Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis

Alison McFadden, Lindsay Siebelt, Joyce L Marshall, Anna Gavine, Lisa-Christine Girard, Andrew Symon, Stephen MacGillvray

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82 Citations (Scopus)


Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines.
A systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24 months after birth.
From the 5180 records identified in searches and a further 11 records found by hand searching 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at four to six weeks (RR 0.85, 95% CI 0.77, 0.94) and six months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at four to six weeks (RR 0.79, 95% CI 0.72, 0.87) and six months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity.
Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances.
Original languageEnglish
Article number42
Number of pages19
JournalInternational Breastfeeding Journal
Early online date21 Oct 2019
Publication statusPublished - 21 Oct 2019


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