A systematic review on the effectiveness of interventions to promote the initiation, duration and exclusivity of breastfeeding

Abstract

Background Breastfeeding is beneficial to infant and child health, woman health and society. Breastfeeding is promoted by various strategies in Hong Kong. Although the breastfeeding initiation rate is increasing, the exclusive breastfeeding rate at 4-6 months remains low in Hong Kong. The current policy and interventions are not effective on promoting breastfeeding and addressing the needs of mothers.

Aims This systematic review aimed to identify effective interventions to promote breastfeeding initiation, duration and exclusivity and their implications to future change of guidelines or policies in breastfeeding promotion.

Method Studies were searched through PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials up to 13thMay, 2013. Grey literature was searched. English publications with full text, experimental or quasi-experimental design, using World Health Organization definitions of breastfeeding classification, targeting to healthy mothers and infants were selected. Quality assessment was done using Consolidated Standards of Reporting Trials and Quality Assessment Tool for Quantitative Studies by Effective Public Health Practice Project.

Result Twenty studies were included in this review. The Baby Friendly Hospital Initiative was found to be the most effective strategy to promote breastfeeding duration and exclusivity. Home visit by peer counselor, a face-to-face intervention, was another effective strategy to increase initiation, duration and exclusivity of breastfeeding. The sole use of educational materials was not effective, but professional breastfeeding support combined with use of educational materials was shown to be effective on lengthening the duration of exclusive and predominant breastfeeding. The evidence of antenatal education programme was not convincing. The inclusion of father with breastfeeding promotion intervention was attempted but the evidence is less strong. The exclusion of infant formula advertisement in the educational package to mothers was effective on increasing breastfeeding rate only before hospital discharge. Findings on professional support interventions were inconsistent.

Conclusion The Baby Friendly Hospital Initiative and home visit peer support are effective on promoting breastfeeding duration and exclusivity. Evidence for other strategies was limited due to low methodological quality and/or inconsistent findings. Future research should be conducted to investigate and identify suitable strategies that are applicable to local setting.