Factors associated with exclusive breastfeeding at 6 months postpartum: a prospective mixed-method cohort study

Exclusive breastfeeding (EBF) rates at 6 months postpartum remain low globally and in Hong Kong. This prospective mixed-method study examined the barriers to and facilitators of sustaining EBF until 6 months postpartum.

Nine hundred forty-two pregnant women completed baseline and at least one of the five follow-up surveys: immediate (<7 days) (T1), 1 month (T2), 2 months (T3), 4 months (T4), and 6 months postpartum (T5). The response rates were 81.0% (T1), 69.9% (T2), 67.3% (T3), 65.8% (T4) and 81.4% (T5). Eighteen participants and 6 partners participated in either individual or focus group interviews at 6 months postpartum.

The quantitative study found that mothers who worked full-time, had attained lower levels of education, lacked breastfeeding experience, and had caesarean sections were less likely to practise EBF at 6 months postpartum. In contrast, mother-in-law's breastfeeding experience, higher breastfeeding intention and better breastfeeding knowledge were positively associated with EBF at 6 months postpartum. Qualitative data identified perceived insufficient breast milk and returning to work as the main barriers, while support from family was the key facilitator.

In addition to education and support for mothers, in order to sustain EBF, it is crucial to engage with family members and for workplaces to create more conducive environments.

This large-scale mixed methods cohort study describes mothers' feeding practices and perspectives from the immediate postpartum period until 6 months. Factors associated with EBF at 6 months included (1) mother and infant attributes, (2) workplace and employment, (3) family and community, and (4) health systems and services. Policies and strategies extending to family members, workplace and health system will create a more conducive environment for sustaining EBF.