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Press Release Date: July 29, 2003
The U.S. Preventive Services Task Force today recommended structured education and counseling programs to promote breastfeeding because such programs increase the proportion of women who begin and continue to breastfeed their babies. Simply telling mothers they should breastfeed or giving them pamphlets is not enough, they said.
According to the Task Force, structured programs share some elements: they include from one to eight individual or group sessions that follow specific formats and last between 30 and 90 minutes; they are led by specially trained nurses, midwives, lactation specialists, and peer counselors; and they include lectures along with practical skills that help women master breastfeeding techniques and deal with problems that may arise from breastfeeding. In addition, structured programs include information about the benefits of breastfeeding for mother and child, how the body produces breast milk, training in positioning the baby and latch-on techniques, and the use of mechanical breast pumps.
The Task Force recommendations, which appear in the July/August issue of Annals of Family Medicine, are based on a systematic review of 35 studies, including 22 randomized control trials of breastfeeding counseling. They examined the effects of education, support, and written materials on increasing breastfeeding rates.
Meanwhile, the Task Force found insufficient evidence to recommend less-intensive intervention such as having primary care providers give others advice or written materials such as pamphlets. The Task Force also found insufficient evidence for peer counseling alone, although some studies show that peer support can enhance structured education programs by encouraging women after they begin to breastfeed to continue the practice longer than they otherwise might. Peer counselors are women who have practical training but not necessarily clinical expertise in breastfeeding techniques.
"We hope that these recommendations will help women and their clinicians understand which kinds of programs are most effective and will encourage their wider availability for pregnant women," said Task Force Chair, Alfred O. Berg, M.D., M.P.H., who is also Chair of the Department of Family Medicine at the University of Washington in Seattle. "In addition, there is a need for further studies about how clinicians and peer counselors can more effectively encourage women to breastfeed."
The Task Force found that supplementing successful programs by providing ongoing support to new mothers through in-person visits or telephone contacts by providers or counselors may help women to stay with breastfeeding for longer periods than 3 months. However, more research is needed in this area. It was clear that providing ongoing support to women is not effective as a stand-alone strategy for increasing rates of breastfeeding.
National data from 1998 showed that 64 percent of all mothers breastfed immediately after giving birth, but only 29 percent of all mothers and 19 percent of black mothers were breastfeeding by 6 months. The goal for Healthy People 2010 is 75 percent of mothers to be breastfeeding right after having a baby, 50 percent at 6 months, and 25 percent at 1 year.
While the programs reviewed by the Task Force did not all take place in primary care clinics, the Task Force highlighted the important role of primary care clinicians in referring women to breastfeeding programs to ensure they begin and continue to breastfeed.
The Task Force is the leading independent panel of experts in prevention and primary care and is sponsored by the Agency for Healthcare Research and Quality. The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force recommends structured breastfeeding education and behavioral counseling programs to promote breastfeeding, a "B" recommendation. The Task Force found insufficient evidence to recommend for or against brief education and counseling by primary care providers, peer counseling used alone and initiated in the clinical setting, and written materials, used alone or in combination with other interventions, an "I" recommendation.
The Task Force conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on report prepared by a team led by Jeanne-Marie Guise, M.D., M.P.H., at AHRQ's Evidence-based Practice Center at Oregon Health & Sciences University in Portland.
The counseling for breastfeeding recommendations and materials for clinicians are available on AHRQ's Web site at http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an E-mail to AHRQPubs@ahrq.hhs.gov. Clinical information also is available from the National Guideline Clearinghouse™ at http://www.guideline.gov.
For more information, please contact AHRQ Public Affairs: (301) 427-1364.