Next Article in Journal
Can Prior Sexual Abuse Explain Global Differences in Measured Self-Esteem in Male and Female Adolescents?
Next Article in Special Issue
Lessons Learned with a Triad of Stakeholder Advisory Boards: Working with Adolescents, Mothers, and Clinicians to Design the TRUST Study
Previous Article in Journal
Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?
Previous Article in Special Issue
Learning from the Implementation of the Child Nutrition Program: A Mixed Methods Evaluation of Process
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 10
Issue 2
10.3390/children10020275
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study

by
Li Liu
1,2,
Gui Xiao
2,
Tingting Zhang
2,
Mengjia Zhou
2,
Xingxing Li
3,
Yu Zhang
3,
Theresah Owusua
4,
Yang Chen
5 and
Chunxiang Qin
1,*
1
Department of Health Management, Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha 410013, China
2
Xiangya School of Nursing, Central South University, Changsha 410013, China
3
School of Medicine, Jishou University, Jishou 416000, China
4
School of Nursing and Midwifery, Catholic University College of Ghana, Sunyani 363, Ghana
5
Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha 410013, China
*
Author to whom correspondence should be addressed.
Children 2023, 10(2), 275; https://doi.org/10.3390/children10020275
Submission received: 13 December 2022 / Revised: 21 January 2023 / Accepted: 25 January 2023 / Published: 31 January 2023
(This article belongs to the Special Issue Maternal and Child's Health)
Versions Notes

Abstract

:
Breastfeeding attitudes are strong predictors of breastfeeding behavior. Gaining a deeper understanding on the levels and determinants of antenatal breastfeeding attitudes is crucial. This cross-sectional study involved 124 pregnant women at a tertiary hospital in Hunan, China. A self-administered questionnaire, the Iowa Infant Feeding Attitude Scale, the Edinburgh Postnatal Depression Scale, the Pregnancy Stress Rating Scale, the Childbirth Attitude Questionnaire, the Perceived Social Support Scale, and the Breastfeeding Knowledge Questionnaire were assessed during their first-trimester, second-trimester, and third-trimester hospital visit. Multiple linear regression was conducted to identify the determinants of breastfeeding attitudes. The participants reported neutral (56.39 ± 5.69) levels of breastfeeding attitudes. The determinants of antenatal breastfeeding attitudes were other family members’ support for exclusive breastfeeding: moderate (β = 0.278, p < 0.05), depressive symptoms (β = −0.191, p < 0.05), and breastfeeding knowledge (β = 0.434, p < 0.001). The variables explained 33.9% (adjusted R2) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001). Namely, other family members’ support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderate of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge was positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Health professionals should identify these modifiable factors that may contribute to poorer breastfeeding attitudes, which is useful in targeting promotions of breastfeeding.

