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"Since around 20 to 25% of adolescent boys and 10% of adolescent girls have at least one same-sex sexual encounter."

click save page each year thousands of adolescents in the United States have a childt the teenage pregnancies has decreased the past two decades  in 2012 the birth rate for US teenagers was the lowest reported in the past 70 years, the time the government has been tracking pregnancies birth rates decline to historic lows not  all racial and ethnic groups there are still differences with the rate of teenage births higher for non-Hispanic Blacks and Hispanics than for whites  the preg rate of teenagers is 34.3 births per thousand

Birth rates have declined attributed by sociologists to kighgh school sex education the rates of a teenager's first sexual encounter and continued rates of intercourse have declined the percent of teenage girls who have never had sexual intercourse dropped from 51% in 1988 to 43% in 2006 to 2010 the use of condoms and other forms of contraception has increased for example virtually all sexually experienced girls aged 15 to 19 have reported using some method of contraception substitutes for sexual intercourse may be put more prevalent for example data from the 1995 national survey of adolescent males found that about half of 15 to 19-year-old boys reported having received oral sex and increase of 44% since the late 1980s it may be possible that oral sex is something teenagers do not even consider sex it may be increasing and viewed as an alternative to oral intercourse to sexual intercourse some organizations conduct events that encourage adolescents to take a virginity pledge this is usually done publicly and it is included in some forms of sex education. Overall, taking a virginity pledge has not resulted in a reduction in teenage pregnancies one result of taking a virginity pledge was that those who did so delayed the start of sexual activity and average of 18 months

Teenage mothers are less likely to be married or to get married tan older, single mothers. Teenage mothers often care for their children without assistance of the child's father. The eenage mothers lack financial and emotional support from others. In some instances the teenage mother discontinues her own education. She may take jobs that are relatively unskilled or are low-paying. In some cases teenage preg develops into long-term dependency upon welfare teenage mothers have been shown to suffer physical and mental health problems related to the stress from the continual demands on her time.

bf An increasing number of publications have evaluated various bfdg peer counsel- ing models. This article describes a systematic review of (a) the randomized trials assess- ing the effectiveness of bfdg peer counseling in improving rates of bfdg initiation, duration, exclusivity, and maternal and child health outcomes and (b) scientific literature describing the scale-up of bfdg peer counseling programs. Twenty-six peer-reviewed publications were included in this review. The overwhelming majority of evidence from randomized controlled trials evaluating bfdg peer counseling indi- cates that peer counselors effectively improve rates of bfdg initiation, duration, and exclusivity. Peer counseling interventions were also shown to ly decrease  the incidence of infant diarrhea and  ly increase the duration of lactational amen- orrhea. bfdg peer counseling initiatives are effective and can be scaled up in both developed and developing countries as part of well-coordinated national bfdg promotion or maternal-child health programs. J Hum Lact. 26(3):314-326.

10.1177/0890334410369481 DOI: 10.1177/0890334410369481 bfdg peer counseling (PC) has been used in developed and developing countries, with examples ranging from La Leche League International to com- munity health worker models. Likely because of fund- ing priorities, scientific research has primarily focused on the effectiveness of PC in improving the breastfeed- ing outcomes of low-income women.

Lay support for bfdg has been addressed in previous reviews1,2; however, it was not the primary focus of those reports. Bhandari et al3 recently pub- lished a systematic review regarding the scaling up of exclusive bfdg (EBF) (ie, increasing the num- ber of EBF promotion recipients while maintaining quality and promoting sustainability3). That useful review, however, concentrated on EBF promotion within the context of HIV/AIDS in sub-Saharan Africa. An increasing number of randomized trials are evalu- ating various bfdg PC models. Our objectives are to systematically review the scientific literature evaluating (a) the effectiveness of bfdg PC in improving rates of bfdg initiation, duration, exclusivity, and maternal and child health outcomes and (b) the scale-up of bfdg PC programs.

included in the initiation section are shown in hree of the 4 high- intensity interventions improved bfdg initiation rates. In a  evaluating a PC intervention among low-income, primarily minority women delivering in Hartford, Connecticut, Chapman et al12 found that women in the PC group were  ly more likely to initiate bfdg compared with controls (90% vs 77%, respectively). When testing a more intensive PC intervention (3 prenatal, daily perinatal, 9 postpar- tum home visits) in this community, with  ly higher breast- feeding initiation rates among those in the intervention group versus controls (90% vs 76%, respectively).

