Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population

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 (less than or equal to 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 post-partum 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 I and 3 months post partum.