Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial

Kate Jolly; Joanne Clarke; Nicola Crossland; Stephan Dombrowski; Eleni Gkini; Pat Hoddinott; Jenny  Ingram; Debbie G F Johnson; Christine MacArthur; Mia Mann; Jennifer McKell; Ngawai Moss; Tracy  Roberts; Julia Sanders; Nicola Savory; Alice Sitch; Beck Taylor; S Tearne; Gill Thomson; Eleanor Williams; Rebecca Woolley; The ABA-feed study group

doi:10.1136/bmj-2025-086558

Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial

Kate Jolly^*, Joanne Clarke, Nicola Crossland, Stephan Dombrowski, Eleni Gkini, Pat Hoddinott, Jenny Ingram, Debbie G F Johnson, Christine MacArthur, Mia Mann, Jennifer McKell, Ngawai Moss, Tracy Roberts, Julia Sanders, Nicola Savory, Alice Sitch, Beck Taylor, S Tearne, Gill Thomson, Eleanor WilliamsRebecca Woolley, The ABA-feed study group

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Objective

To assess the effect of a proactive, assets based, peer support infant feeding intervention in addition to usual care on breastfeeding rates, formula feeding practices, and other outcomes, compared with usual breastfeeding support alone.

Design

UK based, multicentre, parallel group, unblinded, randomised controlled trial.

Setting

17 localities in the UK that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024.

Participants

2475 nulliparous women between 20 and 35 weeks of gestation were randomised 1.43:1, to account for potential clustering by peer supporter: 1458 to the ABA-feed (Assets based feeding help Before and After birth-feed) peer support intervention and 1017 to usual care.

Interventions

The ABA-feed intervention comprised person centred proactive peer support for infant feeding underpinned by an assets based approach (focusing on the capabilities of, and resources available to, participants) and behaviour change theory delivered in person and remotely by text and telephone call. Usual care included universal care from midwives and health visitors and could also include services that provided reactive support such as peer supporters in breastfeeding groups, counselling, helplines, and social media support groups.

Main outcome measures

The primary outcome was any breastfeeding at eight weeks after birth. Secondary outcomes at eight, 16, and 24 weeks after birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support, and healthcare utilisation. Analyses were based on the intention-to-treat principle.

Results

Rates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04. Preplanned subgroup analyses showed no interactions between the intervention and age, prespecified feeding intentions, mother’s education, index of multiple deprivation fifth, or relationship status. Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks. No differences were observed in other secondary outcomes.

Conclusion

The ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context.

Trial registration ISRCTN Registry ISRCTN17395671.

Original language	English
Article number	e086558
Pages (from-to)	e086558
Number of pages	13
Journal	British Medical Journal
Volume	392
DOIs	https://doi.org/10.1136/bmj-2025-086558
Publication status	Published - 31 Mar 2026

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Publisher Copyright:
© Author(s) (or their employer(s)) 2019.

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Jolly, K., Clarke, J., Crossland, N., Dombrowski, S., Gkini, E., Hoddinott, P., Ingram, J., Johnson, D. G. F., MacArthur, C., Mann, M., McKell, J., Moss, N., Roberts, T., Sanders, J., Savory, N., Sitch, A., Taylor, B., Tearne, S., Thomson, G., ... The ABA-feed study group (2026). Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial. British Medical Journal, 392, e086558. Article e086558. https://doi.org/10.1136/bmj-2025-086558

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title = "Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial",

abstract = "ObjectiveTo assess the effect of a proactive, assets based, peer support infant feeding intervention in addition to usual care on breastfeeding rates, formula feeding practices, and other outcomes, compared with usual breastfeeding support alone. DesignUK based, multicentre, parallel group, unblinded, randomised controlled trial. Setting17 localities in the UK that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024. Participants2475 nulliparous women between 20 and 35 weeks of gestation were randomised 1.43:1, to account for potential clustering by peer supporter: 1458 to the ABA-feed (Assets based feeding help Before and After birth-feed) peer support intervention and 1017 to usual care. InterventionsThe ABA-feed intervention comprised person centred proactive peer support for infant feeding underpinned by an assets based approach (focusing on the capabilities of, and resources available to, participants) and behaviour change theory delivered in person and remotely by text and telephone call. Usual care included universal care from midwives and health visitors and could also include services that provided reactive support such as peer supporters in breastfeeding groups, counselling, helplines, and social media support groups. Main outcome measuresThe primary outcome was any breastfeeding at eight weeks after birth. Secondary outcomes at eight, 16, and 24 weeks after birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support, and healthcare utilisation. Analyses were based on the intention-to-treat principle. ResultsRates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8\%) and usual care group (698/1015; 68.8\%); adjusted risk difference 0.01, 95\% confidence interval −0.03 to 0.04. Preplanned subgroup analyses showed no interactions between the intervention and age, prespecified feeding intentions, mother{\textquoteright}s education, index of multiple deprivation fifth, or relationship status. Breastfeeding initiation rates were high (intervention 94.2\%; usual care 92.5\%). At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks. No differences were observed in other secondary outcomes. ConclusionThe ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context. Trial registration ISRCTN Registry ISRCTN17395671.",

