Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes

Associated Factors of Exclusive Breastfeeding Intention among Pregnant Women in Najran, Saudi Arabia

The exclusive breastfeeding (EBF) intention conceived by pregnant women is the most important predictor of breastfeeding (BF) initiation, duration, and continuation. This study explores the associated factors of EBF intention among pregnant women. This was a descriptive cross-sectional study conducted from November 2022 to January 2023 with 382 pregnant women who came to the outpatient clinic in the Maternal and Children Hospital (MCH). Four instruments were used for data collection: the Infant Feeding Intention scale, the Gender-Friendly BF Knowledge scale (GFBKS), the Iowa Infant Feeding Attitude scale (IIFAS), and the basic data questionnaire. The study findings indicated that 51.8% and 75.9% of gravida women had adequate knowledge and a positive attitude regarding BF. Furthermore, 56.3% of the participants had a high intention for EBF. Binary logistic regression illustrated that occupational status, antenatal care, plan for the current pregnancy, BF practice, last child delivery mode, medical disorder during the current pregnancy, age, BF knowledge, and attitude are potential predictors. The goodness of fit test revealed that 46.8% of the EBF intention could be anticipated through the positive pre-mentioned factors. The low EBF intention is modifiable by addressing the previously positive predictors. BF educational interventions should be tailored based on EBF intention predictors in order to be effective and lead to behavior change.

The mothers' breastfeeding behaviour within six weeks postpartum: new scale development and psychometric validation study

BACKGROUND

The evaluation of mothers' breastfeeding behaviour within 6 weeks postpartum could help health workers comprehensively identify maternal breastfeeding shortcomings, clarify nursing problems, and provide targeted interventions. However, no prior study was found, therefore this study aimed to develop and validate the reliability and validity of the mothers' breastfeeding behaviour scale within 6 weeks postpartum.

METHODS

A main two-step approach was used: (1) a qualitative pilot study using the purposive sampling method was adopted to test the fitness, simplicity, and clarity of items with 30 mothers; (2) a cross-sectional survey using the convenient sampling method was conducted for item analysis and psychometric validation with 600 mothers.

RESULTS

The final version of the scale consisted of 36 items with seven dimensions, explaining 68.852% of the total variance. The Cronbach's α, split-half, and retest coefficients were 0.958, 0.843, and 0.753, respectively. The validity of the scale: (1) Content validity: content validity index (CVI) range of items was between 0.882 and 1.000. The scale-level-CVI was 0.990. (2) Structure validity: The fitting indices were as follows: χ²/ⅆf =2.239, RMR = 0.049, RMSEA = 0.069, TLI = 0.893, CFI = 0.903, IFI = 0.904, PGFI = 0.674, and PNFI = 0.763. (3) Convergent validity: The composite reliability and average variance extracted (AVE) of the seven dimensions were between 0.876 and 0.920 and between 0.594 and 0.696. (4) Distinguish validity: The correlation coefficients were less than the square root of the AVE, except for self-decision behaviour, self-coping behaviour, and self-control behaviour. However, the fit index of the original three-factor model was better than that of the other new models, with significant differences (P < 0.001). (5) Calibration validity: The area under the curve was 0.860 or 0.898 when the scale was used to predict exclusive or any breastfeeding at 42 days. The correlation coefficients of the maternal breasting feeding evaluation scale, breastfeeding self-efficacy short-form scale, and the scale were 0.569 and 0.674, respectively.

CONCLUSION

The newly developed mothers' breastfeeding behaviour scale within 6 weeks postpartum consists of 36 items belonging to seven dimensions with good reliability and validity and is a reliable and valid instrument to be used in future maternal breastfeeding behaviour assessments and interventions.

Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study

Breastfeeding attitudes are strong predictors of breastfeeding behavior. Gaining a deeper understanding on the levels and determinants of antenatal breastfeeding attitudes is crucial. This cross-sectional study involved 124 pregnant women at a tertiary hospital in Hunan, China. A self-administered questionnaire, the Iowa Infant Feeding Attitude Scale, the Edinburgh Postnatal Depression Scale, the Pregnancy Stress Rating Scale, the Childbirth Attitude Questionnaire, the Perceived Social Support Scale, and the Breastfeeding Knowledge Questionnaire were assessed during their first-trimester, second-trimester, and third-trimester hospital visit. Multiple linear regression was conducted to identify the determinants of breastfeeding attitudes. The participants reported neutral (56.39 ± 5.69) levels of breastfeeding attitudes. The determinants of antenatal breastfeeding attitudes were other family members' support for exclusive breastfeeding: moderate (β = 0.278, p < 0.05), depressive symptoms (β = -0.191, p < 0.05), and breastfeeding knowledge (β = 0.434, p < 0.001). The variables explained 33.9% (adjusted R²) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001). Namely, other family members' support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderate of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge was positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Health professionals should identify these modifiable factors that may contribute to poorer breastfeeding attitudes, which is useful in targeting promotions of breastfeeding.

The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis

OBJECTIVE

Exclusive breastfeeding intention is an important predictor of exclusive breastfeeding behavior. Antenatal depressive symptoms are a potentially modifiable risk factor for exclusive breastfeeding intention. However, studies of the impact of antenatal depressive symptoms on exclusive breastfeeding intention are sparse and contradictory. Therefore, explorations that evaluate the effects of identical factors of exclusive breastfeeding intention and antenatal depressive symptoms in their relationship are urgently needed. This study aims to (1) investigate the impact of antenatal depressive symptoms on exclusive breastfeeding intention based on confounders related either to antenatal depressive symptoms and/or exclusive breastfeeding intention and (2) explore whether or not identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.

DESIGN AND SETTING

A cross-sectional survey was conducted at a tertiary hospital in Hunan, China.

PARTICIPANTS

A total of 393 pregnant women completed a self-administered questionnaire, a question on their breastfeeding intention, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale during their first-trimester hospital visit. Logistic regression was used to evaluate the impact of antenatal depressive symptoms on exclusive breastfeeding intention. Moderate analysis was employed to explore whether identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.

RESULTS

Antenatal depressive symptoms negatively affect the exclusive breastfeeding intention after controlling as fully as possible for confounders (adjusted OR = 2.88, 95% CI: [1.06, 7.82]) and it was moderated by one of the identical factors (i.e., social support). The results of the simple slope test showed a negative relationship between antenatal depressive symptoms and exclusive breastfeeding intention among pregnant women with low levels of social support (b =-0.011, p < 0.05).

CONCLUSION AND IMPLICATION FOR PRACTICE

Social support moderates the negative effects of depressive symptoms on exclusive breastfeeding intention. Clinical care practices and future intervention research that focus on improving antenatal depressive symptoms and exclusive breastfeeding intention should consider the moderator.