Effects of the Experience of Breastfeeding-Friendly Practices and Breastfeeding Intention and Self-Efficacy on Breastfeeding Behavior: A Cohort Study in Taiwan
Abstract Background: Approximately 80% of births occurred in Baby-Friendly-accredited facilities in Taiwan, although the trend of exclusively breastfeeding infants until 6 months of age has stagnated in the last 10 years. To guide breastfeeding promotion interventions during postnatal stays and encourage mothers to continue breastfeeding for the first 6 months, the factors of breastfeeding behavior within 6 months post-delivery must be investigated. This study explored the relationships among breastfeeding intention, experience of breastfeeding-friendly practices, breastfeeding self-efficacy, and breastfeeding behavior at 4 and 6 months after childbirth.Methods: In this longitudinal cohort study, women who gave birth to healthy newborns at two Baby-Friendly hospitals in Taiwan and who were willing to breastfeed were recruited. Data were collected through a self-developed questionnaire measuring the experience of breastfeeding-friendly practices and through the Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form during hospitalization and at 1, 2, 4, and 6 months after childbirth.Results: A total of 155 women completed the questionnaires 5 times within 6 months. The determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months were longstanding breastfeeding intention during hospitalization, a high score for the experience of breastfeeding-friendly practices, and a high level of breastfeeding self-efficacy during that period. The in-hospital experience of breastfeeding-friendly practices did not predict breastfeeding behavior at 4 and 6 months. Breastfeeding intention (hazard ratio [HR] = 0.40–0.14) and in-hospital breastfeeding self-efficacy (HR = 0.98) were significant as in-hospital risk factors contributing to breastfeeding duration 6 months after childbirth.Conclusions: Longstanding breastfeeding intention, continuation of the experience of breastfeeding-friendly practices, and maintenance of a high level of breastfeeding self-efficacy were the determinants of breastfeeding at 4 and 6 months. Healthcare professionals in Taiwan must support breastfeeding-friendly practices and consider interactive interventions to promote continued breastfeeding at different stages during the first 6 months after childbirth based on the mother’s informed plan of breastfeeding and breastfeeding self-efficacy during their postnatal hospitalization.