In-Depth Breastfeeding Training for Healthcare Professionals: A Systematic Review

Background

Improving breastfeeding rates is a global public health priority requiring a multi-factorial approach which targets sociocultural and health system changes (Rollins et al., 2016). As part of this multi-factorial approach, healthcare professionals (HCPs) among others, play a crucial role in supporting the initiation, establishment, and continuation of breastfeeding (Ikobah et al., 2020). To provide culturally appropriate evidence-based breastfeeding support, HCPs need education that enhances their knowledge and skills and improves their practice (Yang et al., 2018). Lack of education and inconsistency in information given to families can translate into early cessation of breastfeeding (Hauck et al., 2011; Khoury et al., 2002; Pérez-Escamilla, 2019; Simmons, 2002). This can lead to early introduction of infant formula and an increase in health risks for the mother–infant dyad.

On one side, there is no international consensus on how much and what depth of breastfeeding training HCPs should have (Mulcahy et al., 2022), and on the other, many HCPs do not have enough breastfeeding knowledge. The need for more breastfeeding education for HCPs post registration contrasts with the lack of standardisation of educational opportunities as shown in Mulcahy and colleagues’ (2022) systematic review. In this systematic review, post registration refers to continuous education, further learning, or any qualification a professional undertakes after completing their university degree or gained their license to practice. Exploring data from different levels of trainings, five systematic reviews (Balogun et al., 2017; Beake et al., 2011; De Jesús et al., 2016; Gavine et al., 2017; Spiby et al., 2009) showed a lack of standardisation regarding: hours of education, curricula content, and competency-based frameworks. Gavine and colleagues’ (2017) systematic review urged for high quality studies to inform effective breastfeeding training options. The terms “education” and “training” are often used interchangeably. According to Blair and Serafini (2016) training is more focus oriented and specific, shorter, and provides practical skills. Education has a broader, more formal, connotation and can last several years. “Training” is used in this review because what is studied does not always correspond to formal education.

To provide clarity around the levels of trainings, the Lactation Management Curriculum Guide was developed by Wellstart International. The aim was to integrate breastfeeding management knowledge and skills in the curriculum of medicine, nursing, and nutrition programmes (Wellstart International, 2009), and it defined three levels of professional responsibility. This curriculum guide is not an established way of categorising lactation training and is not widely used. However, it informed our review’s classification given that the current literature has no universally accepted distinction in levels of lactation trainings needed for HCPs. This classification includes training hours and scope of practice. Grounded on Bloom’s revised taxonomy, breastfeeding education should distinguish between levels of thinking or cognitive complexity, which require more structured learning (Bloom, 2014). In addition, as suggested by Ericsson’ theory of deliberate practice, learning incorporates a progression from basic knowledge to practical application and ultimately leads to depth of specialisation (Ericsson, 2008).

Level I (basic) refers to pre-registration/university education for medical students and other HCPs who will not specialise in prenatal or post-natal care but who need to learn the fundamentals of breastfeeding. Level I ensures a minimum competency and should be universal, given to all HCPs who encounter breastfeeding dyads. The length and depth vary with some professionals feeling ill-prepared once they have graduated (Dodgson et al., 2014). Level II (intermediate) refers to training as a subject either during pre-registration or post-registration education and its purpose is consistency of knowledge and skills among HCPs. An example of a Level II training is the United Nations Children Fund (UNICEF) Baby Friendly Hospital Initiative (BFHI), which is 20 hours long (World Health Organisation & UNICEF, 2020) and offers a multidisciplinary programme with supervised clinical work (WHO, 2020). The available breastfeeding training literature makes the distinction between pre-registration and UNICEF BFHI training but does not define in-depth training. As there are no universally accepted criteria for in-depth training, we adopted an “arbitrary” length of more than 20 hours as a cut-off. Level III (advanced) refers to “in-depth” training for those who specialise in breastfeeding care, such as International Board Certified Lactation Consultants (IBCLCs), those who are in charge of delivering UNICEF BFHI training, or Breastfeeding and Lactation Medicine Physicians. Level III HCPs supervise, mentor and teach Level I and Level II staff. Thus, Level III includes trainings greater than 20 hours, defined as the minimum structured hours needed to introduce more advanced knowledge and skills and align with certain competency frameworks. It reflects a shift in cognitive complexity and scope of practice, not just duration.

