Home Visitation and Breastfeeding Rates
by Anne Eglash MD, IBCLC, FABM
The dropoff in breastfeeding rates postpartum is a global health issue, not limited to the USA and other high resource countries. According to the World Health Organization, only 38% of infants aged 0 to 6 months are exclusively breastfed. One of the 6 WHO global nutrition targets for 2025 is to increase exclusive breastfeeding in the first 6 months up to at least 50%.
The authors of this week’s CQW sought to explore the effect of home visitation by professionals in increasing breastfeeding rates postpartum. Even if mothers receive optimal support of breastfeeding in the hospital or birthing center, they leave just as breastfeeding dynamics rapidly change and the infant’s nutritional needs are rapidly increasing. We just learned from the Flaherman study discussed in CQW 150 that any formula use at 2 weeks was associated with a 31.4% rate of any breastfeeding at 6 months, and a 5.7% at 12 months.
This article is a systematic review of 26 studies that researched the effect of home visitation by professionals on breastfeeding rates and that used a randomized controlled trial or quasi-experimental trial design. Professionals included physicians, nurses, midwives, IBCLCs, or trained workers who completed the 18-h or 40-h WHO/UNICEF counseling/lactation management courses. The studies were from a variety of countries, with only 5 from the USA. Other countries included Brazil, Australia, Canada, Bangladesh, Switzerland, Denmark, Syria, Italy, Turkey, Holland, and countries in Africa. The studies varied in their criteria of participant selection based on intention to breastfeed. They also varied on the breastfeeding rates measured, i.e. exclusive vs any.
- The majority of studies measuring exclusive breastfeeding rates found that home visitation increased exclusive breastfeeding rates at 0-6 mo postpartum.
- Home visitation programs that only occur postpartum and not during pregnancy had no effect on breastfeeding rates.
- A longer duration of home visit intervention is more likely to have a positive impact on breastfeeding duration rates.
- Home-based interventions with professional support in general did not increase breastfeeding initiation rates.
- Home-based interventions that taught positioning and latch were more likely to increase breastfeeding rates than interventions that had no specific teaching agenda.
See the Answer
Low breastfeeding rate and high early cessation of breastfeeding are observed worldwide. There is a need to review the effects of home visits with professional support on promoting breastfeeding. The present study evaluated the efficacy of home visits on promoting breastfeeding outcomes (i.e., breastfeeding initiation rate, exclusive breastfeeding rate/duration, and breastfeeding rate/duration) using a systematic review.
Search of EMBASE, MEDLINE, CENTRAL—Cochrane central register of controlled trials, PsycInfo, and ClinicalTrials.gov was conducted by February 28, 2019, to identify relevant studies.
A total of 26 studies were included. Fourteen of the included studies investigated rate/duration of exclusive breastfeeding; ten of them demonstrated a significant increase on the rate/duration of exclusive breastfeeding. Sixteen of the included studies investigated rate/duration of breastfeeding; four of them demonstrated a significant increase on the rate/duration of breastfeeding. Four studies evaluated initiation of breastfeeding and three of them did not show a significant effect.
Findings suggest that breastfeeding can be increased by home-based interventions with professional support. Support-based intervention is likely an effective way to promote breastfeeding.
The studies in this systematic review varied greatly in terms of who provided the breastfeeding support, what type of breastfeeding support was offered (structured agenda of topics vs answering questions), the number of visits provided, and the duration of time that home visitations were provided. In addition, the studies varied as to whether they included participants who had a strong intention to breastfeed. This systematic review did not measure whether focusing on participants with strong intention was more likely to show a positive effect of home visitation. This study left me with more questions than answers. Should home visitation programs focus on women with a strong intention to breastfeed? What % of the population has access to professional home visitors for breastfeeding support? How can we ensure that all public health professionals providing home visitation are knowledgeable about breastfeeding, and do they have specific breastfeeding teaching points to discuss on their home visits? Which insurances/national health care programs cover home visitation for breastfeeding support?
I hope some of our readers will share their home-visitation experiences in our comments section!