Determinants of the initiation and duration of breastfeeding among women in Kuwait

Regular breastfeeding surveillance is essential to determine to what extent national breastfeeding targets are being met and how breastfeeding practices change over time. There have been irregular infant feeding studies or national surveys carried out in Kuwait so it is difficult to assess secular trends in breastfeeding practices. The objective of the Kuwait Infant Feeding Study (KIFS) was to identify the incidence and prevalence of breastfeeding up to 26 weeks postpartum among a population of women living in Kuwait and to identify the factors associated with the initiation and duration of breastfeeding. A sample of 373 women recruited shortly after delivery from four hospitals in Kuwait completed a structured, interviewer-administered questionnaire and follow-up telephone interview at 6, 12, 18 and 26 weeks postpartum. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding and survival analysis was used to examine the duration of breastfeeding. In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed prior to hospital discharge, the remainder of breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. At six months of age, 39% of mothers were still breastfeeding but none of the women were fully or exclusively breastfeeding. The median duration of any breastfeeding duration was 13.9 weeks. 2 Breastfeeding at discharge from hospital was independently positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery. Mothers originally from other Arab countries were more likely to initiate breastfeeding in hospital than Kuwaiti mothers. Women whose husbands worked in sales or clerical occupations and Kuwaiti national mothers were at higher risk of early breastfeeding termination. Women whose husband or own mother preferred breastfeeding, breastfed for longer than those women whose husbands or mothers preferred formula feeding or were ambivalent about how they fed the infant. Hospital-related factors including time of first feeds, type of first feed, age of introducing a pacifier and feeding on demand were significantly associated with breastfeeding duration. The results of this study indicate that while breastfeeding is almost universally initiated, very few women achieve the WHO recommendations of exclusive breastfeeding to 6 months of age. The reasons for the high use of prelacteal and supplementary formula feeding warrant further investigation. Data collected in this study will contribute to the limited breastfeeding surveillance data available for Kuwait and inform future public health policy. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding among mothers in Kuwait.