title: Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3.
abstract: BACKGROUND
  The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity.
  
  
  METHODS
  The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies.
  
  
  RESULTS
  Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective.
  
  
  CONCLUSIONS
  Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.
authors.affiliation: 1 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wouk
authors.affiliation: 1 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.|2 Center for Developmental Science, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Kristin P
authors.initials: KP
authors.lastname: Tully
authors.affiliation: 1 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Miriam H
authors.initials: MH
authors.lastname: Labbok
mesh_terms: D001942:Breast Feeding / Q000523:psychology* / Q000639:trends; D005260:Female; D006266:Health Education / Q000379:methods / Q000592:standards; D006291:Health Policy / Q000639:trends; D006293:Health Promotion / Q000379:methods / Q000592:standards* / Q000639:trends; D006761:Hospitals / Q000592:standards / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011181:Postnatal Care / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000639:trends
keywords: Baby-Friendly Hospital Initiative; Ten Steps to Successful Breastfeeding; breastfeeding; breastfeeding support; education; exclusive breastfeeding; intervention; lactation education; prenatal interventions