# Effectiveness of an Educational and Counseling Program (the Green Mother Project Phase 2) to Enhance Breastfeeding and Improve Mothers’ Diets From an Environmental Perspective: Protocol for a Cluster Randomized Controlled Trial

## TL;DR

This study tests an educational program to improve breastfeeding rates and promote sustainable maternal diets, aiming to reduce environmental impact.

## Contribution

The novel contribution is evaluating an intervention that combines breastfeeding promotion with sustainable maternal nutrition in a postpartum context.

## Key findings

- The intervention is expected to increase breastfeeding duration and rates.
- Mothers may adopt healthier and more sustainable diets with lower environmental impact.
- Environmental indicators like carbon and water footprints will be assessed for changes.

## Abstract

Exclusive breastfeeding is recommended as healthier and more sustainable than formula feeding. It produces less waste, requires fewer resources, and has a smaller environmental impact. Breastfeeding has some environmental impact related to increased maternal dietary needs and the use of feeding accessories. In light of the global climate emergency and suboptimal breastfeeding rates, targeted interventions are urgently needed to promote sustainable infant feeding practices. There are few studies that evaluate sustainability interventions in the postpartum period.

The objective of this study is to evaluate the effectiveness of an educational and counseling intervention on breastfeeding and healthy maternal nutrition from an environmental perspective.

A multicenter prospective intervention study is being conducted in 2 cohorts in primary care centers and hospitals in the north metropolitan area of Barcelona. The control group received standard obstetric care. The experimental group additionally received an educational intervention and health care support on breastfeeding and healthy and sustainable maternal nutrition. Pregnant women were monitored from 24 weeks of gestation to 6 months post partum. The rates of different types of breastfeeding, the women’s diet, and the associated environmental impacts (climate change and water footprint) will be analyzed to assess the effectiveness of the intervention.

The development of the educational and counseling intervention has been completed, including the creation of the Guide to Good Practices in Breastfeeding, Nutrition, and Sustainability. Health care professionals received targeted training. Recruitment of pregnant women was conducted from December 2023 to December 2024. Prenatal education sessions and specialized care pathways were designed and implemented. Breastfeeding-friendly spaces were adapted to support the participating centers. Data collection for monitoring breastfeeding practices, maternal diet, and environmental impact indicators (carbon footprint and water footprint), with the follow-up period of 6 months post partum, was extended until September 2025, with a complementary missing data collection in October 2025. Data cleaning for final analysis is expected to conclude by January 2026. This study hypothesizes that mothers who receive higher levels of education and counseling support will (1) breastfeed for a longer duration, (2) adopt healthier and more sustainable dietary practices, and (3) reduce environmental impacts associated with both infant feeding accessories and dietary choices.

We expect an increase in the incidence and prevalence rates of breastfeeding and a shift toward a healthy and sustainable diet with low environmental impact.

ClinicalTrials.gov NCT05729581; https://clinicaltrials.gov/study/NCT05729581

DERR1-10.2196/80358