The advantages of breastfeeding (BF) are recognised worldwide.1 However, in spite of this awareness and the different strategies implemented internationally for its promotion and support, the objectives established by the World Health Organization (WHO) for the optimal duration of BF are not being met.2

On the other hand, we are undergoing a profound technosocial revolution, and information and communication technologies (ICTs) have irrupted with tremendous force and changed the paradigm of health care delivery.

In Spain, the report Indicadores de la Sociedad de la Información por género 2018 (Indicators of the Information Society by Sex, 2018) of the Observatorio Nacional de las Telecomunicaciones y de la Sociedad de la Información (National Surveillance Agency of Telecommunications and the Information Society, ONTSI) showed that 67.3% of the Spanish population had used the internet to obtain health information in recent months.3 One of the areas that is growing fastest in the field of ICTs in health care is mobile phone applications (apps). At present, there are 22 million active app users in Spain, and the number is increasing.4

The aim of our study was to identify existing BF apps, analyse their characteristics and reflect on their potential use as community health tools.

We conducted a mixed study by searching the main app stores using the keyword “lactancia materna” (breastfeeding). We included apps in Spanish available through 01/10/2018 and classified them according to the following variables: operating system, developer, country of origin, available language(s), target population, content/features, feedback, description, download volume and free access (Table 1).

Subsequently, we made a quantitative analysis of app contents and features using quantitative analysis based on the description provided by the developer, and established the following categories: information, tracking and other contents (Table 1).

Of the 270 apps that we identified, we only included the 146 available in Spanish. The most frequent operating system was Android (72.6%). The distribution by origin included 29 countries in 4 continents, with a predominance of apps from European countries (n=87). Fifty-nine percent of European apps were Spanish (n=51). Most were developed for parents (n=73). Over half of the apps (67%) were available in other languages besides Spanish.

The mean number of downloads was 185 035. Fig. 1 presents the app launch growth (number of apps/year), showing an increasing trend and a significant leap in 2016. Most apps were free (91.7%), and the mean price of the rest was 2.33 euro.

Figure 1.

Launching of breastfeeding apps in Spanish; 2009–2108 period.

Source: developed by the authors.

* Up to 1/10/2018.

(0.06MB).

When we analysed the content of the apps, we found that the most frequent feature/content categories were tracking (48.6%) and information (34.2%). The most frequent tracking features were tracking of BF (n=46) and tracking of the baby's habits/routines (n=42). In the information category, the predominant type was information on BF (n=34).

We were surprised by the large number of apps that could be used to track feeding schedules considering that the WHO recommends BF on demand.5

Something worth mentioning regarding the analysis of the quality of the information given by the apps is that of all the apps we found, only Lactapp was pending approval to receive the “Healthy App” certification given by the Health Care Quality Agency of the Department of Health of Andalusia. This is a certification given to health apps that meet quality and safety recommendations and that can be trusted for use by the general population. Another salient finding was that only 3.4% of the developers were doctors/paediatricians or certified BF consultants and offered updated evidence-based information. One example is the breastfeeding app of the Spanish Association of Pediatrics (Lactancia materna AEP), which offers high-quality content developed by the Committee on Nutrition and Breastfeeding of this association.

When it came to feedback, few apps allowed interaction (n=21). Only one, WeMoms, allowed mothers to participate in chats to discuss and address concerns about BF.

The large number of downloads reflects that this is an emerging vehicle for seeking help and information that could complement traditional forms of BF support.6

As health care professionals, we need to adapt to emerging demands and should consider the inclusion of BF apps in our everyday practice as an additional tool for community-based intervention. However, we must be careful in recommending apps, and there need to be quality assessment guidelines and certifications to allow a safe and rigorous use of these apps.

The use of BF apps could also provide ongoing access to information on BF and participation in virtual spaces in which to share experiences and advice with peers to promote successful BF.