Support for healthy breastfeeding mothers with healthy term babies

Anna Gavine; Shona C Shinwell; Phyll Buchanan; Albert Farre; Angela Wade; Fiona Lynn; Joyce Marshall; Sara E Cumming; Shadrach Dare; Alison McFadden

doi:10.1002/14651858.CD001141.pub6

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Figure 1

Applying the trustworthiness screening tool criteria

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Study flow diagram

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Figure 5

Funnel plot of comparison: 1 Breastfeeding only support versus usual care, outcome: 1.1 Stopping breastfeeding (any) at 6 months

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Figure 6

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.2 Stopping exclusive breastfeeding at 6 months

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Figure 7

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.3 Stopping breastfeeding (any) at 4‐6 weeks

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Figure 8

Funnel plot of comparison: Breastfeeding only support versus usual care, outcome: 1.4 Stopping exclusive breastfeeding at 4‐6 weeks

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Figure 9

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.5Stopping breastfeeding (any) at 2 months

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Figure 10

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.6 Stopping exclusive breastfeeding at 2 months

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Figure 11

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.7 Stopping breastfeeding (any) at 3‐4 months

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Figure 12

Funnel plot of comparison 1: Breastfeeding only support versus usual care, outcome: 1.8 Stopping breastfeeding at 3‐4 months

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Figure 13

Funnel plot of comparison 2: Breastfeeding plus support versus usual care, outcome: 2.1 Stopping breastfeeding (any) at 6 months

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Figure 14

Funnel plot of comparison 2: Breastfeeding plus support versus usual care, outcome: 2.2 Stopping exclusive breastfeeding at 6 months

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Figure 15

Funnel plot of comparison 2: Breastfeeding plus support versus usual care, outcome: 2.6 Stopping exclusive breastfeeding at 2 months

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Figure 16

Funnel Plot for Outcome 2.8 Stopping exclusive breastfeeding at 3‐4 months

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Analysis 1.1

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 1: Stopping breastfeeding (any) at 6 months

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Analysis 1.2

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 2: Stopping exclusive breastfeeding at 6 months

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Analysis 1.3

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 3: Stopping breastfeeding (any) at 4‐6 weeks

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Analysis 1.4

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 4: Stopping exclusive breastfeeding at 4‐6 weeks

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Analysis 1.5

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 5: Stopping breastfeeding (any) at 2 months

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Analysis 1.6

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 6: Stopping exclusive breastfeeding at 2 months

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Analysis 1.7

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 7: Stopping breastfeeding (any) at 3‐4 months

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Analysis 1.8

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 8: Stopping exclusive breastfeeding at 3‐4 months

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Analysis 1.9

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 9: Stopping any breastfeeding at 9 months

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Analysis 1.10

Comparison 1: Breastfeeding only support versus usual care 2022, Outcome 10: Stopping any breastfeeding at 12 months

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Analysis 2.1

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 1: Stopping breastfeeding (any) at 6 months

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Analysis 2.2

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 2: Stopping exclusive breastfeeding at 6 months

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Analysis 2.3

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 3: Stopping breastfeeding (any) at 4‐6 weeks

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Analysis 2.4

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 4: Stopping exclusive breastfeeding at 4‐6 weeks

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Analysis 2.5

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 5: Stopping breastfeeding (any) at 2 months

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Analysis 2.6

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 6: Stopping exclusive breastfeeding at 2 months

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Analysis 2.7

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 7: Stopping breastfeeding (any) at 3‐4 months

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Analysis 2.8

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 8: Stopping exclusive breastfeeding at 3‐4 months

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Analysis 2.9

Comparison 2: Breastfeeding plus support versus usual care 2022, Outcome 9: Stopping any breastfeeding at 12 months

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Summary of findings 1. Summary of findings table ‐ Breastfeeding support only compared to usual care