1. Introduction

The World Health Organization (WHO) recommends that mothers exclusively breastfeed their children for 6 months, with a goal of breastfeeding for up to 2 years of age and beyond, but few women achieved it [1,2]. The global exclusive breastfeeding (EBF) rate for infants at 6 months is 43% [2]. A study has found that only 37% of infants under six months in low- and middle-income countries were exclusively breastfed [3], and the rate of EBF for up to 6 months in China was only 29.2% [4]. Breastfeeding attitudes refer to women’s tendency to express their feelings, thoughts, and behaviors related to mental mindfulness as they develop their subsequent EBF behaviors [5]. As a modifiable element, breastfeeding attitudes are one of the strategic intervention directions to improve breastfeeding [6]. Previous researches have demonstrated that breastfeeding attitudes are important predictors of choice of infant feeding practices and EBF duration [7,8]. It has been reported that 82–97% of women make their decision about EBF during pregnancy [9,10]. Of those who have favorable attitudes towards breastfeeding at this point (75–97%), the majority initiate breastfeeding after delivery [11,12]. Therefore, investigating the levels of antenatal breastfeeding attitudes and finding factors that are associated with negative maternal breastfeeding attitudes is important for developing intervention strategies to promote postpartum breastfeeding behaviors.
Our literature review found that breastfeeding attitudes might be affected by maternal age, residence, race/ethnicity, educational status, occupation, marital status, household income, pregnancy intention, breastfeeding intention, breastfeeding knowledge, and social support, etc. [8,13,14,15,16,17,18,19,20,21]. When evaluated in this respect, it is affected not only by the socio-demographic and EBF-related factors mentioned above, but also by one’s perinatal mental health. For example, recent studies reported that depressed and stressed mothers might be poorer in breastfeeding attitudes. Some research found that women with depressive symptoms were more likely to have a negative attitude towards breastfeeding [13,15,18,22,23,24]. Additionally, the research of Duran et al. showed that the mothers’ positive breastfeeding attitudes decreased as their perceived stress levels increased in the postpartum period [16]. Nevertheless, most of the published literature on the relationship between breastfeeding attitudes and mental health focuses on the postpartum period, with few studies mentioning the relation between psychological factors during pregnancy and antenatal breastfeeding attitudes [22].
Pregnancy is most often a period of mental well-being for women. After the drop in hormones during childbirth, there are disturbances in the woman’s mental health. In addition, family roles change and more responsibilities are assigned to the couple. Therefore, it is a period of increased vulnerability to emotional changes, such as depressive symptoms (roughly 20.7% prevalence), pregnancy stress (roughly 94.4% prevalence), and fear of childbirth (6.3–14.8% prevalence) [25,26,27]. These psychological problems have been well documented to have serious adverse impacts on the health of mothers and babies and they may be potential risk factors for breastfeeding attitudes. Identifying these psychological factors that may lead to poorer breastfeeding attitudes, especially when they can be modified, is a high research priority.
In conclusion, further research on breastfeeding attitudes that comprehensively consider antenatal psychological, EBF-related, and socio-demographic factors is needed. A deeper understanding of the levels and specific determinants of antenatal breastfeeding attitudes is essential for policymakers to design district-appropriate targeted interventions to encourage mothers to prepare for breastfeeding. Thus, this study aims to investigate the levels and determinants of antenatal breastfeeding attitudes among pregnant women.

2. Materials and Methods

2.1. Design and Participants

This was a cross-sectional study which was performed from October 2021 to July 2022 in a hospital in Hunan Province, China. The inclusion and exclusion criteria for the participants were as follows. The inclusion criteria included mothers with their first spontaneous pregnancy, older than 18 years, with a singleton gestation of 8–13 weeks’ gestation, and no contraindications to restrict breastfeeding. Additionally, the exclusion criteria included the participants with suicidal tendencies or severe mental illness or who refused to participate in this study.
Sample size calculations (using G*Power version 3.1 [28]) determined that 93 participants were required to provide power (1 − β = 0.80) to examine medium effect size (f2 = 0.15) correlations using multiple linear regression analyses with five hypothesized predictors (EBF intention, breastfeeding knowledge, depressive symptoms, pregnancy stress, and fear of childbirth). Additionally, the α was 0.05. Together with a possible 20% no-response rate, the minimum sample size required was 110.

2.2. Measures

Our primary outcome was breastfeeding attitude. The potential influence factors were the participant characteristics, antenatal depressive symptoms, pregnancy stress, fear of childbirth, breastfeeding knowledge, and social support. The specific measurement tools are shown below.

2.2.1. Participant Characteristics

The pregnant women were asked to complete a self-administered questionnaire. It included socio-demographic and EBF-related characteristics. The following descriptive characteristics of the participants were obtained: age, residence, race/ethnicity, educational status, occupation, marital status, household income, pregnancy intention and EBF intention, and spousal and other family members’ support for EBF. The definition of breastfeeding-related in this study strictly follows the WHOs guidelines [29].

