Effectiveness of social-psychological interventions at promoting breastfeeding initiation, duration and exclusivity: a systematic review and meta-analysis.

Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation ( N  = 2,213; OR  =   2.32, 95% CI [1.33, 4.03], p  =   .003; I ²  = 0%, p  =   .966) and suggested improved exclusive breastfeeding rates up to six months postpartum ( N  = 3,671; OR  =   1.84, 95% CI [1.38, 2.45], p  < .001; I ² = 68.7%, p  < .001). After considering small-sample effects, estimates for exclusive breastfeeding across the postpartum period were non-significant. There were no improvements in women maintaining any (i.e., non-exclusive) breastfeeding to one, two, three, four or six months postpartum ( N  = 4,153; OR  = 0.88, 95% CI [0.72, 1.09], p  =  . 253). Evidence for improvements in perceived and actual breastfeeding support was limited. Sub-group analyses suggest standalone postnatal interventions targeting first-time mothers may support breastfeeding uptake. Findings should be interpreted cautiously as the quality of evidence for each outcome was low with a high risk of bias. Future efforts to support women to breastfeed should assimilate behaviour change research, with process evaluation to identify effective processes to inform a high-quality evidence-base for implementation in practice.