Globally, there are formal programmes (Master’s degrees or Post Graduate Diplomas in Human Lactation/Infant Feeding) and numerous Level III informal, yet comprehensive trainings. Some serve as preparation to the International Board Lactation Consultants Examiners (IBLCE) examination. IBCLCs are breastfeeding and lactation care experts. The IBLCE examination requires 95 hours of education in addition to 1000 clinical hours (depending on the eligibility pathways) (IBCLC Commission, 2023). Thus, most IBCLC trainings are by definition in-depth.

Pre-registration breastfeeding training (Level I) has been studied widely in medicine and nursing (Mulcahy et al., 2022; Sandhi et al., 2023). An unpublished umbrella review aimed to integrate the results of multiple systematic reviews and meta-analyses into a comprehensive exploration of the impact of interdisciplinary training (formal such as UNICEF BFHI or non-accredited). Numerous systematic reviews have already examined the impact of the UNICEF BFHI training (Level II; Balogun et al., 2017; Beake et al., 2011; De Jesús et al., 2016; Gavine et al., 2017; Spiby et al., 2009; Ward & Byrne, 2011). For these reasons, we conducted a systematic review to expand understanding of how in-depth trainings (Level III) can assist HCPs in gaining knowledge and skills, and improve breastfeeding related outcomes.

Methods

Sample: Defining the Articles Reviewed

This systematic review used a framework adapted from the Joanna Briggs Institute (JBI; Aromataris & Munn, 2020) comprising a combination of PICO and PICo, that is, PICOS (Population/participants, Interventions/Phenomena of interest, Comparison/Context, Outcomes, and Study type). The pre-determined study eligibility criteria are detailed in Table 1. Studies were eligible to be included if participants were registered HCPs, studies used a pretest post-test and examined any in-depth breastfeeding training. In the absence of an agreed definition of in-depth training (Level III), we defined it as longer than the 20-hour UNICEF BFHI course which can be considered a Level II. Studies from 2003 onwards were eligible to be included to align with the WHO/UNICEF Global Strategy for Infant and Young Child Feeding, which aimed to ameliorate the development and health of children by encouraging optimal feeding practices (WHO, 2003). Full articles that were available in English, Spanish, or French were included; all other languages were excluded.

OPEN IN VIEWER

Table 1.

Inclusion/Exclusion Criteria.

PICOS	Inclusion Criteria	Exclusion Criteria
Population/ Participants	Qualified or registered HCPs, defined as having obtained knowledge and skills from studying at a higher education institute which grants them a first degree or higher qualification (WHO, 2020) IBCLCs (even though they are not recognised as stand-alone HCPs) have been included as many participate in the healthcare team and some attend training to re-certify with CERPS Any age, nationality, sex, or ethnicity	Pre-registration breastfeeding education Breastfeeding counsellors or peer supporters as they have different scopes of practice
Intervention/ Phenomenon of Interest	Any breastfeeding training which exceeded 20 hours (Level III) Any training which prepares students for the IBLCE examination Any teaching strategy (in-person, virtual or any multi-instructional format), with or without a clinical component	Any UNICEF BFHI training Any breastfeeding training which is up to and including 20 hours
Context/Comparison	Studies in any country(ies) which are hospital-based, community-based or a mixture Comparators could be no training
Outcomes	At least one of the following outcomes: (1) breastfeeding knowledge and skills in course students; (2) breastfeeding rates in settings where HCPs attending in-depth training work; (3) changes in hospitals’ practice or women’s perception of support received by those HCPs who have undertaken in-depth breastfeeding training; and (4) HCPs’ experiences and perceptions of in-depth breastfeeding training, including their motivation to attend and their learning needs	Studies which focused on other outcomes such as the impact of other breastfeeding initiatives (i.e., BFHI 10 steps)Studies that described training without data on these outcomes
Study Type	Primary research that used quantitative, qualitative, or mixed methods designsUnpublished studies and reports such as evidence summaries, evaluations of courses and PhD dissertationsStudies in English, Spanish or FrenchStudies published from 2003 to 2024	Systematic reviews and meta-analysesFull articles in other languagesStudies published prior to 2003

Note. HCP = healthcare professional, BFHI = Baby Friendly Hospital Initiative, IBCLC = International Board Certified Lactation Consultant, UNICEF = United Nations Children’s Fund, WHO = World Health Organisation, CERPS = Continuing Education Recognition Points program.

