Factors that led mothers to initiate and stop breastfeeding in the first 6 months of the baby's life
In the present study, the mothers reported the belief that breast milk was “the best food for the child” and a “healthy food”, as well as its “benefits to the child’s health”, among other factors, as the main reasons for breastfeeding, which is consistent with the findings of other studies (14, 15).
In contrast, the mothers’ reasons for early weaning included “having to work or study”, “insufficient milk”, “the baby's refusal to take the breast”, and “the mother's refusal to breastfeed”, among other factors, a finding that corroborates some studies (16–20). The reasons indicated for stopping breastfeeding are similar to those cited in the work of (21) and are mainly related to the mother’s insecurity about breastfeeding (poor latch). Additionally, returning to work remains an important barrier to the maintenance of exclusive and mixed breastfeeding and contributes to a large drop in the breastfeeding rate between the ages of 3 months and 6 months.
The results obtained in (22) allowed the reasons for non-EBF until the 6th month of the baby's life to be grouped into the following categories: 10 mothers (20%) related early weaning to personal demotivation, 6 (12%) reported a lack of self-will, 2 (4%) reported a lack of time due to work, and 1 (2%) reported a lack of knowledge. Regarding factors related to the baby, 9 mothers (18%) reported that the baby had an aversion to milk, and 2 (4%) reported that the baby seemed to be hungry even after breastfeeding. Regarding physiological factors related to the mother, 20 (40%) reported having little milk, and 20 (40%) reported a consequent cessation in milk production.
Prevalence of exclusive breastfeeding in the first 6 months of life
In the present study, 81% of the mothers correctly identified the period recommended by the WHO for EBF, a result that corroborates the results of several studies (15, 20, 23, 24). However, this knowledge was not enough to ensure that they continued EBF until the child was 6 months old. A study conducted in Malaysia evaluated 213 mothers’ knowledge and beliefs about breastfeeding and concluded that, in addition to having knowledge and taking action, it was necessary to address issues related to culture and traditions and to improve support to ensure successful breastfeeding (15).
The rate of adherence to EBF in the first 6 months of life was 32.5%, which is considered reasonable according to the WHO(25). It should be noted that 49.21% of the children were still being exclusively breastfed but had not reached the 6-month mark at which breastfeeding can be considered EBF. These results regarding EBF are superior to those of (22), in which 12 mothers (24%) exclusively breastfed for a period of 1 or 2 months, 18 mothers (36%) exclusively breastfed for 3 or 4 months, 9 mothers (18%) exclusively breastfed up to 5 months, and only 11 mothers (22%) exclusively breastfed until the 6th month of the child’s life.
The results also corroborate those of (26), in which 7 (5%) of 141 children were never breastfed, 24 (17%) were never exclusively breastfed, 59 (42%) were still being breastfed, and only 2 (1.4%) were still being exclusively breastfed. Despite mothers’ knowledge about the importance of EBF, several studies show that the introduction of bottles and other artificial foods is a reality that invariably leads to early weaning. Hence, breastfeeding should be encouraged as a priority action for disease prevention and for improving the physical and mental health of children and families; this implies the need for mothers to be informed, advised, and guided regarding the costs and benefits of breastfeeding and its impact on the baby’s health (27).
Influence of maternity leave on the prevalence of exclusive breastfeeding
Maternity leave allows the breastfeeding mother to maintain a safe source of income during a period when she needs to be close to her child; this allows greater dedication to the child and is a facilitator of EBF (28).
In the present study, maternity leave did not have a significant influence on breastfeeding and EBF. Recent studies (4, 18, 19, 24, 28, 29) show that the rate of breastfeeding and EBF rapidly decline when women return to work. Mothers on maternity leave had a higher prevalence of EBF than even mothers who were not working, which is in agreement with several studies (28, 30, 31); this shows the protective effect of maternity leave on EBF for all infants younger than 6 months.
