{ "release_id": "c7fb95f1d15a7d13", "id": "maternal:breastfeeding-support", "owner": "maternal", "kind": "intervention", "slug": "breastfeeding-support", "name": "Breastfeeding support and counselling", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "Help with breastfeeding from health workers, peers or programmes, offered before and after the birth. In 2025 the US Preventive Services Task Force recommended providing interventions or referrals during pregnancy and after birth to support breastfeeding. WHO recommends that mothers get practical support to start breastfeeding and to manage common difficulties.", "summary_technical": "USPSTF 2025 (B recommendation) on primary care behavioral counselling to support breastfeeding, with moderate certainty of moderate net benefit (see the claim on this page); an earlier 2016 USPSTF statement with the same grade exists. WHO 2017 Recommendation 3 (recommended, moderate-quality evidence) on practical support to initiate and establish breastfeeding and manage common difficulties, in facilities providing maternity and newborn services. The PROBIT cluster trial in Belarus compared a package modelled on the Baby-Friendly Hospital Initiative with usual practice and found more breastfeeding at 12 months and more exclusive breastfeeding at 3 and 6 months, fewer gastrointestinal infections and less atopic eczema in the first year, and no significant reduction in respiratory infection (see the claims on this page; the infant results are in their own context). The guideline records are linked through the claims; this record links to the shared USPSTF record in core. The recipient is the pregnant or postpartum person and, in the evidence, the infant.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "pregnancy", "postpartum" ], "care-area": [ "breastfeeding" ] } }, "payload": { "subtype": "service", "mechanism": null, "components": null }, "content_digest": "8abeece59cc6b73c4561c9cbd2e9dd01c9e6ef010f16d5397862b5dc3f27cf66", "review": { "content_digest": "8abeece59cc6b73c4561c9cbd2e9dd01c9e6ef010f16d5397862b5dc3f27cf66", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-probit-breastfeeding-duration-and-exclusivity", "owner": "maternal", "subject_entity_id": "maternal:breastfeeding-support", "category": "effect", "statement": "In PROBIT, a cluster-randomized trial in 31 maternity hospitals and polyclinics in Belarus, 16 sites received an intervention modelled on the Baby-Friendly Hospital Initiative and 15 continued usual infant feeding practices; 17046 mother-infant pairs took part and 16491 completed 12 months of follow-up. Infants at the intervention sites were more likely than control infants to be breastfed to any degree at 12 months (19.7% against 11.4%) and more likely to be exclusively breastfed at 3 months (43.3% against 6.4%, P<.001) and at 6 months (7.9% against 0.6%, P=.01).", "context": { "id": "maternal:ctx-probit-belarus-mother-infant-pairs", "label": "Healthy mothers who intended to breastfeed and their full-term infants, Belarus maternity hospitals (PROBIT, 2001)", "recipient": "mixed", "population": "Mother-infant pairs: full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed. 17046 pairs were enrolled and 16491 (96.7%) completed the 12 months of follow-up. Sites, not individuals, were randomized.", "care_setting": "31 maternity hospitals and polyclinics, randomized as clusters: 16 to the experimental intervention and 15 to continuing usual infant feeding practices.", "geography": "Republic of Belarus", "life_stage_note": "Newborns at birth, followed for the first 12 months of life", "life_stage_terms": { "maternal": [ "postpartum", "infant-follow-up" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Cluster-randomized trial conducted June 1996 to December 1997 with 1-year follow-up.", "eligibility": { "inclusion": [ "Full-term singleton infants weighing at least 2500 g", "Healthy mothers who intended to breastfeed" ], "exclusion": [ "Not stated in the abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "Only the PubMed abstract was read. The abstract prints an adjusted odds ratio of 0.47 (95% CI 0.32 to 0.69) next to the 12-month figures without saying what it compares, so this record does not interpret it. The registry lists no masking (masking NONE), and breastfeeding was reported by the study population, which can make the measure less exact. The intervention was modelled on the WHO and UNICEF initiative; the trial does not show how much any one part of it contributed. The trial ran from June 1996 to December 1997 in one country with a different health system from many others, so results may not carry over.