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Open Access 01-12-2019 | Lactation | Research article

The effect of a breastfeeding support programme on breastfeeding duration and exclusivity: a quasi-experiment

Authors: S. A. van Dellen, B. Wisse, M. P. Mobach, A. Dijkstra

Published in: BMC Public Health | Issue 1/2019

Abstract

Background

Breastfeeding has important positive long-term health consequences for infants and mothers. The World Health Organization recommends that all infants should be exclusively breastfed for six months or longer, and advises continuation of breastfeeding for two years or beyond. However, these recommendations are not met in many countries. This study examined whether a comprehensive, evidence-based breastfeeding intervention, the Breastfeeding Support Programme (BSP), promotes prolonged duration and exclusivity of breastfeeding among its participants.

Methods

A quasi-experimental design was used to compare breastfeeding duration and exclusivity in the BSP group (N = 66) to breastfeeding duration and exclusivity in a control group (N = 72). Participants who followed the BSP were provided with 6 consults delivered by a lactation consultant. The consults started during pregnancy and continued up until 10 weeks after delivery. Participants in the control group did not follow the BSP. Pretest and posttest questionnaires were administered through the internet. A Cox proportional hazards regression analysis was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cessation of any and exclusive breastfeeding, while controlling for differences at baseline.

Results

The effect of the BSP on survival rates for any and exclusive breastfeeding were significant while controlling for differences between the two groups at baseline (respectively HR = 0.34, p < .001 [95% CI = 0.18–0.61] and HR = 0.46, p < .001 [95% CI = 0.29–0.72]). Among mothers in the BSP group there was on average 66% less risk of cessation of any breastfeeding and on average 54% less risk of cessation of exclusive breastfeeding at any point in time compared to those in the control group.

Conclusions

The BSP appears to be an effective means to delay cessation of any and exclusive breastfeeding cessation and therefore to increase breastfeeding duration and exclusivity. This is an important finding, because earlier cessation of breastfeeding than desired is a common problem in many countries. Future research into the effectiveness of the BSP could consider random assignment to conditions and test the effectiveness of the intervention in other populations to investigate further whether wide-scale implementation of this intervention could be useful to promote breastfeeding.

Available only for authorised users

In this research exclusive breastfeeding was defined as still receiving breast milk, without artificial feeding. No information was recorded in this research on complementary feeding (i.e.: consumption of other foods or drinks alongside breastfeeding or artificial feeding).

Since the BSP is a relatively small-scale programme, recruitment was spread out over a longer period to ensure sufficient participants for a reliable effect measurement.

Since questions about drinks other than infant formula were not included in our questionnaire, this was not included in our operationalization of exclusive breastfeeding. However, we estimate that it is unlikely that children would have received other drinks than formula, unless they had also begun to receive solid foods and/or formula, since the Dutch Nutrition Centre advises introducing solid foods from month 4-6, and not to introduce water or other drinks until after month 6 [18, 19]. If parents had taken the step not to introduce solid foods or formula before 6 months, then they would most likely not have introduced other drinks either before 6 months. The operationalization used therefore offers a good approximation of exclusive breastfeeding according to the WHO definition.

A negative experience with previous breastfeeding is the only variable which differed at baseline but was not controlled for in the Cox proportional hazards regression analyses. We decided not to control for this variable because first-time mothers were unable to answer this question. Note that a negative experience with previous breastfeeding was negatively correlated to breastfeeding duration in the current sample (r = -.40, p = 0.001). Since the participants in the BSP group scored higher on this variable than participants in the control group, not controlling for this variable leads to a more conservative estimate. The decision not to control for this variable therefore seems justified. Furthermore, because there were almost no individuals with low-level education, we dichotomized education level and education level of the partner into low-medium versus high level to improve reliability of the estimates.

Fomon S. Infant feeding in the 20th century: formula and beikost. J Nutr. 2001;131(2):409S–20S.CrossRef

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.CrossRefPubMed

Chung M, Raman G, Chew P, Magula N, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Technol Asses (Full Rep). 2007;153(153):1–86.

Horta BL, Bahl R, Martinés JC, Victora CG, World Health Organization. Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses; 2007.

Horta BL, Victora CG, World Health Organization. Long-term effects of breastfeeding: a systematic review; 2013.

Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:96–113. https://doi.org/10.1111/apa.13102.CrossRefPubMedPubMedCentral

The World Health Organization’s infant feeding recommendation (2001). Available at: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/index.html. Accessed 20 May 2015.