Video intervention: presented BF benefits and shown in WIC waiting area. WIC staff discussed video and provided written materials. PC intervention: 3 prenatal and weekly pp contacts through 16 wk pp. Topics covered: infant feeding attitudes, misconceptions, support sessions.

One high-intensity intervention found no statisti- cally  difference in bfdg initiation rates between   groups. Morrow et al15 investigated the effect of 6 versus 3 prenatal and postpartum peer counselor home visits in a low-income neighborhood in Mexico City to determine their effect on bfdg initiation. bfdg initiation was nearly universal (6-visit group, 100%; 3-visit group, 98%; controls, 94%); thus, no effect of the intervention was observed for this outcome. ==space

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The 3 low-intensity interventions were not success- ful. and in-person support to British women considering bfdg. The majority of contacts were via tele- phone. No significant differences in bfdg ini- tiation were observed between the intervention and control grou

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Ayrshire, Scotland, found no significant difference in breastfeed- ing initiation rates between their PC and control groups. This intervention provided 1 prenatal visit of unspeci- fied length and did not include peer counselor contact in the hospital, which is often a critical time for breast- feeding initiation. In the third study, MacArthur et al14 delivered a peer support intervention in Birmingham, United Kingdom, involving 2 antenatal support sessions. There was no difference in initiation rates between the peer counselor and control groups (69% and 68%, respectively). This study had limited PC coverage (41% of the intervention group received both visits) and brief counseling sessions (mean duration of

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These  suggest that it is important to include both antenatal and perinatal PC within interventions designed to increase bfdg initiation rates, with the majority of contacts being in pers

Breastfeeding maternal benefits

Breastfeeding maternal benefits are those benefits to the mother who is breastfeeding her infant. These benefits can happen during the time the child is breastfed but then extend to the period in the mother's life after the infant is weaned. <!--

Physical health
Breastfeeding can improve and enhance the physical health of the breastfeeding mother. Breastfeeding and depression in the mother are associated. Mothers who successfully breastfeed are less likely to develop postpartum depression. Breastfeeding significantly increases the time that the mother has no 'periods', known as lactational amenorrhea. This benefit to women with limited access to contraception is helpful in spacing the birth of other children.

Mother and infant bonding
Breastfeeding mothers have been found to have a strong bonding with their infant.

Psychological health
The emotional well-being of the mother is enhanced.

Community health
One benefit to the breastfeeding mother is that she is able to aid new mothers, mothers who have not previously breastfed their infants, and mothers who have not been taught breastfeeding techniques. Many programs have demonstrated the positive benefits to the community by mothers who are or who have breastfed. These women are called breastfeeding peer counselors. They are local women, instructing their peers in the context of their culture and language. They possess the understanding of the culture, context, barriers. Not only do they provide community health benefits by their own expertise in breastfeeding, they receive training in breastfeeding education. The maternal benefits of their own experience extends to their peers to improve breastfeeding outcomes that benefits the whole community.

Maternal bond
Hormones released during breastfeeding help to strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates. Support for a breastfeeding mother can strengthen familial bonds and help build a paternal bond.

Fertility
Exclusive breastfeeding usually delays the return of fertility through lactational amenorrhea, although it does not provide reliable birth control. Breastfeeding may delay the return to fertility for some women by suppressing ovulation. Mothers may not ovulate, or have regular periods, during the entire lactation period. The non-ovulating period varies by individual. This has been used as natural contraception, with greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed.

Hormonal
Breastfeeding releases beneficial hormones into the mother's body. Oxytocin and prolactin hormones relax the mother and increase her nurturing response. This hormone release can help to enable sleep. Breastfeeding soon after birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Pitocin, a synthetic hormone used to make the uterus contract during and after labour, is structurally modelled on oxytocin. Syntocinon, another synthetic oxytocic, is commonly used in Australia and the UK rather than Pitocin.

Weight loss
It is unclear whether breastfeeding causes mothers to lose weight after giving birth.

Reduced cancer risk
For breastfeeding women, long-term health benefits include reduced risk of breast cancer, ovarian cancer, and endometrial cancer. Four of the 6 new  included in this section delivered a high- intensity intervention. Agrasada and colleagues17 eval- uated a PC intervention targeting mothers of low birth weight infants born in the Philippines. At 6 months postpartum, those receiving the PC intervention were ly more likely to be bfdg compared with the reference and control groups (63% vs 31% and 29%, respectively).

