Table 2.

Summary of included studies targeting young mothers in high-income countries to increase EBF

Study, Country	Design	n	Sample characteristics	Intervention Description	Comparison	Reported Outcomes
Arlotti et al. (1998), USA [35]	Quasi experimental	36 Exp: 18 Con: 18	Convenience sample: Prenatal and postpartum mothers who were enrolled in Women, Infants and Children (WIC) program. Low income population in North Florida. Mean age: 23.3 (SD 4.4) Age range: 15–36	Support from peer counsellors a few days after delivery, then at 2 weeks, 1 month, 2 months and 3 months postpartum via telephone, letter or in person at WIC office.	No counsellor/Usual care at same time intervals.	Mean rates of EBFa, experimental VS control: • at 2 weeks, 53% vs 17% • at 1 month, 40% vs 27% • at 2 months, 33% vs 13% • at 3 months, 17% vs 6%
Bunik et al. (2010), USA [36]	RCT	341 Exp: 161 Con: 180	Convenience sample of medically underserved (88% Hispanic/Latino) mothers, recruited from a subsidized hospital in Denver, Colorado. Median age: 22 Age range: 18+ (range not provided)	Two weeks of daily telephone calls by trained bilingual nurses using a culturally informed script. Outcomes assessed by maternal report at 1, 3 and 6 months postpartum.	Usual care	No mothers EBF. There was no significant difference in any BFb or predominantc BF between the groups. Participants in the experimental group, who planned to EBF were more likely to “predominantly” BF at 1, 3 and 6 months. This trend was not seen in the control group.
Chapman et al. (2013), USA [37]	RCT	206 Exp: 103 Con: 103	206 pregnant, overweight/obese, low-income women were recruited. 154 met inclusion criteria at delivery. Pre-pregnancy BMI = 27.0+ Mostly Hispanic, singleton pregnancy, unemployed, high school education, vaginal birth. Median age (exp): 23 (IQR 21–28) Median age (con): 25 (IQR 22–31) Age range: not reported	Specialized breastfeeding peer counselling (SBFPC) 3 x Prenatal, daily in hospital after delivery and up to 11 x postnatal sessions plus routine care.	Brief breastfeeding discussions during routine prenatal visits at the clinic	Experimental group had higher rates of EBF at some time points but the difference was not significant. At 2 weeks experimental group had higher rates of any BF (93% vs 84%, P = 0.09) and ≥ 50% of feeds as breast milk (81% vs 67%, P = 0.08).
Di Meglio et al. (2010), USA [38]	RCT	78 Exp: 38 Con: 40	Breastfeeding mothers with a healthy full-term infant recruited from hospitals in Rochester, New York Mean age (exp): 18.4 (SD 1.3) Mean age (con):18.2 (SD 1.4) Age range: Not reported but participants were < 20 years old.	Telephone support at 2, 4, and 7 days and 2, 3, 4, and 5 weeks post discharge from the hospital; content based on WIC’s breastfeeding promotion efforts, gave telephone numbers. Facilitators: Adolescent peer counsellors trained by La Leche League	Usual care	There was no significant difference for any BF duration between the groups. 68% of experimental group and 75% of control group received supplements at the hospital prior to discharge. Out of the remaining participants, duration of EBF was significantly increased in the experimental group (median 35 days vs 10 days, P < 0.01).
Pugh et al. (2002), USA [39]	RCT	41 Exp: 21 Con: 20	Low-income mothers receiving financial medical assistance support, recruited from hospitals in mid-Atlantic region. Predominantly African American and mostly single. Mean age (exp): 20.86 (SD 3.58) Mean age (con): 22.35 (SD 4.98) Age range: not reported	Usual care plus supplementary visits from a community health nurse/peer counsellor team, daily during hospitalization and then at home during weeks 1, 2, and 4; peer counsellors provided support over the phone twice weekly through week 8 and weekly through month 6. Facilitators: Community health nurse and peer counsellor	Usual care included support from hospital nurses, telephone “warm line” and one visit by a lactation consultant if they birth on a weekday.	More mothers in the experimental group EBF their infants however it wasn’t significant due to the small sample size. • 45% (n = 9) vs 25% (n = 5) at 3 months • 30% (n = 6) vs 15% (n = 3) at 6 months X2 = 1.29–1.75; P = 0.09–0.12
