Interventions to increase the initiation of breastfeeding: a systematic review of studies conducted in the UK and Ireland

Background. The benefits of breastfeeding are well documented and the World Health Organization (WHO) specifically recommends exclusive breastfeeding for six months and up to two years with complementary food. The UK and Ireland continue to report the lowest rates of breastfeeding in the world. Ireland has the lowest reported rate of ‘having ever breastfed’ (55%) and the UK has the fifth lowest (81%). Aim. This review was conducted to evaluate interventions that aimed to improve breastfeeding initiation rates in the UK and Ireland as a foundation for developing breastfeeding initiatives in Northern Ireland (NI). Method. A systematic literature review was conducted using the Population, Intervention, Comparison, Outcomes, Study design (PICOS) Model to define the review question: Which interventions have been tested in the UK or Ireland to improve Breastfeeding initiation rates? The following electronic databases were searched: CINAHL, Cochrane Central Register of Controlled Trials, Embase, MIDIRS, Medline, ProQuest, PsycInfo and Scopus. Groups of search terms were combined relating to ‘breastfeeding’ and ‘initiation’ over the time period (2005-18). Intervention studies were eligible for inclusion if breastfeeding initiation was the primary outcome and they were conducted in the UK or Ireland and published in English. Hand searches of article reference lists were also undertaken to ensure no relevant studies were missed. Each paper was independently assessed by five members of the team and verified for inclusion by consensus. A risk of bias analysis of the included studies was also completed. Findings. In total, 2055 papers were retrieved: 2029 were not eligible. A further 13 duplicates were removed leaving 12 papers for review. Three papers, involving 3316 participants, met the full inclusion criteria. The evidence from these papers of the impact on breastfeeding initiation rates in response to peer, group and one-to-one support interventions conducted was inconclusive. Conclusion. This review highlights the small number of intervention studies conducted in the UK and Ireland evidencing the need to invest in future research focused on improving breastfeeding initiation rates. Future studies should also examine the contextual issues alongside the development and implementation of interventions.
Key words: breastfeeding, initiation, duration, intervention, systematic literature review, evidence-based midwifery