Breastfeeding is the biological norm and the optimal mode for feeding infants to reduce morbidity and mortality (1). Although more than 80% of neonates are “ever breastfed” globally, only 50% initiate breastfeeding (baby put to the breast within an hour of birth) (2, 3), and only one-third of infants are exclusively breastfed for the first six months of their life (2, 4, 5). Sub-optimal infant feeding practices, including pre-lacteal feeding (the feeding of an infant with something other than breastmilk in the first three days of life), non-exclusive breastfeeding, and use of artificial infant formula contribute to 1.4 million child deaths globally (6). In Ethiopia, only 60% of babies are exclusively breastfed for the first six months (7). While the Ethiopian government had set a goal of improving the level of exclusive breastfeeding to 70% by 2015, there has only been a one percent improvement in exclusive breastfeeding rates over the last five years (8). In Ethiopia, non-exclusive breastfeeding was the cause for significantly higher risks of neonatal (9) and infant (10) mortality, and acute malnutrition (11).
Breastfeeding is a complex biological, social and cultural practice influenced by a broad array of socio-demographic, biophysical and psychosocial factors (12). Psychosocial factors, including maternal intention to breastfeed, breastfeeding self-efficacy, knowledge, attitude, and social support, are associated with the early initiation of and continued exclusive breastfeeding (13, 14). Studies from low-income countries have also shown the effects of psychosocial factors on maternal behaviour to exclusively breastfeed for six months, and to continue breastfeeding for two years. These findings indicate that mothers with better self-efficacy who intend to breastfeed, have positive attitudes towards breastfeeding, are knowledgeable, and who have access to support are more likely to exclusively breastfeed for six months (15, 16).
Sociodemographic and economic characteristics of the mother are significantly associated with breastfeeding practice. In low-income countries, Yalcin et al.(2016) (12) analysed health and demographic data of 27 countries from Sub-Saharan African (SSA), and found that older mothers (those aged 25–35 years), women with at least secondary level of education, women who live in rural areas, who belong to richer household wealth quantiles, who had singleton births, and female infants were more likely to exclusively breastfeed their infants for six months. Similarly, in Ethiopia, older aged (17, 18), wealthy or higher income (10, 19), educated (19) and rural resident (20, 21) mothers were more likely to exclusively breastfeed their infants for six months.
Breastfeeding initiation, exclusivity and duration are also influenced by biological and environmental factors, such as place of delivery, support during delivery, and perceptions related to insufficient milk supply (22). Maternal perceptions about adequate milk supply are strongly associated with exclusive breastfeeding practices in high- and low-income countries (13, 23, 24). Mothers who encounter breastfeeding or birth-related difficulties, including nipple pain, are also less likely to exclusively breastfed their infants (25, 26).
Modifiable factors, which impact maternal breastfeeding practices are primarily psychosocial components, including maternal intention to breastfeed, attitudes, self-efficacy, and social support during lactation (13). These psychosocial factors can be potentially modified through interventions focussed on breastfeeding education and promotion (13, 27).
Adequate support for lactating mothers is crucial to improve exclusive breastfeeding practice (3). According to Dennis (2002) (22) unsupported mothers are less likely to initiate, and continue breastfeeding. Maternal breastfeeding intention is dependent on their partners’ breastfeeding attitude (28). Mothers’ perception of how their partner’s preference about infant feeding affects their breastfeeding practice. Mothers continue breastfeeding when their partners prefer breastfeeding conversely, mothers cease breastfeeding when their partners prefer bottle-feeding(28). Maternal breastfeeding intention is strongly predicted by their partners’ breastfeeding beliefs, which impacts on their decision to breastfeed more than their own reasons (29). Fathers can support their partners by providing breastfeeding information to motivate and assist them to breastfeed, as well as providing practical support with care of additional children and housework (30).
A majority of the studies in Ethiopia have assessed the effect of sociodemographic characteristics of mothers on breastfeeding exclusivity (17–19, 31), with fewer addressing mothers’ knowledge attitudes and self-efficacy (16, 32). A cross-sectional study from Ethiopia exploring involvement of fathers in breastfeeding has shown promising effects on breastfeeding practice. However, fathers’ participation was affected by the maternal perception about the role of the father in breastfeeding (33). Work by non-government agencies in Ethiopia have identified a lack of knowledge and traditional gender roles as being limiting factors for fathers’ involvement in breastfeeding in Ethiopia (34, 35). Encouraging fathers’ involvement in breastfeeding, as well as the provision of breastfeeding information during antenatal care, would assist them to be more supportive during breastfeeding (36). Therefore, understanding the level of breastfeeding knowledge, attitudes and the perception of partners’ support from the perspective of expectant couples would inform our understanding of effective breastfeeding interventions targeting fathers and mothers. Therefore, the aim of this study was to compare expectant couples’ breastfeeding knowledge, attitudes, and support in Mekelle, Ethiopia.