The present study investigated the rate of intention to exclusive breastfeeding among women in late pregnancy, and analyzed the factors that influenced this intention. Findings showed that 60.8% of pregnant women in the third trimester planned to exclusively breastfeed in the first 6 months. Supports of exclusive breastfeeding from pregnant women’ husband and family were positively associated with intention of exclusive breastfeeding of pregnant women themselves. In addition, women who have attended the breastfeeding courses during pregnancy have higher willingness of exclusive breastfeeding than women who did not attended the courses.
The prevalence of exclusive breastfeeding at six months in China has changed during the past decade. A review paper showed that exclusive breastfeeding rates in the first six months were between 0.50% and 33.45% in 17 cities including Xi’an in China from 2007–2017(7). Another cohort study conducted in 2014 in rural areas from three cities in Shaanxi Province showed that the exclusive breastfeeding rate at six months was 35.04% (15). The fourth national health service survey in 2008 indicated that the rate of exclusive breastfeeding at six months was 27.6%(16), while this rate increased to 58.5% in the fifth survey in 2013(17). Another quasi-experimental study throughout 14 provinces in Western, Eastern and Central China showed that this rate increased significantly from 42.96% in 2012 to 48.84% in 2015(18). Our findings displayed that the intention to exclusive breastfeeding at six months was 60.8%, which is higher than previous literature results. The above increases may be associated with changes in breastfeeding targets set in the National Program of Action for Child Development in China. The recent target of an exclusive breastfeeding rate was ≥ 50% at sixth month of life from 2011–2020(12).
Breastfeeding practices are influenced by various factors including maternal age, education level, family income and so on. A review study of meta-aggregation of qualitative studies showed that maternal perceptions and self-efficacy, family support, social expectations and policy as factors influencing breastfeeding in China(19). The present study found no significant associations between maternal age, mothers’ occupation, and parity and planning for exclusive breastfeeding within 6 months postpartum. It has been suggested that prior breastfeeding experience rather than parity, predicts maternal willingness to exclusively breastfeed(20). Our results indicated that maternal education level was significantly associated with exclusive breastfeeding after adjusted by maternal age. Higher educational level was negatively associated with exclusive breastfeeding preferences and this was consistent with a Saudi study(21). This might be that mothers with high education level were more likely to be employed and had shorter breastfeeding duration(22).
Family member’s infant feeding preferences was strongly predictive of maternal intention to exclusively breastfeed in first six months(23). Previous studies examining factors associated with intention to exclusive breastfeeding found that perceived support from mothers’ social networks was influential(13). The present study found that mothers who received more supports from their husbands and family members were more likely intend to exclusively breastfeed for 6 months. This finding was consistent with studies from Israel, Canada, and the United States, which show that the odds of intending to exclusively breastfeed were higher if the husband and maternal grandmother preferred exclusive breastfeeding (13). Breastfeeding support from women’ partners improved exclusive breastfeeding rates(24), and a preference for infant formula was associated with earlier breastfeeding cessation(25). In addition, the preferences of the mothers’ own mother or their mother-in-low influence maternal exclusive breastfeeding intentions, and this was not surprising given that the strong influence of the mother-in-low in traditional Chinese families. Previous research has shown that most fathers are afraid to offer support because they think they don't know enough about breastfeeding and can't help when breastfeeding is difficult.
Our study found that infants’ mothers who participated in antenatal breastfeeding classes had a higher intention of exclusively breastfeed than those who did not. This was consistent with findings showed that mothers with more breastfeeding knowledge have a more positive attitude towards exclusive breastfeeding and were more willing to exclusively breastfeed after childbirth(26). As the mother's willingness to exclusive breastfeeding is influenced by maternal husband and other family members, it was also necessary to involve infant fathers in the exclusive breastfeeding education program to improve their knowledge and awareness of breastfeeding. Education programs emphasizing the nutritional value and health benefits of breast milk and targeting the important role of the spouse and whole family are needed in achieving breastfeeding success(27). In addition, multifactorial interventions such as direct face-to-face prenatal education in groups, individual counselling, and postpartum telephone follow-up, could also be used in maintaining exclusive breastfeeding rates during the first 6 months postpartum.
This study has some limitations that need to be addressed. Data collected in this study was via interviewing on an individual basis to answer the questionnaire, and pregnant women in late trimester might felt embarrassed to reveal their no intention to exclusive breastfeeding, which might introduce information bias; Besides, husband and family member’s support on exclusive breastfeeding was also reported by mothers themselves, thus there is a bias also. In addition, this study interviewed pregnancy women in five hospitals in the same city, which might limit the generalization of this finding. Last, the cross-sectional study design could not disclose the causal relation between the examined factors and maternal intention to exclusively breastfeed. Strengths of this study include large sample of participated pregnant women in late trimester and standardized application of the questionnaire. We also collected as many the maternal and family characteristics potentially associated with intentions to exclusively breastfeed such as maternal employment, parity, maternal leave duration, health insurance.