A systematic review of structured compared with non‐structured breastfeeding programmes to support the initiation and duration of exclusive and any breastfeeding in acute and primary health care settings

Abstract

Policies and guidelines have recommended that structured programmes to support breastfeeding should be introduced. The objective of this review was to consider the evidence of outcomes of structured compared with non-structured breastfeeding programmes in acute maternity care settings to support initiation and duration of exclusive breastfeeding. Quantitative and qualitative studies were considered. Primary outcomes of interest were initiation of breastfeeding and duration of exclusive breastfeeding. Studies that only considered community-based interventions were excluded. An extensive search of literature published in 1992-2010 was undertaken using identified key words and index terms. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction; 26 articles were included. Because of clinical and methodological heterogeneity of study designs, it was not possible to combine studies or individual outcomes in meta-analyses. Most studies found a statistically significant improvement in breastfeeding initiation following introduction of a structured breastfeeding programme, although effect sizes varied. The impact on the duration of exclusive breastfeeding and duration of any breastfeeding to 6 months was also evident, although not all studies found statistically significant differences. Despite poor overall study quality, structured programmes compared with standard care positively influence the initiation and duration of exclusive breastfeeding and any breastfeeding. In health care settings with low breastfeeding initiation and duration rates, structured programmes may have a greater benefit. Few studies controlled for any potential confounding factors, and the impact of bias has to be considered.

Influences on infant feeding decisions of first-time mothers in five European countries

“…To the extent that health professionals provide evidence-based information, and their advice carries credibility and authority with the public, there is scope to increase the role they play as educators of mothers (24). Attitudes of health professionals to breastfeeding can, however, vary (25)(26)(27)(28)(29)(30)(31).…”

Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province

“…74,75 A structured programme of breastfeeding promotion, compared with standard care, positively influence the initiation and duration of any breastfeeding, including exclusive breastfeeding. 76 However, as the BFHI is mainly focused at maternity units, with Step 10 focusing on community support, it seems that the influence of the BFHI past the initiation of breastfeeding may not be maintained. 74 Interventions made only at one moment (such as in the maternity ward) and based only in hospitals may increase breastfeeding rates but will only have a short-term effect unless it is combined with Stellenbosch University http://scholar.sun.ac.za 6& complementary strategies.…”

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

“…Beake and colleagues 184 conducted a systematic review to assess whether a structured programme such as the WHO/UNICEF BFI implemented in maternity acute care settings is more likely to be associated with higher rates of initiation and duration of exclusive breastfeeding than no structured programme. The 'structured programme' included a multifaceted approach to support breastfeeding that targeted change at organisational, service delivery and individual behaviour levels.…”

“…The reports identified by our search strategy represent a small proportion of a substantial body of literature that has recently been systematically reviewed by a team including co-applicant FD. 184 A full review of the BFI literature to identify data relating to the incentive 184 review is summarised later in this chapter (see Results of incentives provided to organisations to improve smoking cessation in pregnancy and breastfeeding outcomes). 2.…”