2.2.2. Breastfeeding Attitude

The Iowa Infant Feeding Attitude Scale (IIFAS) was used to assess breastfeeding attitudes [30]. The IIFAS comprises 17 items, including a variety of dimensions of infant feeding attitudes. It uses a five-point Likert scale, with a score of 1 for strongly disagree and 5 for strongly agree. The score range was 17 to 85, with higher scores favoring breastfeeding. The infant feeding attitude score could be divided into three levels according to the score: (1) positive to breastfeeding (70–85), (2) neutral (49–69), and (3) positive to formula feeding (17–48) [30]. This instrument has been introduced in several countries and regions and has been applied in different populations. The Cronbach ‘s α of the Chinese version was 0.62 [31]. The Cronbach’s α was 0.63.

2.2.3. Antenatal Depressive Symptoms

The Edinburgh Postnatal Depression Scale (EPDS) was used to measure antenatal depressive symptoms [32]. The scale was originally developed specifically for postpartum depression but is commonly used to measure levels of depressive symptoms during all periods of the perinatal period because of its simplicity, understandability, and ease of maternal acceptance. It is a 10-item scale, which mothers were instructed to rank on a four-point Likert scale. The total score ranges from 0 to 30. The higher the score, the more severe the depressive symptoms. The Chinese version of EPDS with satisfactory content validity and reliability was adopted (Cronbach’s α was 0.78) [33,34]. In our study, the Cronbach’s α was 0.80.

2.2.4. Pregnancy Stress

The Pregnancy Stress Rating Scale (PSRS) was used to measure pregnancy stress. It is a commonly measured antenatal stress scale and mainly used to evaluate the source of stress in pregnant women and the degree of its impact. The PSRS comprises four stressors. Each item is divided into four levels: “not at all”, “a little”, “often”, and “always”. The total score range from 0 to 90, with a higher score indicating a higher level of pregnancy stress. A Chinese version with a good content validity and reliability was adopted (Cronbach’s α was 0.84) [35]. The Cronbach’s α in our study was 0.95.

2.2.5. Fear of Childbirth

The Childbirth Attitude Questionnaire (CAQ) was used to measure fear of childbirth [36]. This scale has 16 items and includes 4 dimensions. It uses a Likert 4-point scale for each item, with a total score of 16 to 64. Higher scores indicate a more severe fear of childbirth. A Chinese version was compiled and revised by Chinese scholars [37]. Additionally, they showed a satisfactory internal consistency reliability and validity for the questionnaire (Cronbach’s α was 0.91). The Cronbach’s α was 0.95.

2.2.6. Breastfeeding Knowledge

Breastfeeding knowledge was assessed using the Chinese Breastfeeding Knowledge Questionnaire (BKQ), which was compiled by Zhao, M. [38]. The BKQ consisted of 17 statements covering the benefits and skills related to breastfeeding. Each item scored 1 point for a correct answer and 0 points for an incorrect or uncertain answer. The total score is 0~17. The higher the score, the higher the level of maternal breastfeeding knowledge. The Cronbach’s α of it was 0.91 [38]. The Cronbach’s α in our study was 0.87.

2.2.7. Social Support

Social support was evaluated by the Perceived Social Support Scale (PSSS) [39]. The PSSS is designed to evaluate the degree of support that individuals perceive from various sources of social support such as family, friends, and others. It uses a seven-point scale from 1 to 7 for each item, with a total of 12 items. The higher the score, the higher the level of social support perceived by the individual. Clinical applications have shown that the Chinese version of PSSS has satisfactory content validity and reliability (Cronbach’s α was 0.89) [40]. In this study, the Cronbach’s α was 0.95.

2.3. Data Collection

Participants were approached by members of the research team in a room of the obstetric clinic. The researchers introduced the potential participants to the main content and the purpose of our study before the survey. Then, the women were invited to participate in the investigations. Additionally, after obtaining consent from the pregnant women and signing the informed consent form, a link to the electronic questionnaire was sent to eligible pregnant women through Wechat messages. They could complete the questionnaire at their convenience.
In this study, the administration of the study questionnaires was spread over three time periods to reduce the burden on the participants [22]. In detail, the participants were invited to finish questionnaires at three time points: 8–13 weeks of gestation (Time 1, the first trimester), 22–26 weeks of gestation (Time 2, the second trimester) and 34–38 weeks of gestation (Time 3, the third trimester). At Time 1, they completed the self-administered questionnaire and the PSSS. At Time 2, they completed the PSRS and the EPDS. Additionally, at Time 3, they completed the IIFAS, the CAQ, and the BKQ. Each questionnaire took approximately ten minutes to finish. The participants could only successfully submit the questionnaire if they answered all items in the questionnaire completely. the Submitted questionnaires were reviewed by the researcher. If there were any questions, the participants were contacted immediately to confirm the information.