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Breastfeeding support only compared to usual care
Patient or population: healthy breastfeeding women with healthy term babies Setting: any setting Intervention: Support Comparison: Usual care
Outcomes	Risk with Usual care	Risk with Support	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Stopping breastfeeding (any) at 6 months	600 per 1000	558 per 1000 (534 to 582)	RR 0.93 (0.89 to 0.97)	14610 (30 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping exclusive breastfeeding at 6 months	847 per 1000	763 per 1000 (746 to 788)	RR 0.90 (0.88 to 0.93)	16332 (40 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping breastfeeding (any) at 4‐6 weeks	308 per 1000	271 per 1000 (244 to 299)	RR 0.88 (0.79 to 0.97)	11413 (36 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping exclusive breastfeeding at 4‐6 weeks	518 per 1000	430 per 1000 (394 to 466)	RR 0.83 (0.76 to 0.90)	14544 (42 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping breastfeeding (any) at 2 months	384 per 1000	357 per 1000 (295 to 426)	RR 0.93 (0.77 to 1.11)	3169 (13 RCTs)	⊕⊕⊝⊝ Low^a,^b
Stopping exclusive breastfeeding at 2 months	607 per 1000	491 per 1000 (449 to 540)	RR 0.81 (0.74 to 0.89)	4317 (17 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping breastfeeding (any) at 3‐4 months	462 per 1000	402 per 1000 (374 to 430)	RR 0.87 (0.81 to 0.93)	12054 (32 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping exclusive breastfeeding at 3‐4 months	731 per 1000	592 per 1000 (563 to 621)	RR 0.81 (0.77 to 0.85)	11575 (43 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping breastfeeding at 9 months	758 per 1000	660 per 1000 (592 to 736)	RR 0.87 (0.78 to 0.97)	552 (1 RCT)	⊕⊕⊝⊝ Low^c,^d
Stopping breastfeeding at 12 months	891 per 1000	846 per 1000 (802 to 891)	RR 0.95 (0.90 to 1.00)	1311 (2 RCTs)	⊕⊕⊝⊝ Low^b,^e
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_431686173574519163.
^a We downgraded 1 level for serious concerns about inconsistency. Evidence of substantial unexplained heterogeneity. ^b We downgraded 1 level for serious concerns in imprecision. Small number of participants. Optimal Information Size criterion met but 95% CI overlaps the line of no effect and fails to exclude important benefit. ^c We downgraded 1 level for serious concerns about risk of bias. Unclear risk of bias for 3 domains in the single study included for this analysis. ^d We downgraded 1 level for serious concerns about imprecision. Single study with Optimal Information Size criterion not met. ^e We downgraded 1 level due to serious concerns about risk of bias. High or unclear risk of bias in many of the domains in the two studies for this outcome.

Summary of findings 1. Summary of findings table ‐ Breastfeeding support only compared to usual care

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Summary of findings 2. Summary of findings table ‐ Support plus compared to usual care for healthy breastfeeding women with healthy term babies

