The effectiveness of health services interventions to promote and support breastfeeding initiation and exclusivity

Abstract

Worldwide breastfeeding (BF) rates fall short of recommendations. Health services initiatives exist to provide a supportive environment, yet challenges remain. Thus, we set out to systematically review the evidence on health services interventions to promote and support BF initiation and exclusivity. As numerous systematic reviews (SR) have been conducted to assess the effectiveness of interventions on BF outcomes, a review of SR was undertaken. Seven key databases were searched using combinations of search terms including SR, BF, health promotion, health education and health policy. After applying inclusion and exclusion criteria and quality assessment, the search yielded 19 papers published between 1992 and 2012. Commonly cited limitations included diversity in definitions of BF outcomes and heterogeneity of interventions. Preliminary findings show that multi‐component interventions targeting women from the prenatal through to postnatal periods were most effective at improving initiation and exclusivity of BF as compared to single‐component and single‐contact interventions. There is also evidence that a combination of professional and lay support is more effective than professional support alone at increasing exclusive BF rates. Policy implications include the need to invest in multi‐component interventions that follow women up rather than invest in one‐time interventions.