To evaluate the effects of Baby Friendly Initiative (BFI) community training on breastfeeding rates, staff and mothers in a large Primary Care Trust (PCT).

UK Government policy promotes the adoption and implementation of the World Health Organization/United Nations Children's Fund BFI as the best evidence to raise breastfeeding initiation and prevalence.

A total of 141 health visitors and nursery nurses were trained on mandatory three-day BFI courses during 2008; 137 staff (100 health visitors, 37 nursery nurses) took part in the evaluation. Breastfeeding attitudes, knowledge and staff confidence in helping mothers to breastfeed were measured using a validated Breastfeeding Questionnaire and a self-efficacy tool at three time points before and after training.

Breastfeeding rates at eight weeks increased significantly, and a baby born in 2009 was 1.57 times more likely to be breastfed than one born in 2006. Statistically significant improvements in staff breastfeeding attitudes, knowledge and self-efficacy were seen after attending the course, in addition to increases in the appropriate management of breastfeeding problems.

Process evaluation interviews with 43 health visitors, nursery nurses and managers explored views of the training and changes in practice. The response to the course was overwhelmingly positive and felt to be extremely worthwhile. It has led to renewed enthusiasm, improved the consistency of advice among team members and raised confidence levels of all staff who help mothers with breastfeeding. Health visitors felt confident about enabling nursery nurses to take a greater role in breastfeeding support. A small survey of mothers reported increases in exclusive breastfeeding and signs of increased breastfeeding self-efficacy.

Making the training mandatory across the whole PCT has improved the consistency of breastfeeding advice and confidence of all health-care staff who help breastfeeding mothers.