Q&A: Review of breastfeeding literature

Dr. Miriam Labbok, Director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill, and author of the Infant & Young Child Nutrition Project’s latest review of breastfeeding literature, reflects on her findings. 

Download Community interventions to promote optimal breastfeeding: Evidence on early initiation, any breastfeeding, exclusive breastfeeding, and continued breastfeeding.

Why was this literature review needed?

We found that there had not been a review of the literature examining community interventions to promote optimal breastfeeding in more than a decade, and we wanted to compile the evidence since then to inform nutrition programs and policies. There have been several reviews of breastfeeding programs, child health programming in communities, and nutrition in communities, and we were able to re-analyze some of these new data to better understand the impact of breastfeeding support in the community.

Was there anything that surprised you during the review?

One surprise was the limited comparability across the interventions described in the literature. The interventions were carried out, as expected, in a wide variety of settings, but they rarely used the same cadre of workers, the same linkages to (or non-linkages to) local health systems, the same training, the same trainers, the same purposes (e.g., initiation versus exclusive versus duration). Those interventions that were most comparable were generally carried out by the same organization, but not for the purpose of testing differences. The reality is that resources are limited for breastfeeding interventions and perhaps we must learn from whatever is available until there are large-scale, comparable efforts to study this issue.

What did you find most interesting?

This analysis confirmed previous findings, that community efforts can have a substantial impact on breastfeeding practices. It was not clear from this review whether or not community efforts would lead to permanent changes in breastfeeding patterns; however, this analysis confirmed previous speculation regarding the presence of a supportive health system synergized with community efforts: those community interventions that were linked to positive health systems with breastfeeding support already in place appeared to have a greater impact on breastfeeding. This may be due to the fact that a supportive health system supplies an impetus for sustaining the gains, but also may be due to the fact that a supportive health system will not undercut the impact of the community effort by sending mixed messages. This finding underscoring the need for a comprehensive approach is supportive of the approach called for by the World Health Organization and the United Nations Children’s Fund in the Global Strategy for Infant and Young Child Feeding, and by the United States Agency for International Development in its breastfeeding policy. Both policies call for comprehensive intervention approaches, which include the government, health systems, workplaces, and communities in protecting, promoting, and supporting women to choose and succeed in optimal breastfeeding.

Based on this review, what are the top two or three recommendations you would make to program managers?

The strongest messages from this review are (1) the importance of choosing the appropriate worker and providing the appropriate training specifically designed for the needs of the particular setting and the purpose of the program, whether it be initiation, exclusivity, duration, or all; and (2) the increased impact achieved when the community program is complemented by the existence of breastfeeding-supportive practices in the health system or other successful efforts in nutrition, maternal health, or other complementary programs in the community. The third message is that the need for community interventions is great and the time to act is now.