by Allison Laverty Montag IBCLC
What effects do support interventions have on early initiation, exclusive, continued and any breastfeeding rates? Mothers may receive breastfeeding education and counseling in multiple settings. To increase breastfeeding rates, interventions need to be provided in the most effective manner, which has yet to be defined.
Authors of a 2015 metanalysis in Acta Paediatrica reviewed 195 studies on breastfeeding inventions to determine the extent to which interventions provided in various settings can improve breastfeeding outcomes. These setting may include: 1) Health systems and services, 2) Home and family environment, 3) Community environment, 4) Working environment 5) Policy environment, 5) Combination of settings.
Based on this meta-analysis, which statements do you believe are accurate regarding the effect of support interventions on breastfeeding rates? Choose 1 or more
- A pooled effect of studies in rural areas showed higher effect of interventions on early breastfeeding initiation compared to urban areas.
- Interventions delivered concurrently in a combination of settings improved breastfeeding rates significantly by 57%.
- Baby Friendly Hospital support and counselling or education by health staff delivered in multiple settings had the largest effects on breastfeeding initiation in the first hour.
- The highest effect in exclusive breastfeeding was observed when interventions were delivered together in the health systems and community environment.
- Paid maternal leave from work may results in significantly better continued breastfeeding practices at 10 months.
- Family and social support has a significant effect on promoting exclusive breastfeeding.
See the Answer
Answer: A,B,C,D,E but not F
Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis.
Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, Rollins N4, Bahl R Bhandari N
AIM:
To provide comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above.
METHODS:
Of 23977 titles identified through a systematic literature search in PUBMED, Cochrane and CABI, 195 articles relevant to our objective, were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity, we explored its causes by subgroup analysis and meta-regression and applied random effects model.
RESULTS:
Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding.
CONCLUSION:
To promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.
Milk Mob Comment by Allison Laverty Montag IBCLC
In my practice, mothers report frustration with the conflicting and inconsistent advice they receive in numerous settings. In addition to educating the mother and family, educating the whole community including health systems is key to increasing all breastfeeding rates. The combination of counseling and education in multiple venues will have an overall effect of empowering mothers to initiate and continue breastfeeding.
I was surprised and disappointed the review found that family and social support had no significant effect on promoting exclusive breastfeeding. Educating the community in addition to the family may change the breastfeeding atmosphere and acceptance of breastfeeding as the norm.
Until mothers can access knowledgeable and pervasive breastfeeding education, support, and counseling, they will need to continue to advocate for themselves and piece together their network of breastfeeding support
Our take home message is that interventions need to take place in multiple settings to have the greatest effect. All parties including the health system, workplace/employer, home and community need to work together to have the highest impact on increasing breastfeeding rates.
Sally Hammerman
Different mothers in different situations, locations & life histories are effected and affected differently. Use multiple methods to increase general knowledge.