Breastfeeding provides significant benefits to mothers and infants. In Australia, although the overall rate of breastfeeding initiation is high (96%), many women stop in the early months postpartum. There are also inequalities between high and low socioeconomic groups, with women in lower socioeconomic groups less likely to initiate or continue breastfeeding. SILC (Supporting breastfeeding In Local Communities) was a program of community-based strategies based on knowledge of the available evidence about breastfeeding and of the current breastfeeding rates and breastfeeding support programs in Victoria. The aim was to develop and evaluate two new strategies for increasing breastfeeding maintenance in Local Government Areas (LGAs) with breastfeeding rates lower than the Victorian state average. The project was funded by the Department of Education and Early Childhood Development (DEECD) and was conducted by researchers from the Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University.
The primary aim of SILC was to explore whether there was an increased proportion of infants receiving any breast milk at four months in LGAs that offered early home-based breastfeeding support by a Maternal and Child Health Nurse (MCHN) for women at risk of early cessation of breastfeeding (herein referred to as the SILC-MCHN), with or without access to a community-based breastfeeding drop-in centre, compared to comparison LGAs implementing standard Maternal and Child Health (MCH) care. Secondary aims were to determine whether there was an increased proportion of infants receiving any breast milk at three and six months in LGAs allocated to providing the SILC interventions compared with ‘comparison’ LGAs; to compare pre-intervention and post-intervention breastfeeding rates in each LGA and across trial arms; to explore women’s reports of breastfeeding problems; to ascertain women’s satisfaction with infant feeding support; and to explore the views and experiences of SILC-MCHNs and MCH co-ordinators.
The SILC project was designed as a three-arm cluster randomised controlled trial (cluster RCT). Participating LGAs were first divided into three groups, depending on the number of births in each LGA. Within each group, LGAs were then randomly allocated to one of three trial arms:
1. Standard or usual care (comparison arm);
2. Early home-based breastfeeding support by a SILC-MCHN (trial arm 1); or
3. Access to a community-based breastfeeding drop-in centre in addition to home-based breastfeeding support by a SILC-MCHN (trial arm 2).
The evaluation assessed breastfeeding outcomes obtained from routinely collected MCH centre data as well as from postal surveys to women. The research team monitored intervention uptake and assessed whether the interventions were implemented as planned. The intervention programs were pragmatically designed so that if they did increase breastfeeding, they could be readily incorporated into practice in Victoria.
Ten LGAs participated in SILC. Three LGAs were randomly allocated to each intervention arm and four LGAs were allocated to the comparison arm. The SILC interventions ran from July 2012 to March 2013; the first two months of the intervention was a ‘run-in’ period and data collected during this period were used to provide baseline rates of breastfeeding in each LGA to account for this in the final analysis of breastfeeding outcomes.