Breastfeeding Empowerment and performance and the impact of Maternal Health Literacy and Spousal Support: A cross-sectional

Abstract

Abstract: Background and purpose: Breast milk is essential for maintaining the health and quality of life of infants and for their survival. Research suggests that lack of breastfeeding empowerment is a major cause of exclusive breastfeeding failure. Several factors influence mothers’ breastfeeding empowerment and performance, among these factors are mothers’ health literacy and spousal support. This study investigated the relationships of breastfeeding empowerment and performance with health literacy and perceived spousal support among breastfeeding mothers. Research method: This cross-sectional study used random sampling to enroll 342 breastfeeding mothers with six-month-old or younger infants visiting health centers in Tabriz, Iran, during 2022-2023. The sampling method was that first, among the 65 health centers in Tabriz, one-eighth of the centers were randomly selected. Then, the list of eligible mothers was extracted through the SIB system based on the entry criteria according to the date of growth monitoring and vaccination, then the samples were selected randomly according to the sample size determined for each center using the www.random.org website. The data were collected using the interview method by completing the Sociodemographic Characteristics Questionnaire, the Mothers’ Breastfeeding Empowerment Scale (MBES), breastfeeding performance Questionnaire, the Postpartum Partner Support Scale (PPSS), and the Health Literacy for Iranian Adults (HELIA) Scale. The data were analyzed using frequency (percentage), mean (standard deviation), Pearson correlation test, independent t-test, one-way analysis of variance (ANOVA), and the general linear model (GLM). Findings: The mean (standard deviation and range) of MBES, breastfeeding performance Questionnaire, HELIA scale, and PPSS score of participants was 141.98 (sd:33.92 range: 37-185), 19.21 (sd:4.30 range:6-24), 126.08 (sd:21.27 range 33-165), and 64.95 (sd:12.62 range: 20-80), respectively. Bivariate analysis results showed that breastfeeding empowerment had significant positive relationships with the variables of health literacy (r = 0.23, p <0.001), perceived spousal support (r = 0.28, p < 0.001), and family income status (f=4.65, p=0.01) and performance of breastfeeding had significant positive relationships with the variables perceived spousal support (r=0.20, p<0.001) and breastfeeding empowerment (r=0.74, p<0.001), breastfeeding experience (t=1.58, p=0.02), infant's age (r=-0.16, p<0.001) and previous breastfeeding duration (r=0.15, p=0.04). Variables significantly related to breastfeeding empowerment and breastfeeding performance (P < 0.2) were inserted into a GLM, and the results showed that an increase in perceived spousal support significantly increased women’s breastfeeding empowerment (B = 0.546; 95% CI: 0.29-0.79; P<0.001). In addition, working mothers (B = 13.91; 95% CI: 0.88-27.73; P = 0.04) and breastfeeding mothers (B = 72.26; 95% CI: 60.42-84.10; P = 0.04) had significantly higher levels of breastfeeding empowerment than housewives and non-breastfeeding mothers, respectively. Regarding the breastfeeding performance variable, the results of the General linear model showed that breastfeeding performance had significant positive relationships with the breastfeeding empowerment, with the increase in breastfeeding empowerment, breastfeeding performance also increased significantly (p<0.001, 0.07 - 0.10: 95% CL, 0.09 B = 0). Conclusion: Considering the factors related to breastfeeding empowerment and performance, Nurses, midwives and health center staff can play a key role in improving women’s breastfeeding skills by organizing educational classes in order to raise spouses’ awareness, change their attitudes, and encourage them to actively support their wives during the postpartum period. In addition, measures such as inviting spouses to participate in educational breastfeeding sessions held by health care workers in health centers and adopting breastfeeding-friendly policies in the workplace can further empower mothers to breastfeed their infants and subsequently increase the performance of breastfeeding.