A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community

Objective: To assess the efficacy of peer counseling to promote exclusive breastfeeding (EBF) among low-income inner-city women in Hartford, Conn. Design: Participants recruited prenatally were randomly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support (peer counseling group [PC 1) or only conventional breastfeeding support (control group [CG]) and followed through 3 months post partum. Setting: Low-income predominantly Latina community. Participants: Expectant mothers, less than 32 weeks gestation and considering breastfeeding (N = 162). Intervention: Exclusive breastfeeding peer counseling support offering 3 prenatal home visits, daily perinatal visits, 9 postpartum home visits, and telephone counseling as needed. Main Outcome Measures: Exclusive breastfeeding rates at hospital discharge, 1, 2, and 3 months postpartum (n = 135). Results: At hospital discharge, 24% in the CG compared with 9% in the PC had not initiated breastfeeding, with 56% and 41%, respectively, nonexclusively breastfeeding. At 3 months, 97% in the CG and 73% in the PC had not exclusively breastfed (relative risk [RR] = 1.33; 95% Cl, 1.14-1.56) during the previous 24 hours. The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC (99% vs 79%; RR= 1.24; 95% Cl, 1.09-1.41). Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months (33% vs 52%; RR=0.64; 95% Cl, 0.43-0.95). The likelihood of having I or more diarrheal episode in infants was cut in half in the PC (18% vs 38%; RR=2.15; 95% Cl, 1.16-3.97). Conclusion: Well-structured, intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income, inner-city women in the United States.