Health professionals need to target exclusive breastfeeding
Bibliographic record
Abstract
Leading health authorities all recommend infants be breastfed exclusively for the first 6 months of life. The strong endorsement is based on compelling evidence that breastfeeding offers important health-promoting, disease-preventing benefits. Despite these salutary effects, many mothers discontinue breastfeeding or introduce supplementation early in the postpartum period. Suboptimal breastfeeding rates are a long-standing clinical issue. A Cochrane systematic review that examined 52 breastfeeding support trials from 21 countries, and included 56 451 mother–infant pairs, has recently been updated (Renfrew et al. Cochrane Database Syst Rev 2012;5:CD001141). Meta-analyses demonstrated a beneficial effect on breastfeeding duration and exclusivity up to 6 months postpartum with the implementation of any form of extra support; however, trials comparing an intervention of extra professional support to standard care in preventing the discontinuation of any breastfeeding showed a beneficial effect early in the postpartum period, between 4 and 6 weeks postpartum, but this was not sustained to 6 months. Professional support also did not significantly influence exclusive breastfeeding outcomes. The study conducted by Fu et al. is consistent with these Cochrane review results. The purpose of this cluster randomised controlled trial was to evaluate the effect of extra professional support on breastfeeding duration and exclusivity among 722 mothers in Hong Kong. Primiparous women were randomised to: (1) standard postpartum care (control group); (2) standard care plus three in-hospital breastfeeding sessions; or (3) standard care plus weekly telephone calls for the first 4 weeks postpartum. All extra breastfeeding support was provided by highly trained nurses. Whereas breastfeeding duration and exclusivity rates were proportionately higher for mothers who received extra support, these mothers were no more likely to continue to breastfeed, and to do so exclusively, to 6 months than those who received standard care (table 2). Contrary to the preceding Cochrane review, mothers who received telephone-based support had better outcomes than those who received face-to-face support in hospital. Telephone-based interventions (including text messaging) warrant further investigation given that they are a cost-effective way to provide community-based care to new mothers, especially those in rural and remote areas; however, neither intervention with extra support improved breastfeeding exclusivity rates up to 6 months. This finding is not surprising given that 42.3% of all mothers had no intention to exclusively breastfeed their infants. How can we improve breastfeeding exclusivity rates when many mothers actually do not want to exclusively breastfeed? Health professionals have made significant gains in educating women about the benefits of breastfeeding, resulting in improved initiation rates; however, exclusive breastfeeding is rare and far from universal, even in middle- and low-income countries. Perhaps mothers today think ‘any’ breastfeeding is just as good as ‘exclusive’ breastfeeding – but is it? If exclusive breastfeeding rates are to improve, we need to concentrate our efforts on establishing the unique benefits of ‘exclusivity’ over ‘any’ breastfeeding. Furthermore, breastfeeding support trials should focus their primary outcome on breastfeeding exclusivity at 6 months with interventions specifically targeting increasing a mother's goal to breastfeed exclusively and enhancing her self-efficacy to breastfeed without supplementation. We need to actively target exclusive breastfeeding if we want to see improvements in this important clinical outcome. None to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.074 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.008 | 0.015 |
| Insufficient payload (model declined to judge) | 0.016 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".