The benefits, challenges and impacts of accessing social media group support for breastfeeding: A systematic review

Abstract Breastfeeding support is a key component in meeting the public health responsibility of increasing breastfeeding rates, with access to individualised, convenient and linked support across services central to improved outcomes. With the rise of new technology and the COVID‐19 pandemic, social media (SM) support for breastfeeding has become increasingly popular and it is important to understand how and why mothers access such support, and from whom, to optimise services and to meet mothers’ needs. Increasing research is building on women's use and experience of SM for breastfeeding, although there is a paucity of UK data. This systematic review aimed to understand the impacts of SM support for breastfeeding, including benefits and challenges, to establish the evidence for wider provision within maternity services. The search was limited to studies published in English and focused on the self‐directed use of social media groups for breastfeeding (defined as platforms that facilitate group support via interactivity, allowing for user‐generated content and subsequent responses). Of 327 papers retrieved, 13 studies were included for review. The six themes identified were: breastfeeding context, including factors impacting women's decision making; the relational impact of belonging to an online community; increased self‐efficacy; critiques of SM; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. The findings confirm that mothers value SM groups for community support, which normalises breastfeeding and provides the support they attribute to improved outcomes, and highlight that UK research focused on provision linked to wider services is needed.


| INTRODUCTION
Breastfeeding is well established as protective of infant and maternal health, but the United Kingdom has some of the lowest breastfeeding rates in the world (McAndrew et al, 2012;Victora et al., 2016). This has serious public health implications, impacting individuals across the lifespan (Indrio et al, 2017). Despite high levels of intention and motivation to breastfeed, women are struggling to meet their breastfeeding goals, with many stopping before they feel ready (Brown, 2019). This current societal failure to support those mothers who want to breastfeed to meet their goals carries economic, psychosocial, and health burdens across generations (Brown, 2019;Rollins et al., 2016;Victora et al., 2016).
Improved education around how breastfeeding works, how to overcome challenges and understanding of normal baby behaviour, alongside practical and emotional support with breastfeeding, is needed-and desired-by new mothers (Brown, 2017). A wide body of research shows that breastfeeding support, delivered by a range of individuals including professional, trained peers and lay supporters, is a key component in meeting the public health responsibility of increasing UK breastfeeding rates. This support works best when it is high quality, consistent and tailored to the setting (McFadden et al., 2017).
Integral to this is peer support; support delivered by a social network of other mothers who have breastfed, sometimes with or without formal breastfeeding support training (Dykes, 2005). Although research examining outcomes of peer support on breastfeeding rates is mixed, often due to inconsistencies in delivery and measurement (Trickey et al., 2018), the research is clear that mothers value peer support (Thomson & Trickey, 2013). It is most effective when delivered in conjunction with professional support across a combination of settings (Ingram, 2013;Sinha et al., 2015). However, due to a combination of funding cuts and COVID-19, many mothers are increasingly struggling to access face-to-face peer support and are frequently turning to online support to fill the gap (Black et al., 2020;Brown & Shenker, 2020;Regan & Brown, 2019).
With the rise of smartphone use and widespread access to social media (SM) platforms (Aichner et al., 2021), SM communities are now central to accessing parenting support. Seventy-five percent of the global population aged over 13 years are SM users, and Facebook currently has 2.9 billion active monthly users (Data Reportal, 2022), creating a large platform from which to access support and social connection. As a result, most new mothers now use SM to seek advice and believe SM is a beneficial form of support during the transition to parenthood (Baker & Yang, 2018). The need for this support and connection has been heightened during the COVID pandemic, isolating new parents from their existing physical social networks, and preventing the development of new ones (Brown & Shenker, 2021). Although evidence reviews have concluded face-toface support for breastfeeding is most effective, (McFadden et al., 2017), SM functionality and use have changed considerably since the data they examined was collected. As the provision of online breastfeeding support has become more widespread and accessibility has improved, mothers are engaging with it and reporting benefits (Morse & Brown, 2021).
It is important to understand how and why mothers use SM to access breastfeeding support and which mothers find it useful to build on this provision, targeting services effectively. Scoping searches identified several systematic reviews that have provided insight into the evidence available. However, these have focused on internet-based 'interventions' in general (Almohanna et al., 2020;Giglia & Binns, 2014), breastfeeding outcomes (Orchard & Nicholls, 2020) or on specific populations, for example, pregnant women only (McArthur et al., 2018). The findings highlight that interactivity and personalisation are key to successful internet-based interventions (Almohanna et al., 2020) and that they are a viable option for breastfeeding advocacy (McArthur et al., 2018), particularly if used in combination with and to augment standard care (McArthur et al., 2018;Orchard & Nicholls, 2020). Notably, none focused on the evidence in relation to women's experiences of SM groups as a medium for community breastfeeding support.
This systematic review aims to identify the existing evidence in relation to SM group use for breastfeeding support, why mothers access such support and from whom, to optimise services and to meet mothers' needs. The purpose of this systematic review is therefore to: 1. To establish the existing evidence on the use of SM groups/ communities for breastfeeding support.
2. To identify any reported benefits, challenges and impacts of accessing SM group/community support for breastfeeding.
To keep the review focused, the following research question was used: What are the impacts of SM group use for breastfeeding support?