2.4. Data Analysis

SPSS version 22.0 was used to perform the data analysis. For the participants’ characteristics, continuous variables were expressed as the mean (standard deviation, SD). Additionally, categorical variables were expressed as frequencies. Statistical significance was set at two-sided p < 0.05. The univariate effects of the factors were analyzed by independent samples t-tests and one-way ANOVAs or Kruskal–Wallis H test. In addition, Pearson correlations and spearman correlations were used to explore the correlations between breastfeeding attitudes, depressive symptoms, pregnancy stress, fear of childbirth, breastfeeding knowledge, and social support. Finally, the variable with p < 0.15 from univariate analyses and correlation analysis were included in multiple linear regression analyses for testing to determine the factors influencing breastfeeding attitudes.

2.5. Ethical Considerations

We obtained permission from the Ethics Review Committee of Xiangya School of Nursing, Central South University (number: E202159). Detailed informed written consents were provided and explained to the participants. All participants were guaranteed the right to leave the study at any time without giving a reason or explaining why. All data collection instruments did not have any potential adverse effects on them.

3. Results

3.1. The Participants’ Characteristics

Table 1 describes the characteristics of the participants and the distribution of respondents and variables. Between October 2021 and December 2021, 178 women were approached and 159 women consented to participate in this study. After excluding 3 ineligible women, 156 pregnant women were included. As of July 2022, 124 of them who completed all three questionnaires were included in the analysis (79.5% response rate). In total, 97.6% of them were younger than 35 years [mean age (M) = 28.29, SD = 2.92], 91.1% lived in an urban district, 90.3% had Junior college degrees or above, 87.9% were employed, 95.2% were married, 78.2% had a per capita monthly household income greater than CNY 5000, and 82.3% were of a planned or natural pregnancy.
The mean value of the participants in IIFAS was 56.39 ± 5.69 (Min: 45, Max: 70). Additionally, 6.45 ± 3.99, 19.36 ± 13.77, 35.90 ± 10.30, 10.56 ± 4.40, and 69.87 ± 11.14, respectively, in EPDS, PSRS, CAQ, BKQ, and PSSS (Table 2).

3.2. Univariate Analysis

Table 3 reports the results of the univariate analysis. There was a significant difference in breastfeeding attitudes scores according to the EBF intention (F = 10.417, p < 0.05). The variables with p < 0.15 were residence (t = −1.721, p = 0.088), educational status (F = 7.693, p = 0.103), household income (F = 5.119, p = 0.077), spousal support for EBF (F = 5.327, p = 0.070), and other family members’ support for EBF (F = 4.427, p = 0.109).

3.3. Correlation Analysis

Table 4 shows the results of the correlation analysis. It revealed that breastfeeding attitudes were positively associated with breastfeeding knowledge (r = 0.505, p < 0.001). The relationships between breastfeeding attitudes and depressive symptoms (r = −0.134, p = 0.139), pregnancy stress (r = −0.126, p = 0.162), fear of childbirth (r = −0.082, p = 0.365), and social support (r = 0.145, p = 0.108) were insignificant.

3.4. Multiple Linear Regression Analyses

The variables with p < 0.15 in univariate analyses and correlation analysis (Table 3 and Table 4) were included in the multiple linear regression analysis (Table 5). The analysis revealed that the determinants of antenatal breastfeeding attitudes were other family members’ support for exclusive breastfeeding: moderate (β = 0.278, p < 0.05), depressive symptoms (β = −0.191, p < 0.05), and breastfeeding knowledge (β = 0.434, p < 0.001). Namely, other family members’ support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderately supportive of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge were positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. The variables explained 33.9% (adjusted R2) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001).

