Exclusive breastfeeding for 6 months is recommended throughout the world but is not commonly practiced. Investigators in Brazil studied the value of adding home visits to in-hospital activities that promoted breastfeeding. The trial was set in a poor, urban area where a typical hospital stay after delivery was 24 to 48 hours, and the infant mortality rate was 76 per 1000 live births. After the staffs at two maternity hospitals were trained to encourage breast-feeding, 350 healthy mother-infant pairs were randomized to receive 10 postnatal home visits (from trained peer educators during a 6-month period) or no home visits. Breast-feeding data were collected monthly by researchers who were blinded to the intervention.
After the staff training, in-hospital exclusive breast-feeding increased from 21% to 70%. Ten days after discharge, the home-visit group maintained a high level of exclusive breast-feeding (>70%), but the no-visit group did not (30%). During 6 months, the prevalence of exclusive breast-feeding was significantly higher with home visits than without (45% vs. 13%); this was also true for partial breast-feeding (78% vs. 62%). In the no-visit group, exclusive breast-feeding after 30 days was significantly more prevalent among more affluent and better-educated women. In the home-visit group, exclusive breast-feeding rates remained similar across all economic and educational groups.
These results, although probably not fully generalizable to areas with better health funding, suggest that the effects of in-hospital breast-feeding promotion might be short-lived if they are not continually reinforced in the first months of life, particularly among less-privileged families.
Reference:
Coutinho SB et al. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet 2005 Sep 24; 366:1094-100.