Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial
Journal - BMJ
Objective To assess the clinical effectiveness and cost effectivenessof a policy to provide breastfeeding groups for pregnant andbreastfeeding women.Design Cluster randomised controlled trial with prospectivemixed method embedded case studies to evaluate implementationprocesses.Setting Primary care in Scotland.Participants Pregnant women, breastfeeding mothers, and babiesregistered with 14 of 66 eligible clusters of general practices(localities) in Scotland that routinely collect breastfeedingoutcome data.Intervention Localities set up new breastfeeding groups to providepopulation coverage; control localities did not change groupactivity.Main outcome measures Primary outcome: any breast feeding at6-8 weeks from routinely collected data for two pre-trial yearsand two trial years. Secondary outcomes: any breast feedingat birth, 5-7 days, and 8-9 months; maternal satisfaction.Results Between 1 February 2005 and 31 January 2007, 9747 birthrecords existed for intervention localities and 9111 for controllocalities. The number of breastfeeding groups increased from10 to 27 in intervention localities, where 1310 women attended,and remained at 10 groups in control localities. No significantdifferences in breastfeeding outcomes were found. Any breastfeeding at 6-8 weeks declined from 27% to 26% in interventionlocalities and increased from 29% to 30% in control localities(P=0.08, adjusted for pre-trial rate). Any breast feeding at6-8 weeks increased from 38% to 39% in localities not participatingin the trial. Women who attended breastfeeding groups were older(P<0.001) than women initiating breast feeding who did notattend and had higher income (P=0.02) than women in the controllocalities who attended postnatal groups. The locality costwas £13 400 (14 410; $20 144) a year.Conclusion A policy for providing breastfeeding groups in relativelydeprived areas of Scotland did not improve breastfeeding ratesat 6-8 weeks. The costs of running groups would be similar tothe costs of visiting women at home.Trial registration Current Controlled Trials ISRCTN44857041[controlled-trials.com].