Maternity leave lasting less than 6 weeks increases the likelihood of not starting breastfeeding and early weaning by fourfold. A study conducted in all member states of the United Nations showed that the guarantee of paid maternity leave for at least 6 months was associated with an 8.9% increase in EBF (18).
Factors that interfere with breastfeeding
Several factors can positively or negatively affect breastfeeding, including maternal age, maternal education, marital status, location of residence, family income, parity, prenatal care, and perinatal care.
In the present study, only maternal age, maternal education, number of prenatal visits, and parity had a significant relationship with breastfeeding. Younger mothers seemed to be more likely to breastfeed than older mothers, which is in contrast to the results of several recent studies (22, 24, 31–37).
Mothers with a secondary or higher education were 1.55 times more likely to breastfeed than mothers with less than a primary education; this finding partially corroborates the results of (38), which found that the duration of breastfeeding was longer in mothers with a higher educational level.
The mother’s marital status was not associated with breastfeeding, and similarly, younger mothers were more likely to breastfeed, contrary to the findings of (22, 30, 31).
The location of residence was not related to breastfeeding. This contrasts with (39), in which the duration of breastfeeding was higher among children living in rural areas.
The study showed that family income did not interfere with breastfeeding. This does not corroborate the results of (40), in which mothers with a lower income and educational level breastfed for longer periods, but not exclusively; thus, it was assumed that they maintained breastfeeding because they did not work outside the home.
Mothers2 with more than 2 children had a greater likelihood (OR = 1.88) of breastfeeding than mothers with up to 2 children, which corroborates the results of (39) and (38).
Mothers who attended more than 8 prenatal visits were more likely (OR = 1.88) to breastfeed than mothers who attended fewer than 8 visits. The results of the present study are in agreement with those of (39), which states that the attendance of 6 or more prenatal visits may contribute to an increase in the duration of breastfeeding.
Breastfeeding in the first hour after delivery showed no association with EBF. This result is contrary to (41), in which a bivariate analysis showed that first breastfeeding after 6 hours of life (p = 0.032) had a negative association with the duration of breastfeeding, while a multivariate analysis showed that breastfeeding had a positive association with a shorter breastfeeding time.
Relationship between EBF, maternal education, and mother’s purchasing power
In this study, maternal education and mother’s purchasing power were not related to EBF, which is in line with (42) and (26).
Study (43) also showed that education was not related to EBF.
The findings of other studies are contrary to our findings, in which there was a lower prevalence of EBF among mothers with less than a high school education and with an income below one minimum wage (5). A similar result was found in a study conducted in a northern Brazilian capital, where education was significantly related to EBF (31). These findings indicate that education can be a protective factor for breastfeeding. Most likely, women with no or little education are unaware of the importance of EBF until at least 6 months of life because they are unaware of the high nutritional and caloric value of breast milk for the newborn or of the nutrients necessary for growth and development.
Association between exclusive breastfeeding and health care
In the present study, EBF was associated only with breastfeeding counseling (p = 0.029), which corroborates (5) and contrasts with the findings of (43).
The other health care variables – number of prenatal visits, location of visits, child’s birthplace, breastfeeding in the first hour after delivery, and birth weight – were not associated with EBF. This result is in agreement with the findings of (43) regarding the number of prenatal visits and the child’s birthplace. Regarding birth weight, the results of the present study corroborate those of (5).
Contradicting these results, one study (18) showed that infants with low birth weight whose mothers had 12 years or more of education, were between 20 and 35 years old, and were on maternity leave had a higher prevalence of EBF.
The present study shows that of the children who were exclusively breastfed until they were 6 months old, 32.7% were breastfed in the first hour after delivery, compared to 31.9% of those who were not breastfeed in the first hour after delivery. However, there was no significant association between EBF and breastfeeding in the first hour after delivery.
The results of this study are in agreement with those of (5), which reported that of the children who were exclusively breastfed up to 6 months of age, 52.2% breastfed in the first hour of life, and 47.3% breastfed after the first hour. However, contrary to the present study, (5) reported there was a positive association between these 2 variables.