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Support plus compared to usual care for healthy breastfeeding women with healthy term babies
Patient or population: healthy breastfeeding women with healthy term babies Setting: any setting Intervention: Support plus Comparison: usual care
Outcomes	Risk with usual care	Risk with Support plus	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Stopping breastfeeding (any) at 6 months	541 per 1000	508 per 1000 (492 to 524)	RR 0.94 (0.91 to 0.97)	4879 (11 RCTs)	⊕⊕⊕⊝ Moderate^a
Stopping exclusive breastfeeding at 6 months	685 per 1000	541 per 1000 (479 to 616)	RR 0.79 (0.70 to 0.90)	7650 (13 RCTs)	⊕⊕⊝⊝ Low^a,^b
Stopping breastfeeding (any) at 4‐6 weeks	433 per 1000	407 per 1000 (355 to 467)	RR 0.94 (0.82 to 1.08)	2325 (6 RCTs)	⊕⊕⊕⊝ Moderate^c
Stopping exclusive breastfeeding at 4‐6 weeks	542 per 1000	396 per 1000 (309 to 515)	RR 0.73 (0.57 to 0.95)	2402 (6 RCTs)	⊕⊝⊝⊝ Very low^b,^d
Stopping breastfeeding (any) at 2 months	363 per 1000	334 per 1000 (287 to 388)	RR 0.92 (0.79 to 1.07)	2089 (4 RCTs)	⊕⊕⊕⊝ Moderate^c
Stopping exclusive breastfeeding at 2 months	425 per 1000	382 per 1000 (331 to 437)	RR 0.90 (0.78 to 1.03)	4537 (9 RCTs)	⊕⊝⊝⊝ Very low^b,^c,^d
Stopping breastfeeding (any) at 3‐4 months	386 per 1000	374 per 1000 (312 to 443)	RR 0.97 (0.81 to 1.15)	2064 (5 RCTs)	⊕⊕⊝⊝ Low^b,^c
Stopping exclusive breastfeeding at 3‐4 months	587 per 1000	505 per 1000 (440 to 587)	RR 0.86 (0.75 to 1.00)	4766 (10 RCTs)	⊕⊕⊝⊝ Low^b,^c
Stopping breastfeeding (any) at 12 months	858 per 1000	823 per 1000 (780 to 858)	RR 0.96 (0.91 to 1.00)	1431 (2 RCTs)	⊕⊕⊕⊝ Moderate^c
Stopping breastfeeding (any) at 9 months ‐ not reported	‐	‐	‐	‐	‐
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_431754481798286092.
^a We downgraded 1 level for serious concerns on risk of bias. Studies at risk of selection bias due to unclear allocation concealment. ^b We downgraded 1 level for serious concerns regarding inconsistency. Evidence of substantial unexplained heterogeneity. ^c We downgraded 1 level for serious concerns in imprecision. Small number of participants. Optimal Information Size criterion met but 95% CI overlaps the line of no effect and fails to exclude important benefit. ^d We downgraded 2 levels for very serious concerns in risk of bias. Many studies were at risk of selection bias due to unclear allocation concealment. Many studies had high levels of incomplete outcome reporting. Finally, sensitivity analysis excluding a study which could not be adjusted for clustering changed the effect estimate to non‐significant.

Summary of findings 2. Summary of findings table ‐ Support plus compared to usual care for healthy breastfeeding women with healthy term babies

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Table 1. Meta‐regression 1.1. 'Breastfeeding only' support ‐ any breastfeeding at 6 months.

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	33
PERSON:					0.0074	83.1435	30	<0.0001	58.56
Professional	22	10214	1
Non‐Professional	8	3366	0.958 (0.866, 1.060)	0.406
Prof + Non‐prof	3	1030	1.037 (0.911, 1.181)	0.583
Unspecified	0	‐	‐

INTENSITY:					0.0060	74.3190	29	<0.0001	52.73
Low	5	2159	1
Moderate	5	962	0.913 (0.796, 1.047)	0.194
High	17	6276	0.939 (0.841, 1.048)	0.262
Unspecified	6	5213	0.989 (0.877, 1.115)	0.857

SUPPORT:					0.0072	81.8609	28	<0.0001	61.13
F2F	11	7508	1
F2F and phone	13	3681	1.009 (0.918, 1.109)	0.857
F2F, phone and digital	1	103	0.984 (0.710, 1.364)	0.924
Phone	6	2820	1.002 (0.888, 1.132)	0.972
Digital	2	498	0.845 (0.648, 1.102)	0.213

INCOME:
LMIC	7	3037	1		0.0052	81.7673	31	<0.0001	53.32
HMIC	26	11573	1.069 (0.967, 1.183)	0.193
CI: confidence interval;RR: risk ratio.

Table 1. Meta‐regression 1.1. 'Breastfeeding only' support ‐ any breastfeeding at 6 months.

