Systematic review of community breastfeeding support in developing countries: Building on past progress

Background: Breastfeeding is a major contributor to improvements in maternal health and child survival. Breastfeeding protection, promotion and support must be available and acceptable in the community, and therefore, is an important part of a comprehensive support approach. The purpose of this systematic review is to uniquely address community breastfeeding support, to inform program, policy, and research planning. Methods: A systematic review found nearly 200 studies including 5 systematic reviews that included breastfeeding and developing countries; one case study; one review of case studies, and 28 individual articles including 19 countries. These were re-analyzed using forest plots and impact comparisons. Findings: The term “community-based” includes several strategic approaches, and programs vary widely. Nonetheless, increased impact is seen with: 1) building on existing breastfeeding programs or integrated into other accepted, 2) those that emerge from the community or in which there is active involvement of the community change agents, and 3) careful selection of content and quality of the training and supervision. Additional findings are grouped in four areas: program/intervention definition/ description, program impact, program setting, and research needs. Discussion/Recommendations: Overall recommendation is continuation of comprehensive breastfeeding-specific support as outlined in the Innocenti Declaration, Global Strategy and in USAID policy. This is complemented, but not replaced, by integration of breastfeeding support into other primary health care. For community support to be sustainable there should be supportive action by the ongoing systems. Conclusions: A complex behavior such as breastfeeding is best addressed when there is a multi-level and multi-sectoral approach, including community.