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Open Access 01-12-2019 | Review

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

Authors: Alison McFadden, Lindsay Siebelt, Joyce L. Marshall, Anna Gavine, Lisa-Christine Girard, Andrew Symon, Stephen MacGillivray

Published in: International Breastfeeding Journal | Issue 1/2019

Abstract

Background

Many 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.

Methods

A 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.

Results

From 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.

Conclusions

Breastfeeding 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 registration

This systematic review was registered in Prospero (CRD42018086494).

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Title: Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis
Authors: Alison McFadden
Lindsay Siebelt
Joyce L. Marshall
Anna Gavine
Lisa-Christine Girard
Andrew Symon
Stephen MacGillivray
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: International Breastfeeding Journal / Issue 1/2019
Electronic ISSN: 1746-4358
DOI: https://doi.org/10.1186/s13006-019-0235-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Study registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Study registration

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