In a randomized controlled study conducted in Singapore, women who received prenatal education and those who received postnatal support were significantly more likely than those who received only routine obstetric care to be breast-feeding exclusively at six months (relative risks, 2.2 and 2.1, respectively).1 Compared with those in the routine-care group, women in the prenatal intervention group were more likely to be exclusively breast-feeding at six weeks and three months (1.7 and 1.9, respectively); similarly, women in the postnatal intervention group were more likely than those in the routine-care group to be breast-feeding exclusively at two weeks, six weeks and three months (1.8, 1.9 and 1.9, respectively). Of the two strategies, postnatal support had slightly stronger associations with rates of any breast-feeding.

The World Health Organization recommends exclusive breast-feeding—that is, breast milk only, without formula or water—for the first six months of an infant’s life and partial breast-feeding for up to 24 months thereafter. However, relatively few women are able to establish and maintain the practice. To determine whether professional support could help women initiate and maintain breast-feeding, researchers recruited 450 healthy pregnant women attending prenatal clinics at a tertiary hospital in Singapore between February 2004 and May 2006. The women were eligible if they delivered at 34 weeks or later, intended to breast-feed and had no illness that would prevent them from doing so. The women were randomized into three groups: those who received routine obstetric care only; those who also received one prenatal breast-feeding education session that included the opportunity to speak to a lactation consultant; and those who also received two sessions of postnatal lactation support (one before discharge and the other at the first postnatal visit). At a baseline prenatal interview, the women were asked about their demographic characteristics and prior experiences with breast-feeding; they were also given a diary to track infant feeding for six months. The researchers examined the rates of exclusive, predominant, partial and no breast-feeding at two-week, six-week, three-month and six-month follow-up interviews; modified Cox regression analysis was used for pairwise comparisons of breast-feeding rates across study groups. Descriptive statistics were analyzed on an intention-to-treat basis.

The mean age of the women was 29.4 years, and 90% had household incomes of less than S$5,000 (US$3,294). Sixty-four percent of the women had a primary education or less, and 60% had had more than one child; 56% had breast-fed previously. Across the three study groups, the most common mode of delivery (76% vaginal births), mean gestational age (39.2 weeks) and mean birth weight (3,179 g) were also similar.

At six weeks, 17% of women receiving routine care only and 29% of those in the prenatal intervention group were breast-feeding exclusively. Those proportions were 13% and 24%, respectively, at three months, and 9% and 19% at six months. Those receiving the prenatal intervention were significantly more likely than those receiving only routine care to be practicing exclusive breast-feeding at six weeks, three months and six months, with relative risks of 1.7, 1.9 and 2.2, respectively.

Among women who received the postnatal intervention, 38% were breast-feeding exclusively at two weeks, 31% at six weeks, 24% at three months and 22% at six months. The proportion exclusively breast-feeding was significantly higher in the postnatal intervention group than in the routine-care group at all four points, with relative risks of 1.8, 1.9, 1.9 and 2.1, respectively.

Although there was no significant difference in the rate of exclusive breast-feeding at two weeks between women in the postnatal intervention group and women in the prenatal intervention group, women who had received the postnatal intervention were more likely than those who had received the prenatal intervention to be exclusively or predominantly breast-feeding (relative risk, 1.5). In addition, the proportion practicing any type of breast-feeding at six weeks was higher in the postnatal intervention group than in either of the other groups (1.2 each).

According to the authors, the “lack of breast feeding is significantly associated with higher use and cost of health care,” and promotion of the practice leads to “improved short and long term health of breast fed children [and] improved wellbeing for mothers who have breast fed.” They suggest that “future research…compare the specific cost effectiveness of…strategies for improvement of breast feeding practice.”


1. Su LL et al., Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial, BMJ, 2007, 335(7620):596–599.