Breastfeeding support: What works? A population-based pragmatic trial and a multi-ethnic cohort study

Abstract

Although the breastfeeding prevalence is higher in Norway than in most other high-income countries, there is a gap between recommendations and current breastfeeding practice. The aims of this thesis were to assess the effectiveness of the Baby-Friendly community health services on breastfeeding and maternal satisfaction in a pragmatic trial in 54 municipalities. Socioeconomic inequalities in breastfeeding have persisted in Norway for several decades. Therefore, we conducted an observational study nested within the trial to explore whether socioeconomic inequalities in exclusive breastfeeding could be explained by established determinants of breastfeeding. Furthermore, we investigated inequalities in breastfeeding related to gestational diabetes and ethnic origin, using data from the Stork Groruddalen cohort. Women in the intervention group were more likely to exclusively breastfeed compared to those who received routine care: 17.9% vs 14.1% until 6 months (cluster adjusted odds ratio 1.33; 95% confidence interval (CI) 1.03 to 1.72). The intervention had no effect on breastfeeding until 12 months. Maternal satisfaction with the breastfeeding experience did not differ, neither did perceived breastfeeding pressure. We observed that socioeconomic inequalities in exclusive breastfeeding were largely explained by other sociodemographic factors, smoking habits and breastfeeding difficulties. In the Stork Groruddalen cohort it has been found that women with an origin from South Asia and the Middle East were much more likely to be diagnosed with gestational diabetes than women from Western Europe. It has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes. We found that gestational diabetes was associated with earlier cessation of predominant breastfeeding: (adjusted hazard ratio 1.33, 95% CI 1.01 to 1.77). Women with an origin from South Asia and the Middle East ended predominant breastfeeding earlier than Western European women. The Baby-friendly community health services had a significant impact on exclusive breastfeeding. As a supplement to this population-based intervention, targeted approaches may be necessary to reduce inequalities in breastfeeding related to socioeconomic position, ethnic origin and gestational diabetes.