by Amy Spangler
March 07, 2009

We all know it. Babies who breastfeed are healthier. Mothers who breastfeed are healthier. Healthy moms and babies are happier. All babies should be breastfed and all mothers should breastfeed. The question is how to make that happen.

What does and doesn’t work?
In an effort to determine which breastfeeding interventions effectively increase breastfeeding rates compared to “usual care,” the U.S. Preventive Services Task Force (USPSTF) reviewed studies published between September 2001 and February 2008. Thirty-eight out of 4,877 studies met the selection criteria which called for “randomized controlled trials (RCTs) of primary care-initiated interventions to promote breastfeeding, mainly in developed countries.” Of the 38 studies, two were conducted in developing countries. Interventions included changes in maternity care practices, worksite lactation programs, peer-to-peer support, maternal education, and media marketing.

A random-effects meta-analyses revealed that breastfeeding interventions resulted in significantly increased rates of exclusive breastfeeding both short-term (0–3 months) and long-term (6–8 months). When interventions provided during pregnancy and after birth were considered together, the increase in breastfeeding rates was significantly greater than when either was considered alone. When breastfeeding interventions were combined with lay support (such as peer counseling), the increase in short-term breastfeeding rates was greater compared to usual care.

But despite evidence of an increase in breastfeeding rates, the more critical measure of the effectiveness of various interventions is whether or not maternal and child health outcomes improve as a result of the intervention. A previous analysis conducted by the USPSTF in 2003 reported an association between breastfeeding and many beneficial child and maternal health outcomes. However, the data was observational, so cause and effect could not be determined. In addition, very few of the RCTs conducted since 2001 have explored the relationship between breastfeeding interventions and maternal and child health outcomes, focusing instead on changes in breastfeeding rates.

More data is needed
When you look closely at this and other breastfeeding studies, you find that the devil is in the definitions. Studies often employ different definitions of exclusive breastfeeding. For the purpose of this review, the authors adopted as exclusive breastfeeding the following definitions: “no supplement of any kind,” “including water while breastfeeding,” and “occasional formula is permissible while breastfeeding.” In addition, breastfeeding initiation was defined as “any breastfeeding at discharge from the hospital or up to 2 weeks after birth.”

The review highlights the fact that quality evidence is in short supply. Of the 38 studies, only 11 were classified as good (29 percent), 14 (37 percent) were fair, and 13 (34 percent) were ranked poor. The authors concluded that more RCT data is needed before the effectiveness of various breastfeeding interventions can truly be determined.