Interventions to increase the initiation of breastfeeding: a systematic review of studies conducted in the UK and Ireland: A systematic review of studies conducted in the UK and Ireland

Marlene Sinclair, Julie EM McCullough, Nicola Armstrong, Ruth Carroll, Eimear Barrett, Janet Calvert, Rosemary Dodds, Diana Gossrau-Breen, Isobel Maria Healy, Maria Herron, Briege Lagan, Jenny McNeill, Michael O'Rorke, Joanna Purdy, Seaneen Sloan, Janine Stockdale

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


The benefits of breastfeeding are well documented and the World Health Organization (WHO) specifically recommends exclusive breastfeeding for six months and up to two years with complementary food. The UK and Ireland continue to report the lowest rates of breastfeeding in the world. Ireland has the lowest reported rate of ‘having ever breastfed’ (55%) and the UK has the fifth lowest (81%).
Aim. This review was conducted to evaluate interventions that aimed to improve breastfeeding initiation rates in the UK and Ireland as a foundation for developing breastfeeding initiatives in Northern Ireland (NI).
Method. A systematic literature review was conducted using the Population, Intervention, Comparison, Outcomes, Study design (PICOS) Model to define the review question: Which interventions have been tested in the UK or Ireland to improve
Breastfeeding initiation rates? The following electronic databases were searched: CINAHL, Cochrane Central Register of Controlled Trials, Embase, MIDIRS, Medline, ProQuest, PsycInfo and Scopus. Groups of search terms were combined relating to ‘breastfeeding’ and ‘initiation’ over the time period (2005-18). Intervention studies were eligible for inclusion if breastfeeding initiation was the primary outcome and they were conducted in the UK or Ireland and published in English. Hand searches of article reference lists were also undertaken to ensure no relevant studies were missed. Each paper was independently assessed by five members of the team and verified for inclusion by consensus. A risk of bias analysis of the included studies was also completed. Findings. In total, 2055 papers were retrieved: 2029 were not eligible. A further 13 duplicates were removed leaving 12 papers for review. Three papers, involving 3316 participants, met the full inclusion criteria. The evidence from these papers of the impact on breastfeeding initiation rates in response to peer, group and one-to-one support interventions conducted was inconclusive.
Conclusion. This review highlights the small number of intervention studies conducted in the UK and Ireland evidencing the need to invest in future research focused on improving breastfeeding initiation rates. Future studies should also examine the
contextual issues alongside the development and implementation of interventions.
Original languageEnglish
Pages (from-to)112-119
Number of pages8
JournalEvidence Based Midwifery
Issue number4
Publication statusPublished - 14 Dec 2018

Bibliographical note

Funding Information:
Breastfeeding rates increased at all-time points in the intervention group: initiation rates increased from 53.3% to 57.3% (p=0.405). Participants giving birth in district maternity units demonstrated an increase in initiation from 46.6% to 49.5% (p= .555). However, the research team reported a significant increase of 6.8 percentage points in any breastfeeding at two weeks post-birth (p=0.017) and duration (58.2%) compared to a district general hospital (49.5%). Women reported they found the support enjoyable and helpful. This particular study was funded by Grampian Primary Care NHS Trust and The Chief Science Office, Scottish Executive Research Practice Scheme.

Funding Information:
Women in the intervention group (n=1371) received antenatal breastfeeding advice and if they initiated breastfeeding, the trained peer support worker continued to give postnatal support. The primary outcome was initiation of breastfeeding, which was defined as ‘having had breastmilk at any time from birth until discharge from hospital’, and information was collected via computerised hospital records. There was a slight increase in the initiation of breastfeeding in the intervention group, although not statistically significant (69% vs 68.1%, p=0.4). This study was funded by Heart of Birmingham Teaching Primary Care Trust.

Publisher Copyright:
© 2018 The Royal College of Midwives.

Copyright 2021 Elsevier B.V., All rights reserved.


  • breastfeeding, initiation, duration, intervention, systematic literature review, evidence-based midwifery

ASJC Scopus subject areas

  • Fundamentals and skills
  • Maternity and Midwifery


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