According to the investigated relationships of cultural dimensions of lactating mothers and lactation patterns, results of the present study indicated that there was a statistical significant relationship between masculinity-femininity dimension and lactation patterns, so that women with higher scores in this dimension were more likely to have exclusive breastfeeding. In other words, women had breastfeeding, were more oriented to masculinity compared to other patterns. These results are in line with a study by Berg et al. (2014) who reported that health behavior such as infection control and prevention was higher in societies with higher scores of masculinity-femininity dimension; and there was a significant correlation between them 38. In this regard, Hofstede argues that cultures, which are oriented toward masculinity, gender roles are clearly distinct between men and women. Men tend to focus on male gender roles (such as family breadwinners, earning money), while women focus on female gender roles (such as childcare). In fact, men have masculine behavior, and women have feminine behavior 26.
Therefore, mothers, who are more oriented toward masculinity, seem to focus more on female gender roles such as breastfeeding, which is a kind of childcare that increases rate of exclusive breastfeeding. In this regard, studies reported that women, who have a more traditional attitude to gender roles, breastfed their infants longer 39–41. In societies with traditional gender roles, it is expected that men are breadwinners and family supporters; and women are responsible for housekeeping and child care 42, 43.
On the other hand, Isabella and Isabella stated that success in breastfeeding helped mothers to be more satisfied with their maternal roles, so that the success in breastfeeding is understood as a sign of mothers’ ability to be mothers and accept their gender roles 44.
In the individualism -collectivism dimension, results of the present study indicated that despite the higher mean of this dimension in those with exclusive breastfeeding than those, who had non-exclusive breastfeeding, the difference was not statistically significant. The results were consistent with a study by Tracy et al. (2012). The research results indicated that lactating mothers had higher scores of collectivism scale than those with formula feeding, but this difference was not statistically significant. On the other hand, researchers of this study reported that countries such as Indonesia and Pakistan had high rates of breastfeeding (95% and 94%, respectively) and were considered as collectivist countries 45.
Therefore, it seems that the more people are collectivist, the more they pay attention to family value and loyalty, and prefer family interest to self-interest 26. Therefore, this issue may lead to high rate of exclusive breastfeeding.
In the uncertainty avoidance dimension, results of the present study indicated that there was no significant relationship between uncertainty avoidance and lactation pattern, while Mackenbach reported that uncertainty avoidance scores were associated with breastfeeding 32.
Despite the fact that results of the present study found no significant relationship between lactation patterns and uncertainty avoidance dimension, it seems that higher uncertainty avoidance scores in mothers, who had non-exclusive breastfeeding, were due to maternal uncertainty about sufficiency of breastfeeding for full growth of their infants. To resolve this uncertainty and anxiety, mothers have added formula feeding or supplementary food or both to their breastfeeding. An important reason for reducing exclusive breastfeeding rates has been the public and caregivers’ opinion about the inadequacy of exclusive breastfeeding for infants less than 6 months of age leading to the use of other lactation patterns such as formula feeding or co-feeding 7.
In the power distance dimension, results of the present study showed no significant relationship between lactation patterns and this dimension. In this regard, Mackenbach reported a significant inverse relationship between power distance dimension and breastfeeding 32. The difference between results of the present study and Mackenbach’s research may be due to the fact that Mackenbach‘s research was based on conducted studies in European countries, while the present study was conducted in Iran as a developing country.
However, results of this study about dimensions of long-term and short-term orientation and indulgence- restraint indicated that there was no significant relationship between lactation patterns and these dimensions. However, results of studied dimensions in the present study indicated that mothers had long-term orientation and restraint. According to Hofstede’s studies, cultures with a long-term orientation are more focused on reinforcing values towards future rewards, especially endurance and sustainability. On the other hand, public orientation towards restraint indicates the existence of strict norms in society. There is a feeling that satisfying activities should be regulated by social norms 26.
Results of the present study indicated that exclusive breastfeeding was also associated with some maternal individual and fertility factors such as education and type of delivery. In this regard, results of a study by Al-Sahab et al. indicated that maternal higher education had a positive effect on exclusive breastfeeding (46). Furthermore, Zanardo et al. reported that the emergency and elective cesarean delivery was similarly associated with reduced rates of exclusive breastfeeding 47.
The present study had some limitations: first, the non-exclusive breastfeeding group included the use of breastfeeding with supplementary food. Therefore, it might affect results of the present study. Second, the present cross- sectional study was conducted in comprehensive health centers; hence, number of mothers who had formula feeding, was lower in the non-exclusive breastfeeding group. Therefore, it is suggested conducting a case-control study with exclusive breastfeeding and formula feeding of infants.
In addition, most studies on Hofstede’s cultural dimensions model have emphasized studies on organizations 48, 49 and there are few studies on Hofstede’s cultural dimensions and health behavior, especially long-term- short-term orientation and indulgence-restraint dimensions. Therefore, further research on this issue is suggested.