Health systemsFor our meta-analyses we considered several interventions included in the BFHI: individual counselling or group education, immediate breastfeeding support at delivery, and lactation management. These interventions increased exclusive breastfeeding by 49% (95% CI 33–68) and any breastfeeding by 66% (34–107; table 1). An earlier meta-analysis reported a negative association between caesarean sections and early breastfeeding but no eff ect at 6 months. Our findings suggest that in the presence of adequate support, a caesarean section is not necessarily a barrier to timely breastfeeding initiation (risk ratio [RR] 0·95 [95% CI 0·84–1·07]) or to exclusive breastfeeding (1·08 [0·82–1·41]; data not shown).