Table 5 Comparison of psychosocial interventions for breastfeeding in lower- and middle-income countries^a

Intervention goal

To use cognitive behavioral therapy to reduce prenatal anxiety and to facilitate participants wellbeing, social support, and bonding with their baby during pregnancy

To provide medical follow up, educate provide emotional support, check on breastfeeding, check on maternal-child relationship, discuss problems and help women who have given birth, discuss family planning

To promote exclusive breastfeeding until 6 months of age (as well as assess effects on diarrhea and child growth)

To educate and counsel mothers about exclusive breastfeeding and early initiation of breastfeeding

To use cognitive-behavioral therapy to increase the rate and duration of exclusive breastfeeding in the first six months postpartum

To determine the effect of home-based breastfeeding counselling by peer counsellors

To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding

Time point

Antenatal

Postnatal

Postnatal

Antenatal and postnatal

Antenatal and postnatal

Antenatal and postnatal

Antenatal and postnatal

Frequency of delivery

Weekly for 5 visits in early to mid-pregnancy, with a 6th visit in the 3rd trimester

At least once or in a series of 4 home visits

A series of 12 monthly visits until the child reached the age of one

15 sessions

7 sessions

5 sessions

7 sessions

Location

Health facility

Home

Home

Home

Home

Home

Home and health facility

Delivery agent

Non-specialized providers

Trained midwives

Community health workers and nutrition workers

Peer counsellors

Community health workers

Trained peers

Trained peers

Outcome(s) related to breastfeeding

Exclusive and recent breastfeeding both within 24 h of birth and within 24 h of an assessment at six weeks postpartum

Exclusive breastfeeding and breastfeeding practices (see below for examples) at 4 months postpartum

Primary: Exclusive breastfeeding at 3 months postpartum; Secondary: Exclusive breastfeeding at 4, 5, and 6 months of life

Prevalence of exclusive breastfeeding at 5 months postpartum and timing of initiation of breastfeeding

Rate and duration of exclusive breastfeeding at 6 months postpartum

Prevalence of exclusive breastfeeding at 12 and 24 weeks

Prevalence of exclusive breastfeeding at 6 months

Result(s) related to breastfeeding

HMHB had a marginally significant impact on early breastfeeding i.e. in the first 24 h of life (75.4% HMHB vs. 69.0% controls; OR 1.4, 95% CI: 0.99–1.92). In unadjusted per protocol analyses, HMHB increased the odds of early (OR 1.7, 95% CI:1.2–2.6) and recent breastfeeding i.e. measured in the prior 24 h at six-weeks after birth (OR 2.1, 95% CI:1.1–4.0)

A significantly higher proportion of mothers who received four doses or one dose of the intervention, respectively, exclusively breastfed their infants (28.5% and 30%, respectively) compared to controls who received no intervention (20%), p = 0.02. However, no differences were found between these groups for other breastfeeding outcomes, e.g. breastfeeding at four months postpartum, giving fluids on the first day after birth, bottle feeding

Exclusive breastfeeding rates were significantly higher, 79% in the intervention group and 48% in the control group at 3 months (OR 4.0, 95% CI 3.0–5.4). The mean duration of exclusive breastfeeding in the intervention group was 122 days, versus 41 days in the control group

Prevalence of Exclusive breastfeeding was significantly higher at 5 months, (70%) for the intervention group and (6%) for the control group. Difference = 64%; 95% CI 57%-71%). 64% of the intervention group initiated breastfeeding in the first hour compared to 15% in the control group

At 6 months postpartum 59.6% in the intervention group and 28.6% in the control group exclusively breastfed. (Adj. HR = 0.4, 95% CI: 0.3–0.6). Prelacteal feeding was less likely among intervention mothers (Adj. RR = 0.5, 95% CI 0.3–0.8)

In Uganda, exclusive breastfeeding prevalence at 12 weeks was 82% (intervention) vs. 44% (control) (PR 1.89, 95% CI 1.70–2.11), and at 24 weeks, 59% vs. 15% (PR 3.83, 95% CI 2.97–4.95). In Burkina Faso, at 12 weeks, it was 79% vs. 35% (PR 2.29, 95% CI 1.33–3.92), and at 24 weeks, 73% vs. 22% (PR 3.33, 95% CI 1.74–6.38). In South Africa, at 12 weeks, it was 10% vs. 6% (PR 1.72, 95% CI 1.12–2.63), and at 24 weeks, 2% vs. < 1% (PR 5.70, 95% CI 1.33–24.26)

The prevalence of exclusive breastfeeding at 6 months was 23.6% in the home-based intervention group, 9.2% in the health facility-based intervention group and 5.6% in the control group. In the home-based intervention group mothers had four times increased likelihood of exclusive breastfeeding compared with controls (Adj. RR = 4·01, 95% CI: 2.30–7·01). No significant difference was found comparing exclusive breastfeeding in health- facility based intervention group and control group