The electronic searches found 4,394 records (see Figure 1). After duplicates were removed, 2,965 records remained for title and abstract screening of which 2,905 were irrelevant. A total of 59 full texts were retrieved and assessed for eligibility and 56 studies were excluded. No further published material or other references from grey literature were found. Three quantitative studies were included in the review; no qualitative or mixed-methods studies were found. One study (Watkins et al., 2017) involved non-HCPs as well as HCPs, and it was not possible to isolate HCP data. The training met the length of the inclusion criteria, and because most participants were HCPs it was included. Given that the number of studies was small and there was heterogeneity in the outcome measurements, meta-analysis was not possible.

OPEN IN VIEWER

Figure 1.

PRISMA flow.

Data Analysis

Methodical steps were employed for data analysis. Using Covidence, data were extracted and tabulated to allow comparison of the baseline characteristics of the sample. The data extracted is summarised in Tables 2 and 3. Table 2 presents the setting, the study design, the aim of the study and sample size as well as type of HCPs. Table 3 summarises training type, outcomes measured and how these were measured. The methodological robustness of each study and the risk of bias were measured. The quality of studies was examined with validated tools. The Mixed Methods Appraisal Tool (MMAT; Hong et al., 2018) was used to appraise the quality of studies, as it allows for the evaluation of empirical studies (qualitative, RCT, non-RCT studies, quantitative descriptive and mixed-methods studies).

OPEN IN VIEWER

Table 2.

Characteristics of Included Studies.

Author and Year	Setting (Date of Study)	Study Design	Aim of Study	Sample Size (n) and Participants
McGuinness et al. (2025)	IrelandParticipants attended the training in 2023	Pre and post educational study	To evaluate the knowledge, attitudes and practice of HCPs after completing of a university graduate programme for breastfeeding and lactation	n = 55 of which:n = 20 nursesn = 21 midwivesn = 14 allied health professionals (which included doctors, dieticians, physiotherapists and IBCLCs)
Pessa Valente et al. (2021)	ItalyHCPs attended the training in 2017–2020	Longitudinal with development, implementation and assessment phase	To develop a Problem Based Learning (PBL) curriculum for a short in-service training on breastfeeding and to assess the effect on knowledge and skills	n = 105 of which:n = 20 doctors (n = 8 paediatricians,n = 12 gynaecologists) n = 44 midwives, n = 27 nurses, and n = 14 other professionals
Watkins et al. (2017)	U.S.Participants completed the online training in 2014	A non-experimental pre-test–post-test self-report design	To investigate if after a 45-hr lactation course: breastfeeding knowledge, beliefs and attitudes improved; perceived behavioural control over performance of evidence-based lactation support improved and intentions to carry out evidence-based lactation support practices increased	n = 71 of which:n = 28 registered nursesn = 6 registered dieticiansn = 2 medical office personneln = 2 midwifen = 1 midwife assistantn = 1 nurse practitioner

Note. HCP = healthcare professional, IBCLC = International Board Certified Lactation Consultant.

OPEN IN VIEWER

Table 3.

Summary of Variables and Instruments.