4. Discussion

This study showed that the antenatal breastfeeding attitudes of pregnant women in Changsha, China were at a neutral level. Additionally, depressive symptoms, breastfeeding knowledge, and other family members’ support for EBF are determinants of antenatal breastfeeding attitudes. In addition, surprisingly, other family members’ support for EBF was a negative influence on positive breastfeeding attitudes.
In this study, the mean breastfeeding attitudes score (56.39 ± 5.69) for pregnant women living in Hunan, China was generally consistent with the pregnant women living in Tianjin, China (59.8 ± 7.63), they were higher than pregnant women living in Ethiopia (54.7 ± 3.12) but lower than pregnant women in most developed countries, such as Canada (64.00 ± 10.40), the UK (66.81 ± 10.47), the USA (67.40 ± 7.30), and Greece (70.00 ± 7.60) [20,41,42,43,44,45]. Studies suggest that breastfeeding attitudes scores of 70–85 indicate a positive attitude toward breastfeed, scores of 49–69 indicate a neutral attitude, and scores of 17–48 indicate a negative attitude toward breastfeed [30]. The positive attitudes toward antenatal breastfeeding were the strongest predictors and were related to a 20–30% increase in postnatal breastfeeding initiation and maintenance rates [22,46,47]. The neutral attitude of pregnant women implied that they did not have a determined preference for exclusive breastfeeding or formula feeding. A neutral score of IIFAS also predicts a shorter duration of exclusive breastfeeding [30]. Thus, a more immediate intervention should target this group of Chinese women whose attitudes toward breastfeeding are mixed or ambivalent. Future research to develop and evaluate breastfeeding promotion programs should pay attention to breastfeeding attitudes from the antenatal period.
Our study firstly revealed depressive symptoms as an important determinant of antenatal breastfeeding attitudes for pregnant women. In the multiple linear regression analyses, antenatal depressive symptoms were significantly and negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Nevertheless, the results of our correlation analysis of depressive symptoms and breastfeeding attitudes were not statistically significant. This indicated that the negative effect of depressive symptoms might be masked by other factors. In addition, this inconsistency may be also related to the presence of the other potential confounders and mediating or moderating variables between the independent and dependent variables [48,49], which deserves further exploration. Meanwhile, it suggests that future research needs to pay attention to the negative effect of antenatal depressive symptoms on positive breastfeeding attitudes. Additionally, confounders need to be considered as comprehensively as possible when conducting such studies. Previous studies also reported the negative relationship between positive breastfeeding attitudes and depressive symptoms, but they were conducted in the postpartum period [13,15,18,23,24]. However, breastfeeding attitudes were usually established before delivery [50]. Therefore, it may be more important and effective to improve breastfeeding attitudes through interventions that address perinatal depression. Additionally, it is recommended to start the intervention before delivery.
In our study, in addition to general social support, we also considered breastfeeding-specific support (i.e., the level of support for EBF from spouses and other family members). Therefore, we found that other family members’ support for EBF was also a factor of antenatal breastfeeding attitudes. Nevertheless, interestingly, the result of multiple linear regression analyses showed that other family members’ support for EBF was a negative influence on positive breastfeeding attitudes. Pregnant women whose other family members were moderately in favor of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. On the one hand, this may be related to the reverse buffering effect of social support [51]. According to the esteem enhancement theory, when individuals receive social support, they are requested to recognize limitations in their ability to solve problems independently [52,53]. Thus, receiving an overabundance of social support may hurt the recipient’s autonomy and self-reliance, especially if more support is received than given. This in turn damages their independent and capable self-image, which is detrimental to both physical and psychological health [54].Therefore, we hypothesize that the excessive support for EBF from other family members may increase the negative impact of diverse sources of stress (e.g., pregnancy and feeding babies) on maternal mental health, and then negatively affect their breastfeeding attitudes. This needs to be empirically verified in the future studies. On the other hand, we think it may be also related to some traditional cultural factors that are unique to China, such as the relationship between a mother-in-law and daughter-in-law. Practicing traditional confinement periods during the postnatal period is typical in Asian countries [55]. Women are always encouraged to spend a specific period of confinement at their homes, which is considered to be a period of recovery from childbirth [55,56]. During the birth recovery period, most of the maternal caregivers in a family are their mothers-in-law. However, generally, disharmony between a mother-in-law and daughter-in-law is a deep-rooted family conflict in many Asian countries [57]. A poor relationship between mothers-in-law and daughters-in-law is one of the important factors for maternal depression [58]. The strained relationship can easily stimulate the mother’s spirit and emotions, and then they may subconsciously reject the idea that their mother-in-law strongly supports EBF [59]. Therefore, when designing and developing strategies of care around prenatal the promotion of EBF, researchers and health professionals should not only be concerned about the pregnant woman herself, but also about her other family members, especially her mother-in-law. For example, some educational courses that convey tips on how to improve family relationships are necessary.
Additionally, we also found that breastfeeding knowledge was the most important determinant of breastfeeding attitudes. Previous studies have widely reported the significance of breastfeeding knowledge [16,20,60]. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Therefore, it is suggested that prenatal education that covers the benefits and skills related to EBF is essential.
Limitations
There are several limitations. First, even though we observed significant results regarding antenatal depressive symptoms and breastfeeding attitudes, the sample size of the study was slightly small. Future research should be focused on larger samples such as a large population-based sample. Second, although we conducted our study using a sample with a low rate of loss to the follow-up, a sampling bias due to the voluntary nature of participation in the study may have affected the findings. For example, we recognized that the underrepresentation of rural pregnant women probably restricted the generalizability of our findings. Third, we controlled as many potential confounding factors as possible based on the literature review. However, there may still be several unobserved variables that may influence the outcome, such as how breastfeeding-friendly the mother’s environment is. Fourth, since we mainly focused on prenatal breastfeeding attitudes, the attitude of these women after childbirth and their actual feeding practices were not described in this study. Additionally, the study was conducted electronically for convenience reasons. Future research needs to consider the refinement of these aspects.
Clinical implications
This study has implications for clinical work in the promotion of EBF, especially the improvement of maternal breastfeeding attitudes. At first, considering that the neutral levels of breastfeeding attitudes and the important determinant role of breastfeeding knowledge, health professionals need to implement education programs for pregnant mothers as early as possible to equip these mothers with positive breastfeeding attitudes. In addition, the early identification and intervention of maternal mental health problems, especially antenatal depressive symptoms, should be implemented to ensure that mothers are motivated to initiate and maintain breastfeeding. Meanwhile, how to adjust and balance the level of support for EBF among the other family members is also something that health professionals must consider when working to improve the breastfeeding attitudes of pregnant women.

