Low-income women are more likely to breastfeed when given health education

Low-income women are more likely to breastfeed when given health education - especially when learning takes place in an informal, interactive discussion group setting, according to a new review of studies.

“It’s not just about giving information,” says review coauthor M.J. Renfrew. “It’s about how the information is conveyed.”

Five of the seven studies included in the review measured breastfeeding initiation rates among low-income women in the United States. When the review combined the results of those five studies, the authors found “a statistically significant increase in the number of women starting to breastfeed.”

According to Renfrew, a woman’s decision to begin breastfeeding is heavily influenced by her cultural background. So the breastfeeding education methods that work best are those that are tailored to a woman’s background, education and culture.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Women who do not breastfeed have a greater risk of ovarian and breast cancer. Breastfed babies are less likely to suffer respiratory infections and ear infections. And later in life, these children also have lower risks of juvenile diabetes and obesity.

These well-established long- and short-term benefits underscore the urgent need to find interventions that help women start breastfeeding, Renfrew says.

“Breastfeeding education is a neglected practice, and women are not getting the care and support they need,” says Renfrew, who heads the Mother and Infant Research Unit at the University of York, in England.

In the United States, 25 percent of women stop breastfeeding within two weeks after they begin, Renfrew says.

The review examined a range of research interventions including physician training, study manuals, lectures and peer counseling.

Those findings are not new, Renfrew said, but the review of seven studies, “brings together a body of knowledge that increases the weight and confidence of that understanding.”

Because breastfeeding provides clear health protections, Renfrew says a “health disparity” has developed in those populations of women who feed their infants formula, instead of breast milk.

In high-income countries, like the United States, the lowest rates of breastfeeding are found in low-income women, the review found. Renfrew adds that low-income mothers are more than 25 percent less likely to breastfeed than women in higher income groups.

Today, the standard breastfeeding education approach is more formal, with information often disseminated in lectures to large groups. This is true especially in the United States, according to Renfrew.

In years past, expectant mothers received breastfeeding advice and support from their mothers or by watching other women in their lives breastfeed successfully. Renfrew says that kind of casual peer mentoring and modeling is slipping away.

“Women should feel confident about choosing to breastfeed. It is a skill that can be acquired. If a woman does [just] one thing, she should find herself a good support person,” she says.

In one of the single studies detailed in the review, intervention included two to four prenatal breastfeeding education sessions for 10 to 15 minutes each. A lactation consultant conducted the one-on-one sessions. After birth, the consultant followed up with a daily visit in the hospital. Following discharge from the hospital, the consultant continued to meet with mother and baby during regularly scheduled health check-ups.

Renfrew finds compelling evidence that it does not take an overwhelming amount of support to help women start breastfeeding. That’s good news in light of the limited funding and resources currently allocated to breastfeeding education, she says.

In the United States, 25 percent of women stop breastfeeding within two weeks after they begin, Renfrew says.