Effectiveness of breastfeeding educational interventions during pregnancy on breastfeeding practices in rural Central Ethiopia: cluster randomized controlled trial.

BACKGROUND

Despite its well-established benefits, breastfeeding practices differ across communities, and many women exhibit suboptimal practices due to cultural influences and limited access to accurate information. Nulliparous pregnant women, in particular, lack prior breastfeeding experience and are often strongly influenced by family members such as mothers-in-law. However, there is limited evidence on whether involving these influential family members in breastfeeding education can improve breastfeeding practices. This study evaluated the effectiveness of breastfeeding educational interventions delivered to pregnant women together with their mothers-in-law, and pregnant women alone versus pregnant women in routine care in rural Central Ethiopia.

METHODS

A community-based, three-arm, cluster randomized controlled trial was conducted among 510 pregnant women enrolled before 16 weeks of gestation. The study arms were: (1) pregnant woman with her mother-in-law, (2) pregnant woman alone, and (3) control group receiving routine care. Fifty-one non-adjacent clusters were randomly assigned using simple randomization. The intervention consisted of eight home-based educational sessions: six during pregnancy and two postpartum. Outcomes included pre-lacteal feeding, colostrum feeding, early initiation of breastfeeding, and exclusive breastfeeding.

RESULTS

In the intervention groups (pregnant women and their mother-in-law paired, and pregnant women alone) there were significantly lower incidence of pre-lacteal feeding than pregnant women in the control group (9.1% and 11.4% vs. 19.8%, p = 0.011), and a higher incidence of colostrum feeding (92.7% and 90.4% vs. 81.4%, p = 0.004), early initiation of breastfeeding (80.4% and 72.5% vs. 53.3%, p < 0.001) and exclusive breastfeeding (80.9% and 74.3% vs. 59.9%, p < 0.001). Breastfeeding in both intervention groups have significant effect on breastfeeding practices; avoiding pre-lacteal feeding [RR = 2.17, 95%CI: (1.19, 3.85) and RR = 1.79(1.06, 2.86)], colostrum feeding [RR = 1.14(1.01, 1.29) and RR = 1.11(1.01, 1.23)], early initiation of breastfeeding [RR = 1.51(1.14, 1.99) and RR = 1.36(1.02, 1.82)], and exclusive breastfeeding [RR = 2.08(1.43, 3.03) and RR = 1.56(1.05, 2.33)] as compared to the control group.

CONCLUSION

Involving mothers-in-law in breastfeeding educational interventions in addition to active interventions to pregnant women alone has broader practical implication for improving recommended breastfeeding practices.

TRIAL REGISTRATION: ClinicalTrials.gov identifier (NCT number): NCT06236412, January 23, 2024.