Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis

Abstract

BackgroundMany infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines.MethodsA systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24 months after birth.ResultsFrom the 5180 records identified in searches and a further 11 records found by hand searching, 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at 4 to 6 weeks (Relative risk [RR] 0.85, 95% CI 0.77, 0.94) and 6 months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at 4 to 6 weeks (RR 0.79, 95% CI 0.72, 0.87) and 6 months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity.ConclusionsBreastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances.Study registrationThis systematic review was registered in Prospero (CRD42018086494).

Delayed onset of breastfeeding: what is stopping us?

“…According to 'Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis'. 1 Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding.…”

“…Counselling by health care workers is an important determinant for initiation of breastfeeding. 1 Delayed initiation of breast milk has detrimental effect on child growth and development. The effective outcome for the untoward breastfeeding techniques is the contribution of such complications on under 5 mortality.…”

Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.

“…These models should take into account the mothers' needs rather than reciting a list of bene ts from breastfeeding or opting for more authoritarian and traditional ways; models in which health professionals tell mothers "what they should do" or even "scold them". Counseling has shown to be effective for breastfeeding and other health behaviors (9). In this study, the counseling provided was based on previous formative research that analyzed the main obstacles to breastfeeding in this population and the ways in which they would like to be supported.…”

“…Interpersonal Counseling (IC) has proven to be an e cient intervention to change breastfeeding rates (8)(9). In a systematic review conducted in 2018 (9), where 63 interventions were analyzed, IC was associated with a decreased risk of early termination of exclusive breastfeeding at 4-6 weeks (RR = 0.79, 95% CI 0.72, 0.87) and at 6 months (RR = 0.84, 95% CI, 0.78, 0.91). Interventions were heterogeneous in terms of time duration, counselors' training, face to face or phone counseling, among other factors.…”

The Role of Public Health Center Staffs in Socialization, Education and Campaign to Increase Exclusive Breastfeeding Coverage

“…Interventions should be done face-to-face, but can also be provided by telephone. This counseling was carried out starting from antenatal and postnatal, because information about exclusive breastfeeding needed since pregnant women are able to prepare for breastfeeding needs and can provide a full 6 months (McFadden et al, 2019;Susiloretni et al, 2019).…”