeeding Item PROVIDER/PRACTICE Other (Provider Practice)

Intervention Description: Determined the effectiveness of primary care-based, and pre- and postnatal interventions to increase breastfeeding.

Intervention Results: In Best Infant Nutrition for Good Outcomes (BINGO) at 3 months, high intensity was greater for the LC+EP (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.08, 6.84) and LC (OR = 3.22; 95% CI = 1.14, 9.09) groups versus usual care, but not for the EP group alone. In PAIRINGS at 3 months, intervention rates exceeded usual care (OR = 2.86; 95% CI = 1.21, 6.76); the number needed to treat to prevent 1 dyad from nonexclusive breastfeeding at 3 months was 10.3 (95% CI = 5.6, 50.7).

Conclusion: LCs integrated into routine care alone and combined with EP guidance from prenatal care providers increased breastfeeding intensity at 3 months postpartum.

Study Design: RCT

Setting: Urban, prenatal clinic in the Bronx, NY

Population of Focus: Women who spoke English or Spanish, ≥ 18 years old, in the first or second trimester of a singleton pregnancy, without risk factors for a premature birth or maternal/infant condition that would prevent or complicate breastfeeding

Data Source: Mother self-report

Sample Size: Best Infant Nutrition for Good Outcomes (BINGO) • Lactation Consultant (LC) (n=77/73) • Electronically Prompted (EP) Guidance by Prenatal Care provider (n=236/223) • LC + EP (n=238/226) • Control (n=77/73)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Peer Counselor Home Visits Telephone Support Provision of Breastfeeding Item

Intervention Description: To evaluate a specialized breastfeeding peer counseling (SBFPC) intervention promoting exclusive breastfeeding (EBF) among overweight/obese, low-income women.

Intervention Results: The intervention had no impact on EBF or breastfeeding continuation at 1, 3, or 6 months postpartum. In adjusted posthoc analyses, at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding (adjusted odds ratio [aOR]: 3.76 [95% confidence interval (CI): 1.07-13.22]), and giving at least 50% of feedings as breast milk (aOR: 4.47 [95% CI: 1.38-14.5]), compared with controls. Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth (aOR: 0.24 [95% CI: 0.07-0.86]).

Conclusion: In a Baby-Friendly hospital setting, SBFPC targeting overweight/obese women did not impact EBF practices but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth.

Study Design: RCT

Setting: Hartford Hospital in Hartford, CT

Population of Focus: Pregnant women ≥ 18 years, with prepregnancy BMI ≥ 27, ≤ 36 weeks GA, singleton pregnancy, without medical conditions that may interfere with breastfeeding, ≤ 185% federal poverty level, planning to stay in the area for 6 months, and considering breastfeeding

Data Source: Mother self-report

Sample Size: Randomized Intervention (n=76) Control (n=78) 6-Month Follow-Up • Intervention (n=55) • Control (n=53)

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): Other Education PATIENT_CONSUMER Provision of Breastfeeding Item Educational Material

Intervention Description: Community forum participants voted for an education and resource distribution program (using a baby box) to help reduce local infant mortality.

Intervention Results: The proportion of participants at the follow-up survey who reported bed-sharing most or all of the time (5.7%) was lower than those participants who had said they were likely or very likely to bed-share in the post-education survey (11.3%). Although nearly all participants (98.6%) in the post-education survey reported that they were likely to use the baby box, at the postpartum follow-up, 39.1% reported actual use of the baby box.

Conclusion: The program positively impacted self-reported likelihood of several health behaviors. A community-driven approach to maternal education and resource distribution may be beneficial in other cities.

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 Educational Material Other Education Provision of Breastfeeding Item PROVIDER/PRACTICE Hospital Policies Other (Provider Practice) POPULATION-BASED SYSTEMS COMMUNITY Other (Communities) Provider Training/Education

Intervention Description: A breastfeeding promotion program conducted on the Navajo reservation.

Intervention Results: Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful.

Conclusion: This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Study Design: QE: pretest-posttest

Setting: Shiprock, NM

Population of Focus: All mothers with infants born at the Shiprock hospital

Data Source: Medical record review

Sample Size: Preintervention (n=988) Postintervention (n=870)

Age Range: Not specified