Nutrients · 7 authors, 4 centres
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This cross-sectional study of 1001 mothers in China found that breastfeeding duration remains far below WHO recommendations, with only 13.1% breastfeeding beyond 24 months. Key protective factors included higher maternal breastfeeding knowledge, family support, higher income, and workplace accommodations like breastfeeding breaks. The findings highlight the need for targeted interventions across different economic regions and parity levels to improve breastfeeding duration in China.
**Background:** Despite WHO/UNICEF recommendations for exclusive breastfeeding for 6 months and continued breastfeeding to 2 years or beyond, breastfeeding rates in China remain low. The Chinese Nutrition and Health Surveillance (CNHS)-2013 reported exclusive breastfeeding rates of only 20.8% for infants under 6 months, and continuous breastfeeding rates of 11.5% at 1 year and 6.9% at 2 years. This study aimed to identify influencing factors of breastfeeding duration across individual, family, and social support levels to inform interventions.
**Methods:** A cross-sectional web-based survey was conducted from January to February 2020 on the Wenjuanxing platform, recruiting mothers of children aged 6-60 months via WeChat. The final sample included 1001 valid responses from 26 Chinese provinces. Breastfeeding duration was the main outcome, divided into 5 levels. The questionnaire covered individual factors (maternal demographics, child characteristics, breastfeeding knowledge via 11 questions), family factors (income, marital satisfaction, family/friend support), and social support (maternity leave, workplace accommodations, public breastfeeding convenience, formula advertising exposure). Statistical analysis used Kruskal-Wallis tests for univariate analysis and multivariable ordinal logistic regression. Subgroup analyses were performed by economic zone (eastern, central, western, northeast) and parity (first child vs. second child or above).
**Key Results:** Among 1001 participants (mean maternal age 26.60±3.14 years, 60.4% from eastern region, 90.6% urban), breastfeeding duration distribution was: <6 months (9.9%), 6-12 months (38.6%), 12-18 months (31.8%), 18-24 months (6.7%), and >24 months (13.1%). In the main multivariable analysis (full sample, n=942), significant risk factors for shorter breastfeeding included maternal age ≥31 years (OR=0.45, 95%CI: 0.29-0.71), junior high school education or below (OR=0.37, 95%CI: 0.20-0.71), and cesarean delivery (OR=0.73, 95%CI: 0.56-0.95). Protective factors included being a freelancer/full-time mother (OR=2.04, 95%CI: 1.54-2.70), higher breastfeeding knowledge score (OR=1.14 per point, 95%CI: 1.06-1.22), maternal support for breastfeeding >24 months (OR=2.46, 95%CI: 1.67-3.64), low birth weight (OR=2.67, 95%CI: 1.69-4.23), first bottle use at 4-6 months (OR=2.40, 95%CI: 1.80-3.21), household income >1405 USD/month (OR=2.03, 95%CI: 1.43-2.88), and having one hour of breastfeeding time per working day (OR=1.83, 95%CI: 1.04-3.20). Among employed mothers (n=622), continuing breastfeeding after returning to work was strongly protective (OR=5.32, 95%CI: 3.17-8.92). Subgroup analyses revealed substantial regional heterogeneity: in the western region, paternal support for breastfeeding >24 months showed a very strong association (OR=34.88, 95%CI: 5.38-226.07), while in the northeast, high income (>1405 USD) was strongly protective (OR=10.86, 95%CI: 2.32-50.86). The top reasons for weaning included fear of child dependency (40.3%), perceived low nutritional value of breast milk (33.1%), and reduced milk supply (24.5%).
**Clinical Implications:** This study demonstrates that breastfeeding duration in China remains substantially below WHO recommendations, with multiple modifiable factors at individual, family, and social levels. Key actionable targets include: improving breastfeeding education (especially in less developed western regions), promoting early initiation of breastfeeding within 2 hours of birth, delaying bottle introduction beyond 4 months, ensuring workplace accommodations (breastfeeding breaks, lactation rooms), regulating infant formula advertising, and expanding social support networks. The regional heterogeneity suggests that tailored interventions are needed for different economic zones. Limitations include potential recall bias (retrospective design) and selection bias (internet-based recruitment), though the high internet penetration rate in China (94.6% among 20-49 year olds) mitigates this concern.