WHO UNICEF. Tracking Progress for breastfeeding policies and Programmes: global breastfeeding scorecard 2017. Geneva: World Health Organization; 2017. Retrieved from: http://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2017/en/

Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013;131(3):e726–32. https://doi.org/10.1542/peds.2012-1295.CrossRefPubMedPubMedCentral

10.

Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin N Am. 2001;48(2):273–97. https://doi.org/10.1016/S0031-3955(08)70026-9.CrossRef

11.

Peeters D, Lanting C, Van Wouwe J. Peiling melkvoeding van zuigelingen 2015. Leiden: TNO; 2015.

12.

Kerkhoff Z, Martijn R, van der Horst M, van Wouwe J, Boxem J. Een verkennend onderzoek naar de relatie tussen borstvoedingsduur en tevredenheid. Leiden: TNO; 2008.

13.

Buchner FL, Hoekstra J, Van Rossum CT. Health gain and economic evaluation of breastfeeding policies: Model simulation. RIVM Rapport 350040002. 2007.

14.

Theurich MA, Davanzo R, Busck-Rasmussen M, Díaz-Gómez NM, Brennan C, Kylberg E, Bærug A, McHugh L, Weikert C, Abraham K, Koletzko B. Breastfeeding rates and programs in Europe: a survey of 11 national breastfeeding committees and representatives. J Pediatr Gastroenterol Nutr. 2019;68(3):400–7.CrossRef

15.

Naylor AJ. Baby-friendly hospital initiative: protecting, promoting, and supporting breastfeeding in the twenty-first century. Pediatr Clin. 2001;48(2):475–83.

16.

Kist-van Holthe JE, et al. JGZ-richtlijn Voedselovergevoeligheid. JGZ Tijdschrift voor jeugdgezondheidszorg. 2014;46(2):36–42.CrossRef

17.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal. 2009;7(12):1423.

18.

Borstvoeding geven. http://www.voedingscentrum.nl/nl/mijn-kind-en-ik/borstvoeding-en-flesvoeding/borstvoeding-geven.aspx. Accessed 3 May 2019.

19.

De oefenhapjes (4 tot 6 maanden). https://www.voedingscentrum.nl/nl/mijn-kind-en-ik/eerste-hapjes/de-oefenhapjes-4-tot-8-maanden-.aspx Accessed 3 May 2019.

20.

Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth. 2010;23(4):135–45. https://doi.org/10.1016/j.wombi.2010.02.002.CrossRefPubMed

21.

De Oliveira MI, Camacho LA, Tedstone AE. Extending breastfeeding duration through primary care: a systematic review of prenatal and postnatal interventions. J Hum Lact. 2001;17(4):326–43. https://doi.org/10.1177/089033440101700407.CrossRefPubMed

22.

Hannula L, Kaunonen M, Tarkka MT. A systematic review of professional support interventions for breastfeeding. J Clin Nurs. 2008;17(9):1132–43. https://doi.org/10.1111/j.1365-2702.2007.02239.x.CrossRefPubMed

23.

Imdad A, Yakoob MY, Bhutta ZA. Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health. 2011;11(3):S24. https://doi.org/10.1186/1471-2458-11-S3-S24.CrossRefPubMedPubMedCentral

24.

Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. Breastfeeding promotion interventions and breastfeeding practices: a systematic review. BMC Public Health. 2013;13(3):S20. https://doi.org/10.1186/1471-2458-13-S3-S20.CrossRefPubMedPubMedCentral

25.

Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.CrossRefPubMed

26.

Kim S, Park S, Oh J, Kim J, Ahn S. Interventions promoting exclusive breastfeeding up to six months after birth: a systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud. 2018. https://doi.org/10.1016/j.ijnurstu.2018.01.004.CrossRef

27.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. https://doi.org/10.1016/0749-5978(91)90020-T.CrossRef

28.

Hardeman W, Johnston M, Johnston D, Bonetti D, Wareham N, Kinmonth AL. Application of the theory of planned behaviour in behaviour change interventions: a systematic review. Psychol Health. 2002;17(2):123–58. https://doi.org/10.1080/08870440290013644a.CrossRef

29.

Duckett L, Henly S, Avery M, Potter S, Hills-Bonczyk S, Hulden R, Savik K. A theory of planned behavior-based structural model for breast-feeding. Nurs Res. 1998;47(6):325–36.CrossRef

30.

Dodgson JE, Henly SJ, Duckett L, Tarrant M. Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers. Nurs Res. 2003;52(3):148–58.CrossRef

31.