Key messages
• Joining a social media (SM) group to seek support is common among those mothers intending to breastfeed.
For these mothers SM groups have the potential to provide valued support where it is lacking, or in addition to their existing networks.
• SM groups offer reciprocity of knowledge sharing and esteem support. Belonging to a supportive online community promotes emotional wellbeing and selfefficacy, improving breastfeeding outcomes.
• Online peer support is valued and trusted as a complementary source of information and shared experience.
Mothers are aware of issues of reliability, lack of regulation and the need to be discerning of online advice.

| METHODS
To address the research questions through the identification of key terms and synonyms a search strategy (Table 1) and eligibility criteria (Table 2) were designed, modifying the Population, Issue, Context, Outcome (PICO) tool (Fineout-Overholt & Johnson, 2005). This was modified to include both Issue (qualitative) and Intervention (quantitative) terms, to capture the most comprehensive range of results (Aveyard et al., 2016).

| Eligibility criteria
Published and unpublished studies meeting the inclusion criteria ( Although there is no definitive definition of SM, for the purposes of this review SM is limited to platforms which facilitate group support via interactivity, allowing for user-generated content and subsequent responses. This includes online web-based message board communities (e.g., Babycenter, Mumsnet), but excludes specific app-only technologies, due to their limited, targeted use. No date limits were set to capture all relevant studies, recognising that the definition of SM would apply restrictions to dates in relation to its inception. The broadly agreed date for the inception of these platforms, using the definition of SM as virtual communities, is 1997 (Aichner et al., 2021). Facebook (founded in 2004, 1.93 billion daily active users), Twitter (2006, 174 million) and Instagram (2010, 500 million) are the three leading platforms (Alhabash & Ma, 2017;Statista, 2021).
Eligibility criteria were developed with a second reviewer to reduce bias and included studies checked by both reviewers against the criteria set. However, improving interrater reliability through both reviewers conducting the literature search was not possible as this systematic review forms part of a thesis, requiring flexibility (Siddaway et al., 2019).

| Search strategy and screening
Literature was sought from October to November 2021. Scoping searches highlighted a focus on intervention outcomes rather than experiences in previous reviews and a need to set clearly defined search limits to identify relevant studies. As a result, 16 search terms were used in various combinations using Boolean operators (Table 1) where the SM support group was related to parenting in general, rather than primarily being focused on breastfeeding support (see Figure 1 for the full list of reasons for exclusion). Thirteen articles remained for review.

| Data extraction
A data extraction form was adapted (Aveyard et al., 2016) to summarise the study characteristics, findings, strengths and limitations and to aid the analysis of the 13 remaining studies (Appendix A).
These were also appraised using published critical appraisal check- (1), the United States (6), Australia (2), the United Kingdom (2) and Ireland (2). Although comparisons can be drawn demographically between these research locations, care was taken to acknowledge the differing cultural and social contexts (including attitudes and breastfeeding rates) in relation to breastfeeding support. Of the UK studies, one involved a small sample (n = 12) and the other (n = 12), although a large number of group posts (n = 1230) were also included in the analysis. The latter was also 6 years old, so a lack of current UK literature was notable, particularly in the pandemic context and surge of SM use.

