John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Several reviews from the Cochrane Pregnancy and Childbirth Group present evidence on ways to help mothers to breast feed their babies. In the latest version of one of these, in February 2017, Alison McFadden from the University of Dundee in Scotland and her co-authors present the latest evidence and we asked her to update us in this podcast.

Alison: “Breastfeeding has a fundamental impact on the health of children, and there is good evidence that not breastfeeding increases mortality and morbidity due to infectious diseases. Not breastfeeding is also associated with increases in hospitalisation for problems such as gastroenteritis, respiratory disease, and ear infections, as well as higher rates of childhood diabetes, obesity and dental disease. Breastfeeding is also important for women’s health. It’s been found that not breastfeeding is associated with increased risks of breast and ovarian cancer, and diabetes.
The World Health Organization recommends that babies are breastfed exclusively until six months of age, with breastfeeding then continuing as an important part of the child’s diet until they are at least two years old. However, current breastfeeding rates in many countries do not reflect this recommendation. Only around one in three babies under six months are exclusively breastfed worldwide, and in many high and middle income countries, the rates are much lower.
The reasons why women need support to enable them to breastfeed include pro-active marketing of breastmilk substitutes leading to widespread public and professional acceptance that breastmilk substitutes and breastfeeding are nearly equivalent, lack of acceptance of breastfeeding in the workplace or in public places, and the fact that many health professionals don’t have the necessary skills to teach and support women to breastfeed.
Our review looks at ways that might help with the latter. We investigate the effect of interventions that provide additional support for breastfeeding mothers, analysing the numbers of women who stop any breastfeeding or who stop breastfeeding exclusively before four to six weeks, and before six months.
Our latest update contains over 100 trials, involving more than 83,000 mother-infant pairs. The studies were carried out in 29 countries including low, middle and high-income settings. The tested interventions varied widely. They included support offered to women either individually or in groups, face-to-face or by telephone. The support was provided by health professionals, peer supporters or a combination of both, some of whom had received special training. The intensity of the support also varied from less than 3 to more than 9 contacts.
We found that when breastfeeding support is offered to women, the duration and exclusivity of their breastfeeding is increased, with a greater effect on the prolongation of exclusive breastfeeding than on reducing the cessation of any breastfeeding. We rated the overall quality of the evidence as moderate because of the wide variation in the types of interventions, settings and the alternatives with which the support interventions were compared.
We also found moderate quality evidence that support might be more effective if it is offered as standard by trained personnel, and includes ongoing scheduled visits so that women can predict when support will be available. Finally, strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
As a simple take home message, the practical implications of our review are that all women everywhere should be routinely offered trained breastfeeding support and that this should be readily accessible to them.”

John: If you would like to look deeper into this large evidence base, perhaps to explore the different strategies in more detail; you’ll find lots of useful information in the Cochrane Review. It’s available in full online. Just go to Cochrane library dot com and search ‘Support for breastfeeding mothers’.