Interventions for promoting the initiation of breastfeeding.

BACKGROUND: Despite the widely documented health benefits of breastfeeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups.

OBJECTIVES: To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 May 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003) and the following databases from inception to October 2002: MEDLINE, CINAHL, ERIC, Applied Social Sciences, PsychLIT, EMBASE, British Nursing Index, BIDS, EPI-centre. We also searched the following in October 2002 for 'grey literature: 'SIGLE, DHSS Data, and Dissertation Abstracts. We handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to October 1998. We scanned reference lists of all articles obtained.

SELECTION CRITERIA: Randomised controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem.

DATA COLLECTION AND ANALYSIS: One review author independently extracted data and assessed trial quality for checking by a second author. We contacted investigators to obtain missing information.

MAIN RESULTS: Seven trials involving 1388 women were included. Five trials involving 582 women on low incomes in the USA showed breastfeeding education had a significant effect on increasing initiation rates compared to routine care (relative risk (RR) 1.53, 95% confidence interval (CI) 1.25 to 1.88).

AUTHORS' CONCLUSIONS: Evidence from this review shows that the forms of breastfeeding education evaluated were effective at increasing breastfeeding initiation rates among women on low incomes in the USA.