Author and Year	Training Length and Type	Variables Measured	Instruments Used to Measure Each Variable	Reliability And Validity of Each Instrument
McGuinness et al. (2025)	A 6 month graduate pro- gramme, composed of blended learning (synchronous and asynchronous learning) with a student workload of 250 hours	(1) Breastfeeding knowledge and practices measured through a pre (T0) and post-tests (T1 right after and T2 after 4- 6 months)	A validated tool (Theodoridis et al., 2021)	No description of reliability but some validity
Pessa Valente et al. (2021)	29 hours in-person course to be delivered in four days over four consecutive weeks	(1) Breastfeeding knowledge and practices measured through a pre (T0) and post-tests (T1 right after and T2 after 4–6 months)(2) Breastfeeding rates measured between 2017–2019(3) Learning needs	A mix of unspecified multiple-choice questionsLearning needs were assessed via an online survey	No description
Watkins et al. (2017)	45 hours	(1) Breastfeeding knowledge and skills through a pre and post-test	A modified version of the Breastfeeding Knowledge Questionnaire (Dodgson & Tarrant, 2007) and the Minnesota Infant Feeding Questionnaire (Duckett et al., 1988)	No description but some validity

The JBI checklist for quasi-experimental studies (non-randomised experimental studies) was used to assess the risk of bias (Tufanaru et al., 2020). Quality appraisal of all studies was conducted by one reviewer and checked by a second reviewer. The results of quality appraisal were not used to exclude studies but to report on the overall quality of the evidence. The last phase involved contrasting and interpreting the results found across the studies. A narrative synthesis supported this as it helped facilitate the investigation of differences and similarities, evaluate the strength of evidence, and provide a summary of knowledge based on the review questions (Lisy & Porritt, 2016).

Results

The Intervention

The variables measured and instruments to measure these are presented in Table 3. The length of each training and delivery modes varied. The training for the Pessa Valente et al. (2021) study was 29 hours, delivered in person. The Watkins et al. (2017) was 45 hours long and took place through an online platform. The McGuinness et al. (2025) study was 250 hours long and used a blended learning approach.

The TIDieR framework evaluated in-depth the quality of reporting (see Table 4). Overall, there was either a lack of data or insufficient reporting from most studies, which is necessary for a comprehensive exploration. Despite being the shortest training, the Pessa Valente and colleagues’ (2021) study gave detailed information on the materials used as well as the learning activities and was the only study that specified the use of a pilot course to test the curriculum, timetable, manuals, and learning materials. Watkins et al. (2017) described in detail their syllabus. The McGuinness et al. (2025) only stated the main themes (see online Supplementary File 2). These two studies (McGuinness et al., 2025; Watkins et al., 2017) did not report whether the intervention was modified or adhered to once it was delivered. None of the studies described if and how the trainings were evaluated by the team delivering them and if improvements were identified for future cohorts.

OPEN IN VIEWER

Table 4.

Quality of reporting of health interventions according to TIDieR (Hoffmann et al., 2014).

Item number	Item	McGuiness et al., 2025	Pessa Valente et al., 2021	Watkins et al., 2017
1.	Brief nameProvide the name or a phrase that describes the intervention	Yes	Yes	Yes
2.	Why Describe any rationale, theory, or goal of the elements essential to the intervention	Yes	Yes	Yes
3.	What (materials) Describe any physical or informational materials used in the intervention	Not reported	Yes	Not reported
4.	What (procedures) Describe each of the procedures, activities, and/or processes used in the intervention	Not reported	Yes	Not reported
5.	Who provided Describe expertise, background and any specific training given for intervention provider(s)	Not reported	Yes	Yes
6.	How Modes of Intervention whether provided individually or in a group delivery	Yes	Yes	Yes
7.	Where Type(s) of location(s) where Intervention occurred including necessary infrastructure or relevant features	Yes	Yes	Yes
8.	When and how much Describe number of times intervention was delivered and over what period of time including number of sessions, their schedule, duration, and intensity	Reported but not fully	Yes	Reported but not fully
9.	Tailoring If intervention tailoring was planned, describe what, why, when, and how	N/A	N/A	N/A
10.	Modification If intervention was modified, describe the changes	Not reported	Yes	Not reported
11.	How well planned If intervention adherence or fidelity was assessed, describe how and by whom, and if strategies were used to maintain or improve fidelity, describe them	Not reported	Yes	Not reported
12.	How well (actual) If intervention adherence or fidelity was assessed, describe the extent to which it was delivered as planned	Not reported	Not reported	Not reported

Quality Appraisal

The quality of the study methodology is essential to permit conclusions to be drawn from the outcomes (Hong et al., 2018). The results from the MMAT are in a summary in Table 5. The study by Pessa Valente et al. (2021) used an adequate sampling strategy; the sample was representative of the target population; the measurements and statistical analysis were appropriate. For these two studies (McGuinness et al., 2025; Watkins et al., 2017) either confounders were not accounted in the design and analysis or they were not complete.

