No abstract

Background There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant’s diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation. Objectives To assess the effectiveness of support for breastfeeding mothers. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (3 October 2011). Selection criteria Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother-infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of ‘any breastfeeding’ (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported. Authors’ conclusions All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.

Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding. Design Randomised controlled trial. Setting 32 general practices in London and south Essex. Participants 720 women considering breast feeding. Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks. Secondary outcomes were the proportion of women giving any breast feeds, or bottle feeds at four months, duration of any breast feeding, time to introduction of bottle feeds, and satisfaction with breast feeding. Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks (65% (218/336) in the intervention group and 63% (213/336) in the control group; relative risk 1.02, 95% confidence interval 0.84 to 1.24). Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups. Not all women in the intervention group contacted counsellors postnatally, but 73% (123/179) of those who did rated them as very helpful. More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources. Conclusions Women valued the support of a counsellor in breast feeding, but the intervention did not significantly increase breastfeeding rates, perhaps because some women did not ask for help.

Maternity services should address the components identified by the study findings as constituting good breastfeeding support. Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women's views on what support they want, together with when and how they want it provided.

Putting body weight at the center of thinking and talking about health is referred to as the weight-centered health paradigm (WCHP). This has resulted in arguments for a paradigm shift away from focusing on weight and focusing instead on health and well-being. We reviewed the literature to identify the main components of the WCHP. From the results, we created a framework, named the WCHP 3C Framework. The 3C Framework describes the people and industries contributing to the WCHP and the central claims of the paradigm. It also identifies the three major types of critique of the WCHP: ideological, empirical, and technical. Finally, the 3C Framework highlights that the WCHP is contributing to weight stigma and fat phobia, reduced health and well-being, and poorer quality of life. We hope the 3C Framework will contribute to a paradigm shift in weight science.