Jan is concerned and rightly so at the thought that mothers in only one arm of 
the PROBIT study were given support in accordance with Baby-Friendly 
practice, to establish breastfeeding.  
This study was done as health workers were trying to 'sell' Baby-Friendly 
practice in Belarus.  Routine care there was not conducive to successful 
breastfeeding.  They had the resources to institute change, but not in all 
institutions at once.  This gave them the unique opportunity to compare 
outcomes according to presence or absence of Baby-Friendly policies and 
practice.  Because of the outcomes of this study, it will never be ethically 
defensible to replicate it, even if it were possible.  
If they had simply implemented the care in the hospitals for which they had 
sufficient resources without documenting the impact in the way they did, we 
would have much less solid arguments for why Baby-Friendly care needs to be 
the minimum standard of care for ALL women.  Everywhere.  It might have 
been harder to get the ideas accepted by the hospitals not affected by the 
first wave of changes. 

Because they set up the study the way they did, they can now gather 
prospective data from both arms of the study which gives us the invaluable 
chance to see long term effects of not supporting breastfeeding compared to 
supporting it.   

This trial was done in a small time-window of opportunity.  Imagine if someone 
had done something like this with formula advertising packs to mothers, again 
measuring duration of exclusive breastfeeding as the dependent variable, and 
the presence or absence of advertising packs as the independent one.

To my mind, this study was not like the multicenter study to determine which 
formula type is associated with the highest rates of diabetes in children, which 
I found ethically objectionable on several counts.  I'm happy to have this 
study to point to when we need to argue to maintain safe staffing, for 
example.  When they want to know what harm could come of cutting back the 
number of people available to help mothers, we can give them an answer.

Rachel Myr
Kristiansand, Norway

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