A Cochrane review included 28 studies; statistical analyses were conducted on data from 23 trials with a total of 104 238 women. Five trials involving 582 women on low incomes in the USA showed healthcare professional-led breastfeeding education had a significant effect on increasing initiation rates compared to routine care (RR 1.57, 95% CI 1.15 to 2.15; low quality evidence). Interventions from non-healthcare professional counsellors and support groups improved rates of breastfeeding initiation in 8 trials (average RR 1.22, 95% CI 1.06 to 1.40; n=5712, I² = 86%, low-quality evidence) compared to women who received standard care. However, in three trials (n=76 373), there was no clear difference between groups in terms of the number of women practicing early initiation of breastfeeding (average RR 1.70, 95% CI 0.98 to 2.95; I² = 78%, very low-quality evidence.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by heterogeneity.