What promotes breastfeeding better, family inclusive or mother only? Time for an RCT?

breastfeeding education for fathers before the birth

On FamilyIncluded.com/category/breastfeeding, we have covered a variety of projects to improve breastfeeding that engage with fathers and families, showing that it works in many different cultures. But there is an unanswered question: do these approaches work better or less well than approaches that only communicate with women?

This is not to suggest that all breastfeeding programmes should be family inclusive – some mothers may not want that or even have it as a possibility. Rather, the question is: is it ever appropriate only to offer mother-only programmes?

Two recent Cochrane reviews on breastfeeding interventions reveal some confusion about what constitutes a breastfeeding intervention. The first Cochrane review of “interventions for promoting the initiation of breastfeeding”, Balogun et al 2016, lists and then excludes two evaluations of breastfeeding programmes on the grounds that the two interventions were “primarily for fathers and not pregnant women, thus did not target the population of interest”. The excluded studies are Wolfberg 2010 (80% increase in breastfeeding initiation) and Maycock et al 2013 (8.5% increase in breastfeeding at 6 weeks). It is not clear why the authors of this review excluded articles on the grounds of the method adopted, rather than the outcomes achieved, given that the title of the review included all interventions.

Another Cochrane review of interventions to prolong breastfeeding, published just one month later, Lumbiganon et al 2016, does, in contrast, include family inclusive approaches, including the Wolfberg 2010 study. But this review does not compare family inclusive and exclusive approaches.

In the research about parenting support programmes, pioneered by Phillip and Carolyn Cowan over many years of longitudinal trials, different approaches have been compared to each other:

  • Mother only / father only
  • Mother and father together
  • Mother and father together, with the intervention including a focus on coparenting (how the parents work together).

Child outcomes are highest when the intervention works with the parents together and addresses their coparenting relationship.

This kind of comparison has not been undertaken yet in the field of breastfeeding. Most studies are of mother-only approaches and on this website we have been covering both father-only groups and coparenting approaches.

We believe it is time for a randomised controlled trial that compares three different approaches with  a control group where only mothers are engaged.

  • information for fathers, delivered separately (e.g. fathers’ group and digital tools)
  • information delivered to parents together
  • the same, but also including a coparenting approach, as recently described on this website, which addresses how parents can work together and support each other.

The predicted result is that the coparenting approach will be the most effective, because it engages with the dynamics within the family, which is the strongest of all the inluences on all aspects of newborn health. And if this is the finding, then the default offer of any service should include these family approaches as much as possible given other constraints, alongside options for mothers who want/have to engage alone.


Balogun OO, O’Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, Renfrew MJ & MacGillivray S (2016), Interventions for promoting the initiation of breastfeeding, Cochrane Database of Systematic Reviews

Cowan PA, Cowan CP, Ablow J, Johnson V & Measelle J (Eds.) (2005), The Family Context of Parenting in Children’s Adaptation to School, Mahwah, NJ: Lawrence Erlbaum Associates

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho J & Hakimi M (2016), Antenatal breastfeeding education for increasing breastfeeding duration, Cochrane Database of Systematic Reviews

Maycock B, Binns CW, Dhaliwal S, Tohotoa J, Hauck Y, Burns S, et al. (2013) Education and support for fathers improves breastfeeding rates: a randomized controlled trial, Journal of Human Lactation 29.4

Wolfberg AJ, Michels KB, Shields W, O’Campo P, Bronner Y & Bienstock J (2004), Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention, American Journal of Obstetrics and Gynecology 191

Photo: Christopher Allison Photography. Creative Commons.