Inhibiting and protective factors of exclusive breastfeeding in an Island population in Spain: a longitudinal study

Breastfeeding provides important health benefits for both mothers and infants. In Spain, the rate of exclusive breastfeeding (EBF) at 6 months is 47%, which remains below the 60% target proposed by the World Health Organization for 2030. The objective of this study was to identify the protective and inhibiting factors associated with EBF in a population of pregnant women in Tenerife (Canary Islands, Spain). We conducted a longitudinal, prospective study among women attending midwife consultations for pregnancy check-ups at a primary healthcare center between November 2018 and January 2021. We followed 83 women, collecting data at different time points during pregnancy and postpartum (hospital stay, 15 days, 1 month, 4 months, and 6 months). Descriptive statistics and univariable and multivariable logistic regression analyses were performed. The inhibiting factors for EBF were pacifier use during the hospital stay, on EBF after birth (OR: 0.06, 95% CI: 0.02, 0.23), pacifier use at 15 days (OR: 0.13, 95% CI: 0.04, 0.42) and at 4 months (OR: 0.23, 95% CI: 0.07, 0.79), gynecological problems of the woman (OR: 0.14, 95% CI: 0.03, 0.61), the presence of nipple pain at 15 days affecting EBF at 4 months (OR: 0.18, 95% CI: 0.06, 0.56) and at 6 months (OR: 0.21, 95% CI: 0.07, 0.68), perception of insufficient milk at 15 days (OR: 0.15, 95% CI: 0.05, 0.49) and at 1 month (OR: 0.06, 95% CI: 0.02, 0.20), and giving birth in a privately managed hospital without Baby-Friendly Hospital Initiative (BFHI) accreditation (OR: 0.17, 95% CI: 0.05, 0.66). Protective factors for EBF were the woman’s prior knowledge of the benefits of breastfeeding for her child (OR: 5.25, 95% CI: 1.03, 26.80) and for herself (OR: 3.98, 95% CI: 1.31, 12.02), as well as having a foreign nationality (OR: 3.04, 95% CI: 1.05, 8.80). The factors impacting EBF can be addressed with improved care practices for women during pregnancy, childbirth, and the early postpartum period. It is essential to train healthcare professionals and implement the BFHI in Spain, where it is primarily carried out in public hospitals, but not in private ones.