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Increasing Breastfeeding Initiation and Duration at a Community Level: An Evaluation of Sagkeeng First Nation’s Community Health Nurse and Peer Counselor Programs

Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 4th Floor Brodie Centre, Room 408-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5 Canada.

The effectiveness of two Sagkeeng First Nation breastfeeding initiatives—prenatal instruction by a community health nurse and a postpartum peer counselor (PC) program for breastfeeding women—was evaluated at a community level through chart audits (1992 to 1997, n = 283). Breastfeeding initiation rates increased from 38% in 1995 to 60% in 1997 (OR = 2.2, 95% CI 1.2-4.1, P= .01, adjusted for birth weight and parity). PC clients were half as likely to wean (RR = 0.5, 95% CI 0.25-0.98, P= .04, adjusted for birth weight and parity), with 61% still breastfeeding at 2 months (vs 48% nonclients) and 56% at 6 months (vs 19%). PC clients had fewer problems (median 1 vs 2, P= .044) and greater satisfaction with breastfeeding (median5vs 4, P= .07). Qualitative interviews (n = 22) confirmed PC clients as more satisfied and more confident about breastfeeding, with fewer problems and more information.

Key Words: peer counseling • breastfeeding decision-making model • Native American • peer support • breastfeeding resource materials • mother-to-mother support

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