Predictors of exclusive breastfeeding practice among Bulgarian mothers
Information for nursing staff, 2025, 57(2), 12-21.
K. Atias
Department of Psychology, “Paisiy Hilendarski” University – Plovdiv
Abstract. Exclusive breastfeeding as a biological norm has a number of benefits for the infant and is recommended by the World Health Organization as a way of feeding during the first six months of life. The aim of this paper was to investigate predictors of exclusive breastfeeding. A cross-sectional study was conducted among women (n = 406) who had given birth in the previous 6 months. Data on postpartum depression were collected using the Edinburgh Postnatal Depression Scale (α = 0.870) and showed that 22.3% of women had depression (score ≥ 13). Binary logistic regression was applied to examine predictors. The results showed that mode of delivery (p = 0.006), early initiation of breastfeeding (p < 0.001), postpartum depression (p = 0.001), maternal age (p = 0.015), and maternal educational level (p = 0.009) are independent predictors, whereas early initiation of breastfeeding, maternal age, and postpartum depression had a simultaneous impact in predicting exclusive breastfeeding. Breastfeeding initiation in the first 1-2 hours postpartum increased the possibility of exclusive breastfeeding nearly 2-fold compared with initiation of breastfeeding in the first 24 hours. Normal delivery also increases the possibility of exclusive breastfeeding compared with cesarean delivery. Maternal age increases the possibility of exclusive breastfeeding, with the lowest possibility in women aged 20-24 years. Also, women with university education are more likely to breastfeed exclusively than women with secondary education. The summary results suggest that changes in maternal and baby health care have the potential to increase the incidence of exclusive breastfeeding, with all the resulting benefits. Primarily, these are: 1) reduction in cesarean section rates (52.71% of the sample), 2) enabling and supporting breastfeeding in the first 1-2 hours after birth (17.2% of the sample) during skin-to-skin contact, and 3) screening for postnatal depression (25.1% of the sample) followed by timely therapy.
Key words: exclusive breastfeeding, initiation of breastfeeding, childbirth, postpartum depression, mental health