The Impact of Peer Support Through Mobile Health Applications on Breastfeeding Outcomes: A Systematic Review and...

Fewer than 40% of infants are exclusively breastfed for the first 6 months despite global recommendations, hindered by socioeconomic, cultural, and systemic barriers. Mobile health (mHealth) technologies provide scalable breastfeeding support, but the effectiveness of digital peer support across settings remains underexplored. This systematic review and meta-analysis searched PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library for randomised controlled trials (RCTs) published between 1 January 2010 and 1 May 2025 (PROSPERO reference number: CRD420251164765). Studies involved pregnant or postpartum women (up to 12 months) receiving mHealth peer support compared with standard care or non-peer digital interventions. Primary outcomes were exclusive and any breastfeeding rates; secondary outcomes included self-efficacy, duration, frequency, initiation, attitudes, and satisfaction. Data were narratively synthesised, and pooled estimates calculated via random-effects meta-analysis. From 3102 identified records, seven RCTs involving 3591 participants were included, of which five studies were eligible for quantitative meta-analysis. Interventions delivered peer support through mobile apps, phone calls, group chats, mentoring, and real-time messaging. The meta-analysis found no significant effect on any breastfeeding at the primary time point (RR = 1.07, 95% CI 0.95-1.21; I² = 55.0%), but it did significantly improve exclusive breastfeeding at 4-6 months postpartum (RR = 1.13, 95% CI 1.01-1.26; I² = 0%). Leave-one-out sensitivity analyses supported the robustness of both estimates, although the lack of heterogeneity for exclusive breastfeeding should be interpreted cautiously because of the small number of studies. Narrative findings also showed localised gains in overall breastfeeding and greater maternal confidence, satisfaction, and perceived support, especially with interactive and culturally relatable peer support. mHealth peer support shows promise for improving exclusive breastfeeding, especially at 4-6 months postpartum, but evidence for any breastfeeding is less consistent and mostly limited to HICs/UMICs. Future studies should focus on LMICs, hybrid models, long-term follow-up, process evaluation, and cost-effectiveness.