Evaluation of the effectiveness of a structured breast-feeding promotion program integrated into a maternal and child health service in Jerusalem.

2 quasi-experimental designs (comparison groups and time trends) were used to evaluate a breastfeeding promotion program in Jerusalem that was integrated into the maternal-child health service. The program which was incorporated into the maternal-health program in 1981 sought to increase the percentage of women breastfeeding and prolong its duration. The intervention group consisted of 118 consecutive births that took place in 1985 while the control group was comprised of 192 births also occurring in 1985 registered at a maternal-child health service of an adjacent neighborhood where promotion of breastfeeding was not part of the program. Consistent and significant differences were found between these 2 groups in the percent breastfeeding. In the intervention group 80% initiated breastfeeding and 29% were still breastfeeding at 26 weeks; among controls these percentages were 75% and 12% respectively. At 13 weeks postpartum 29% of inventions in the intervention group were being fully breastfed and at 26 weeks 5% were in this category; among controls these statistics were 18% and 2%. Educational status exerted a significant effect on breastfeeding in the control group. Among mothers with under 13 years of schooling 65% started breastfeeding 20% were still nursing at 13 weeks and 3% were breastfeeding at 26 weeks; in contrast among controls with 13 or more years of education these percentages were 85% 50% and 25% respectively. No differences in breastfeeding were noted by educational level in the intervention group. Among mothers who did not return to outside employment a higher percentage in the intervention group breastfed at each age than nonworking mothers in the control group. Multiple regression analysis identified 4 independent variables that had a significant effect on the duration of full and total breast-feeding: education previous experience younger maternal age and program exposure. Finally time trend analysis indicated a marked change in percent of women breastfeeding at 26 weeks from 10% in the preintervention period to 16% during the programs 1st year to 29% in the 1985 birth cohort.