BackgroundBreastfeeding is of great importance to public health because of indisputable evidence about its benefits to the health of mothers, their infants, and children; however Scotland struggles to view breastfeeding as a normal activity. Nonetheless, mother-to-mother (peer) breastfeeding support is popular. In response to the Scottish Government's 2011 document Improving Maternal and Infant Nutrition: A Framework for Action, we have produced guidance for professionals in health boards and voluntary sector agencies that is informed by the evidence about breastfeeding peer support. MethodsWith the agreement of policy makers, health professionals, and voluntary sector agencies, we searched CINAHL, MIDIRS, and BNI databases for systematic reviews published in English between Jan 1, 1985, and Feb 1, 2013, using the keywords “peer support”, “infant feeding”, or “breastfeeding”. We identified eight systematic reviews about the effectiveness of breastfeeding peer support. Acknowledging that gaps remained in the evidence about the delivery of breastfeeding peer support, we considered plausible theory and ten ethical principles (do good, do not harm, equity, respect, empowerment, sustainability, social responsibility, participation, openness, and accountability) to help guide decision making about provision of local breastfeeding peer support. We conducted a Health Inequalities Impact Assessment (HIIA) to identify how breastfeeding peer support might differentially affect those protected by the 2010 Equality Act. FindingsAlthough the breastfeeding peer support guidance was informed by systematic review level evidence, we also needed to address issues for which we lacked such evidence. Thus, the presentation of the current national and international policy context, summaries of relevant randomised controlled trials, and definitions of breastfeeding peer support, contributed to the guidance. The integration of the HIIA findings that were cross-referenced with the consideration of ethical principles provided a template of how health boards and voluntary sector agencies might conduct their own HIIA and apply ethical decision making in response to local breastfeeding peer support issues. InterpretationAdopting this pragmatic approach has enabled meaningful engagement that takes account of professional experience. This approach has helped produce guidance that is realistic in aiming to change and enhance current breastfeeding practice in Scotland. FundingNone.