Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials.

Kim SK, Park S, Oh J, Kim J, Ahn S.

BACKGROUND: The World Health Organization (WHO) recommends that mothers practice 
exclusive breastfeeding (EBF) of their infants for 6 months. Various
breastfeeding support interventions have been developed to encourage mothers to
maintain breastfeeding practices. Research aim: This study aims to review how
effectively breastfeeding support interventions enable mothers to practice EBF
for 6 months and to suggest the best intervention strategies.
METHODS: Six databases were searched, including MEDLINE, EMBASE, Cochrane,
CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from
journals written in English or Korean and published between January 2000 and
August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months
were screened.
RESULTS: A total of 27 RCTs were reviewed, and 36,051 mothers were included. The 
effectiveness of breastfeeding support interventions to promote EBF for 6 months 
was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]:
1.81-3.76). A further subgroup analysis of intervention effects shows that a baby
friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15-12.61),
a combined intervention (OR = 3.56; 95% CI: 1.74-7.26), a professional provider
led intervention (OR = 2.76; 95% CI: 1.76-4.33), having a protocol available for 
the provider training program (OR = 2.87; 95% CI: 1.89-4.37) and implementation
during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83-6.03)
increased the rate of EBF for 6 months.
CONCLUSION: We suggest considering a multicomponent intervention as the primary
strategy and implementing BFHI interventions within hospitals. Evidence indicates
that intervention effectiveness increases when a protocol is available for
provider training, when interventions are conducted from the pre- to postnatal
period, when the hospital and community are connected, and when healthcare
professionals are involved.