5. Conclusions

This study showed neutral levels of breastfeeding attitudes among pregnant women in Hunan, China. In addition to the already widely reported breastfeeding knowledge, the determinants of breastfeeding attitudes in our study also included antenatal depressive symptoms and other family members’ support for EBF. Identifying and balancing these modifiable factors that may contribute to poorer or better breastfeeding attitudes may be useful in evaluating the future breastfeeding-promoting interventions. Additionally, in the preliminary analysis, the effect of other family members’ support for EBF and depressive symptoms did not reach statistical significance. However, these two variables were statistically significant in the multiple linear regression. This indicated that the negative effect of other family members’ support for EBF and depressive symptoms might be masked by other factors. In addition, this inconsistency may be also related to the presence of the other potential confounders and mediating or moderating variables between the independent and dependent variables [48,49], which deserves a further exploration.

Author Contributions

Conceptualization, L.L.; methodology, L.L. and G.X.; validation, L.L., G.X., M.Z. and T.Z.; formal analysis, L.L.; investigation, G.X., L.L., T.Z., M.Z., X.L. and Y.Z.; resources, Y.C. and C.Q.; data curation, L.L., M.Z. and G.X.; writing—original draft preparation, L.L.; writing—review and editing, L.L., G.X., T.Z., M.Z., X.L., Y.Z. and T.O.; supervision, Y.C. and C.Q.; project administration, Y.C. and C.Q.; funding acquisition, C.Q. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the National Natural Science Foundation of China, grant number 72074225; and the Key Research and Development Program of Hunan Province of China, grant number 2021SK2024, 2020SK2089. The APC was funded by the National Natural Science Foundation of China.

Institutional Review Board Statement

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Institutional Ethical Committee (Registration No. E202159) of Xiangya School of Nursing, Central South University conducted on 6 August 2021.

Informed Consent Statement

Written informed consent was obtained from all subjects/patients for conducting the study. The identity of all participants was masked by using codes.

Data Availability Statement

Not applicable.

Acknowledgments

The authors would like to thank all the pregnant women who provided valuable information for this study and the hospital staff who gave assistance to them.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