| Data synthesis
To address the research question underpinning this review (What is the impact of SM group use for breastfeeding support?), a modified narrative synthesis approach was taken (Popay et al., 2006), using three stages. This approach was considered appropriate to identify common themes across the literature, although these do not all relate directly to the data collected in each study (Braun & Clarke, 2014).
First, after familiarisation with the studies, initial codes were produced using NVivo v12, identifying themes via inductive thematic analysis. Second, themes were reviewed in relation to the coded extracts, which were then defined and named. Third, the robustness of the synthesis was evaluated independently by a second reviewer (Popay et al., 2006).
A reflexive journal was used to reflect on methodological decisions and the reviewer's background in breastfeeding support and influences as a health professional. Confidence in the findings was developed via both prolonged engagement with and persistent observation of SM groups before the review.

| Study quality
All the studies explored SM use for breastfeeding support, with seven including analysis of impacts on breastfeeding outcomes/duration (Black et al., 2020;Herron et al., 2015;Skelton et al., 2018;Wilson, 2020) (see Table 3). The studies all had clearly defined aims and recruitment strategies and noted the breastfeeding context (including demographic and sociocultural background) as confounding factors in drawing conclusions on the impact of SM group support. Overall, there were a few issues with study quality. Although sample sizes were generally small, this was expected for the qualitative methods, generating rich insights from individuals (Braun & Clarke, 2014).
These were confirmed by content analyses of large numbers of SM posts, enhancing the findings (Snelson, 2016). Most of the studies commented on the potential reflexivity issues arising from research done by those with direct connection to the SM group being studied (in some cases as a midwife or breastfeeding counsellor).
The two papers by Skelton et al. (2020Skelton et al. ( , 2018 analyse the same data using different methods. Thematic analysis is used to identify themes in relation to mothers' use and experience of accessing support via a single Breastfeeding Support Facebook (BSF) group (Skelton et al., 2018). The subsequent paper (Skelton et al., 2020) uses inductive content analysis to analyse the same interview and focus group data, iteratively guiding a second quantitative phase of the study through a theoretical lens. This has strengths and limitations. The mixed methods and sequential analyses provide the relationship between BSF group support, outcomes and selfefficacy and strengthen these findings using thematic analysis of focus group data. Two further papers (Bridges, 2016;Bridges et al., 2018), while relating to two separate studies, also involve the same lead author. While this approach provides rich data and triangulation of findings, it should be noted that multiple papers from the same authors may impact the breadth of the review.

| Study themes
Six themes were identified from the 13 included studies: breastfeeding context, including sociocultural antecedents and individual factors impacting women's decision making; the impact of belonging to an online community, relating to the virtual relationships underpinning the impact online support; increased self-efficacy; critiques of SM support; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. Seven studies mentioned all six themes and a further two contained five of the six (Table 4). All the studies recognised the significance of the context in which women breastfeed (Theme 1), and the function of the SM support group as an online community. The nature of support available via SM groups, and on which topics (Theme 5), was discussed by all studies. Self-efficacy was also a prevalent theme, with 13 studies identifying the impact of access to SM support on women's belief in their own capacity to achieve their breastfeeding goals as a predictor of improved experiences and outcomes.  It is well established that social support for breastfeeding (including 'significant others' or 'strong ties' such as partners, close family members and friends) and living and working within a culture that respects breastfeeding, and a society that facilitates and supports it, are key to women's decision making and success (Brown, 2017;Tarkka et al., 1999). Many women do not have access to adequate or consistent support through their existing networks (Wilson, 2020). (2010)  wellbeing and breastfeeding outcomes. Little data was collected in relation to differences between mother-to-mother, trained peer support and professional support, although Herron et al. (2015) highlighted variations in Netmums thread dynamics, with reduced engagement with posts from professionals. On Facebook groups associated with breastfeeding organisations, trained peer support motivated engagement (Bridges, 2016) and trust, playing a vital role in moderating discussion that positively impacted the community (Bridges et al., 2018).

