The effect of prenatal education on exclusive breastfeeding among women in Quito. Prospective cohort study

Abstract

Background: Breast milk is the optimal food for humans, however, many mothers encounter difficulties sustaining exclusive breastfeeding (EBF). Prenatal education (PE) has been suggested as a potential strategy to promote EBF. There remains a gap in understanding how PE influences EBF duration. Methods: This prospective cohort study aimed to evaluate the effect of PE on EBF continuation among mothers who gave birth in private and public hospitals in Quito, Ecuador. A total of 278 participants were recruited, with 152 receiving PE and 126 not receiving it. Data was collected through structured surveys. Baseline clinical information was obtained through face-to-face interviews conducted after delivery and before discharge. Then, follow-up telephone interviews were conducted at one, four, and six months postpartum. Results: Comparisons between the exposed (PE) and unexposed groups revealed significant differences in education level, health insurance, antenatal care visits, rooming-in rates, parity, and maternal breastfeeding (BF) intentions. Participants who received PE demonstrated a significantly longer mean duration of EBF compared to those who did not (89.4 ± 77.2 days vs. 66.1 ± 70.2 days, p = 0.004). The incidence rate of EBF abandonment was 11.81 per 100 person-months in the PE group and 14.91 per 100 person-months in the non-PE group. Cox survival analysis indicated a lower risk of EBF cessation among mothers who received PE (adjusted hazard ratio [aHR] = 0.58, 95% CI = 0.40-0.84, p = 0.004). Other factors associated with EBF discontinuation included delivery at a public health facility, postpartum depression, specific reasons for stopping BF, insufficient supply, return to work, healthcare provider recommendations, family advice, and negative BF experiences. Conclusion: Standardized PE programs have a significant and independent positive impact on EBF duration among mothers in Quito, Ecuador. These findings underscore the importance of integrating PE into routine prenatal care and providing comprehensive postpartum support to promote BF continuation. It is necessary to develop targeted interventions to address modifiable risk factors for BF cessation.