Can Help From a Trained Peer Keep Breastfeeding Going? What Two New Studies Found

How a UK study of intensive one-to-one helpers (Jolly et al., BMJ 2026) and a Hong Kong study of video calls (Lok et al., JAMA Network Open 2026) tested support from trained volunteer peer supporters

A large UK study and a Hong Kong study tested whether support from trained volunteer peer supporters helps first-time mothers keep breastfeeding. In the UK, regular contact from pregnancy to eight weeks after birth did not change how many babies were getting breast milk. In Hong Kong, two video calls did not change breastfeeding at six months, but more babies were fed only breast milk at two months and mothers felt more confident.

Why breastfeeding support matters to families

Many parents start out breastfeeding and then find, within days or weeks, that it is harder than they expected. Sore nipples, worries about whether the baby is getting enough, broken sleep and conflicting advice can all wear down a new mother's confidence. For many families, stopping earlier than planned is a source of real disappointment. That is why researchers keep asking a practical question: what kind of help actually makes a difference?

How peer support became part of the picture

Doctors and scientists have studied breastfeeding for decades. A major international review in 2016 brought together evidence that breastfeeding helps protect babies against infections and protects mothers against breast cancer, and estimated that if almost all babies were breastfed, around 823,000 young children's deaths and 20,000 deaths from breast cancer could be prevented each year worldwide [1]. It also noted that mothers in wealthier countries tend to breastfeed for a shorter time than mothers in poorer ones.

One idea that grew popular is "peer support", which means help from a trained volunteer or lay supporter rather than a health professional, often someone who has been through a similar experience. Researchers have studied carefully what peer support means in health care [2]. In some lower-income countries, this worked remarkably well. In Mexico City, for example, mothers who received six home visits from trained peer counsellors were far more likely to be feeding only breast milk at three months: 67% did so, compared with 12% of mothers without visits [3]. A study in Burkina Faso, Uganda and South Africa, called PROMISE-EBF (a study of exclusive breastfeeding promotion by peer counsellors), also found large gains in two of the three countries [4].

In the UK, however, the story was different. A careful review in 2012 found that peer support had not made a clear difference in UK studies [5]. One large UK study placed peer supporters in antenatal clinics and found that about 69% of women started breastfeeding with or without them [6], and the same service did not help women keep going for longer [7]. In another study, volunteer counsellors were available but breastfeeding rates did not change, possibly because some women did not ask for help [8]. A large summary of 116 studies worldwide concluded that extra support probably helps mothers keep breastfeeding for longer overall, but the evidence was less certain for breastfeeding at two months [9]. Meanwhile, an Australian study called Ringing Up about Breastfeeding earlY (RUBY), carried out in three hospitals in the state of Victoria, found that when trained volunteer mothers phoned first-time mothers regularly after birth, more babies were still getting breast milk at six months: 75% compared with 69% [10].

These mixed results led researchers to ask two different questions. Would a more intensive, more personal form of help, starting in pregnancy and offered to every first-time mother, finally work in the UK? And would short video calls aimed at mothers who wanted to breastfeed but felt unsure of themselves help them in the early weeks?

Two studies, two different approaches

The UK study was called the Assets based feeding help Before and After birth-feed (ABA-feed) trial [11]. "Assets" here means the strengths a mother already has, such as supportive family, friends and local services. It took place in 17 local areas across England, Wales and Scotland where breastfeeding rates were low. Between January 2022 and January 2024, 2,475 women expecting their first baby joined, whether or not they planned to breastfeed. A computer decided at random which women would get the extra help, so the groups could be compared fairly. About three in five (1,458) were matched with a trained "infant feeding helper", usually a volunteer peer supporter. The helper met them at around 30 weeks of pregnancy to talk about feeding and about who could support them, then offered a daily text or phone call for the first two weeks after birth and kept in touch until the baby was eight weeks old. The other 1,017 women received normal care from midwives and health visitors.

The Hong Kong study took place on the postnatal wards of four public hospitals [12]. It enrolled 442 first-time mothers who wanted to breastfeed but scored low on a questionnaire measuring breastfeeding confidence, which researchers call "self-efficacy" [13]. Babies born early, born small or needing intensive care were not included. Half the mothers (224) were offered two 30-minute video calls with a trained volunteer mother, at about 10 days and one month after birth, on top of normal care. The other 218 received normal care, which already included help from breastfeeding specialists in hospital. The two studies were run separately at around the same time, and neither research team refers to the other's work.

What the researchers found

In the UK study, the extra help made almost no difference. At eight weeks, about 70 in every 100 babies in each group were getting at least some breast milk: 69.8% with a helper and 68.8% without [11]. There was also no difference in how many babies were fed only breast milk, or in breastfeeding at 16 and 24 weeks. Mothers with a helper did report feeling a little better supported, and some measures suggested slightly less anxiety, at eight weeks, but these differences had faded by 16 weeks. Rates of babies needing hospital care were similar in both groups, and no serious problems were linked to the helpers.

In the Hong Kong study, the main goal was to see whether more babies would be fed only breast milk at six months. They were not, by a clear enough margin: about 20 in every 100 babies in the video-call group compared with about 16 in every 100 in the other group, a gap that could have happened by chance [12]. At two months, though, there was a clearer difference: about 27 in every 100 babies in the video-call group were fed only breast milk, compared with 19 in every 100. That early advantage did not hold up clearly at four or six months. The mothers who were offered calls did feel more confident about breastfeeding by four months. How many babies were getting at least some breast milk was similar in both groups throughout. Only about two in three mothers joined the first call, and just over half joined the second. The study did not report on possible harms.

