Mother's milk is the gold standard of nutrition for the growth and development of infants [1] and has a unique biological and emotional impact on the health of both mother and baby [2]. Mother's milk is highly effective in promoting health and preventing numerous disorders and diseases in children[3]. Furthermore, breastfeeding offers significant economic and social benefits for both families and a nation's healthcare system[1].
According to WHO guidelines, exclusive breastfeeding entails the first hour of birth and continuing it for the first 6 months without introducing complementary foods such as formula, bottles, pacifiers, or even water, except for necessary vitamin supplements. Breastfeeding should ideally continue up to the age of 2 years [4–6] .
WHO estimates that approximately one-third of breastfeeding mothers exclusively breastfeed during the first 6 months[7]. In a global survey of 194 countries conducted in 2018, the rate of exclusive breastfeeding was around 40%. Only 23 countries reported rates exceeding 60% [5, 8]. Research from countries such as the United States, Tanzania, Brazil, Turkey, Australia, and Thailand suggests that exclusive breastfeeding is approximately 21–68% for the first three months and 15–30% for six months[7, 9]. The results of a systematic study and meta-analysis in Iran show that the rate of exclusive breastfeeding for 6 months ranges from 38–59%[10].
The significance of breastfeeding in low-income and middle-income countries surpasses that of high-income countries[11], even though the rate of exclusive breastfeeding in these countries is only 37%. However, the duration of breastfeeding in these countries tends to be longer compared to developed nations[11]. Studies indicate that, in many societies, although breastfeeding initiation rates are high, they sharply decline in the first weeks postpartum[7, 12].
Researchers have identified various reasons for the reduction or cessation of exclusive breastfeeding. In a qualitative review of 40 studies, Sari Laanterä highlighted that the primary cause of exclusive breastfeeding failure is mothers' lack of knowledge Sari Laanterä. Another meta-analysis found that the rate of early breastfeeding after cesarean delivery was significantly lower than that after vaginal delivery, although no significant difference was observed during the first 6 months[13]. In Saudi Arabia, factors such as the mother's young age, sore nipples, insufficient breastfeeding skills, and the perception of insufficient milk supply have been cited as contributing to decreased exclusive breastfeeding[14]. In Ghana, in addition to the aforementioned factors, insufficient support from spouses has led to early discontinuation of breastfeeding. Concerns about HIV also play a role[15]. Other studies have indicated that lack of support from those around first-time mothers, return to the workplace, and education levels below a diploma are reasons for exclusive breastfeeding failure[16].
As part of the WHO and UNICEF's goals for 2025, exclusive breastfeeding for the first 6 months of life is recommended to reach at least 50% [7, 8, 10]. Among WHO's guidelines for supporting breastfeeding, 10 actions in child-friendly hospitals can enhance the practice of exclusive breastfeeding [17]. Studies have shown that in addition to child-friendly hospitals, home visits during the first month postpartum to provide guidance and support to mothers play a pivotal role [4]. Additionally, planning for community support and creating a child-friendly environment can improve the conditions for exclusive breastfeeding[18].
In light of the changing individual and societal conditions across time and regions, the causes for exclusive breastfeeding failure in each society require continuous evaluation. In recent years, no comprehensive study has been conducted to identify the maternal factors contributing to the failure of exclusive breastfeeding in Mazandaran State in Iran. By pinpointing the causes of both continued and exclusive breastfeeding failure, we can better plan to address this critical issue in infant health. Consequently, this study aims to determine the maternal factors contributing to exclusive breastfeeding failure in xxx at 2019.