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A Randomized Controlled Trial

Donna J. Chapman, PhD, RD; Grace Damio, MS, CD-N; Sara Young, MSN, RN, IBCLC; Rafael Pérez-Escamilla, PhD

Arch Pediatr Adolesc Med. 2004;158:897-902.

Background  Breastfeeding peer counseling has improved breastfeeding rates in developing countries; however, its impact in this country has not been adequately evaluated.

Objective  To evaluate the effectiveness of an existing, breastfeeding peer counseling program within the United States.

Design  Randomized, prospective, controlled trial in which participants were recruited prenatally and randomly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling.

Setting  An urban hospital serving a large population of low-income Latinas.

Participants  Pregnant women (26 weeks' gestation) were recruited from the hospital's prenatal clinic. Inclusion criteria specified that participants be low income, be considering breastfeeding, have delivered a healthy, full-term singleton, and have access to a telephone.

Intervention  Breastfeeding peer counseling services included 1 prenatal home visit, daily perinatal visits, 3 postpartum home visits, and telephone contact as needed.

Main Outcome Measures  Breastfeeding rates at birth and 1, 3, and 6 months postpartum.

Results  The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls (8/90 [9%] vs 17/75 [23%]; relative risk, 0.39; 95% confidence interval, 0.18-0.86). The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month (36% vs 49%; relative risk, 0.72; 95% confidence interval, 0.50-1.05) and 3 months (56% vs 71%; relative risk, 0.78; 95% confidence interval, 0.61-1.00).

Conclusion  These findings demonstrate that, in the United States, peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum.

From the Department of Nutritional Sciences, University of Connecticut, Storrs (Drs Chapman and Pérez-Escamilla); Hispanic Health Council, Hartford, Conn (Ms Damio); and Department of Women's Health, Hartford Hospital, Hartford (Ms Young).

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