author = "Kate Jolly and Joanne Clarke and Nicola Crossland and Stephan Dombrowski and Eleni Gkini and Pat Hoddinott and Jenny Ingram and Johnson, \{Debbie G F\} and Christine MacArthur and Mia Mann and Jennifer McKell and Ngawai Moss and Tracy Roberts and Julia Sanders and Nicola Savory and Alice Sitch and Beck Taylor and S Tearne and Gill Thomson and Eleanor Williams and Rebecca Woolley and \{The ABA-feed study group\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. ",

year = "2026",

month = mar,

day = "31",

doi = "10.1136/bmj-2025-086558",

language = "English",

volume = "392",

pages = "e086558",

journal = "British Medical Journal",

issn = "0959-8138",

publisher = "BMJ Publishing Group",

}

Jolly, K, Clarke, J, Crossland, N, Dombrowski, S, Gkini, E, Hoddinott, P, Ingram, J , Johnson, DGF, MacArthur, C, Mann, M, McKell, J, Moss, N, Roberts, T, Sanders, J, Savory, N, Sitch, A, Taylor, B, Tearne, S, Thomson, G, Williams, E, Woolley, R & The ABA-feed study group 2026, 'Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial', British Medical Journal, vol. 392, e086558, pp. e086558. https://doi.org/10.1136/bmj-2025-086558

TY - JOUR

T1 - Peer support intervention (ABA-feed) to improve breastfeeding

T2 - UK based, multicentre, parallel group, randomised controlled trial

AU - Jolly, Kate

AU - Clarke, Joanne

AU - Crossland, Nicola

AU - Dombrowski, Stephan

AU - Gkini, Eleni

AU - Hoddinott, Pat

AU - Ingram, Jenny

AU - Johnson, Debbie G F

AU - MacArthur, Christine

AU - Mann, Mia

AU - McKell, Jennifer

AU - Moss, Ngawai

AU - Roberts, Tracy

AU - Sanders, Julia

AU - Savory, Nicola

AU - Sitch, Alice

AU - Taylor, Beck

AU - Tearne, S

AU - Thomson, Gill

AU - Williams, Eleanor

AU - Woolley, Rebecca

AU - The ABA-feed study group

PY - 2026/3/31

Y1 - 2026/3/31

N2 - ObjectiveTo assess the effect of a proactive, assets based, peer support infant feeding intervention in addition to usual care on breastfeeding rates, formula feeding practices, and other outcomes, compared with usual breastfeeding support alone. DesignUK based, multicentre, parallel group, unblinded, randomised controlled trial. Setting17 localities in the UK that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024. Participants2475 nulliparous women between 20 and 35 weeks of gestation were randomised 1.43:1, to account for potential clustering by peer supporter: 1458 to the ABA-feed (Assets based feeding help Before and After birth-feed) peer support intervention and 1017 to usual care. InterventionsThe ABA-feed intervention comprised person centred proactive peer support for infant feeding underpinned by an assets based approach (focusing on the capabilities of, and resources available to, participants) and behaviour change theory delivered in person and remotely by text and telephone call. Usual care included universal care from midwives and health visitors and could also include services that provided reactive support such as peer supporters in breastfeeding groups, counselling, helplines, and social media support groups. Main outcome measuresThe primary outcome was any breastfeeding at eight weeks after birth. Secondary outcomes at eight, 16, and 24 weeks after birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support, and healthcare utilisation. Analyses were based on the intention-to-treat principle. ResultsRates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04. Preplanned subgroup analyses showed no interactions between the intervention and age, prespecified feeding intentions, mother’s education, index of multiple deprivation fifth, or relationship status. Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks. No differences were observed in other secondary outcomes. ConclusionThe ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context. Trial registration ISRCTN Registry ISRCTN17395671.

AB - ObjectiveTo assess the effect of a proactive, assets based, peer support infant feeding intervention in addition to usual care on breastfeeding rates, formula feeding practices, and other outcomes, compared with usual breastfeeding support alone. DesignUK based, multicentre, parallel group, unblinded, randomised controlled trial. Setting17 localities in the UK that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024. Participants2475 nulliparous women between 20 and 35 weeks of gestation were randomised 1.43:1, to account for potential clustering by peer supporter: 1458 to the ABA-feed (Assets based feeding help Before and After birth-feed) peer support intervention and 1017 to usual care. InterventionsThe ABA-feed intervention comprised person centred proactive peer support for infant feeding underpinned by an assets based approach (focusing on the capabilities of, and resources available to, participants) and behaviour change theory delivered in person and remotely by text and telephone call. Usual care included universal care from midwives and health visitors and could also include services that provided reactive support such as peer supporters in breastfeeding groups, counselling, helplines, and social media support groups. Main outcome measuresThe primary outcome was any breastfeeding at eight weeks after birth. Secondary outcomes at eight, 16, and 24 weeks after birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support, and healthcare utilisation. Analyses were based on the intention-to-treat principle. ResultsRates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04. Preplanned subgroup analyses showed no interactions between the intervention and age, prespecified feeding intentions, mother’s education, index of multiple deprivation fifth, or relationship status. Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks. No differences were observed in other secondary outcomes. ConclusionThe ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context. Trial registration ISRCTN Registry ISRCTN17395671.

U2 - 10.1136/bmj-2025-086558

DO - 10.1136/bmj-2025-086558

M3 - Article (Academic Journal)

C2 - 41916664

SN - 0959-8138

VL - 392

SP - e086558

JO - British Medical Journal

JF - British Medical Journal

M1 - e086558

ER -

Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial

Abstract

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