The World Health Organization has recommended exclusive breastfeeding for infants up to 6 months of age since 2001, with continued breastfeeding until 2 years or longer [13]. According to data released by UNICEF in 2001, the global rate of exclusive breastfeeding for infants at 4 months was only 67%, and by 6 months, it dropped to 43% [4]. In China, the rate of exclusive breastfeeding for infants aged 0–6 months was only 29.5%[6], while in western China, it was 20.53%. A study conducted in the United States by Ryan et al. [14] found that the rate of exclusive breastfeeding in the early postpartum period was 65%, but by the time infants reached 6 months of age, the rate dropped to 32%. Our research results showed that the breastfeeding situation for infants aged 0–3 months was relatively good, with breastfeeding rates of 54.83% at 1 month, 51.13% at 2 months, and 45.57% at 3 months. However, the rate of exclusive breastfeeding significantly decreased after 4 months of age, with rates of 37.35% at 4 months, 29.41% at 5 months, and a decrease to 20.53% by 6 months, which is lower than the national average in China (29.5%).
Mothers' own Factors
The research findings indicate that there is no association between the age, educational level, and parity of mothers and breastfeeding in a certain region of western China. As China’s economy, culture, and educational levels have improved, women have higher levels of education, and late marriage and delayed childbirth have become the norm. Among the participants in the survey, 58.55% were over 30 years old, 87.15% had completed high school or above, and 54.17% had given birth to a second child, all supporting the above viewpoint. However, this finding is not necessarily consistent with other national studies, which suggest that mothers of two or more children are three times more likely to want to formula-feed their babies relative to first-time mothers [15]. There are also studies indicating that in the United States and Finland, mothers under the age of 25, with lower levels of education, and giving birth to their first child are more inclined to use formula feeding due to lack of experience with breastfeeding[16, 17]. The cultural backgrounds and breastfeeding policies of different countries, as well as different levels of acceptance of breastfeeding, contribute to these different findings.
The results indicate that there is no association between family income, medical expense payment methods, and breastfeeding in the local region. Different income levels do not significantly affect the frequency of breastfeeding, as it depends more on the mother’s and family’s willingness and practical circumstances for breastfeeding. However, there is also research data suggesting that in the United States, breastfeeding rates is lowest among low-income women [15]. Some studies suggest that the influence of family income on breastfeeding is complex, as higher income may provide more economic support and better nutritional conditions, thereby facilitating breastfeeding implementation. Busy work and high-stress lifestyles may make it difficult for mothers to have sufficient time and energy for breastfeeding [18]. The majority of birth mothers medical expenses were covered by health insurance, accounting for 81.06%, which is consistent with China’s health insurance policies, and showed no significant difference in breastfeeding rates.
The research results show a significant association between the amount of breast milk secretion in mothers and breastfeeding (OR = 7.707, 95% CI: 4.431–13.405). lactation after childbirth is a direct factor affecting exclusive breastfeeding. Specifically, the earlier the lactation starts, the more abundant the breast milk production. Early and uninterrupted skin-to-skin contact between the newborn and the mother, as well as initiating breastfeeding within the first hour after delivery, can promote early colostrum secretion and successfully establish breastfeeding, leading to a higher probability of exclusive breastfeeding for up to 6 months.
In this survey, it was found that mothers with pregnancy complications (OR = 3.45, 95% CI: 1.791–6.665) may have a certain impact on postpartum breastfeeding. The main reason is that mothers with pregnancy complications receive treatment and disease control, and the use of medication may affect the secretion and quality of breast milk. However, this does not mean that mothers cannot breastfeed. There is evidence indicating that the benefits of breastfeeding for mothers with pregnancy complications have been well established [19]. The breastfeeding rate is low for women with gestational diabetes[20]. Providing formula milk to infants born to mothers with gestational diabetes may reduce breast milk production, leading to a decrease in breastfeeding rates[21].
The normalcy of the mother’s nipples is indeed a protective factor for breastfeeding. In the survey, it was found that nipple abnormalities, particularly inverted nipples, were the most common and were not conducive to breastfeeding[22] (OR = 2.422, 95% CI: 1.515–3.870). For mothers, the condition of their nipples directly affects their lactation ability and the health of their infants. Nipples serve as the entrance for the baby to suckle breast milk, and nipple abnormalities may prevent the baby from latching onto the nipple and accessing breast milk effectively. The baby’s suckling is the most effective way to stimulate milk production, which significantly helps promote the establishment of successful breastfeeding.
This study found a correlation between prenatal breastfeeding knowledge training for infant mothers in the local area and exclusive breastfeeding[23]. Regression analysis results showed that mothers who received breastfeeding knowledge training during pregnancy had a higher probability of breastfeeding their infants within 6 months compared to those who did not receive such training (OR = 2.054, 95% CI: 1.252–3.370). Receiving prenatal education can change the perception of mothers and their families towards breastfeeding [24]. The more comprehensive the knowledge about breastfeeding is for mothers and their families, the more enduring their confidence in breastfeeding becomes. The study also found that implementing prenatal breastfeeding education for pregnant women significantly improves their confidence in establishing breastfeeding after childbirth, fostering a positive attitude towards breastfeeding[25].
