Influence of Health Literacy on Maintenance of Exclusive Breastfeeding at 6 Months Postpartum: A Multicentre Study

Abstract

Background: International organizations recommend initiating breastfeeding within the first hour of life and maintaining exclusive breastfeeding for the first 6 months. However, worldwide rates of exclusive breastfeeding for 6-month-old infants is far from meeting the goal proposed by the World Health Organization, which is to reach a minimum of 50% of infants. Education is one of the factors affecting the initiation and continuation of breastfeeding, and incidentally, it is also related to lower health literacy. This study explored the influence of health literacy on maintenance of exclusive breastfeeding at 6 months postpartum. Methods: A longitudinal multicenter study with 343 women were recruited between January 2019 and January 2020. The first questionnaire was held during the puerperium (24–48 h) with mothers practicing exclusive breastfeeding, with whom 6-month postpartum breastfeeding follow-up was performed. Socio-demographic, clinical and obstetric variables were collected. Breastfeeding efficiency was assessed using the LATCH breastfeeding assessment tool. The health literacy level was evaluated by the Newest Vital Sign screening tool. A multivariate logistic regression model was used to detect protective factors for early exclusive breastfeeding cessation. Results: One third of the women continued exclusive breastfeeding at 6 months postpartum. Approximately half the participants had a low or inadequate health literacy level. An adequate health literacy level, a high LATCH breastfeeding assessment tool score (>9 points) and being married were the protective factors against exclusive breastfeeding cessation at 6 months postpartum. Conclusion: Health literacy levels are closely related to maintaining exclusive breastfeeding and act as a protective factor against early cessation. A specific instrument is needed to measure the lack of “literacy in breastfeeding”, in order to verify the relationship between health literacy and maintenance of exclusive breastfeeding.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

“…We did not observe differences in the rates of EBF at 3 or 6 months of follow-up in either group, despite (at least in the rst telephone contact), there being a greater proportion of mothers who had had a COVID-19 infection at the time of the birth who had gone back to work and who reported a lower application of conditions aimed at facilitating the continuation of breastfeeding. Although it is true that the rates of EBF are higher than those described at three and six months in other studies conducted in our eld [47][48][49] , they do not reach the value determined by the WHO as one of their objectives for 2025 (rates of EBF at 6 months of at least 50%) 50 . With regard to the impact that the pandemic has had on the rates of EBF at 3 and 6 months, we noted how in the study conducted by Maria et al 29 on the newborns of mothers with a COVID-19 infection at the time of birth between March and June 2020, they obtained rates of EBF at 3 months of 16% vs. 93.5% in the newborns of those mothers without a COVID-19 infection; differences that were in uenced by the initial recommendation to separate the mother-infant pair and by the fear of transmitting the infection via breast milk.…”

A Metanalysis of Trends in Knowledge and Practice of Breastfeeding in Egypt: A Case Study from the Eastern Mediterranean Region

“…However, metanalysis and systemic review have shown that a multifaceted approach of implementation during both the prenatal and postnatal periods increased the rate of EBF by 3.3 times at 6 months (Kim et al, 2018) and community outreach counseling (Kimani-Murage et al, 2017). However the higher level of education and in particular maternal health literacy level was shown to significantly increase EBF to 6 months (Valero-Chillerón et al, 2022). Maternal health literacy is defined as the acquisition of required cognitive and social skills to enable women to access, understand, appraise, and use the information needed to maintain and enhance their health conditions (Liu et al, 2020).…”

Exploring the interplay: Maternal electronic health literacy and its impact on early childhood development and parenting practices

“… Valero-Chillerón et al (2022). also found that health literacy levels were closely related to maintaining exclusive breastfeeding and play a protective role against early cessation.…”