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Table 2. Meta‐regression 1.2. 'Breastfeeding only' support ‐ exclusive breastfeeding at 6 months

					Total model statistics
Factor	Number of interventions	Number of women	RR (95% CI)	P value	Tau²	Chi²	P value	I²
	44
PERSON:					0.0251	233.3179	40	<0.0001	97.31
Professional	28	11780	1
Non‐Professional	12	3663	0.966 (0.853, 1.093)	0.583
Prof + Non‐prof	3	749	1.024 (0.832, 1.259)	0.826
Unspecified	1	140	0.345 (0.149, 0.799)	0.013

INTENSITY:					0.0233	244.6064	40	<0.0001	96.02
Low	7	5603	1
Moderate	14	2896	0.815 (0.696, 0.953)	0.010
High	18	6315	0.949 (0.822, 1.096)	0.476
Unspecified	5	1518	0.952 (0.789, 1.147)	0.603

SUPPORT:					0.0245	218.5338	39	<0.0001	96.37
F2F	20	6027	1
F2F and phone	13	6647	1.113 (0.982, 1.260)	0.093
F2F, phone and digital	1	20	1.199 (0.779, 1.845)	0.409
Phone	8	3043	1.059 (0.919, 1.220)	0.425
Digital	2	595	1.016 (0.793, 1.303)	0.898

INCOME:					0.0187	230.0321	42	<0.0001	96.31
LMIC	22	5622	1
HMIC	22	10710	1.151 (1.047, 1.265)	0.003

CI: confidence interval;RR: risk ratio.

Table 2. Meta‐regression 1.2. 'Breastfeeding only' support ‐ exclusive breastfeeding at 6 months

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Table 3. Meta‐regression 1.3. 'Breastfeeding only' support ‐ any breastfeeding at 4‐6 weeks

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	37
PERSON:					0.0909	110.94	34	<0.0001	76.55
Professional	27	7526	1
Non‐Professional	8	2882	0.963 (0.717, 1.293)	0.801
Prof + Non‐prof	2	774	1.182 (0.723, 1.934)	0.505
Unspecified	0	‐	‐	‐

INTENSITY:					0.0966	100.86	33	<0.0001	75.74
Low	11	4548	1
Moderate	8	1323	0.749 (0.504, 1.115)	0.155
High	15	4019	0.991 (0.732, 1.342)	0.953
Unspecified	3	1292	1.349 (0.839, 2.168)	0.217

SUPPORT/TYPE:					0.1056	108.26	33	<0.0001	79.59
F2F	11	4631	1
F2F and phone	17	3893	1.027 (0.754, 1.398)	0.866
F2F, phone and digital	0	‐	‐	‐
Phone	7	2173	0.923 (0.624, 1.364)	0.687
Digital	2	485	1.437 (0.707, 2.919)	0.316

INCOME:					0.0770	104.47	35	<0.0001	76.01
LMIC	7	2688	1
HMIC	30	8494	1.257 (0.903, 1.750)	0.175
CI: confidence interval;RR: risk ratio.

Table 3. Meta‐regression 1.3. 'Breastfeeding only' support ‐ any breastfeeding at 4‐6 weeks

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Table 4. Meta‐regression 1.4. 'Breastfeeding only' ‐ exclusive breastfeeding at 4‐6 weeks

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	45
PERSON:
Professional	31	11266	1		0.0480	231.253	42	<00001	91.75
Non‐Professional	11	2529	0.853 (0.710, 1.025)	0.09
Prof + Non‐prof	3	749	1.288 (0.939, 1.766)	0.116
Unspecified	0	‐	‐	‐

INTENSITY:
Low	12	7327	1		0.0516	197.13	41	<0.0001	89.54
Moderate	13	2113	0.790 (0.633, 0.986)	0.037
High	17	4330	1.015 (0.836, 1.232)	0.879
Unspecified	3	774	1.067 (0.754, 1.511)	0.714

SUPPORT:					0.0612	207.04	40	<0.0001	90.91
F2F	17	4679	1
F2F and phone	17	6797	1.016 (0.837, 1.24)	0.869
F2F, phone and digital	1	20	1.193 (0.285, 4.991)	0.809
Phone	7	2312	0.925 (0.714, 1.199)	0.556
Digital	3	736	0.867 (0.591, 1.272)	0.464

INCOME:					0.0508	223.312	43	<0.0001	93.12
LMIC	15	3223	1
HMIC	30	11321	1.126 (0.942, 1.347)	0.193

Table 4. Meta‐regression 1.4. 'Breastfeeding only' ‐ exclusive breastfeeding at 4‐6 weeks

