Knowledge and Performance of Exclusive Breastfeeding among Mothers in Dibis District, Kirkuk Governorate, Iraq: A Population-based Study

Background: Despite its vital role in child health, breastfeeding is often hindered by social, cultural, and health system barriers. Objectives:  To assess mothers’ knowledge and practice of exclusive breastfeeding (EBF) in Dibis district, Kirkuk, and examine its association with selected demographic factors. Materials and Methods: A household-based descriptive cross-sectional study was conducted in Dibis, Kirkuk Governorate, from June 2020 to January 2023, involving 1823 mothers of children aged ≤ two years. Data were collected using a structured questionnaire covering sociodemographic characteristics, knowledge of EBF, and actual breastfeeding practices. Descriptive and inferential statistics were used to analyze associations between sociodemographic factors and mothers' knowledge and performance. Results:  Mothers’ knowledge and performance regarding EBF were at a moderate level. Significant associations were observed between EBF and the mother's level of education (P-value = 0.046).  The mother’s age at marriage (P-value = 0.090) and the number of family members (P-value = 0.074) were not statistically significant. Binary logistic regression analysis indicated that mothers who regularly visited primary health care centers were twice as likely to practice EBF (OR = 2.011; 95% CI: 1.263–3.203). Among all predictors, normal vaginal delivery emerged as the strongest factor, with mothers who delivered vaginally being over four times more likely to exclusively breastfeed (OR = 4.547; 95% CI: 3.181–6.496). Conclusion: Mothers showed moderate knowledge and performance, with education, delivery type, and healthcare access identified as key factors. Further research should explore cultural and systemic barriers to breastfeeding in Iraq.