| Theme 3: Increased self-efficacy
Self-efficacy or women's belief in their capacity to achieve their goals is well established as a predictor of breastfeeding success and satisfaction (Awaliyah et al., 2019). Ten studies noted the impact of SM group use on the sense of agency and empowerment reported by participants. Within the online community, breastfeeding is perceived as normal and desirable, and solutions are offered to challenges that reinforce ongoing goals as achievable (Black et al., 2020). For mothers, reading about the successful experiences of others offers encouragement and the sharing of skills offers support to overcome challenges . This is particularly evident within a sociocultural context of low breastfeeding rates: few women are supported with lived and shared experiences by close friends and family and many experience the recommendation to switch to formula feeding as a solution to practical and emotional challenges.
Where family support is available, it may contradict current evidencebased recommendations, and women seek clarification from peers online (Alianmoghaddam et al., 2018). This is particularly important for increasing breastfeeding self-efficacy among groups with lower breastfeeding rates and greater perceptions of breastfeeding barriers .
Mothers who choose to become and remain members of breastfeeding SM groups perceive them as empowering, encouraging active participation in decision making through the provision of health information (Bridges, 2016). Easy access to this information and peer support increases confidence in a woman's ability to manage problems and make decisions, which in turn increases breastfeeding rates (Bridges, 2016;Sheehan et al., 2009) The community also plays an important role in increasing selfefficacy and self-esteem by offering the opportunity to help others, and women are keen to share in a sense of community and connectedness through reciprocity (Bridges, 2016;Skelton et al., 2020).
This is a critical therapeutic process within support groups (Pagano et al., 2010), increasing self-efficacy through altruistic 'paying forward' of support, and was a key theme across all studies. Herron et al. (2015) identified

| Theme 4: Issues arising from SM support for breastfeeding
Ten studies highlighted concerns in relation to SM breastfeeding support. The most common of these was the reliability of information available within groups, an issue regularly highlighted in the wider literature (Ellis & Roberts, 2019), although the generation of women widely using SM for health and parenting support generally view it as a reliable source (Morse & Brown, 2021). The findings of the studies reviewed suggest that women who belong to online breastfeeding support communities felt real-time information from peers with lived experience was a valid and reliable resource, often trusting this over advice from healthcare professionals (Skelton et al., 2018), and use it to compensate for poor support elsewhere .
However, women are aware that information on SM is unregulated, sometimes impacting their confidence in the advice (Regan & Brown, 2019). Women acknowledged the need to be discerning, particularly in relation to medical advice (Regan & Brown, 2019), and that this ability develops as they become 'expert' themselves (Herron et al., 2015), but is also dependent on women's general digital and health literacy (Alianmoghaddam et al., 2018). Online self-correction may also occur, where inaccurate postings are promptly corrected through teamwork from the within message threads (Herron et al., 2015) and online communities (Skelton et al., 2020), potentially increasing their reliability as a resource.
Trust in the reliability of information and in the motivations of others exists where connection and rapport develop as a result of empathetic facilitation and support styles (Bridges et al., 2018).
Mothers report seeking a wide variety of opinions on an issue to direct their decision making  and this growing trust in the community, and reliability of the advice is key to the adoption of recommendations and goal setting (Black et al., 2020;Skelton et al., 2018). However, these findings may be impacted by the demographics of those who are self-motivated to seek online support, with overrepresentation of more affluent and highly educated women within the samples. All studies recognised this as a limitation.
Polarised debate and experiences or fear of judgement were also reported (Herron et al., 2015;Regan & Brown, 2019). On message boards, differentiation was found between 'support' and 'debate' threads, with the latter often expressing negative sentiment reflecting public discourse, rather than positive support. This was largely regarded as an opportunity for discussion, resulting in becoming politically aware and developing confidence in parenting decisions and philosophies (Bridges, 2016;Herron et al., 2015).
However, judgement, conflicting advice and polarisation had negative impacts for some, a key finding in developing insight into the wider experiences of women using SM support (Herron et al., 2015;Regan & Brown, 2019).

