Effectiveness of Mobile App–Based Peer Support on Breastfeeding Outcomes Amongst Pregnant Women and Postpartum Mothers: A Global Systematic Review
1
Institute of Epidemiology and Health Care, University College London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Despite global recommendations promoting exclusive breastfeeding (EBF) for the first six months of life, fewer than 40% of infants achieve this target due to persistent socioeconomic, cultural, and systemic barriers. Mobile health (mHealth) technologies offer scalable breastfeeding support solutions, though the effectiveness of digitally delivered peer support across contexts remains underexplored. This systematic review and meta-analysis searched PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published between 1 January 2010 and 1 May 2025 (PROSPERO: CRD420251164765). Studies included pregnant or postpartum women (up to 12 months postpartum) receiving peer support via mHealth applications compared with standard care or non-peer digital interventions. Primary outcomes were exclusive and any breastfeeding rates, with secondary outcomes including breastfeeding self-efficacy, duration, frequency, initiation, attitudes, and satisfaction. Data were synthesized narratively, and pooled estimates were calculated using random-effects meta-analysis. From 3,102 identified records, seven RCTs involving 3,591 participants were included in high-and upper-middle-income counties. No studies from low income country. Interventions primarily delivered peer support via mobile apps or proactive phone calls, incorporating group chats, mentoring, and real-time messaging. Pooled analyses showed significant improvements in exclusive breastfeeding (RR = 1.16, 95% CI 1.05–1.27, p < 0.01) and any breastfeeding (OR = 1.34, 95% CI 1.10–1.62, p < 0.01) with no heterogeneity (I² = 0%). Sensitivity analyses confirmed effect robustness. Mothers reported higher confidence, satisfaction, and perceived support, particularly when culturally relatable peers and interactive features were included. Overall, mHealth-based peer support significantly enhanced breastfeeding outcomes in high-and upper-middle-income contexts, where digital access is widespread. However, dropout rates, digital inequities, and cultural differences limited engagement and global applicability. Future research should emphasise inclusive, context-adapted designs, trials in low- and middle-income countries, and long-term evaluations to strengthen global breastfeeding promotion strategies.
Despite global recommendations promoting exclusive breastfeeding (EBF) for the first six months of life, fewer than 40% of infants achieve this target due to persistent socioeconomic, cultural, and systemic barriers. Mobile health (mHealth) technologies offer scalable breastfeeding support solutions, though the effectiveness of digitally delivered peer support across contexts remains underexplored. This systematic review and meta-analysis searched PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published between 1 January 2010 and 1 May 2025 (PROSPERO: CRD420251164765). Studies included pregnant or postpartum women (up to 12 months postpartum) receiving peer support via mHealth applications compared with standard care or non-peer digital interventions. Primary outcomes were exclusive and any breastfeeding rates, with secondary outcomes including breastfeeding self-efficacy, duration, frequency, initiation, attitudes, and satisfaction. Data were synthesized narratively, and pooled estimates were calculated using random-effects meta-analysis. From 3,102 identified records, seven RCTs involving 3,591 participants were included in high-and upper-middle-income counties. No studies from low income country. Interventions primarily delivered peer support via mobile apps or proactive phone calls, incorporating group chats, mentoring, and real-time messaging. Pooled analyses showed significant improvements in exclusive breastfeeding (RR = 1.16, 95% CI 1.05–1.27, p < 0.01) and any breastfeeding (OR = 1.34, 95% CI 1.10–1.62, p < 0.01) with no heterogeneity (I² = 0%). Sensitivity analyses confirmed effect robustness. Mothers reported higher confidence, satisfaction, and perceived support, particularly when culturally relatable peers and interactive features were included. Overall, mHealth-based peer support significantly enhanced breastfeeding outcomes in high-and upper-middle-income contexts, where digital access is widespread. However, dropout rates, digital inequities, and cultural differences limited engagement and global applicability. Future research should emphasise inclusive, context-adapted designs, trials in low- and middle-income countries, and long-term evaluations to strengthen global breastfeeding promotion strategies.
| eISSN: | 2654-1459 |
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