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Table 5. Meta‐regression 2.1 'Breastfeeding plus' ‐ any breastfeeding at 6 months

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	12
PERSON:					<0.00005	4.5171	9	0.8742	<0.001
Professional	8	3601	1
Non‐Professional	3	1221	1.045 (0.969, 1.127)	0.25
Prof + Non‐prof	0	‐
Unspecified	1	57	0.775 (0.605, 0.994)	0.044

INTENSITY:					<0.00005	9.0329	8	0.3395	0.76
Low	1	1154	1
Moderate	4	1236	1.037 (0.879, 1.225)	0.664
High	5	1607	0.990 (0.891, 1.100)	0.855
Unspecified	2	882	0.884 (0.667, 1.171)	0.391

SUPPORT:					<0.00005	10.2209	10	0.4213	0.12
F2F	11	4469	1
F2F and phone	1	410	0.969 (0.606, 1.548)	0.895
F2F, phone and digital	0	‐
Phone	0	‐
Digital	0	‐

INCOME:
LMIC	2	1012	1		<0.00005	9.537	10	0.4820	<0.005
HMIC	10	3867	0.872 (0.633, 1.202)	0.402

Table 5. Meta‐regression 2.1 'Breastfeeding plus' ‐ any breastfeeding at 6 months

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Table 6. Meta‐regression 2.2. 'Breastfeeding plus' ‐ exclusive breastfeeding at 6 months

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	14
PERSON:					0.2225	213.847	12	<0.0001	99.03
Professional	9	4671	1
Non‐Professional	5	2979	1.033 (0.612, 1.744)	0.903
Prof + Non‐prof	0	‐	‐
Unspecified	0	‐	‐

INTENSITY:					0.487	189.8528	10	<0.0001	99.02
Low	1	1154	1
Moderate	3	1165	0.993 (0.332, 2.969)	0.990
High	8	4449	0.692 (0.253, 1.898)	0.475
Unspecified	2	882	0.683 (0.212, 2.200)	0.523

SUPPORT:					0.0584	68.6107	11	<0.0001	97.25
F2F	11	6004	1
F2F and phone	2	1447	0.338 (0.225, 0.508)	<0.005
F2F, phone and digital	0	‐	‐
Phone	0	‐	‐
Digital	1	199	0.776 (0.440, 1.369)	0.382

INCOME:					0.1712	181.2251	12	<0.0001	98.91
LMIC	6	3807	1
HMIC	8	3843	1.517 (0.968, 2.377)	0.069
CI: confidence interval;RR: risk ratio.

Table 6. Meta‐regression 2.2. 'Breastfeeding plus' ‐ exclusive breastfeeding at 6 months

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Table 7. Meta‐regression 2.3. 'Breastfeeding plus' ‐ any breastfeeding at 4‐6 weeks

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	7
PERSON:					<0.00005	9.8833	5	0.0786	0.01
Professional	5	1454	1
Non‐Professional	2	871	1.046 (0.849, 1.290)	0.67
Prof + Non‐prof	0	‐	‐
Unspecified	0	‐	‐

INTENSITY:					<0.00005	4.3241	4	0.3639	0.01
Low	0	‐	** NOTE baseline ‘Moderate’
Moderate	3	681	1
High	3	1172	1.015 (0.799, 1.289)
Unspecified	1	472	Not included in model

SUPPORT:					<0.00005	9.9954	5	0.0754	0.02
F2F	6	2090	1
F2F and phone	1	235	1.042 (0.769, 1.411)	0.793
F2F, phone and digital	0	‐	‐
Phone	0	‐	‐
Digital	0	‐	‐

INCOME:					N/A	N/A	N/A	N/A	N/A
LMIC	0	‐
HMIC	7	2325	N/A
CI: confidence interval;RR: risk ratio.