Brazil and discharged within 5 days postpartum. The investigators observed that compared with the intervention group, higher rates of bfdg cessation at 4 months postpartum

countrie
Brazil and discharged within 5 days postpartum. The investigators observed that compared with the intervention group, higher rates of bfdg cessation at 4 months postpartum (20% vs 33%, respectively).

healthy infants in a neonatal intensive care unit in Boston, Massachusetts, Merewood and colleagues19 observed ly higher odds of any bfdg at 12 weeks postpartum in their inter- vention group, which received weekly peer counselor visits for 6 weeks, compared with controls.

evaluated a unique combina- tion of a peer counselor partnered with a nurse. In this small  (N = 41) conducted in the US mid-Atlantic region, the PC group tended to have higher breast- feeding rates at 6 months than controls (45 vs 35%, respectively). However, the difference between the groups was not, possibly because of the small sample size.

telephone-based inter- vention conducted in Montreal, Mongeon et al21 eval- uated a volunteer PC model that provided 1 prenatal home visit, weekly telephone contact for the  ft

Brazil and discharged within 5 days postpartum. The investigators observed that compared with the intervention group, higher rates of bfdg cessation at 4 months postpartum (20% vs 33%, respectively).

healthy infants in a neonatal intensive care unit in Boston, Massachusetts, Merewood and colleagues19 observed ly higher odds of any bfdg at 12 weeks postpartum in their inter- vention group, which received weekly peer counselor visits for 6 weeks, compared with controls.

evaluated a unique combina- tion of a peer counselor partnered with a nurse. In this small  (N = 41) conducted in the US mid-Atlantic region, the PC group tended to have higher breast- feeding rates at 6 months than controls (45 vs 35%, respectively). However, the difference between the groups was not, possibly because of the small sample size.

telephone-based inter- vention conducted in Montreal, Mongeon et al21 eval- uated a volunteer PC model that provided 1 prenatal home visit, weekly telephone contact for the  first

in Mexico,

Osun State, Nigeria;

Dhaka City, Bangladesh;

Houston, TX, USA;

Bhandari and colleagues27 evaluated the effective- ness of a community-based intervention promoting EBF in Haryana State, India. This intervention used multiple  channels,  including  traditional    birth attendants, community health workers, community rep- resentatives, nurse midwives, and other health care workers, to deliver EBF messages. ly more infants in the intervention group were exclusively bfdg at 3, 4, 5, and 6 months postpartum compared with controls.

Research conducted in the Philippines by EBF at 6 months post- partum were ly higher among mothers in the

low-income, inner-city Latinas in Hartford, Connecticut, PC group were  ly more likely to exclusively breastfeed throughout the   compared with controls. At 3 months postpartum, mothers in the PC group were almost 15 times more likely to be exclusively breast- feeding compared with controls.

Most recently, Hopkinson and Konefal Gallagher26 conducted a unique trial in Houston, Texas, among mothers of full-term Latino infants at low risk for hyperbilirubinemia who were receiving both breast milk and formula. The trial sought to determine whether assigning mixed feeders to a bfdg clinic appointment, where they met with a peer coun- bfdg Peer Counseling on Maternal and Child Health Outcomes

ow birth weight infants in Brazil, observed higher rates of EBF at 4 months postpartum in the intervention (vs control) group. Similarly, in the telephone-based PC intervention evaluated rates were ly higher throughout the   in the intervention (vs control) group. These  suggest that in some settings, PC programs that are designed to promote initiation or duration may actually improve bfdg exclusivity as well.

