Understanding the research
When reading these papers it is important to consider the methodology, sample sizes, response rates and reported findings to determine their relevance. Where systematic reviews or meta-analyses are available, allowing analysis of findings from a number of well-selected studies, these obviously provide a stronger evidence base on which it is possible to base arguments with greater conviction.
It is always important to bear in mind the following when considering the strength of any evidence:
- Carrying out randomised controlled trials which are clearly recognised as the “gold standard” is not always possible as it is not ethical to randomly allocate mothers in a way which arbitrarily may decide that half of the group will bottle feed
- Many studies are flawed by staff or mothers deviating from the protocol, as this may seem counter-intuitive or too hard to follow in the situation in which they are being cared for or living
- Sample sizes, particularly for older infants, become very small, particularly in countries such as the UK with low breastfeeding continuation rates/exclusivity; it is therefore difficult to accurately infer statistics
- In specialist areas such as caring for preterm infants, it is difficult to recruit mothers at such difficult times; again, small numbers are reflected in a lack of solid evidence about many aspects of care
- Breastfeeding may be documented as having a “small protective effect” against certain illnesses. Whilst it is clearly accurate to say that that the risk of not breastfeeding is greater with some conditions than others, what is a “small protective effect” in one child is likely to have a much more dramatic effect across a whole population.