The US Preventive Services Task Force (USPSTF) reviewed studies about behavioral counseling to support breastfeeding during pregnancy and after childbirth.
The recommendation statement considered breastfeeding as feeding at the breast or with a bottle containing breast milk.1 Few studies of interventions included in the USPSTF review examined the direct health effects of breastfeeding. But other research has shown that breastfeeding can reduce infants’ risk of acute otitis media, asthma, weight gain and obesity, childhood leukemia, and type 1 diabetes. Prior studies have also shown that breastfeeding can reduce mothers’ risk of breast and ovarian cancers, hypertension, and type 2 diabetes.
Breastfeeding in the US
As of 2021, only 59.8% of US infants aged 6 months were breastfed and only 27.2% were exclusively breastfed. The US has a national goal of 42.4% of infants being breastfed exclusively through age 6 months and 54.1% being at least partially breastfed at 1 year.
Lower breastfeeding rates in the US are reported among mothers who are Black, younger than 30 years, single, or living outside of metropolitan areas; whose highest education level is high school; and who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children. New mothers who belong to racial and ethnic minority groups may be less likely to receive breastfeeding support than White mothers. In addition, some geographic areas in the US are less likely to have birthing facilities that support breastfeeding practices soon after birth.
Behavioral Counseling to Support Breastfeeding
Interventions that help increase breastfeeding rates include education and support. Education programs typically provide general breastfeeding information that focuses on its benefits, practical breastfeeding skills such as latching, and managing common complications. Education programs may also include family members.
Support programs, often provided by nurses, midwives, clinicians, lactation care professionals, and trained peers, can discuss the benefits of breastfeeding and provide encouragement, reassurance, and opportunities to address breastfeeding questions and problems. Observations of breastfeeding can help new mothers learn about positioning the infant and latching.
Support programs that occur during the prenatal, peripartum, and postpartum periods tend to be more effective than those limited to a single period such as 1 trimester of pregnancy. New and expectant mothers can participate individually, in a group, in person, or remotely via video, telephone, or text, during an in-home visit, or in a hospital or a medical office.
Pros and Cons of Behavioral Counseling for Breastfeeding
The USPSTF review found that breastfeeding rates were significantly higher among new mothers who participated in behavioral counseling interventions compared with those who did not receive this support. These interventions were also associated with increased rates of exclusive breastfeeding among new mothers. In addition, 22 studies reported that mothers receiving behavioral counseling about breastfeeding had fewer problems with breastfeeding (including mastitis and sore nipples or breasts).
Potential harm from behavioral counseling interventions was reported in only 1 study, in which some mothers reported feeling more anxious and less confident than those who did not participate in this counseling intervention.
Should Behavioral Counseling Be Used for Breastfeeding?
The USPSTF concluded that primary care behavioral counseling interventions have a moderate net benefit. The USPSTF recommends that primary care clinicians provide interventions or referrals to support breastfeeding for all adolescents and adults who are pregnant or postpartum.
For More Information
Published Online: April 8, 2025. doi:10.1001/jama.2025.4144
Conflict of Interest Disclosures: None reported.
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Rebecca Voelker, MSJ1 저자 소속 논문 정보