OPEN IN VIEWER

Table 5.

Methodological Quality Assessment Using the Mixed Methods Appraisal Tool (Hong et al., 2018).

Quantitative Non-Randomised	(1) Are participantsrepresentative of the targetpopulation?	(2) Are measurementsregarding both the outcomeand the interventionappropriate?	(3) Are there completeoutcome data?	(4) Are confounders accountedfor in design and analysis?	(5) Was the interventionadministered as intendedduring the study period?
McGuinness et al. (2019)	Yes	Yes	Yes	Yes some	Yes
Watkins et al. (2017)	Yes	Yes	Yes	No	Yes
Quantitative Descriptive
Pessa Valente et al. (2021)	(1) Is the sampling strategy relevant to address the research question?	(2) Is the sample representative of the target population?	(3) Are the measurements appropriate?	(4) Is the risk of nonresponse bias low?	(5) Is the statistical analysis appropriate to answer the research question?
	Yes	Yes	Yes	Yes	Yes

The JBI critical appraisal checklist showed how the risk of bias differed across the different domains (see Figure 2). There was no ambiguity in terms of the temporal relationship, between “cause” and “effect.” There is a risk of selection bias when randomisation is not used. Random selection could have made the studies more robust, but the samples seem representative. The validity of the causal inferences was weak for most studies. No study used a control group. Only the Pessa Valente and colleagues’ (2021) study had two post-tests’ measurements and this is important to measure knowledge retention. Not all participants in the three studies (McGuinness et al., 2025; Pessa Valente et al., 2021; Watkins et al., 2017) completed the post-test, which represents a threat to the internal validity and potentially attrition and analysis bias (Cherry et al., 2024). Given how knowledge and skills were tested the outcome measurements could be unreliable. Only the Pessa Valente and colleagues’ (2021) study declared funding from the Regional Health Authority of Friuli Venezia Giulia. Thus, it is not possible to ascertain if there could be funding bias for the other two studies. The overall risk of bias for all studies was high.

OPEN IN VIEWER

Figure 2.

Summary risk of bias.

Discussion

The fact that this systematic review only found three studies to include shows that more research is urgently needed in regard to in-depth breastfeeding training. Given the small number of studies and the limitations, these results must be interpreted with caution. No randomised controlled trials (RCTs) were included in this review, and these could provide stronger evidence. Balogun and colleagues’ (2017) Cochrane review proposed randomisation for a UNICEF BFHI training between staff taking and not taking training, and this could be done similarly for in-depth breastfeeding trainings.

Overall, in-depth training was found to increase course participants’ knowledge as well as their skills. Studies in our review focused mainly on knowledge acquisition. No studies evaluated the impact that HCPs who attend in-depth training might have on hospital practices. Murphy et al. (2019) argued that the aim of HCP’s training is to increase knowledge, improve self-efficacy, and apply knowledge into practice. Watkins et al. (2017) warned that all layers of the organisation need to be involved so that education is not a bandaid to promote evidence-based practice. For HCPs to apply this new knowledge into practice, institutional changes are needed including changes in the philosophy of the wards. Spiby and colleagues’ (2009) systematic review demonstrated that this change must take place. Hannula and colleagues’ (2008) systematic review showed that HCPs need to be supported by their organisations to be able to practice and cement knowledge assimilation and long-term retention.

Breastfeeding rates were only measured in one study. The influence of training on breastfeeding rates is difficult to isolate from other factors. Training as a stand-alone intervention is not the only reason for improvement in breastfeeding rates (Gavine et al., 2017). Other factors such as: BFHI 10 steps implementation (Fallon et al., 2019), personal breastfeeding experience (Brodribb et al., 2008), and sociodemographic factors, may have contributed. A systematic review (Mulcahy et al., 2022) showed that it is essential to measure at different timepoints, as this can reflect measurable outcomes in terms of breastfeeding rates. The paucity of data in our review implies that it was not possible to assess the impact of in-depth training on breastfeeding rates.

