Factors associated with continued breastfeeding at one year and two years: an analysis of Thailand’s Multi-Indicator Cluster Survey (MICS)

Abstract Background The World Health Organization and the United Nations Children’s Fund recommend that mothers continue breastfeeding for two years or longer, alongside appropriate complementary foods. However, there is limited evidence on the factors associated with continued breastfeeding in Thailand. This study aimed to identify the determinants of continued breastfeeding at one year and two years. Method This study used secondary data from four rounds of the Thailand Multiple Indicator Cluster Survey (MICS), conducted in 2012, 2015–2016, 2019, and 2022, by the National Statistical Office, with support from UNICEF. The analysis included 2,495 children aged 12–15 months and 2,503 children aged 20–23 months. Continued breastfeeding at one year and two years followed standard MICS definitions. Descriptive statistics and logistic regression were used to examine associated factors. Results Continued breastfeeding rates were higher at one year than at two years across all survey rounds. In 2022, 33% of children continued breastfeeding at one year and 20% at two years. At one year, continued breastfeeding was positively associated with residing in the North (AOR = 3.89, 95% CI: 1.31–11.59) or South (AOR = 4.92, 95% CI: 1.66–14.55) compared to Bangkok, receiving antenatal care from nurses or midwives (AOR = 2.43, 95% CI: 1.38–4.30), having 5–12 ANC visits (AOR = 2.52, 95% CI: 1.13–5.61), and delivery at private health facilities (AOR = 2.58, 95% CI: 1.12–5.90). The richest wealth quintile showed lower odds (AOR = 0.19, 95% CI: 0.06–0.54) compared to the poorest. At two years, positive associations included normal vaginal delivery (AOR = 1.80, 95% CI: 1.02–3.16) and absence of prelacteal feeds (AOR = 2.34, 95% CI: 1.19–4.59), while lack of immediate skin-to-skin contact after birth was associated with lower odds (AOR = 0.49, 95% CI: 0.26–0.92). Conclusion Healthcare service factors, particularly antenatal care quality and immediate postnatal practices, are key determinants of continued breastfeeding in Thailand. Strengthening breastfeeding support during antenatal care, promoting vaginal delivery when appropriate, and ensuring skin-to-skin contact and exclusive breastfeeding after birth may improve breastfeeding duration.