Abstract
BackgroundDespite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.MethodsUsing a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.ResultsAlmost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.ConclusionThis study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.
Highlights
Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average
The findings of this study will provide the needed evidence to develop and tailor interventions to complement national breastfeeding policies. Study design This was a six-month, prospective cohort study conducted in the United Arab Emirates (UAE) between February 2018 and July 2019
Women who had a high breastfeeding self-efficacy (BSE) in the immediate postpartum period were over 4 times more likely to continue to breastfeed to 6 months in comparison to those who lacked confidence in their breastfeeding ability (AOR 4.50; 95% CI 1.58, 12.85; p < 0.003)
Summary
Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend initiating breastfeeding within the first hour of birth with exclusive breastfeeding (EBF) for the first 6 months of life and continued breastfeeding with appropriate complementary food for up to 2 years of age or beyond [2, 3]. Focusing on modifiable factors, which are often more responsive to change than demographic and health-related variables, is fundamental when developing targeted interventions to increase breastfeeding exclusivity rates among women
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