Abstract
BACKGROUND: The World Health Organization (WHO) aims to achieve a 50% rate of exclusive breastfeeding (EBF) during the first six months of life by 2025. Continuing breastfeeding up to six months is determined by an individual woman's choice and the availability of breastfeeding-friendly environments. METHODS: In this multicenter prospective longitudinal study, we identified breastfeeding-friendly environmental factors that were associated with breastfeeding practices from days 1-5 to six months postpartum. Breastfeeding-friendly environmental factors were assessed using structured questionnaires for mothers who gave birth under a Baby-Friendly Hospital Initiative (BFHI). We evaluated uptake of breastfeeding by asking mothers if they used the indicated practices, as well as their perceived level of acceptance of breastfeeding among their live-in family members and their perceived availability of lactation rooms in public settings. From 2012 to 2016, we recruited 1,870 women at 1-5 days postpartum from obstetrics medical facilities in Taiwan and followed their breastfeeding status at one, two, four, and six months postpartum. The definition of EBF was that the infant had received only breast milk since birth, with no supplemental infant formula. We categorized breastfeeding practices into two groups: continuing EBF and non-continuing EBF at six months. We used logistic regression models to identify factors associated with continuing EBF at six months postpartum. RESULTS: The prevalence of EBF and non-EBF at six months postpartum was 30.9% and 69.1%, respectively. The logistic regression analysis revealed that above university-level education, multiparity, and vaginal delivery were positively associated with continuing EBF. The Ten Step Baby-Friendly Hospital Initiative practices, perceived acceptance of breastfeeding in live-in families, and perceived availability of lactation rooms in public settings, were associated with a higher likelihood of continuing EBF. Postpartum women who returned to work at or after two months postpartum were more likely to report non-continuing EBF than women who did not return to work. CONCLUSION: Those who promote public health should advocate for breastfeeding-friendly practices, including the adoption of breastfeeding-friendly measures in public and workplace settings and providing increased support for breastfeeding mothers during and after hospitalization.