Psychosocial and context factors associated with breastfeeding and complementary feeding changes in Belize: a mixed methods approach
Authors: Slekiene Jurgita , Gamma Anna Elizabeth , Wade Paulette , Robateau Denise , Oketch Jecinter Akinyi , Palacios Silvie 
Published: February 2024

Abstract
Background
UNICEF advocates for children's rights, aiming to meet their basic needs and expand their opportunities to reach their full potential. Reducing child mortality rates and enhancing health are crucial to this mission. This can be achieved through measures like breastfeeding and complementary feeding practices. This study aims to analyse these practices in Belize using data from three past Multi Indicator Cluster Studies (MICS) and conducted a research study that seeks to identify barriers and other factors influencing breastfeeding, including the impact of the Baby-Friendly Hospital Initiative (BFHI), with a specific focus on the role of maternal mental health. The study specifically examines breastfeeding within the first hour after birth, exclusive breastfeeding for the first six months of life (EBF), and continued breastfeeding for up to two years and more (BF).
Methods
A mixed-methods design was employed, integrating both quantitative and qualitative approaches, to assess the context and psychosocial factors underlying breastfeeding and complementary feeding practices among caregivers in Belize. This included analysis of secondary MICS data from 2006, 2011 and 2015-16, supplemented by a desk review, and primary data collection in Belize in August/September 2022 using face-to-face interviews with 45 caretakers (mainly women) of children under two years of age, Key Informant Interviews (KII’s), and Focus Group Discussions (FDG’s) with mothers, healthcare staff and other caretakers. Maternal mental health was assessed using Self-Reporting Questionnaire (SRQ-20).
Results
The findings indicate that two out of three children were not exclusively breastfed for the first six months. Among the 45 interviewed caretakers, 93% reported overall breastfeeding (this includes exclusive, non-exclusive, and complementary breastfeeding), 82% practiced EBF during the first six months, and 78% breastfed their baby within one hour after birth. This suggests that while is the tendency for EBF to increase, general BF practices were more common than EBF and both were more prevalent than breastfeeding immediately after birth. Every second interviewed woman was at risk to develop common mental health disorders. However, there was no direct significant association between mental health and breastfeeding. Correlation analysis revealed that mothers with poorer mental health have more children, are less educated, are from lower socioeconomic backgrounds, are more aware of barriers related to breastfeeding compared to mothers with good mental health.
Conclusions
Despite significant improvements in EBF over the years in Belize, behaviour change interventions should particularly focus on vulnerable groups: mothers who are poorer, less educated, and living in rural areas. Further investigation is needed into contextual and psychosocial factors influencing these outcomes, with a specific emphasis on maternal mental health to comprehensively address the challenges associated with breastfeeding and complementary feeding practices.