Breastfeeding rates among low-income women in the east-south-central United States are among the lowest in the country. This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee. A postpartum survey and chart review were conducted with WIC clients at nine health departments. Response rate was 99% (291/293). Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group (n= 156) compared with women in the no-peer counselor group (n= 135) (53% vs. 33%,p<0.001, and 26% vs. 13%,p=0.006, respectively). Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding (OR=2.43, 95% CI=1.23-4.67) and to be breastfeeding at 6 weeks (OR=2.78, 95% CI=2.08-9.5 1), than those in the no-peer counselor group.