The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review
Written by Jennifer Kehinde, Claire O’Donnell and AnnMarie Grealish Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, United Kingdom
The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. Studies suggest that the decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage. Therefore, this review aims to determine the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum.
A systematic review of the studies identified by electronic database search (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Psych INFO, and Sociological Abstracts and Applied Social Sciences Index and Abstracts (ASSIA) published between 2014 – 2021.
A total of 14 studies met the inclusion criteria. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care.
Background
Breastfeeding is the best practice for child health, development, and nutrition (Chong, 2015). According to the world health organization (WHO) and UNICEF’s breastfeeding advocacy initiative, breastfeeding should be initiated within an hour of birth and continued for six months, without any supplements, liquids, or foods except liquid medications (WHO and UNICEF, 2015). Breastfeeding avails the newborn of the best start in life as it facilitates growth and development, deepens the bond between mother and newborn, and enhances the wellbeing of the newborn (Peñacoba and Catala, 2019). Colostrum produced immediately after childbirth contains nutrients and leucocytes strengthening the immunity of the newborn (Brecchia, 2016).
Breast milk contains all food nutrients in correct proportion (Martin et al., 2016). In addition to these nutrients, it contains immune cells, stem cells, omega-3 fatty acids as well as alpha-linolenic acid which cannot be found in baby formulas or artificial milk (Boquien, 2018; Belfort et al., 2016; Gidrewicz and Fenton, 2014). Alpha-linolenic acid has been found to have beneficial effects on the infant’s neurological and retinal development (Birch et al., 1993; Khor et al., 2020; Innis, 2014). Breastfeeding is an important protective factor against childhood obesity as well as reduces the incidence of chronic diseases in advanced stages of adulthood (Yan et al., 2014; Giugliani et al., 2015). Early breastfeeding initiation and an extended period of breastfeeding are linked to quicker return of the uterus to its pre-pregnant state (involution), reduced risk of breast cancer as well as cancer of the ovaries (Luan et al., 2013; Chowdhury et al., 2015).
Significant economic impacts of breastfeeding on health service systems includes decrease in extra health care costs for respiratory syncytial virus commonly found in non-breastfed infants (Quesada et al., 2020). Remarkably, breastfeeding has been linked to a decrease in yearly expenses for private and government insurers in treating diseases preventable by breastfeeding (Santacruz-Salas et al., 2018). To maximize the health and economic benefits of breastfeeding, society must support breastfeeding protection and promotion (Shin, 2010; Rollins et al., 2016). Breastfeeding support and promotion unarguably aid in safeguarding human and environmental health by reducing environmental harm associated with carbon emissions generated from baby formular manufacturing and transportation (Dadhich et al., 2021). Therefore, breastfeeding support and education are key to improving human nutrition and health in the face of global health challenges (Victora et al., 2016a).
Regardless of the continuous increase of awareness on breastfeeding over the last decade, breastfeeding rates remain at minimal levels in most countries of the world (Victora et al., 2016b; Prentice, 2022). To this effect, the World Health Assembly has developed strategies to increase the rate of breastfeeding and indeed exclusive breastfeeding to at least 50% by the year 2025 (McGuire, 2015). Statistics as recorded in the WHO’s global breastfeeding scorecard shows that only 44% of newborn babies are breastfed within one hour after birth as compared to the WHO’s aim of improving breastfeeding initiation rates to 70% globally (WHO, 2019).
Data from the World Health organization shows that exclusive breastfeeding rates for babies below the age of six months is currently at 40% with only 23 countries achieving at least 60% of newborn babies being exclusively breastfed (WHO, 2021). These low rates are mostly prevalent in the Americas and Europe as only 6% of countries in the Americas record an exclusive breastfeeding rate above 60% (WHO, 2021) and 25% in the entire European region (Theurich et al., 2019).
However, despite all the improvements recognized and anticipated with the adoption of breastfeeding as the best form of feeding for newborns, breastfeeding initiation and exclusivity rate is yet to be scaled up to a substantial level globally (Buturović et al., 2017; Edwards et al., 2021). Global decline in breastfeeding rates have been linked to difficulties experienced by mothers while trying to initiate breastfeeding (Gianni et al., 2019).
The WHO has identified the importance of breastfeeding education, emphasizing this as the core element of health promotion during preatal visits (Coffman, 2019). Breastfeeding education and support delivered by qualified and skilled healthcare professionals positively influences women’s attitudes toward breastfeeding initiation (Lumbiganon et al., 2016; White, 2020; Tanaka and Horiuchi, 2021; Iliadou et al., 2018; Mulcahy et al., 2011). Therefore, the aim of this review is to determine the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum.
Conclusion
The study authors conclude that, “Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education.”
