Published: 08 November 2016
Interventions that promote increased breastfeeding rates and breastfeeding duration among women: An umbrella review
To facilitate the implementation of the HSE Breastfeeding Action Plan, the Department of Health requested the HRB to carry out a review of interventions which aim to increase initiation, exclusivity and duration of breastfeeding. The goal of this review was to identify evidence of effective interventions from good quality systematic reviews to promote and increase breastfeeding rates.
Methods: Databases including PubMed, CINAHL, Embase, MEDLINE, DARE, Trip and Health Evidence databases were searched to identify relevant systematic reviews published between 2005 and 2015. Quality assessment of all reviews was conducted.
Results: Thirty-six good quality systematic reviews were identified which reported on breastfeeding interventions. The reviews were conducted on a diverse range of interventions and were categorised under: education/counselling/ support, and other breastfeeding interventions.
Despite the heterogeneity of the reviews, there is evidence that education, counselling and support have a major role to play in the promotion of breastfeeding. However, because of the variability of the reviews it is not possible to say during which period of maternity care is most beneficial to provide education, counselling and support; who should provide it; or what component of these interventions might be the most beneficial in order to increase breastfeeding rates. Education, counselling and support are included in the WHO/UNICEF Breastfeeding Hospital Initiative. From the ‘other’ interventions group it emerged that four of the nine effective interventions described are also included in the Ten Steps to Successful Breastfeeding advocated by the BFHI. These interventions are: structured programmes to promote breastfeeding, promoting early skin-to-skin contact (SSC), having the practice of rooming-in for mother-infant dyads and avoiding supplementary infant feeding.
Conclusions: While there are apparent gaps in research in relation to some interventions, there is nevertheless a substantial body of consistent evidence that provides a sound basis to proceed with education, counselling and support programmes. These should be of high intensity and continue over the antenatal, intrapartum and extended postnatal period in order to improve rates of breastfeeding among women in Ireland. The existence of structured programmes (such as UNICEF/WHO BFHI) in hospitals, including the above-mentioned education and support, early mother-infant contact, rooming-in and avoidance of supplemental feeds has been shown to be effective.