Effectiveness of Breast-Feeding Peer Counseling in a Low-Income, Predominantly Latina Population

Abstract

Low-income women breast feed their infants much less often than the general population of women. Rates have improved after adopting breast-feeding peer counseling in developing countries, but its efficacy in the United States remains uncertain. The authors conducted a randomized, prospective trial at an urban hospital serving a large number of low-income Latina women aged 18 years or older recruited from the prenatal clinic at 26 weeks gestation or earlier. All the participants were considering breast feeding, and all delivered healthy singleton infants at term. Women randomized to the intervention group had at least 1 prenatal home visit by a peer counselor who spoke of the benefits of breast feeding, discussed myths surrounding this practice, and provided guidance and written materials. A counselor saw the women at least once a day while hospitalized after delivery and provided hands-on aid in proper breast-feeding techniques. All participants had at least 3 postpartum home visits, the first I within 24 hours of discharge. Control women received routine education in breast feeding and had access to an international board-certified lactation consultant. The 95 women assigned to active intervention and 75 control women were similar demographically and socioeconomically. Nearly 90% of those in the intervention group reported perinatal contact with a peer counselor; the number of visits averaged 2.7. Approximately half the women acknowledged postpartum home visits and telephone calls. Peer counseling was significantly associated with initiating breast feeding. Compared with control women, those counseled had a 61% lower risk of not starting breast feeding. Results at 1 month and 3 months postpartum were less impressive but still evident. At 6 months postpartum, no effect of peer counseling on the incidence of breast feeding was apparent. Competent peer counselors practicing in the United States are able to induce low-income women to start breast feeding their newborn infants, and this effect remains evident 3 months after birth. Whether this is a cost-effective procedure remains to be determined.