Awareness of Exclusive Breast Feeding and its Association with Maternal and Infant Characteristics
DOI:
https://doi.org/10.71000/wwn0k624Keywords:
Colostrum, Exclusive Breastfeeding, Infant Health, Maternal Health, Breastfeeding Awareness.Abstract
Background: Exclusive breastfeeding (EBF) provides optimal nutrition during the first six months of life and is important for infant growth, development, and health. This study assessed awareness and practice of EBF and examined their relationship with maternal and infant characteristics.
Methodology: A hospital-based cross-sectional study with retrospective assessment of breastfeeding history was conducted at the Pediatric Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from November 2024 to June 2025. A total of 953 breastfeeding mothers were recruited through non-probability judgmental sampling. Data were collected using a structured questionnaire covering maternal and infant demographics, EBF awareness and practice, colostrum practices, breastfeeding-related knowledge, antenatal care, maternal health, and infant characteristics. Data were analyzed using SPSS version 26 with descriptive statistics and binary logistic regression.
Results: Among 953 mothers, 29.2% had secondary education, 13.7% were illiterate, 94.9% belonged to the middle economic category, and 64.4% lived in rural areas. The mean maternal age was 27.61 ± 4.69 years and mean infant age was 7.50 ± 1.40 months. EBF for the first six months was reported by 75.1% of mothers, while 89.1% were aware of EBF. Colostrum was discarded by 32.7%. Breastfeeding difficulties included perceived insufficient milk supply (37.8%), pain during breastfeeding (25.6%), and difficulty initiating breastfeeding (24.8%). In logistic regression, awareness regarding EBF (OR = 55.878, p < 0.001), awareness of diet during breastfeeding (OR = 4.678, p < 0.001), and knowledge of the breastfeeding procedure (OR = 2.374, p = 0.001) were positively associated with EBF practice. Overall classification accuracy was 85.8%.
Conclusion: EBF practice and awareness were high in the study population; however, colostrum discarding and breastfeeding difficulties remained common. Awareness of EBF, diet during breastfeeding, and correct breastfeeding procedures were significantly associated with EBF practice, supporting continued maternal breastfeeding education and counselling.
References
World Health Organization. Exclusive breastfeeding for optimal growth, development and health of infants. eLENA intervention. Updated 9 August 2023. Available from: https://www.who.int/tools/elena/interventions/exclusive-breastfeeding
UNICEF, World Health Organization. Global Breastfeeding Scorecard 2023: Rates of breastfeeding increase around the world through improved protection and support. 2023. Available from: https://www.unicef.org/documents/global-breastfeeding-scorecard-2023
Halasa S, Safadi R, Nabolsi M, Dohrn J, Ahmad M. Breastfeeding practices and exclusive breastfeeding among Syrian refugee mothers in Jordanian host communities. J Migr Health. 2025;100324.
Rostamgohari Z, Nematollahi M, Foroughameri G, Alikamali M, Shahraki SK. The effect of virtual learning program on planned behaviors and self-efficacy related to exclusive breastfeeding in mothers of late preterm infants: a quasi-experimental study. J Neonatal Nurs. 2025;31(2):101610.
Du Y, Onyango-Makumbi C, Walia B, Owor M, Musoke P, Owora AH. Correlates of early breastfeeding cessation and breastmilk expression in Uganda: a case-control study. J Int Med Res. 2024;52(3):03000605231223041.
Iqbal S, Batool SM, Ahmed RI. Exclusive breastfeeding practice and associated factors among mothers of infants under 6 months of age. Pak J Health Sci. 2024:115-119.
Yadollahi P, Padashian F, Doostfatemeh M. Five-factor model personality traits, exclusive breastfeeding, and self-efficacy: a mediational analysis. BMC Pregnancy Childbirth. 2024;24(1):279.
Syahri IM, Laksono AD, Fitria M, Rohmah N, Masruroh M, Ipa M. Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter? BMC Public Health. 2024;24(1):1225.
Sandhi A, Lee GT, Chipojola R, Huda MH, Kuo SY. The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: a cross-sectional study. Int Breastfeed J. 2020;15(1):65.
Jama A, Gebreyesus H, Wubayehu T, et al. Exclusive breastfeeding for the first six months of life and its associated factors among children aged 6-24 months in Somaliland. Int Breastfeed J. 2020;15(1):5.
Rahman A, Nomani D, Taneepanichskul S. Trends and determinants of exclusive breastfeeding among adolescent mothers in rural Bangladesh. Int J Environ Res Public Health. 2020;17(24):9315.
Riaz A, Bhamani S, Ahmed S, Umrani F, Jakhro S, Qureshi AK, et al. Barriers and facilitators to exclusive breastfeeding in rural Pakistan: a qualitative exploratory study. Int Breastfeed J. 2022;17:59. doi:10.1186/s13006-022-00495-4.
