Effect of Antenatal Breastfeeding Counseling on Early Initiation and Exclusive Breastfeeding in India: Systematic...

World Health Organization and United Nations Children's Fund recommend initiation of breastfeeding within 1 hour of birth and exclusive breastfeeding (EBF) for the first 6 months of life. In India, just 55.8% of children under 6 months are exclusively breastfed, and only 50.1% initiated breastfeeding in the first hour of life (National Family Health Survey 6). Several studies have shown the effectiveness of antenatal breastfeeding interventions in improving breastfeeding outcomes. However, no systematic review and meta-analysis report is available for India for this kind of study.

(1) To determine the effect of antenatal breastfeeding counseling on early initiation of breastfeeding (EIBF) and on EBF for 6 months (EBF6). (2) To determine the most effective way for breastfeeding counseling in terms of unit, time, and provider.

Randomized controlled trials, quasi-experimental studies, comparative studies, and intervention studies were searched using four databases published from January 1, 2015, to May 20, 2025 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nine studies with 14,414 participants (seven for EIBF and five for EBF6 with 10,964 and 6,668 participants, respectively) were included in this review and meta-analysis. A random-effects model was used to pool the results, and subgroup analyses were performed.

Combined effect size for EIBF was 1.509 (1.163-1.958, p = 0.002), and for EBF6, it was 1.494 (1.067-2.093, p = 0.019), showing a significant increase in EIBF and EBF rates resulting from breastfeeding counseling/education interventions. These interventions were found most effective when delivered one to one, irrespective of provider, time, and settings.

Individualized antenatal breastfeeding counseling interventions continued till 6 months postpartum, preferably by trained health care workers, are effective in enhancing early initiation, as well as to sustain EBF.