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The Anderson et al article1 on a peer counseling intervention to increase exclusive breastfeeding (EBF) is timely, given proposed Healthy People 2010 revised goals of 60% of mothers EBF at 3 months and 25% at 6 months.2 Currently, just 46% of US mothers EBF at hospital discharge, while 17% do so at 6 months.3 The Anderson et al study involved several elements of “best practice” education and support, including prenatal home visits (n = 3), daily hospital visits, and postpartum home visits (n = 9), designed to boost EBF.
Anderson et al found dramatic differences in EBF rates through 3 months in this low-income Latina community. Results, reported as risks of non-EBF, suggest that 59% of intervention group women vs 44% of controls were EBF at hospital discharge. (Though unstated, one assumes this is a dichotomous variable and that all other mothers weren't EBF.) By 3 months, EBF rates fell but were still significantly higher in the intervention group, 20.6% vs 1.4% of controls. The study hospital is 1 of only 42 (as of 2004) Baby-Friendly hospitals in the United States (ie, certified as implementing the 10 Steps to Successful Breastfeeding).
Additional implementation details would help determine the acceptability of this resource-intensive intervention. That is, the reference to peer counselor coverage being 89% for the prenatal home visits leaves unclear how many women received 0, 1, 2, or 3 prenatal home visits. Similarly, the number of women receiving hospital and home visits during the first through sixth weeks is unclear. Authors state that the cost-effectiveness of EBF peer counseling should be further studied. Any such work must incorporate the considerable time required for travel and supervision, as opposed to clinical contact time alone.
The intrapartum experience is key. Thus, it is discouraging that EBF rates in both groups were not higher, given the study hospital's Baby-Friendly status. At Baby-Friendly hospitals, 78.4% of mothers EBF at hospital discharge (median, 86% [range, 25%-100%])4 vs 59% in the Anderson et al treatment group. Neither Hispanic ethnicity nor low-income status is associated with decreased EBF in Baby-Friendly hospitals.4 Therefore, the sample's characteristics are unlikely to explain the low EBF rates relative to other Baby-Friendly hospitals. Variation in EBF assessment undoubtedly accounts for some, but not all, of the discrepancy.
The difficulty of sustaining EBF is clear. Just 21% of women receiving this intensive intervention and delivering in a Baby-Friendly hospital were EBF at 3 months. Considerable effort will be required to reach the proposed Healthy People 2010 goal of 60% EBF at 3 months.
Correspondence: Dr Bonuck, Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (kbonuck@montefiore.org).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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