What this means for you and your baby

If you are expecting your first baby, these studies are reassuring in one way: in places where midwives, health visitors and hospital specialists already support breastfeeding, most mothers who want to breastfeed do so for some time, with or without a peer supporter. Extra contact from a volunteer did not, by itself, change that. If you would like peer support, many mothers value it; in the UK study, women from many different backgrounds, including younger mothers and those planning to use formula, found the helpers acceptable, whether contact was in person or remote [14].

If you want to breastfeed but feel unsure, the Hong Kong results suggest that talking with an experienced mother in the early weeks may help build your confidence. Confidence matters: earlier research among Chinese mothers found that mothers who felt more confident were more likely to feed only breast milk [15]. Any feeding worry that involves your baby's health, such as poor weight gain or difficulty latching, should still be checked by your midwife, health visitor or doctor. In[Neo]Sight has a separate article on tongue tie and the procedure used to treat it, and parents of babies in neonatal care may find our article on breastfeeding support in the neonatal intensive care unit (NICU) useful.

What researchers are working on next

The UK team concluded that offering this intensive help to every first-time mother should not be rolled out, but that support aimed at communities where fewer babies are breastfed deserves careful testing. In the UK study, the differences between groups looked slightly larger among mothers in the poorest areas and among those planning to combine breast and formula feeding, but these could be chance findings. A review of support delivered by phone or online has also suggested that it may help with feeding only breast milk more than with breastfeeding overall [16]. Future studies are likely to focus on reaching mothers sooner after birth, on mothers who feel least confident, and on whether the cost is worthwhile; an earlier Australian analysis suggested phone-based peer support could be good value [17].

The bottom line

Neither study met its main goal. Intensive peer support offered to every first-time mother in the UK did not change how many babies were breastfed, and two video calls in Hong Kong did not change feeding at six months. The Hong Kong study did suggest an early boost in feeding only breast milk and a rise in mothers' confidence that was still present at four months. For families, peer support remains one helpful option among many, especially for mothers who want to breastfeed and would welcome someone who has been there before.

References

  1. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490. doi:10.1016/S0140-6736(15)01024-701024-7) ↩
  2. Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40(3):321-332. doi:10.1016/S0020-7489(02)00092-500092-5) ↩
  3. Morrow AL, Guerrero ML, Shults J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999;353(9160):1226-1231. doi:10.1016/S0140-6736(98)08037-408037-4) ↩
  4. Tylleskär T, Jackson D, Meda N, et al. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet. 2011;378(9789):420-427. doi:10.1016/S0140-6736(11)60738-160738-1) ↩
  5. Jolly K, Ingram L, Khan KS, Deeks JJ, Freemantle N, MacArthur C. Systematic review of peer support for breastfeeding continuation: metaregression analysis of the effect of setting, intensity, and timing. BMJ. 2012;344:d8287. doi:10.1136/bmj.d8287 ↩
  6. MacArthur C, Jolly K, Ingram L, et al. Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial. BMJ. 2009;338:b131. doi:10.1136/bmj.b131 ↩
  7. Jolly K, Ingram L, Freemantle N, et al. Effect of a peer support service on breast-feeding continuation in the UK: a randomised controlled trial. Midwifery. 2012;28(6):740-745. doi:10.1016/j.midw.2011.08.005 ↩
  8. Graffy J, Taylor J, Williams A, Eldridge S. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. BMJ. 2004;328(7430):26. doi:10.1136/bmj.328.7430.26 ↩
  9. Gavine A, Shinwell SC, Buchanan P, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2022;10(10):CD001141. doi:10.1002/14651858.CD001141.pub6 ↩
  10. Forster DA, McLardie-Hore FE, McLachlan HL, et al. Proactive Peer (Mother-to-Mother) Breastfeeding Support by Telephone (Ringing up About Breastfeeding Early [RUBY]): A Multicentre, Unblinded, Randomised Controlled Trial. EClinicalMedicine. 2019;8:20-28. doi:10.1016/j.eclinm.2019.02.003 ↩
  11. Jolly K, Clarke J, Crossland N, et al. Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial. BMJ. 2026;392:e086558. doi:10.1136/bmj-2025-086558 ↩
  12. Lok KYW, Ip CHL, Dai Y, et al. Video-Based Peer Support and Exclusive Breastfeeding and Maternal Self-Efficacy: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(5):e2614490. doi:10.1001/jamanetworkopen.2026.14490 ↩
  13. Ip WY, Yeung LS, Choi KC, Chair SY, Dennis CL. Translation and validation of the Hong Kong Chinese version of the breastfeeding self-efficacy scale-short form. Res Nurs Health. 2012;35(5):450-459. doi:10.1002/nur.21493 ↩
  14. Clarke J, Crossland N, Dombrowski S, et al. Experiences of the ABA-Feed Infant Feeding Intervention: A Qualitative Study With Women, Peer Supporters and Coordinators. Matern Child Nutr. 2025:e70124. doi:10.1111/mcn.70124 ↩
  15. Loke AY, Chan LK. Maternal breastfeeding self-efficacy and the breastfeeding behaviors of newborns in the practice of exclusive breastfeeding. J Obstet Gynecol Neonatal Nurs. 2013;42(6):672-684. doi:10.1111/1552-6909.12250 ↩
  16. Gavine A, Marshall J, Buchanan P, et al. Remote provision of breastfeeding support and education: Systematic review and meta-analysis. Matern Child Nutr. 2022;18(2):e13296. doi:10.1111/mcn.13296 ↩
  17. McLardie-Hore FE, Forster DA, McLachlan HL, et al. Is proactive telephone-based breastfeeding peer support a cost-effective intervention? A within-trial cost-effectiveness analysis of the 'Ringing Up about Breastfeeding earlY' (RUBY) randomised controlled trial. BMJ Open. 2023;13(6):e067049. doi:10.1136/bmjopen-2022-067049 ↩