According to the findings of the present study, the time range of CCB was between 1 to 36 months with an average of 19.23 ± 7.09 and a median of 22 months. The highest time of CCB was 24 months (32.9%) and CCB in 59% of cases occurred before 24 months.
In a previous study in Iran, the mean CCB was 21 ± 5.7. The highest time of CCB was 24 months (36.8%) and complete cessation of breastfeeding occurred in 50% of children before 24 months (7). Another study conducted in Golestan of Iran was a median of 22 months and a mean of 20.44 months of CCB (14). The status of the present study is more unfavorable than the studies found. In a study conducted in Tehran, the average duration of breastfeeding was 11.75 months (15). In Haji Kazemi's study, the average duration of breastfeeding was 17.4 months (16). In another study conducted in Iran reported an average duration of breastfeeding of 17.31 months (11). The status of the present study is more favorable than the mentioned studies. Perhaps one of the reasons for the different duration of breastfeeding in different cities of Iran is cultural and social differences, because in this country there are different ethnic and racial groups with different cultures and customs regarding child nutrition.
The point of interest in literature reviewing in Iran is that the duration of breastfeeding seems to have improved in recent years, although there is still a gap of 2 years with the recommendations of the WHO. In Iran, breastfeeding is culturally and religiously important and valuable, and breastfeeding women are more supported in the family. According to studies, the duration of breastfeeding in other Middle Eastern countries is shorter than in Iran. In a study in Turkey, only 12.3% of mothers breastfeed their baby for at least a year, and the average duration of breastfeeding was 7.7 ± 3.3 months (17). In a study conducted in the UAE, the duration of breastfeeding was reported to be 8.6 months (18). Also the rate of breastfeeding up to 12 months in Qatari women has been reported to be 2.4% (19). Perhaps one of the reasons for this was Iran's efforts to establish a National Committee to Promote Breastfeeding, with about 80% of births taking place in Baby Friendly Initiative hospitals in 2008 (20, 21). In 1992, “Ten Steps to Successful Breastfeeding” were approved by the World Health Assembly, since that time, foundation of infant nutrition policies at UNICEF and WHO in the form of Baby Friendly Hospital Initiative (BFHI). BFHI takes steps to successfully start breastfeeding infants after birth, as well as to continue breastfeeding in inpatient wards. One of the benefits of BFHI is the exclusive feeding of infants with breast milk, which will lead to optimal development and health of the child (22).
In this study the most common reasons for mothers to wean their baby before 24 months of age are decreased baby desire, Insufficient milk supply and baby refusal to breastfeeding. In a study conducted in Shiraz province, one of the neighboring provinces of Kerman, Insufficient milk supply and infant refusal to breastfeed were reported as the main reasons for stopping breastfeeding, which is consistent with the present study (23). Another study conducted in Iran, 28% of mothers stated that the reason for stopping breastfeeding was insufficient milk (21). In a study conducted in Qatar, 44% of women mentioned lack of milk as a reason for stopping breastfeeding (19). Other studies have shown that mothers' perceptions of not having enough milk was a reason for stopping early breastfeeding (18, 24, 25). Milk production is controlled by the number of breastfeeding times and the baby's demand (26). On the other hand, according to research, nutrition according to the plan may lead to insufficient milk production (27). Therefore, mothers should be taught appropriate techniques to increase milk, because, even in societies where the diet is poor, most mothers are able to produce enough milk for the proper growth of their babies.
In the present study, people who used non-hormonal contraceptive methods (natural and condoms) had longer breastfeeding periods than those who used hormonal methods (such as pills and IUD ). In a study conducted in Gilan, (one of the northern cities of Iran) there was a significant relationship between discontinuation of breastfeeding and taking birth control pills (15). The results of Radwan et al.'s study also showed that mothers who used non-hormonal contraceptive methods or had no contraceptive method breastfed their baby for 9–10 months, while mothers who used hormonal contraceptive methods 5.8 ± 7.1 months breastfed their baby(18). In this case, the evidence on the relationship between the type of contraception and cessation of breastfeeding is limited, and there is still insufficient evidence that hormonal methods of contraception have a negative effect on breast milk. In a systematic review of combined contraceptives and breastfeeding, 15 articles were reviewed, some of which considered the use of combined contraceptives to be effective in reducing breastfeeding duration while a number of articles did not show such an effect (28). It seems that more detailed studies are needed to determine the exact effect of hormonal methods of contraception on breastfeeding.
There was a significant relationship between place of residence (city or village) and the time of complete cessation of breastfeeding; rural households had a cessation of CCB later than urban. In a study conducted in India, the duration of breastfeeding in rural mothers was longer than in urban areas (29). This relationship was also observed in the researches of Lubala and Thulier (30, 31), which are consistent with the present study. This can be due to cultural differences and lifestyles in urban and rural areas as well as rural women having more free time to breastfeed and are mostly housewives.
There was a significant relationship between the number of households and the time of CCB. Families of 4 people stopped breastfeeding later than 3 people. The results of a study conducted in the Congo showed that the duration of breastfeeding increases with the birth rate of the child in the family, and in fact the last child has the longest breastfeeding period in the family (32).This may be due to the mother's increased experience and skills compared to breastfeeding in previous children.
In the present study, there was no significant relationship between birth weight and CCB. Among the weights of 6, 12, and 24 months, only the weight of the child at the age of 6 months was directly related to the time of complete cessation of breastfeeding. Other studies have shown that babies who had a higher birth weight at the time of CCB were earlier (33, 34). Unfortunately, there is not enough evidence to compare but perhaps the reason that six months' weight was associated with an increase in breastfeeding duration is that six months is the time to start complementary feeding for children, and it is believed that if the baby is not gaining weight well, it is a sign of breast milk deficiency and complementary feeding should start earlier. On the other hand, mothers whose six-month-old baby weighs well will realize the adequacy and effectiveness of their milk and are therefore more encouraged to continue breastfeeding for longer.
One of the strengths is that this issue is done for the first time in Kerman and is one of the few studies that has been done with this volume of samples in Iran. Kerman is wide in terms of geographical distance and there are cultural, economic and social differences in different parts of the city. In order for our sample size to cover all economic and social groups, we selected the desired sample from all centers.
One of the limitations of this research is the limitation in interpreting the results. Also transferring the results of this study with other communities should be done with caution. Another limitation of this study was the timing of the Covid 19 crisis, which was a major challenge for face-to-face data collection, and this prolonged the study process.
One of the good practices that Kerman province has taken to improve the breastfeeding index in recent years is the establishment of a specialized breastfeeding counseling center as a single center, which in comparison with other provinces of the country seems to have had a good effect on increasing the duration of breastfeeding. Therefore, it is suggested that governments establish such centers in communities.