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, DESIGN, sentence 1", "applicability_note": "Design and dates.", "snapshot": { "id": "maternal:pubmed-11242425-2026-10-14", "retrieved_at": "2026-10-14T18:18:22Z", "content_hash": "8dcbf9669d14648122628ab01147c489157378a3a94dcb01d7a0197aaf7d0137", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1001-jama-285-4-413", "source_type": "publication", "title": "Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus", "canonical_url": "https://doi.org/10.1001/jama.285.4.413", "identifiers": [ { "scheme": "doi", "value": "10.1001/jama.285.4.413", "normalized_value": "10.1001/jama.285.4.413", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "11242425", "normalized_value": "11242425", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": null, "publisher": "JAMA", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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The raw file is committed at research/snapshots/mj-ctgov-NCT01561612.json.", "public_text": "quote" } } ], "review": { "content_digest": "33953bcd172f0bb27c344f0c05521d8e38f5db1019393449115acd5d7ff8e083", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-probit-breastfeeding-duration-and-exclusivity.json" }, { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-probit-infant-infection-and-eczema", "owner": "maternal", "subject_entity_id": "maternal:breastfeeding-support", "category": "effect", "statement": "In PROBIT, infants at the intervention sites had a significantly lower risk of one or more gastrointestinal tract infections (9.1% against 13.2%; adjusted odds ratio 0.60, 95% CI 0.40 to 0.91) and of atopic eczema (3.3% against 6.3%; adjusted odds ratio 0.54, 95% CI 0.31 to 0.95) in the first 12 months of life, with the intervention group first in each pair. There was no significant reduction in respiratory tract infection (39.2% in the intervention group, 39.4% in the control group; adjusted odds ratio 0.87, 95% CI 0.59 to 1.28).", "context": { "id": "maternal:ctx-probit-belarus-infants-first-year", "label": "Infants in the first 12 months of life, Belarus maternity hospitals (PROBIT, 2001)", "recipient": "child", "population": "The infants of the PROBIT mother-infant pairs, assessed for gastrointestinal tract infection, respiratory tract infection and atopic eczema during the first 12 months of life.", "care_setting": "31 maternity hospitals and polyclinics (cluster-randomized sites).", "geography": "Republic of Belarus", "life_stage_note": "Infants from birth to 12 months", "life_stage_terms": { "maternal": [ "infant-follow-up" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "First 12 months of life (abstract).", "eligibility": { "inclusion": [ "Full-term singleton infants weighing at least 2500 g whose mothers intended to breastfeed" ], "exclusion": [ "Not stated in the abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "Only the PubMed abstract was read. The abstract does not say that the intervention group is named first in the infection and eczema comparisons, so that order is an inference from the breastfeeding sentence before it. The trial tested a package that promoted breastfeeding; the infant results show what happened under the package and do not separate breastfeeding from other differences between sites. The registry holds longer follow-up outcomes for the children and mothers (adiposity, asthma, cognition and others); no results for them were read. 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ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. 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ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Guideline development methodology, paragraph 1", "applicability_note": "The GRADE method was followed.", "snapshot": { "id": "maternal:who-2017-bf-facilities-guideline-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:21:52Z", "content_hash": "192ac5cc6b548f67f6298485909cf4c680f4567f0df62525b3db5f7c47f266c5", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2017-bf-facilities-guideline", "source_type": "guideline", "title": "Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services", "canonical_url": "https://www.who.int/publications/i/item/9789241550086", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155008-6", "normalized_value": "9789241550086", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-11-02", "publisher": "World Health Organization", "edition": "2017. ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Purpose of the guideline, paragraph 1", "applicability_note": "Purpose of the guideline.", "snapshot": { "id": "maternal:who-2017-bf-facilities-guideline-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:21:52Z", "content_hash": "192ac5cc6b548f67f6298485909cf4c680f4567f0df62525b3db5f7c47f266c5", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2017-bf-facilities-guideline", "source_type": "guideline", "title": "Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services", "canonical_url": "https://www.who.int/publications/i/item/9789241550086", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155008-6", "normalized_value": "9789241550086", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-11-02", "publisher": "World Health Organization", "edition": "2017. ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendations, closing paragraph", "applicability_note": "The guideline supersedes the 1989 Ten Steps.", "snapshot": { "id": "maternal:who-2017-bf-facilities-guideline-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:21:52Z", "content_hash": "192ac5cc6b548f67f6298485909cf4c680f4567f0df62525b3db5f7c47f266c5", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2017-bf-facilities-guideline", "source_type": "guideline", "title": "Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services", "canonical_url": "https://www.who.int/publications/i/item/9789241550086", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155008-6", "normalized_value": "9789241550086", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-11-02", "publisher": "World Health Organization", "edition": "2017. ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendations (page x), Recommendation 14", "applicability_note": "Recommendation 14 of the same guideline: antenatal counselling about breastfeeding.", "snapshot": { "id": "maternal:who-2017-bf-facilities-guideline-pdf-2026-10-14", "retrieved_at": "2026-10-14T18:21:52Z", "content_hash": "192ac5cc6b548f67f6298485909cf4c680f4567f0df62525b3db5f7c47f266c5", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2017-bf-facilities-guideline", "source_type": "guideline", "title": "Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services", "canonical_url": "https://www.who.int/publications/i/item/9789241550086", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-155008-6", "normalized_value": "9789241550086", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-11-02", "publisher": "World Health Organization", "edition": "2017. ISBN 978-92-4-155008-6. The who.int page shows 2 November 2017, which the atlas uses for WHO sources and decisions. The WHO IRIS item record (handle 10665/259386, fetched through the IRIS API as mj-iris-item-10665-259386.json) lists an issue date of 2017-11-02, the same day. The PDF was fetched from IRIS (bitstream 601a8af5-0919-4ffb-a11d-fb534d96ed03) and has 120 pages. Whether a later edition replaces it was not checked.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "c99bf8ae71accd6043c5de3deda7954e2dfd0f88f038a287373f31b60dc17913", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2017-breastfeeding-support-recommendation-3.json" } ], "decisions": [ { "type": "recommendation", "id": "maternal:rec-uspstf-2025-breastfeeding-counselling", "direction": "for", "intervention_id": "maternal:breastfeeding-support", "context_id": "maternal:ctx-uspstf-2025-pregnant-postpartum-and-infants", "guideline_snapshot_id": "maternal:uspstf-breastfeeding-2025-2026-10-14", "guideline_id": "maternal:guideline-uspstf-2025-breastfeeding", "issuer_id": "core:uspstf", "jurisdictions": [ "US" ], "jurisdiction_note": "United States (the issuer is a United States task force).", "strength_label": "B recommendation", "strength_system": "USPSTF letter grades: A, B, C and D recommendations, and the I statement for when the evidence is insufficient to recommend for or against. 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The WHO IRIS record (handle 10665/259386) lists an issue date of 2017-11-02, the same day.", "superseded_by": null, "supersession_status": null, "claim_id": "maternal:claim-who-2017-breastfeeding-support-recommendation-3" } ], "milestones": [], "relationships": { "outgoing": [ { "predicate": "recommended_for", "label": "USPSTF 2025: provide interventions or referrals to support breastfeeding (B)", "clinical_claim_not_fact": true, "family": "clinical", "other_entity_id": "maternal:breastfeeding", "other_entity_in_atlas": true, "claim_id": "maternal:claim-uspstf-2025-breastfeeding-counselling", "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "recommended_for", "label": "WHO 2017 Recommendation 3: practical support to start breastfeeding", "clinical_claim_not_fact": true, "family": "clinical", "other_entity_id": "maternal:breastfeeding", "other_entity_in_atlas": true, "claim_id": "maternal:claim-who-2017-breastfeeding-support-recommendation-3", "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "evaluated_for", "label": "PROBIT: breastfeeding at 12 months 19.7% against 11.4%; exclusive at 3 months 43.3% against 6.4%", "clinical_claim_not_fact": true, "family": "clinical", "other_entity_id": "maternal:breastfeeding", "other_entity_in_atlas": true, "claim_id": "maternal:claim-probit-breastfeeding-duration-and-exclusivity", "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "related_to", "label": "The US Preventive Services Task Force", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "core:uspstf", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "part_of", "label": "Filed under this front", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "maternal:front-newborn-support", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": true, "role": null, "valid_from": null, "valid_to": null } ], "incoming": [ { "predicate": "investigates", "label": "Investigated in", "clinical_claim_not_fact": false, "family": "sourced", "other_entity_id": "maternal:probit-trial", "other_entity_in_atlas": true, "claim_id": null, "evidence": { "snapshot_id": "maternal:ctgov-nct01561612-2026-10-14", "locator": "protocolSection.armsInterventionsModule.interventions[0].name" }, "primary": false, "role": null, "valid_from": null, "valid_to": null } ] }, "page_path": "interventions/breastfeeding-support/", "context_path": "api/v1/context/maternal--breastfeeding-support.md" }