| Theme 5: Nature of support and topics
Four studies used methods that involved the direct analysis of online posts (Bridges et al., 2018;Herron et al., 2015;Lebron et al., 2020;Wagg et al., 2019). Identifying similarities in the content and motivations for online posts, their findings were consistent: women turn to SM group support both where their access to face-to-face support is inadequate and to complement this support. They seek information most often statistically, but emotional and esteem support (encouragement and reassurance) are significant (Wagg et al., 2019).
These findings are supported by the other studies; women value, seek and benefit from online interaction, giving and receiving social and emotional support alongside knowledge sharing (Black et al., 2020;Skelton et al., 2020). Emotional and esteem support result in increased confidence, self-efficacy and empowerment, with positive impacts on breastfeeding outcomes and experience (Bridges, 2016).
Looking at common topics, the studies found that queries generally related to breastfeeding management (including physical and practical management such as positioning, attachment and feeding frequency), health (including mother and baby, physical and mental health) and the breastfeeding journey (including work-related queries, feeding in public and parenting philosophies) (Bridges et al., 2018;Wagg et al., 2019;Wilson, 2020). The specific topics women seek support for correlate with the most common breastfeeding problems, which lead to early cessation (Bridges et al., 2018).
Informational support relating to the physiology and management of breastfeeding is evident as a clear need, not being effectively fulfilled elsewhere, including by professionals (Regan & Brown, 2019;Skelton et al., 2018). It is clear, however, that women are also seeking to fulfil emotional support needs, including reassurance about what is normal and solidarity in the breastfeeding journey, and to reduce social isolation (Regan & Brown, 2019;Skelton et al., 2020). This is achieved via information seeking, sharing and giving, centred on previous knowledge and experience, alongside encouragement to continue (Lebron et al., 2020). Sustained breastfeeding duration was linked to a positive attitude derived from greater knowledge and confidence (Wilson, 2020).
Another key finding was that many of these social and informational benefits can also be derived from 'lurking' (reading posts without interacting). High levels of passive viewing were observed, offering mothers the opportunity to observe and learn at a level of anonymity that suited their needs and circumstances (Herron et al., 2015). This behaviour was also influenced by group dynamics and culture, including how a woman felt her query would be received . This changed over time: with time and breastfeeding experience, women posed fewer questions but answered more , developing a community of practice through joint problem solving and reciprocity (Skelton et al., 2020).
Several studies also commented on the potential impact of group moderators on group function and support, noting their significance for correcting misinformation (Regan & Brown, 2019;Skelton et al., 2020) and modelling an empathetic approach to providing support (Bridges et al., 2018).

| Theme 6: Breastfeeding duration
Breastfeeding duration as an outcome was explored by eight studies.
All noted that direct causation cannot be determined due to the complexity of the breastfeeding context and the impossibility of controlling for confounding factors. However, they conclude that SM group use is a variable in sustained breastfeeding, through influence on breastfeeding knowledge, attitudes and behaviours (Skelton et al., 2020), increased self-efficacy (Black et al., 2020) and receipt of emotional support (Bridges, 2016), which may result in extended goals (Black et al., 2020) and duration . There were also impacts noted on wider parenting practices (Herron et al., 2015) and philosophies associated with extended breastfeeding duration, such as babywearing or bedsharing (Bridges, 2016).
One study found half of the women who seek online support in SM groups to initiate or continue breastfeeding continue to do so weeks and months later (Herron et al., 2015). This may reflect the motivation of those who seek help but also suggests a positive impact of a group membership. The normalisation of breastfeeding and related behaviours within the online community was also noted, with an impact on the breastfeeding goals women set, extending what they felt was achievable and desirable (Black et al., 2020). Motivation is a key antecedent of breastfeeding success, and by seeing others succeed, group members are motivated through increased selfefficacy to extend their goals (Black et al., 2020; beyond wider social norms.  found an average intended breastfeeding duration of 18.9 months and a significant relationship between intended duration and Facebook support. The sample studied by Skelton et al. (2020) also reported higher initiation rates, exclusivity and longer duration than the national average.
Confidence, knowledge and attitude are significant predicators of breastfeeding duration. Wilson (2020) found that these variables can be modified by SM group use, resulting in sustained exclusive breastfeeding at 6 months. The strength of social support available was also significant, with women continuing to breastfeed beyond 6 months more likely to describe their social support, including from the SM group, as positive (Wilson, 2020).
Evidence suggests that provision with a wide delivery context, enabling mothers to individualise the support they receive based on cultural, social and clinical need, and convenience, is best received and most valued (Trickey et al., 2018). SM groups do this by extending the reach of breastfeeding support provision beyond standard care from maternity and health services, providing access when needed throughout the breastfeeding journey. The mothers' studied attributed this support to longer breastfeeding duration and improved experiences (Skelton et al., 2018). Strategies to improve breastfeeding continuation rates are needed to support individual women to meet their goals and to enhance public health (Brown, 2017). Self-directed SM group use is viewed as convenient and accessible by the current generation of women, and their use for health-related and parenting support needs is widely seen as both normal and acceptable (Alianmoghaddam et al., 2018). Women are turning to online communities to fill the gap created by geographic family dispersal (Alianmoghaddam et al., 2018), a lack of breastfeeding knowledge in existing social networks (Bridges, 2016) and the underresourcing of face-to-face services (Regan & Brown, 2019). Those who seek and engage with this form of support find value in a community which normalises and celebrates breastfeeding, providing informational, social and emotional support, which they perceive to result in extended goals and duration. As such, SM appears to provide an ideal, near-universal and costeffective platform for widening breastfeeding support and improving outcomes (Wilson, 2020).

