Breastfeeding as a protective factor of maternal depression: a multi-country analysis from Africa and South Asia

The association between breastfeeding (BF) and maternal mental health remains underexplored in low- and middle-income countries (LMICs). This study examined the relationship between BF and depressive symptoms among mothers in selected LMICs across Africa and South Asia.

We conducted a secondary analysis of nationally representative Demographic and Health Survey (DHS) data from Lesotho (n = 793; 2023-2024), Mozambique (n = 5092; 2022-2023), Bangladesh (n = 4971; 2022), and Nepal (n = 1401; 2022). The pooled sample comprised 12,257 mothers aged 15-49 years with complete data on BF status and depressive symptoms. Depression was assessed using DHS items adapted from the Patient Health Questionnaire (PHQ), applying a dichotomous cut-off score of ≥ 10. BF was categorized as ever versus never. Country-specific and pooled logistic regression models were estimated, adjusting for maternal age, education, and household wealth.

Breastfeeding prevalence was high across countries (Lesotho: 92.3%; Mozambique: 96.3%; Bangladesh: 95.7%; Nepal: 98.9%), while the prevalence of depressive symptoms ranged from 4.0 to 7.6%. BF was associated with lower depressive symptoms in unadjusted analyses but reached significance only in Bangladesh (β = -0.861, p < .001) and the pooled sample (β = -0.449, p < .01) in the adjusted model. Overall, mothers who never breastfed showed a consistently higher risk of depression than those who had breastfed.

This multi-country analysis provides evidence of an inverse association between BF and maternal depressive symptoms in LMICs, with significant effects observed primarily in Bangladesh. Integrating maternal mental health support into BF promotion programs may be beneficial. Longitudinal studies with more detailed BF measures are needed to clarify causal pathways.