Australian National Breastfeeding Strategy 2010-2015

4.2 What works best?

Page last updated: 15 July 2010

There is a myriad of government and non-government activity in protecting, promoting and supporting breastfeeding. While most of the evidence about what works best is from overseas, there are nevertheless important findings relevant to the implementation of the Australian National Breastfeeding Strategy. The evidence used in developing the Australian National Breastfeeding Strategy was sourced from a variety of references, including systematic reviews from the Cochrane Collaboration and the United States Centre for Disease Control and Prevention, peer reviewed journals and documented expert opinion in sources such as The Best Start Inquiry.

Key findings from the review of evidence include:

  • The timing of breastfeeding interventions is crucial for effectiveness. Interventions can occur at different stages within the breastfeeding continuum (see Figure 1.1). Some may occur during the antenatal phase in a hospital or community setting, while others occur during or soon after the birth, and again others may target the medium and longer-term postnatal stages at home or in a community setting. Some interventions may also be employed at multiple stages (e.g., breastfeeding education).
  • Combinations of interventions addressing both the antenatal and postnatal stages were considered more effective in improving initiation rates and prolonging the duration of breastfeeding (Chung et al. 2008, Protheroe et al. 2003, Su et al. 2007). Multifaceted or combination interventions were generally more effective than standalone interventions, noting that promotion and education initiatives are often combined (Aniansson et al. 1994).
  • Continuity of care enables women to develop a relationship with the same caregiver(s) throughout pregnancy, birth and the postnatal period. There is strong level one evidence which demonstrates that continuity of midwifery care across these periods (Hodnett 2001) is as safe as traditional models of care, and can achieve beneficial effects (Hodnett 2001; Waldenstrom and Turnbull 1998; Waldenstrom et al. 2001).
Figure 4.1 summarises the findings of Chung et al. (2008), a systematic review of evidence of the effectiveness of primary care initiated interventions to promote and support breastfeeding.

Figure 4.1

Comparing breastfeeding interventions to routine care

Effectiveness of antenatal and postnatal interventions:
  • Antenatal breastfeeding interventions increased the rate of any short-term breastfeeding, with postnatal interventions also effective in increasing short-term exclusive breastfeeding.
  • A combination of antenatal and postnatal breastfeeding interventions was more effective in increasing the rates of both intermediate and long-term ‘any breastfeeding’.

Effectiveness of different types of activities and interventions:
  • Structured breastfeeding education with or without other components increased the rate of ‘any breastfeeding’ initiation.
  • Individual level professional support with or without other components significantly increased the rate of any intermediate duration breastfeeding.
  • Peer support with or without other components increased the rate of short- and long-term ‘any breastfeeding’ and the rate of short-term exclusive breastfeeding duration.
  • The Baby Friendly Hospital Initiative increased the exclusive breastfeeding rates at three months by 43.3 per cent compared to 6.4 per cent through usual care, and at six months by 7.9 per cent compared to 0.6 per cent for usual care.

Source: Chung et al. (2008)

Note: The report by Chung et al. (2008) used the following categories of breastfeeding durations: breastfeeding initiation is any breastfeeding at discharge or before two weeks post delivery, short-term is one to three months of breastfeeding, intermediate-term is four to five months, long-term is six to eight months, and prolonged is nine months or more.
  • There is evidence from overseas suggesting that hospitals that have adherence to the Baby Friendly Health Initiative can have an impact on breastfeeding initiation and duration rates (see Figure 3.1) (Fairbank et al. 2000, Chung et al. 2008). This can be achieved either through encouraging implementation of the Ten Steps to Successful Breastfeeding or undertaking a more formal accreditation program to have the birthing service recognised as baby friendly (Fallon et al. 2005).
  • There is also evidence to suggest that the Baby Friendly Health Initiative may be effective for people from priority groups, particularly for groups that would otherwise have low rates of breastfeeding initiation, and that the tenth step, which covers the transition from hospital to the community, is critically important (Bechara Coutinho et al. 2005, Chung et al. 2008).
  • Evidence is available on the effectiveness of trained peer support (Shealy et al. 2005, Sikorski et al. 2003).
  • There is some evidence that social marketing media campaigns can have an impact on breastfeeding initiation and duration rates (Foster et al. 2006, Protheroe et al. 2003, Shealy et al. 2005).
  • Evidence supports the understanding that breastfeeding education efforts are more successful at prolonging full breastfeeding to six months if they involve partners and significant caregivers (Protheroe et al. 2003, Olayemi 1996, Chung et al. 2008).
  • Providing printed breastfeeding information as a standalone intervention (e.g., pamphlets, books, posters) tended to be ineffective at improving breastfeeding rates (Guise et al. 2003).
  • A US study of low-income American women found that rooming-in of mother and baby during the hospital stay was particularly effective when combined with formal breastfeeding education, employment of a breastfeeding counsellor and training of hospital staff (Protheroe et al. 2003).
  • For Aboriginal and Torres Strait Islander people the available evidence suggests one-on-one or small group structured education sessions are more likely to be effective, with peer support particularly important. A recurring theme is the importance of outreach services, and the importance of support occurring in a ‘familiar’ home or community environment. It is important that other influential family and support network members such as grandmothers and aunts, have access to appropriate information and health professionals are trained about valuing and supporting breastfeeding. Health professionals’ cultural awareness and listening skills are critical and Aboriginal and Torres Strait Islander health workers have a valuable role in increasing the uptake of support services and improving outcomes (OATSIH 1998).
  • There has been limited research into the effectiveness of workplace initiatives designed to encourage breastfeeding, although some studies, mainly from the US, showed encouraging results (Cohen et al. 1994, Bar Yam 1997).