SynthesisAdvances in nutrition (Bethesda, Md.)2012
Scaling up of breastfeeding promotion programs in low- and middle-income countries: the "breastfeeding gear" model.
Synthesis in Advances in nutrition (Bethesda, Md.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02756169 (Effect of an Immediate-postpartum Support by IBCLC to Women With Obesity, on Breastfeeding Performance), which is not on this map. Cited by 133 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of an Immediate-postpartum Support by IBCLC to Women With Obesity, on Breastfeeding Performance: A Randomized Trial.
Who cites it
133 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Nutritional counseling strategies in breastfeeding: a scoping review.Frontiers in nutrition · 2026Pooled it
- Implementation of the Baby-Friendly Hospital Initiative in Mexico: a systematic literature review using the RE-AIM framework.Frontiers in public health · 2023Pooled it
- Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women.International journal for equity in health · 2021Pooled it
- Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review.International journal for equity in health · 2021Pooled it
- Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review.Health policy and planning · 2020Pooled it
- Innovative approaches for improving maternal and newborn health--A landscape analysis.BMC pregnancy and childbirth · 2015Pooled it
- Promoting Breastfeeding Among Latina Women in a Community Pediatric Clinic.Journal of immigrant and minority health · 2026Trial
- The impact of a package of behaviour change interventions on breastfeeding practices in East Java Province, Indonesia.Maternal & child nutrition · 2022Trial
- Trial
- Breastfeeding counseling based on formative research at primary healthcare Services in Mexico.International journal for equity in health · 2021Trial
- Volunteers' experiences of providing telephone-based breast-feeding peer support in the RUBY randomised controlled trial.Public health nutrition · 2020Trial
- Online participatory intervention to promote and support exclusive breastfeeding: Randomized clinical trial.Maternal & child nutrition · 2019Trial
- Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh.The Journal of nutrition · 2018Trial
- Combining Intensive Counseling by Frontline Workers with a Nationwide Mass Media Campaign Has Large Differential Impacts on Complementary Feeding Practices but Not on Child Growth: Results of a Cluster-Randomized Program Evaluation in Bangladesh.The Journal of nutrition · 2016Trial
- Trial
- Socio-Cultural Experiences of Exclusive Breastfeeding Among Banjar Mothers in Indonesia.Healthcare (Basel, Switzerland) · 2026Article
- Disseminating and Implementing the Science of Pediatric Obesity Treatment and Prevention.Obesity (Silver Spring, Md.) · 2026Article
- How is health equity considered in scale-up guidance? A scoping review of process models for scaling public health innovations.Health promotion international · 2026Article
- Perspective: Infant Feeding Policies among Women Living with HIV in Latin America and the Caribbean: Should They Be Updated?Advances in nutrition (Bethesda, Md.) · 2026Article
- Digital Insights into Workplace Breastfeeding in Indonesia: A Google Trends Analysis of Barriers and Opportunities.Nutrients · 2025Article
73 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Breastfeeding (BF) promotion is one of the most cost-effective interventions to advance mother-child health. Evidence-based frameworks and models to promote the effective scale up and sustainability of BF programs are still lacking. A systematic review of peer-reviewed and gray literature reports was conducted to identify key barriers and facilitators for scale up of BF programs in low- and middle-income countries. The review identified BF programs located in 28 countries in Africa, Latin America and the Caribbean, and Asia. Study designs included case studies, qualitative studies, and observational quantitative studies. Only 1 randomized, controlled trial was identified. A total of 22 enabling factors and 15 barriers were mapped into a scale-up framework termed "AIDED" that was used to build the parsimonious breastfeeding gear model (BFGM). Analogous to a well-oiled engine, the BFGM indicates the need for several key "gears" to be working in synchrony and coordination. Evidence-based advocacy is needed to generate the necessary political will to enact legislation and policies to protect, promote, and support BF at the hospital and community levels. This political-policy axis in turn drives the resources needed to support workforce development, program delivery, and promotion. Research and evaluation are needed to sustain the decentralized program coordination "gear" required for goal setting and system feedback. The BFGM helps explain the different levels of performance in national BF outcomes in Mexico and Brazil. Empirical research is recommended to further test the usefulness of the AIDED framework and BFGM for global scaling up of BF programs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.