From http://www.ahrq.gov/news/press/pr2003/brfeedpr.htm :

Task Force Recommends Specific Types of Programs to Promote Breastfeeding
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.ahrq.gov/clinic/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 [log in to unmask] Clinical information also is available
from the National Guideline Clearinghouse™ at http://www.guideline.gov.

For more information, please contact AHRQ Public Affairs: Barbara Najar,
(301) 427-1399 ([log in to unmask]); Farah Englert, (301) 427-1865
([log in to unmask]).

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