EBF reported improved EBF rates in their intervention , but this difference was not statistically. Muirhead et al16 observed that mothers in the PC   tended to be more likely to avoid using formula at 16 weeks post- partum (14%) compared with   s (8 %). There was no difference in EBF rates at 1 month postpartum

The overwhelming majority of  evaluated in this section found a positive impact of peer counselors on EBF practices. Those that did not report a signifi- cant impact of peer counselors on EBF were not designed to improve this outcome. PC, peer counseling; pp, postpartum.

results The maternal and child health benefits of breast- feeding have long been recognized. We identified 5 trials (Table 4) examining the effect of bfdg PC on rates of infant diarrhea. Bhandari et al27 evalu- ated the effectiveness of a community-based EBF intervention in Haryana, India, using prevalence of infant diarrhea as the primary outcome. Results showed   less incidence of diarrhea in the past week at both 3 and 6 months after the intervention in the intervention vs    infants (22% vs 30% and 25 vs 28%, respectively). The incidence of diarrheal epi- sodes requiring treatment was   lower in the intervention    (vs   s) at both time points. Four trials evaluated infant diarrhea as a secondary outcome. Morrow and colleagues15 reported that con- trol   infants were    more likely to experience diarrhea through 3 months postpartum compared with infants whose mother received the intervention (26% vs 12%). Similarly, in a  con- ducted in Hartford, Connecticut,   and col- leagues10 found that       infants were    more likely to experience 1 or more diar- rhea episodes compared with those in the PC    (38 vs 18%, respectively; risk ratio, 2.15; 95% CI. 1.16- 3.97). These findings were confirmed by Agrasada et al,17 who reported that infants in their child care  reference

and      experienced rates of diarrhea that were nearly twice that of the PC    (28%, 31%, and 15%, respectively). Furthermore, infants in this trial who were exclusively breastfed experienced no diarrhea. observed a non-  reduction in the number of new cases of diarrhea within 21 days of their intervention (12% intervention, 22%   s). Thus, all 5  that assessed infant diarrhea demonstrated reduced rates of diarrhea among infants whose mothers received the PC intervention, with the difference being   in 4 of 5.

in rates of maternal amenorrhea as a secondary outcome in their PC trial. Extended duration of lactation-induced maternal amenorrhea is associated with decreased fer- tility rates, which is important for women who are not using modern methods of contraception. reported   that more women in the PC    remained amenorrheic through 3 months postpartum compared with   s (53% vs 33%, respectively).

Peer counselor training. The training provided to bfdg peer counselors in these randomized tri- als varied widely and is summarized in Table 5. In several, few details were provided regarding the training process.

Bolivia, Ghana, and Madagascar28,29 identified the impact of community-based programs in improving the rates of timely initiation of bfdg (TIBF; ie, breast- feeding within 1 hour after birth) and EBF during the first month. Evaluators used a longitudinal  design lasting 3 to 4 years. In all 3 countries, the scaling- up process involved formative research, policy analysis and advocacy, materials development, training of health care providers including community health workers, social marketing, and multisectorial partner- ships. In Madagascar, 12 000 community volunteers were trained in bfdg promotion. Results from repeated representative  community  surveys showed statistically  improvements in both TIBF and EBF during the first 6 months associated with the scaling-up interventions. Improvements were detected as early as 9 months after the beginning of the imple- mentation. The impact on these outcomes was sus- tained during the 3 to 4 years that the  was conducted.

Philippines dem- onstrated that it was possible to develop a network of well-trained bfdg peer counselors at the barangay level (smaller administrative unit), based on a community-driven initiative with strong support from national and local authorities.30 A pre–post  design showed that 3 PC home visits to women with children younger than 2 months old who were not exclusively bfdg led to impressive improve- ments in the rates of any bfdg and EBF. As a result, the PC program has been replicated in 9 addi- tional barangays. This program is being tied to the ongoing effort by the country’s department of health to improve health care services to 1 million people living in low-income urban areas.

in Pakistan  that community health workers (known as “lady health workers”) responsible for the delivery of diverse home and primary health care–based education and services can    improve rates of colos- trum feeding.31 This model is of interest for scaling up because it   that it is possible to improve some bfdg outcomes through existing national or regional community health worker programs without forming a new cadre of bfdg peer counselors. Brazil has launched the Baby-Friendly Primary Health Care Unit Initiative (BFPHCI) in an attempt to adhere to the tenth step of the Baby-Friendly Hospital Initiative. This new initiative includes 10 steps32,33 that should be met at the local primary health care unit (ie, not at the hospital level) to promote and support bfdg at the community level. Some of these steps include bfdg training for all primary health care unit staff, including community health agents (equivalent to peer counselors),34 and the for- mation of bfdg support  s. In the state of Rio de Janeiro, where BFPHCI has been scaled up,32,33 EBF rates among children younger than 6 months were    higher among primary health care    units-->