Examining breastfeeding self-efficacy as a mediator between maternal food insecurity and breastfeeding practices in Soweto, South Africa

Objectives: This study examined the potential mediating effect of breastfeeding self-efficacy on the relationship between maternal food insecurity and breastfeeding status.Design: A community-based, cross-sectional study was conducted.Subjects and setting: The study included 197 mothers from Soweto, South Africa, with infants under one month old, enrolled in the PLAY Love And You (PLAY) Study.Outcome measures: Data were collected via self-report questionnaires post-delivery, including maternal sociodemographic characteristics, breastfeeding status, food insecurity, and breastfeeding self-efficacy. Generalised Structural Equation Modelling assessed whether maternal food insecurity was associated with breastfeeding status and whether this was mediated by breastfeeding self-efficacy, adjusting for sociodemographic confounders.Results: Notably, 74% of mothers initiated breastfeeding within the first hour, and 87% were currently breastfeeding. No significant associations were found between maternal food insecurity and breastfeeding status, nor did breastfeeding self-efficacy mediate these relationships. However, early initiation of breastfeeding (β = 1.14, p = 0.03) and relationship status (β = −0.53, p = 0.002) emerged as critical factors associated with breastfeeding status and self-efficacy. Mothers who initiated breastfeeding within the first hour were significantly more likely to continue breastfeeding (p = 0.01), and currently breastfeeding mothers had higher self-efficacy scores (p = 0.01).Conclusions: The study found no significant mediating effect of breastfeeding self-efficacy on the relationship between maternal food insecurity and breastfeeding status among urban Black South African mothers. These findings underscore the need to address broader determinants of food security and maternal confidence, while future research should explore additional psychological and social factors for effective interventions.Trial registration: Pan African Clinical Trial Registry identifier: PACTR202202747620052.