Literature review for - Flourish Paediatrics

In a systematic review of factors that positively influence breastfeeding duration to 6 months
Meedya identified three groups of modifiable factors that influence women’s breastfeeding
decisions (Meedya, Fahy et al. 2010). These were breastfeeding intention, breastfeeding selfefficacy
and social support. Fathers were a component of the social support. Sociodemographic
factors that affect prolonged breastfeeding behaviours were also identified as
age, marital status, education and income level. There is strong evidence that older age,
being married, being well educated and having a higher income are each associated with
longer breastfeeding duration. However these cannot be modified after the pregnancy has
commenced.
Meedya concluded “What is known is that women have positive and prolonged breastfeeding
experiences when they have a strong desire to breastfeed for longer periods of time, when
they are confident in their ability to breastfeed and are well supported by their family. There
have been no interventional studies that have simultaneously aimed to address these three
issues simultaneously i.e. to enhance the women’s breastfeeding intention, to enhance her
sense of self-efficacy and to strengthen her supports. It is reasonable to assume that research
aimed at modifying these three factors together is likely to be more successful than trying to
modify each one individually.”
The National Institute of Clinical Studies identified the best available evidence on
Breastfeeding Promotion (National Institute of Clinical Studies 2005)
“Evidence suggests that long-term intensive promotion of breastfeeding is most successful,
spanning the pre and postnatal period, and involving multiple contacts with a professional
breastfeeding promoter or peer counsellor. Well-conducted educational and support
interventions for mothers prior to, and immediately after, childbirth are effective in
improving rates of initiation as well as duration of breastfeeding (up to three months).
Interventions that target hospital practices are particularly effective, such as rooming-in, early
skin-to-skin contact and non-use of commercial hospital discharge packs. Factors such as the
support of the baby’s father and the time at which the decision to breastfeed is made
(preferably before or early in the pregnancy) are also important. Professional and peer
support have had a significant impact on short-term duration and exclusivity of breastfeeding.
Peer support is particularly effective for low income, ethnic minority or disadvantaged
groups. Postnatal home visits may enhance effectiveness. One-to-one education is best for
persuading those women planning to use infant formula to change to breastfeeding. Beyond
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