| DISCUSSION
However, while 10 studies identified potential issues relating to the reliability and regulation of online breastfeeding support, just three commented on the potential impacts of trained peer support and/or health professional input (Bridges, 2016;Bridges et al., 2018;Herron et al., 2015). They conclude that there are differences in how information is received, with Bridges (2016) and Bridges et al. (2018) identifying the positive impact on trust and perceptions of reliability when SM groups are facilitated by a breastfeeding organisation comprising of trained supporters/professionals. Herron et al. (2015) found lower engagement on message boards with professional posts. Regan and Brown (2019) note variability in group moderation and the concerns and challenges this presents to mothers, but there is a paucity of research in this area, with no specific evidence of the function, types or impact of SM group moderation on online breastfeeding support communities.
Although some comparisons can be made, the studies also span disparate healthcare systems, in the US, Australia, New Zealand and the UK. As reported by the studies, the context in which women breastfeed, medical and sociocultural, including varying breastfeeding rates, is a significant factor in breastfeeding attitudes and behaviour.
Therefore, there may be a global variation that could impact findings and generalisability, including limited or lack of access to SM and technology.

| Limitations of this review
Although inevitable as part of a PhD study, a major limitation of this review is that it was conducted by a single reviewer. However, the process was made more rigorous by a second reviewer checking the criteria used and is small enabling both to become familiar with the studies analysed. Both reviewers reviewed the themes and an agreement was reached.
To enable findings to be analysed across comparable selfdirected group use, eligibility criteria were narrowed to exclude groups aimed only at specific populations, for example, those with preterm babies, or exclusively expressing. Although this ensured the findings can be compared and synthesised with greater confidence, it may exclude some further insights. Future reviews could consider specialised groups and groups developed as interventions.
Excluding interventions also limits the sample to those women who are motivated to engage in self-directed SM group use and those who find it beneficial and remain group members. Content analysis aside, it also limits insights to those willing to take part in studies. It is therefore unknown how impacts of SM support may differ among less motivated or less digitally literate/engaged samples.
The studies tended to have homogeneous samples-predominantly White, married or partnered women with a high level of education. This is representative of the higher prevalence of breastfeeding and digital literacy among this population (Bartick et al., 2017).  and  examine Facebook group support use specifically among African-American mothers, with a mixed-income range and of whom a greater proportion was single or separated than the other studies. However, most still fell into a higher age bracket (mean = 30) and education level was not recorded. Limited diversity within and across samples does limit the generalisability of findings to the wider population. This is a common issue across many self-selecting health and breastfeeding support studies, which often underrecruit participants from ethnic minority backgrounds.
Women from ethnic minority backgrounds are less likely to join breastfeeding peer support groups than White women (McAndrew et al., 2012), and this may also apply to Facebook groups (La Leche League, 2020). Those who seek support online struggle to find local groups that reflect and share their experiences, with Black British mothers reporting joining American BSF groups solely for Black women to feel part of a relatable breastfeeding community (CIBII, 2018). Greater reliance on friends and family, and fewer representative online communities may also have seen COVIDrelated impacts on breastfeeding support being greater for some women (Brown, 2017).

| CONCLUSIONS
There is a paucity of UK research, a gap that needs to be addressed to determine the specific impact of SM group use on the UK breastfeeding context. However, this review finds that women across the countries included finding SM support beneficial. It identified that the women who seek and engage with self-directed SM support most often are those with high levels of intention and motivation and that they perceive access to peer and professional support within virtual communities as extending their breastfeeding goals and achieved duration. Currently, many of these women stop breastfeeding before they are ready to do so. The results of this review confirm the importance of further research to understand how health professionals and wider services can draw on the benefits of SM group provision to better support women and to underpin greater investment.

AUTHOR CONTRIBUTIONS
Holly Morse was responsible for study conception, selecting and reviewing all articles, draft manuscript completion and critical revisions. Amy Brown was responsible for draft manuscript support and critical revisions.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analysed in this study.