Impact of peer counseling on exclusive breastfeeding: A randomized controlled trial

Date of Completion

January 2005


Health Sciences, Nutrition




We conducted a secondary data analysis to identify reasons for not BF and factors associated with ever BF among low-income mothers in the U.S. This was a retrospective study that used a convenience sample of Puerto Rican women with children younger than 6 years. About half the participants reported to have ever breastfed the index child. The most common reason given for not BF was “mother did not want to breastfeed or mother was embarrassed to breastfeed in public.” Mothers with higher access to social capital were more likely to have breastfed the index child compared with their counterparts with less social capital (OR = 2.25; 95% CI, 1.02–4.95), suggesting that social support is an important predictor of BF in this Puerto Rican community. ^ Findings from this first study and that of another study conducted by our research group in this community, led to the design and conduct of a randomized controlled trial on the efficacy of peer counseling on EBF. Expectant mothers at less than 32 weeks gestation, were recruited in a prenatal clinic and randomly assigned to either an intervention (prenatal, perinatal and postnatal EBF support from a peer counselor) or a control (conventional BF support from the nursing staff) group. Baseline socio-demographic characteristics were similar in both groups except Hispanic origin and language of interview. At hospital discharge 91% in PC compared to 76% in CG had initiated BF (p = 0.025), with the percent EBF being 59% and 44%, respectively (p = 0.072). At 3 months postpartum, 27% in PC and 3% in CG EBF during the previous 24 hours (p < 0.001). Likewise, the percent EBF at 3 months postpartum, using the “since birth” definition was significantly higher (p < 0.001) for PC (21%) than CG (<2%). Women in PC (53%) were more likely than their counterparts in CG (33%) to remain amenorrheic at 3 months postpartum (p = 0.025). Findings remained significant after adjusting for baseline differences in participant characteristics. Thus, our results indicate that timely and well-structured intensive BF support provided by hospital and community based peer counselors is effective at improving EBF rates among low-income, inner-city women in the U.S. ^