Background: Breast-feeding is considered the optimum method of infant nutrition conveying health and psychological benefits for mother and baby. Women from disadvantaged groups are less likely to initiate or successfully establish breast-feeding and with the current emphasis on addressing health inequalities there is an identified need to tailor breast-feeding strategies towards this population.
Objectives: To appraise and synthesize the best available evidence on effectiveness and maternal satisfaction of interventions supporting the establishment of breast-feeding in the early postnatal period, up to seven days following delivery, for women from disadvantaged groups.
Inclusion criteria
Types of participants: Women from disadvantaged groups, defined as those from socio-economically deprived areas; low income; under 20 years or substance dependent.
Types of intervention(s)/phenomena of interest: Any study exploring practical, motivational, informative and/or educational interventions supporting disadvantaged women to establish breast-feeding.
Types of studies: Quantitative and qualitative studies.
Types of outcomes: The establishment of breast-feeding/lactation within the postnatal period; perceived usefulness and acceptability of the intervention to support breast-feeding establishment in the postnatal period.
Search strategy: Searches were conducted for any published or unpublished material, in the English language, between 1992 and March 2013. A three-step search of databases including ASSIA; Campbell Collaboration; CINAHL, Cochrane Database; EBSCO; EThOS; Journals @OVID; Medline and SAGE journals was conducted.
Methodological quality: Each paper was assessed by two independent reviewers for methodological quality using the appropriate critical appraisal instrument from Joanna Briggs Institute.
Data collection: Data was collected using standardized extraction tools developed by Joanna Briggs Institute.
Data synthesis: Data was synthesized according to their methodological approach using instruments from the Joanna Briggs Institute. Where this was not possible, findings are presented in a narrative form.
Results: A total of 10 studies were included in the review. Two were quantitative studies (prospective cohort studies) and eight were qualitative studies (qualitative components of a mixed methodology study and seven qualitative studies). Forty-five findings were extracted from the qualitative components of the studies. Findings were synthesized into 12 categories. Categories were synthesized into three findings. The quantitative review demonstrated that technical assistance and information provision resulted in greater awareness of breast-feeding physiology, increased rates and a longer duration of breast-feeding. The qualitative synthesized findings suggested that maternal satisfaction was enhanced when proactive practical assistance was given within the confines of a collaborative relationship. Professional support offering positive encouragement and delivering socio-culturally appropriate strategies were considered by mothers as helping to meet their breast-feeding objectives. Disempowering practices included inaccessible information, conflicting advice and judgmental attitudes from health care providers.
Conclusions: The review identified interventions aimed at enhancing technical skill and knowledge as clinically effective in establishing successful breast-feeding. Disadvantaged women considered support strategies offering culturally relevant advice and specific to their individualized needs as the most acceptable and effective in meeting their breast-feeding intentions.
Implications for practice: The evidence suggests that health care interventions facilitating both maternal awareness of the physiology of breast-feeding and the acquisition of technical skill assists establishment of breast-feeding. Proactive, professional support complementing practical advice with positive encouragement and tailored to the mother's specific needs appears to be both useful and acceptable for disadvantaged women establishing breast-feeding.
Implications for research: Future studies should evaluate how health care professionals promote the establishment of breast-feeding for women from disadvantaged groups specifically in relation to the additional socio-cultural barriers experienced by these groups.