References

  1. Hamze, L.; Mao, J.; Reifsnider, E. Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China. Midwifery 2019, 74, 68–75. [Google Scholar] [CrossRef] [PubMed]
  2. WHO. Infant and Young Child Feeding. Available online: https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding (accessed on 7 December 2022).
  3. Victora, C.G.; Bahl, R.; Barros, A.J.; França, G.V.; Horton, S.; Krasevec, J.; Murch, S.; Sankar, M.J.; Walker, N.; Rollins, N.C. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet 2016, 387, 475–490. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. China Development Research Foundation. Survey Report on Factors Affecting Breastfeeding in China. Available online: https://www.cdrf.org.cn/jjh/pdf/mu.pdf (accessed on 7 December 2022).
  5. Casal, C.S.; Lei, A.; Young, S.L.; Tuthill, E.L. A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support. J. Hum. Lact. 2017, 33, 21–47. [Google Scholar] [CrossRef] [PubMed]
  6. Chekol Abebe, E.; Ayalew Tiruneh, G.; Asmare Adela, G.; Mengie Ayele, T.; Tilahun Muche, Z.; Behaile, T.M.A.; Tilahun Mulu, A.; Asmamaw Dejenie, T. Levels and Determinants of Prenatal Breastfeeding Knowledge, Attitude, and Intention Among Pregnant Women: A Cross-Sectional Study in Northwest Ethiopia. Front. Public Health 2022, 10, 920355. [Google Scholar] [CrossRef]
  7. Kloeblen-Tarver, A.S.; Thompson, N.J.; Miner, K.R. Intent to breast-feed: The impact of attitudes, norms, parity, and experience. Am. J. Health Behav. 2002, 26, 182–187. [Google Scholar] [CrossRef]
  8. Mercan, Y.; Tari Selcuk, K. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PLoS ONE 2021, 16, e0249538. [Google Scholar] [CrossRef]
  9. Colaizy, T.T.; Saftlas, A.F.; Morriss, F.H., Jr. Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2003. Public Health Nutr. 2012, 15, 702–710. [Google Scholar] [CrossRef] [Green Version]
  10. Taha, Z.; Garemo, M.; El Ktaibi, F.; Nanda, J. Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes. Nutrients 2022, 14, 806. [Google Scholar] [CrossRef]
  11. Vogel, A.M. Intended plans for breastfeeding duration: A simple tool to predict breastfeeding outcome. Acta Paediatr. 2003, 92, 270–271. [Google Scholar] [CrossRef]
  12. Scott, J.A.; Binns, C.W.; Oddy, W.H.; Graham, K.I. Predictors of breastfeeding duration: Evidence from a cohort study. Pediatrics 2006, 117, e646–e655. [Google Scholar] [CrossRef] [Green Version]
  13. Galler, J.R.; Harrison, R.H.; Ramsey, F.; Chawla, S.; Taylor, J. Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados. Infant Behav. Dev. 2006, 29, 189–203. [Google Scholar] [CrossRef]
  14. Mitchell-Box, K.; Braun, K.L.; Hurwitz, E.L.; Hayes, D.K. Breastfeeding attitudes: Association between maternal and male partner attitudes and breastfeeding intent. Breastfeed. Med. 2013, 8, 368–373. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  15. Arifunhera, J.H.; Srinivasaraghavan, R.; Sarkar, S.; Kattimani, S.; Adhisivam, B.; Vishnu Bhat, B. Is maternal anxiety a barrier to exclusive breastfeeding? J. Matern. Fetal Neonatal Med. 2016, 29, 2798–2801. [Google Scholar] [CrossRef] [PubMed]
