The Role of Maternal Ideations on Breastfeeding Practices in Northwestern Nigeria: a Cross-sectional Analysis

Abstract Background Early initiation of breastfeeding (EIBF) within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with EIBF and EBF practices. Methods A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September through October 2019. A random sample of over 3000 women with at least one child under 2 years was obtained. Respondents were asked about their health behaviors including breastfeeding practices for their youngest child under 2 years. Breastfeeding-related ideations were developed using the Ideation Model of Strategic Communication and Behavior Change. Mixed-effects logistic regression models were used to derive predicted probabilities for EIBF and EBF while adjusting for ideations and socio-demographic variables. Results Among 3039 women with a child under 2 years of age, 42.1% (95% CI: 35.1% - 49.4%) practiced EIBF, while 37.5% (95% CI: 29.8% - 46.0%) out of 721 infants aged 0-5 months were exclusively breastfed. Women who knew that EIBF was protective on the health of the newborn had 7.9 and 7.0 percentage points (pp) higher likelihood of EIBF and EBF practices respectively. Women who believed colostrum was harmful both had 8.4 pp lower likelihood of EIBF and EBF practices. We found a higher likelihood of practicing EIBF (5.1 pp) and EBF (13.3 pp) among women who knew at least one benefit of breastfeeding. Knowledge of the appropriate time to introduce complementary feeding and having self-efficacy to practice EBF were positively associated with 11.2 pp and 13.1 pp increased likelihood of practicing EBF alone. Household wealth, maternal occupation and attending ANC4+ times were associated with EIBF, while health provider’s influence was associated with EBF. Conclusion Social and Behavior Change (SBC) programs should focus on improving women’s knowledge about breastfeeding and its benefits, dispelling myths around colostrum as bad milk, building women’s confidence to exclusively breastfeed, and improving antenatal care uptake to support breastfeeding promotion.