Serano et al. (2010), Chile [40]	Quasi-experimental comparative panel design - RCT deemed not appropriate due to risk of contamination	100 Exp: 35 Con: 65	Mothers with healthy newborns recruited from 3 health clinics in Santiago, Chile. Low-income community. Predominantly unemployed. Mean age: 24.3 (SD 5.9) Mean age (con): 24.08 (SD 5) Age range: 14–43	During 2nd well-child clinic visit, nurses provided video instruction on how to massage baby. Mothers also received a booklet and were encouraged to massage their baby for 10–15 min once a day from Day 15.	No treatment	At age 2 months, massage group infants weighed significantly more than control-group infants. There were no weight differences between the 2 groups at age 4 months. There were no differences between the 2 groups on the incidence of exclusive maternal breast-feeding at age 2 or 4 months.
Snell et al. (1992), USA [41]	RCT	88 Exp: 50 Con: 38	Hispanic mothers recruited from Family Centered Perinatal Care Unit in California. Mean age (exp): 25.2 (18–43) Mean age (con): 24.3 (18–36) Age range: 18–43	The study period (12 weeks) was divided into 2-week blocks and randomly assigned to experimental (non-gift pack) and control (gift pack) groups. Mothers were then interviewed (by telephone) at 1 and 3 weeks old.	The control group received a gift pack including samples of formula.	• EBF at 1 week: 80% vs 68% • EBF at 3 weeks: 68% vs 33% Supplementing or bottle feeding: • At 1 week: 20% vs 32% • At 3 weeks: 32% vs 66%
Wambach et al. (2011), USA [42]	RCT	390 Exp: 128 Con1: 128 Con2: 134	Enrolled adolescent mothers in their second trimester from prenatal clinics and school settings. All first-time mothers. Predominantly African American, and single. Mean age: 17 (SD 0.9) Age range: 15–18	Co-delivered by lactation consultant (LC) and peer counsellor (PC). Two prenatal classes consisting of content from Breastfeeding Educated and Supportive Teen club (BEST) curriculum, in-hospital support and postpartum telephone calls at 4, 7, 11, 18 days and 4 weeks. Participants also received a free double electric pump.	Con1 = attention control delivered by nurse and PC, included 2 prenatal classes, telephone support, and in-hospital PC visit (not on the topic of BF). Con2 = usual care	• Median BF duration was significantly higher in experimental group: 177 (exp) vs 42 (con1) vs 61 (con2) days. P < 0.001 • No significant differences for EBF initiation or duration • High overall rates of supplementation. At 3 weeks postpartum 69% (exp), 70% (con1), 82% (con2) were supplementing with formula.
Washio et al. (2017), USA [43]	Randomized two-arm parallel group design	36 Exp: 18 Con: 18	Puerto Rican mothers enrolled in a WIC program, who initiated breastfeeding. Mean age (exp): 24.1 (SD 4.7) Mean age (con): 23.0 (SD 4.6) Age range: not reported	Standard breastfeeding services from WIC – onsite LC, bilingual PC, weekly peer support meetings, free breast pump, enhanced food package for BF mothers. Plus, monthly financial incentives (total = $270) if they could demonstrate BF or pumping.	Standard breastfeeding services from WIC	Significantly higher rates of BF in experimental group vs control: • 89% vs 44% at 1 month • 89% vs 17% at 3 months • 72% vs 0% at 6 months • Mean duration of BF was 149 (exp) vs 49 (con) days. (P < 0.001) No significant difference in self-reported EBF rate.

Notes & Abbreviations:

^aEBF Exclusive breastfeeding

^bBF Breastfeeding

^cPredominant breastfeeding in this study was defined as feeding 4 oz. or less of formula per day

Exp Experimental/intervention group

Con Control group

PC Peer counsellor

LC Lactation consultant

WIC Women, Infants and Children Office