No qualitative studies were included, showing a knowledge gap around women’s perception of support received by those HCPs who undertake in-depth training, as well as HCPs’ experiences of and motivations to attend in-depth trainings. To study the levels of satisfaction in families who received lactation care from HCPs with in-depth training (for example IBCLCs or Breastfeeding Medicine specialists) would be important for all families but also for clinically complex cases. Clinically complex breastfeeding dyads sometimes have been seen by many HCPs who have not been able to resolve their issues. A study by Glassman et al. (2022) collected qualitative data of mothers’ perception of support by a paediatrician/IBCLC in a medical home and reported high levels of satisfaction. In addition, the importance of training participants being able to discuss their own positive or negative breastfeeding experiences (personal and professional) was not raised in the studies. However, other research suggests that this can have a significant impact on parental satisfaction. When HCPs participate in breastfeeding training where there is an allocated space to debrief and reflect about their own breastfeeding experiences, their attitudes can be improved and parental satisfaction increases (Ekstrom et al., 2012, Ekstrom & Thorstensson, 2015).

In this review, only the Pessa Valente and colleagues’ (2021) study reported that, through the pre-education phase, HCPs were encouraged to co-create and define their learning needs. There is an intimate interplay between learning needs and motivation to learn (Filgona et al., 2020). People are motivated to attend training because of certain learning needs, or on some occasions the employer might have identified learning deficits. Little is known on what HCPs want or need to learn when they join in-depth breastfeeding training.

This review did not find any studies which addressed the outcome related to HCPs motivation to attend in-depth training. There has been little research on motivational factors, or their relevance to breastfeeding training (Pérez-Escamilla et al., 2016). Having the motivation to join in-depth training is a behaviour influenced by a multitude of intrinsic and extrinsic factors (Ryan & Deci, 2000). Intrinsic motivation examples include: interest/passion (in the topic), mastery (seeking professional improvement), lactation qualification (becoming an IBCLC) or challenge (facing complex breastfeeding cases). Extrinsic factors include: work requirement, material rewards, professional recognition, career progression, or social respect. Self-determination theorists explain that rather than being one or the other, motivation exists along a continuum (Barta, 2024). Within breastfeeding education research, neither intrinsic nor extrinsic motivational factors have been studied for in-depth training.

No study explored the relationship between the demographic characteristics and the outcomes. Unreported or not evaluated characteristics can act as potential confounders. Only McGuinness and colleagues’ (2025) study specified having two groups (IBCLCs and non-IBCLC students) which were compared. IBCLCs can choose to attend in-depth training when they need to recertify. Having attended lactation trainings and being an IBCLC can be an advantage in terms of knowledge and practice. Cantrill et al. (2003) showed in their Australian study that midwives’ knowledge was significantly correlated to three predictors: holding a lactation qualification, having breastfed for more than 3 months, and having substantial clinical experience.

In the three included studies, in-depth lactation training was multidisciplinary. This has advantages to single or bi-profession training as it can ensure that all HCPs “speak” the same language, promoting true continuity of care (Bernstein et al., 2022) and breaking down disciplinary barriers (Morrison & Chamberlain, 2024). Mulcahy and colleagues’ (2022) systematic review recommended an interdisciplinary approach to be used when delivering breastfeeding skills-based training. A systematic review found that when BFHI Step 10, which emphasises “coordination among HCPs at discharge” was implemented it helped mothers maintain breastfeeding (Pérez-Escamilla et al., 2016). In addition, if HCPs have the same knowledge base and follow BFHI Step 10, this can have a greater impact on health outcomes.