Sultana M, Dhar S, Hasan T, Shill LC, Purba NH, Chowdhury AI, Shuvo SD. Knowledge, attitudes, and predictors of exclusive breastfeeding practice among lactating mothers in Noakhali, Bangladesh. Heliyon. 2022;8(10):e11069. doi:10.1016/j.heliyon.2022.e11069.
Rana MM, Islam MR, Karim MR, Islam AZ, Haque MA, Shahiduzzaman M, Hossain MG. Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: a community clinic based study. PLoS One. 2020;15(5):e0232027. doi:10.1371/journal.pone.0232027.
Hernández-Luengo M, Álvarez-Bueno C, Martínez-Hortelano JA, Cavero-Redondo I, Martínez-Vizcaíno V, Notario-Pacheco B. The relationship between breastfeeding and motor development in children: a systematic review and meta-analysis. Nutr Rev. 2022;80(8):1827-1835. doi:10.1093/nutrit/nuac013.
Kalhor M, Yazdkhasti M, Simbar M, et al. Predictors of exclusive breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2025;20:52. doi:10.1186/s13006-025-00744-2.
Alissa N, Alshareef M. Factors influencing exclusive breastfeeding in Saudi Arabia. Healthcare (Basel). 2024;12(6):639. doi:10.3390/healthcare12060639.
World Health Organization. WHO guideline for complementary feeding of infants and young children 6-23 months of age. Geneva: World Health Organization; 2023. ISBN 978-92-4-008186-4.
Mekebo GG, Argawu AS, Likassa HT, et al. Factors influencing exclusive breastfeeding practice among infants under six months in Ethiopia. BMC Pregnancy Childbirth. 2022;22(1):630.
Al Shahrani AS, Hushan HM, Binjamaan NK, Binhuwaimel WA, Alotaibi JJ, Alrasheed LA. Factors associated with early cessation of exclusive breast feeding among Saudi mothers: a prospective observational study. J Family Med Prim Care. 2021;10(10):3657-3663. doi:10.4103/jfmpc.jfmpc_852_21.
World Health Organization, UNICEF. Implementation guidance on counselling women to improve breastfeeding practices. Geneva: World Health Organization; 2021. ISBN 978-92-4-003232-3.
Yu J, Wei Z, Lukoyanova O, Borovik T, Fewtrell MS. Maternal infant-feeding attitudes and feeding choice at 3 and 6 months postpartum. Breastfeed Med. 2020;15(8):528-534.
Alyousefi NA. Determinants of successful exclusive breastfeeding for Saudi mothers: social acceptance is a unique predictor. Int J Environ Res Public Health. 2021;18(10):5172. doi:10.3390/ijerph18105172.
Gebretsadik GG, Tadesse Z, Mamo L, Adhanu AK, Mulugeta A. Knowledge, attitude, and determinants of exclusive breastfeeding during COVID-19 pandemic among lactating mothers in Mekelle, Tigrai: a cross-sectional study. BMC Pregnancy Childbirth. 2022;22:850. doi:10.1186/s12884-022-05186-w.
Ariff S, Saddiq K, Khalid J, Sikanderali L, Tariq B, Shaheen F, et al. Determinants of infant and young complementary feeding practices among children 6-23 months of age in urban Pakistan: a multicenter longitudinal study. BMC Nutr. 2020;6:75. doi:10.1186/s40795-020-00401-3.
Hasan M, Hassan MN, Khan MSI, Tareq MA, Afroj MS. Prevalence, knowledge, attitudes and factors associated with exclusive breastfeeding among mothers in Dhaka, Bangladesh: a cross-sectional study. Popul Med. 2021;3:1-7.
Karcz K, Lehman I, Królak-Olejnik B. The link between knowledge of the maternal diet and breastfeeding practices in mothers and health workers in Poland. Int Breastfeed J. 2021;16:58. doi:10.1186/s13006-021-00406-z.
Abid N, Abid F, Rauf A, Ali R. Breastfeeding knowledge, attitude and practices among new mothers. Ann Punjab Med Coll. 2021;15(1):40-45.
Aslam MZ, Johnson J, Baig M, Musaddique A. Factors influencing colostrum avoidance in developing countries: insights from a literature review. J Asian Midwives. 2024;11(2):81-97. doi:10.71071/JAM/v11i2.1.17.
Gebretsadik GG, Tkuwab H, Berhe K, Mulugeta A, Mohammed H, Gebremariam A. Early initiation of breastfeeding, colostrum avoidance, and their associated factors among mothers with under one year old children in rural pastoralist communities of Afar, Northeast Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth. 2020;20:448. doi:10.1186/s12884-020-03151-z.
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Copyright (c) 2026 Anees Fatema, Syed Farjad Ali Shah, Nighat Un Nisa, Ayesha Babar Kawish, Maryam Firdous, Saif Ullah (Author)
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