McMillan B, Conner M, Green J, Dyson L, Renfrew M, Woolridge M. Using an extended theory of planned behaviour to inform interventions aimed at increasing breastfeeding uptake in primiparas experiencing material deprivation. Br J Health Psychol. 2009;14(2):379–403. https://doi.org/10.1348/135910708X336112.CrossRefPubMed

32.

Bai Y, Middlestadt SE, Peng CY, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact. 2010;26(1):26–34. https://doi.org/10.1177/0890334409350168.CrossRefPubMed

33.

Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, Finkelstein J. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc. 2006;13(1):16–23. https://doi.org/10.1197/jamia.M1749.CrossRefPubMedPubMedCentral

34.

Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. 2011;24(5):589–96. https://doi.org/10.3122/jabfm.2011.05.110067.CrossRefPubMed

35.

Bonell CP, Hargreaves J, Cousens S, Ross D, Hayes R, Petticrew M, et al. Alternatives to randomisation in the evaluation of public health interventions: design challenges and solutions. J Epidemiol Community Health. 2011;65(7):582–7. https://doi.org/10.1136/jech.2008.082602.CrossRefPubMed

36.

DiNardo J. Natural experiments and quasi-natural experiments. The new Palgrave dictionary of economics. 2016:1–2.

37.

Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27(3):379. https://doi.org/10.1037/0278-6133.27.3.379.CrossRefPubMed

38.

Thulier D, Mercer J. Variables associated with breastfeeding duration. J Obstet Gynecol Neonatal Nurs. 2009;38(3):259–68. https://doi.org/10.1111/j.1552-6909.2009.01021.x.CrossRefPubMed

39.

van Rossem L, Oenema A, Steegers EA, Moll HA, Jaddoe VW, Hofman A, et al. Are starting and continuing breastfeeding related to educational background? The generation R study. Pediatrics. 2009;123(6):e1017–27. https://doi.org/10.1542/peds.2008-2663.CrossRefPubMed

40.

Lanting CI, Wouwe JP, Reijneveld SA. Infant milk feeding practices in the Netherlands and associated factors. Acta Paediatr. 2005;94(7):935–42. https://doi.org/10.1111/j.1651-2227.2005.tb02014.x.CrossRefPubMed

41.

Scott JA, Landers MC, Hughes RM, Binns CW. Factors associated with breastfeeding at discharge and duration of breastfeeding. J Paediatr Child Health. 2001;37(3):254–61. https://doi.org/10.1046/j.1440-1754.2001.00646.x.CrossRefPubMed

42.

Van Rossum CT, Büchner FL, Hoekstra J. Quantification of health effects of breastfeeding: review of the literature and model simulation: RIVM report 350040001/2005. Bilthoven: RIVM; 2006.

43.

Buijssen M, Jajou R, van Kessel FG, Zeilmaker MJ, Wijga AH, van Rossum CT. Health effects of breastfeeding: an update: systematic literature review. RIVM report 2015–0043. Bilthoven: RIVM; 2015.

44.

Clark TG, Bradburn MJ, Love SB, Altman DG. Survival analysis part I: basic concepts and first analyses. Br J Cancer. 2003;89(2):232.CrossRef

45.

Bradburn MJ, Clark TG, Love SB, Altman DG. Survival analysis part III: multivariate data analysis–choosing a model and assessing its adequacy and fit. Br J Cancer. 2003;89(4):605.CrossRef

46.

Kools EJ, Thijs C, Kester AD, van den Brandt PA, de Vries H. A breast-feeding promotion and support program a randomized trial in the Netherlands. Prev Med. 2005;40(1):60–70.CrossRef

47.

Gijsbers B, Mesters I, Knottnerus JA, Kester AD, Schayck CP. The success of an educational program to promote exclusive breastfeeding for 6 months in families with a history of asthma: a randomized controlled trial. Pediatr Asthma Allergy Immunol. 2006;19(4):214–22.CrossRef

48.

Blackford JU. Propensity scores: method for matching on multiple variables in Down syndrome research. Intellect Dev Disabil. 2009;47(5):348–57.CrossRef

Title: The effect of a breastfeeding support programme on breastfeeding duration and exclusivity: a quasi-experiment
Authors: S. A. van Dellen
B. Wisse
M. P. Mobach
A. Dijkstra
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Lactation
Published in: BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-019-7331-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effect of a breastfeeding support programme on breastfeeding duration and exclusivity: a quasi-experiment

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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