This review has highlighted poor reporting and reporting is essential to assess pedagogical robustness. The information reported regarding many trainings can be scant, vague, or merely descriptive (Navarro et al., 2021). The length, the curriculum content, the delivery mode, the professional background of the teaching faculty, and whether there is a clinical component, are some examples. Not all studies in this review specified the trainer’s professional background or teaching experience. Spiby and colleagues’ (2009) systematic review urged investigation of the differences in outcomes based on the delivery of training by trainers with different backgrounds. Pérez-Escamilla (2025) stressed that IBCLCs play a key role in building and creating human resources in lactation as they provide breastfeeding education at all levels. Balogun and colleagues’ (2017) systematic review underlined the difficulty in adopting a universal breastfeeding curriculum due to the huge variation in training materials, and this certainly applies to in-depth trainings too. Boss and colleagues’ (2021) systematic review suggested publishing an online manual which would describe in more detail the intervention development process, which could permit replicability.

This review found only one study which examined an in-depth training that could be considered given its length as a stepping stone for the IBCLC credential (McGuinness et al., 2025). However, the number of in-depth IBCLC training courses has most likely grown around the world for these two reasons. First, there is a clear need to fill the gap in knowledge for those who specialise in breastfeeding. Second, the number of IBCLCs around the world keeps increasing; currently 38,154 in 134 countries (IBLCE, 2025). Yet, there is no international directory of these in-depth trainings. IBCLE’s Preferred Provider is a directory which advertises continuous education (CERPS) programmes. In the United States, the Lactation Education Accreditation and Approval Review Committee (LEAARC) has a directory of its accredited programmes (LEAARC, 2020).

Future research should focus on finding out why HCPs are attending in-depth trainings (including IBCLCs trainings) around the world, who they are, if minority groups are accessing them and to what extent, and who funds the training (employers or individuals). Given IBCLCs’ key role in maternal and infant health, investigating the impact of IBCLC trainings sets a research priority. Pérez-Escamilla (2025) stressed that IBCLCs need to be included in all healthcare systems (Pérez-Escamilla, 2025). E. M. Chetwynd and colleagues’ (2019) systematic review showed that face-to-face support by an IBCLC increased rates of breastfeeding at 6 months. Pascual and colleagues’ (2025) systematic review and meta-analysis found that IBCLC support offered during hospitalisation and continued through the post period could improve breastfeeding outcomes. In Italy, having one IBCLC in a medical centre increased initiation rates by 10% and maternal satisfaction by 33% (Chiurco et al., 2015).

Further studies could reveal which professions seek IBCLC training, for what reasons and what motivates those who already hold a degree and sometimes have many years of experience in maternity care to pursue the IBCLC qualification. The IBCLC qualification has not yet been recognised as a stand-alone credential and IBCLCs are not considered allied HCPs around the world. Studying the impact of IBCLCs in-depth trainings could lead to more effective use of resources by providing an evidence-based curriculum for in-depth training for HCPs. In the long run it could facilitate the integration and recognition of IBCLCs as allied HCPs.

Limitations

This review has several limitations. Given the novel scope of the research topic, the number of studies included in the review was limited. Meta-analysis could not be achieved as there was insufficient or dissimilar data. None of the qualitative questions were answered due to a lack of studies. HCPs need different breastfeeding training (including content, length, and depth) based on their scope of practice and professional responsibility. Another limitation is that there are no universally accepted criteria for in-depth training and therefore we used an “arbitrary” length of more than 20 hours as a cut-off. Data extraction was not performed in duplicate, but it was checked by a second reviewer (due to limited resources). There was language bias as full articles which were not available in English, Spanish, or French, were not considered so we may have missed publication in other languages.

Conclusion

As far as we were aware, this was the first systematic review to assess in-depth breastfeeding training globally. Only three quantitative studies were found. All three studies looked at breastfeeding knowledge as an outcome. Based on the findings of this review, we cannot make recommendations other than to highlight the urgent need for further research. International consensus is needed on different levels of lactation training required by HCPs depending on how much contact they have with breastfeeding dyads. Future research should address the methodological and conceptual limitations of the studies found. Future studies should also measure a wider range of outcomes and use validated tools to test knowledge. Given that lactation support is a crucial public health target, the gap in knowledge is a priority for future research of in-depth trainings, including those leading to the IBCLC qualification.

Supplemental Material