Healthcare Provider Breastfeeding Education: A Systematic Review of Program Components and Evaluation Methods

The 1991 Baby-Friendly Hospital Initiative and the Surgeon General’s 2011 Call to Action to Support Breastfeeding require lactation training for healthcare staff across all disciplines that provide maternal or child care. There is currently no uniform policy in the United States for breastfeeding education of healthcare providers in either resident or continue education training. Previous reviews have established that healthcare provider support can significantly improve breastfeeding initiation and duration rates, but have not examined evaluation methods beyond changes in institutional breastfeeding rates. A keyword search of databases yielded a sample of 12 articles. This systematic review used the Matrix Method to analyze healthcare provider lactation education programs in the U.S. for use of previously validated curriculum components, effectiveness, and evaluation methods. Federally-funded projects in the 1990s yielded several rigorously evaluated curriculums, but only half of the programs in the sample used previously validated curriculum components. Programs that used both hands-on and didactic instructional methods tended to be more effective, but program planners tended to use one-dimensional evaluation methods that lacked rigor. Programs that use previously validated curriculums can use less rigorous evaluation methods, but novel components should be evaluated on multiple dimensions assessing efficacy in the spheres of organization, provider, and patient. Use of previously validated curriculums can potentially reduce the resource investment required by organizations seeking to establish or improve their lactation education programs for providers across the continuum of maternal child health. There is a policy need for the establishment of breastfeeding education standards for healthcare providers.