Table 7. Meta‐regression 2.3. 'Breastfeeding plus' ‐ any breastfeeding at 4‐6 weeks

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Table 8. Meta‐regression 2.4. 'Breastfeeding plus' ‐ exclusive breastfeeding at 4‐6 weeks

Factor	Number of studies	Number of women	RR (95% CI)	P value	Total model statistics
Factor	Number of studies	Number of women	RR (95% CI)	P value	Tau²	Chi²	df	P value	I²
	7
PERSON:					0.457	45.2117	4	<0.0001	94.89
Professional	5	1651	1
Non‐Professional	2	751	0.697 (0.213, 2.280)
Prof + Non‐prof	0	‐	‐
Unspecified	0	‐	‐

INTENSITY:					0.4011	45.0465	4	<0.0001	95.05
Low	0	‐	** NOTE baseline ‘Moderate’
Moderate	2	529	1
High	4	1401	0.561 (0.185, 1.701)	0.307
Unspecified	1	472	Not included in model

SUPPORT:					0.3455	44.1268	5	0.0001	95.79
F2F	5	1834	1
F2F and phone	2	568	0.659 (0.236, 1.839)	0.426
F2F, phone and digital	0	‐	‐
Phone	0	‐	‐
Digital	0	‐	‐

INCOME:					0.4544	42.7192	4	<0.0001	95.86
LMIC	2	568	1
HMIC	5	1834	1.517 (0.457, 5.040)	0.496
CI: confidence interval;RR: risk ratio.

Table 8. Meta‐regression 2.4. 'Breastfeeding plus' ‐ exclusive breastfeeding at 4‐6 weeks

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Comparison 1. Breastfeeding only support versus usual care 2022

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Stopping breastfeeding (any) at 6 months Show forest plot	30	14610	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.89, 0.97]

1.2 Stopping exclusive breastfeeding at 6 months Show forest plot	40	16332	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.88, 0.93]

1.3 Stopping breastfeeding (any) at 4‐6 weeks Show forest plot	36	11413	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.79, 0.97]

1.4 Stopping exclusive breastfeeding at 4‐6 weeks Show forest plot	42	14544	Risk Ratio (M‐H, Random, 95% CI)	0.83 [0.76, 0.90]

1.5 Stopping breastfeeding (any) at 2 months Show forest plot	13	3169	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.77, 1.11]

1.6 Stopping exclusive breastfeeding at 2 months Show forest plot	17	4317	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.74, 0.89]

1.7 Stopping breastfeeding (any) at 3‐4 months Show forest plot	32	12054	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.81, 0.93]

1.8 Stopping exclusive breastfeeding at 3‐4 months Show forest plot	43	11575	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.77, 0.85]

1.9 Stopping any breastfeeding at 9 months Show forest plot	1	552	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.78, 0.97]

1.10 Stopping any breastfeeding at 12 months Show forest plot	2	1311	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.90, 1.00]

Comparison 1. Breastfeeding only support versus usual care 2022

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Comparison 2. Breastfeeding plus support versus usual care 2022

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Stopping breastfeeding (any) at 6 months Show forest plot	11	4879	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.91, 0.97]

2.2 Stopping exclusive breastfeeding at 6 months Show forest plot	13	7650	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.70, 0.90]

2.3 Stopping breastfeeding (any) at 4‐6 weeks Show forest plot	6	2325	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.82, 1.08]

2.4 Stopping exclusive breastfeeding at 4‐6 weeks Show forest plot	6	2402	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.57, 0.95]

2.5 Stopping breastfeeding (any) at 2 months Show forest plot	4	2089	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.79, 1.07]

2.6 Stopping exclusive breastfeeding at 2 months Show forest plot	9	4537	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.78, 1.03]

2.7 Stopping breastfeeding (any) at 3‐4 months Show forest plot	5	2064	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.81, 1.15]

2.8 Stopping exclusive breastfeeding at 3‐4 months Show forest plot	10	4766	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.75, 1.00]

2.9 Stopping any breastfeeding at 12 months Show forest plot	2	1431	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.91, 1.00]

Comparison 2. Breastfeeding plus support versus usual care 2022

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