The survey results indicate that the rate of exclusive breastfeeding among professional women in the local area is relatively low, which may be associated with a lower inclination towards exclusive breastfeeding (OR = 0.491, 95% CI: 0.288–0.836). Mothers' willingness to breastfeed after childbirth Non-working women prefer exclusive breastfeeding to working women [26]. Non-professional mothers, in contrast to their professional counterparts, often have lessincome, leading to a higher tendency towards breastfeeding due to economic reasons. On the other hand, professional mothers may face numerous challenges when returning to work and initiating breastfeeding, such as the lack of suitable breastfeeding environments, the inability to breastfeed on schedule, insufficient sleep, and other factors leading to increased pressure in both work and personal life, making it difficult to sustain exclusive breastfeeding[27, 28]. Therefore, they often opt for mixed feeding, resulting in a significantly shorter duration of exclusive breastfeeding.
Data analysis indicates that the mode of birth for mothers in the local area may have an impact on breastfeeding within the first six months (OR = 0.519, 95% CI: 0.323–0.833). Vaginally born mothers are able to suckle early and breastfeed on demand, so their postpartum lactation time is early, they secrete more milk and have a high breastfeeding rate [29]. Cesarean section surgery birth mothers have adverse effects on breastfeeding [30]. This is mainly due to the fact that cesarean sections can cause physiological and psychological changes in women, resulting in weak uterine contractions and a lowered pain threshold, and that mothers after cesarean sections may need to use painkillers or other medications for pain and fatigue, which may affect the production and secretion of breastmilk [31].
Data analysis has shown a correlation between maternal psychological issues and breastfeeding (OR = 0.437, 95% CI: 0.230–0.830). Factors such as postpartum sleep deprivation, fatigue, role transition, pain, and the infant illness can affect the function of the hypothalamic-pituitary axis in mothers, leading to a decrease in prolactin secretion[32]. This can result in negative emotions such as low mood, worry, and anxiety in mothers. These psychological problems have an impact on the mother-infant relationship and the growth and development of the baby [33, 34]. As the primary caregiver, the mother’s well-being and positive mindset play a crucial role in establishing a close parent-infant bond and promoting the growth and development of the baby.
Infant Factors
The results of this study indicate that there is no association between the infant gender and exclusive breastfeeding. There were 391 male infants and 376 female infants, with a X2 value of 1.279 and P > 0.05, indicating no significant association. It is important to note that infant jaundice[35] and various infectious diseases can impact breastfeeding [36, 37] (OR = 2.376, 95%CI:1.482–3.809). Breast milk contains immunological substances such as lactoferrin, immunoglobulins, lymphocytes, and macrophages, which can reduce the likelihood of respiratory infections, diarrhea, and skin infections in infants. Additionally, breastfeeding can lower bilirubin levels, promote intestinal motility, and accelerate the excretion of bilirubin, which helps prevent and treat infant jaundice. If newborns suffer from infectious diseases such as pneumonia, neonatal jaundice, and neonatal diarrhea, leading to decreased appetite and weakened suckling ability, mothers may experience delayed lactation due to lack of suckling stimulation from the infant[38]. Some mothers may develop mastitis due to themilk stasis, further increasing the difficulty of exclusive breastfeeding and impacting breastfeeding[39]. The treatment of these diseases may require changes in feeding methods or the use of special formulas, impacting breastfeeding as well.
Social Factor
In 1981, the World Health Organization released the “International Code of Marketing of Breast-milk Substitutes,” which was updated in 2017, leading to some improvements in breastfeeding rates[38, 41]. Many countries have laws in place to protect the rights and benefits of breastfeeding. For example, some countries require employers to provide appropriate facilities for employees to breastfeed and offer support in terms of working time and location [42]. In public places such as parks, malls, and airports, many locations provide breastfeeding facilities such as nursing rooms or lactation rooms. These spaces offer privacy for mothers to breastfeed and avoid any inconvenience associated with breastfeeding in public. Healthcare professionals such as doctors, nurses, and nutritionists can provide guidance and support to mothers regarding breastfeeding, including proper techniques and how to address common issues. Additionally, some hospitals offer specialized breastfeeding clinics to provide further guidance and assistance to mothers. Media promotion and education are also important means to encourage societal support for breastfeeding. Measures such as extending maternity leave, providing economic subsidies or incentives, and establishing dedicated nursing rooms, as well as providing necessary equipment and supplies to support breastfeeding in the workplace, have contributed to an increase in exclusive breastfeeding rates.
There are many factors influencing exclusive breastfeeding, and there may be significant differences among different countries and regions. This study investigated the factors influencing breastfeeding rates in a specific region in western China, where the exclusive breastfeeding rate was found to be relatively low and needs improvement. Some influencing factors may differ from the viewpoints presented in published studies, possibly due to regional differences, survey methods, and quality control. Continuously promoting the benefits of exclusive breastfeeding through widespread education and awareness is our long-term goal.