Breastfeeding Support for Healthy Mothers and Infants

Do breastfeeding support interventions effectively extend the duration and exclusivity of breastfeeding in mothers and healthy infants delivered at full term?

There is moderate evidence that women who receive breastfeeding support interventions are more likely to continue breastfeeding up to 6 months postpartum; these interventions also appear to increase exclusive breastfeeding (i.e., breast milk is the only form of nutrition). The type of support (i.e., virtual, in-person, or by a health professional vs. a peer) does not significantly affect outcomes.¹ (Strength of Recommendation: A, consistent, good-quality patient-oriented evidence.)

Although the World Health Organization, American Academy of Pediatrics, and American Academy of Family Physicians recommend exclusive breastfeeding until infants are 6 months of age, only 25% of mothers in the United States follow these recommendations, and less than 36% breastfeed after 1 year.² The U.S. Preventive Services Task Force suggests providing breastfeeding support, which can include reassurance, information, and counseling, to increase breastfeeding rates.³ The authors of this Cochrane review sought to investigate the effectiveness of breastfeeding support on breastfeeding duration and exclusivity.

This Cochrane review included 116 trials of 98,816 healthy mother-infant pairs.¹ Compared with standard care, interventions included breastfeeding support services—not otherwise well-defined—and breastfeeding support in combination with maternal and child health interventions. Maternal and child health interventions combined with breastfeeding support were collectively labeled by the authors as “breastfeeding plus” and included health care services such as vaccinations, baby clinics, intrapartum care, and contraceptive services. Outcomes examined the rates that women stopped any breastfeeding or stopped exclusive breastfeeding at predefined times after birth (4 to 6 weeks and 2, 4, 6, 9, and 12 months).

Breastfeeding support reduced the risk of stopping breastfeeding at 4 to 6 weeks (risk ratio [RR] = 0.88; 95% CI, 0.79 to 0.97; moderate-certainty evidence) and 6 months (RR = 0.93; 95% CI, 0.89 to 0.97; moderate-certainty evidence). Breastfeeding support also improved the possibility of exclusive breastfeeding at 4 to 6 weeks (RR = 0.83; 95% CI, 0.76 to 0.90; moderate-certainty evidence) and 6 months (RR = 0.90; 95% CI, 0.88 to 0.93; moderate-certainty evidence).

Breastfeeding plus appeared to increase exclusive breastfeeding at 4 to 6 weeks (RR = 0.73; 95% CI, 0.57 to 0.95; very low-certainty evidence) and 6 months (RR = 0.79; 95% CI, 0.70 to 0.90; low-certainty evidence). Breastfeeding plus was associated with an increase in any breastfeeding at 6 months (RR = 0.94; 95% CI, 0.91 to 0.97; moderate-certainty evidence). Whether a physician or other clinician provided the support or it was delivered in person had no impact on outcomes; however, the authors noted that interventions appeared to be more effective when performed at four or more visits.¹

Significant heterogeneity of the study populations and the types of breastfeeding support offered make it challenging to broadly apply these conclusions. Meta-regression performed to mitigate heterogeneity suggested that these interventions may have a greater effect in low- to middle-income countries (45% of the study population). A review by the National Institute for Health and Care Excellence in the United Kingdom reported a similar conclusion and demonstrated that breastfeeding interventions improve exclusive breastfeeding at 6 and 12 weeks postpartum.⁴

Breastfeeding is a focus of the Healthy People 2030 campaign, which suggests that at least 42.4% of mothers should be exclusively breastfeeding at 6 months and that at least 54.1% should be breastfeeding at 1 year.² Based on this Cochrane review, clinicians should consider offering support resources with at least four contacts. Different communities require separate types of support.¹ Future studies should help differentiate which intervention components are beneficial, which should be expanded on a larger scale, and how best to link support to patients to improve health care outcomes and decrease costs.

The practice recommendations in this activity are available at https://www.cochrane.org/CD001141.

This article reflects the opinions of the authors and does not reflect the opinion of the Department of the Army, the Department of the Air Force, the Department of the Navy, the Defense Health Agency, the Department of Defense, or the U.S. government.