Increasing breastfeeding initiation and duration at a community level: an evaluation of Sagkeeng First Nation's community health nurse and peer counselor programs.

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 (median 5 vs 4, P = .07). Qualitative interviews (n = 22) confirmed PC clients as more satisfied and more confident about breastfeeding, with fewer problems and more information.