title: Rethinking research in breast-feeding: a critique of the evidence base identified in a systematic review of interventions to promote and support breast-feeding.
abstract: OBJECTIVE
  To appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups.
  
  
  METHODS
  A systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base--topics, quality and gaps--is reported.
  
  
  RESULTS
  Many studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Cost-effectiveness studies were rare.
  
  
  CONCLUSIONS
  Policy goals both in the UK and internationally support exclusive breast-feeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.
authors: Mother and Infant Research Unit, Department of Health Sciences, Area 4, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK. mjr505@york.ac.uk
authors: M J
authors: MJ
authors: Renfrew
authors: H
authors: H
authors: Spiby
authors: L
authors: L
authors: D'Souza
authors: L M
authors: LM
authors: Wallace
authors: L
authors: L
authors: Dyson
authors: F
authors: F
authors: McCormick
mesh_terms: D001942:Breast Feeding; D019317:Evidence-Based Medicine; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008913:Minority Groups; D017063:Outcome Assessment, Health Care; D011050:Policy Making; D011634:Public Health; D011640:Public Policy; D012106:Research / Q000458:organization & administration*; D018401:Sample Size; D012944:Social Support; D013997:Time Factors; D006113:United Kingdom