  16. Duran, S.; Kaynak, S.; Karadaş, A. The relationship between breastfeeding attitudes and perceived stress levels of Turkish mothers. Scand. J. Caring Sci. 2020, 34, 456–463. [Google Scholar] [CrossRef] [PubMed]
  17. Omoronyia, O.E.; Ayuk, A.E.; Bisong, E.M.; Nwafor, K.N. Maternal knowledge of effective breastfeeding and its benefits, as potential determinant of attitudes to infant feeding: A survey in Calabar, Nigeria. Afr. J. Reprod. Health 2020, 24, 69–77. [Google Scholar] [CrossRef] [PubMed]
  18. Yahya, N.F.S.; Teng, N.; Shafiee, N.; Juliana, N. Association between Breastfeeding Attitudes and Postpartum Depression among Mothers with Premature Infants during COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 915. [Google Scholar] [CrossRef]
  19. Bień, A.; Kulesza-Brończyk, B.; Przestrzelska, M.; Iwanowicz-Palus, G.; Ćwiek, D. The Attitudes of Polish Women towards Breastfeeding Based on the Iowa Infant Feeding Attitude Scale (IIFAS). Nutrients 2021, 13, 4338. [Google Scholar] [CrossRef] [PubMed]
  20. Abdulahi, M.; Fretheim, A.; Argaw, A.; Magnus, J.H. Determinants of Knowledge and Attitude towards Breastfeeding in Rural Pregnant Women Using Validated Instruments in Ethiopia. Int. J. Environ. Res. Public Health 2021, 18, 7930. [Google Scholar] [CrossRef] [PubMed]
  21. Weinfield, N.S.; Anderson, C.E. Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample. J. Nutr. Educ. Behav. 2022, 54, 118–124. [Google Scholar] [CrossRef]
  22. Amiel Castro, R.T.; Glover, V.; Ehlert, U.; O’Connor, T.G. Antenatal psychological and socioeconomic predictors of breastfeeding in a large community sample. Early Hum. Dev. 2017, 110, 50–56. [Google Scholar] [CrossRef]
  23. Khodabandeh, M.; Kashani, L.; Pirastehfar, Z.; Dargahloo, S.D.; Tabarestani, M.; Dordeh, M.; Rohni, A.; Heydari, O.; Ghazanfarpour, M. Relationship between Attitude towards Breastfeeding and Postpartum Depression in Kerman, Iran. Int. J. Pediatr. Mashhad 2020, 8, 11751–11759. [Google Scholar] [CrossRef]
  24. Scheid, C.R.; Paulson, J.L.; Miller-Graff, L.E. Feelings and feedings: Psychopathology and breastfeeding attitudes in women with a history of intimate partner violence. Psychol. Trauma: Theory Res. Pract. Policy 2021, 13, 394–402. [Google Scholar] [CrossRef] [PubMed]
  25. Zhang, S.B. The Course of Maternal Pregnancy-Specific Stress across Pregnancy and Effects on Primary Pregnancy Outcomes: A Prospective Study; The Chinese Center for Disease Control and Prevention: Beijing, China, 2017.
  26. Nilsson, C.; Hessman, E.; Sjöblom, H.; Dencker, A.; Jangsten, E.; Mollberg, M.; Patel, H.; Sparud-Lundin, C.; Wigert, H.; Begley, C. Definitions, measurements and prevalence of fear of childbirth: A systematic review. BMC Pregnancy Childbirth 2018, 18, 28. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Yin, X.; Sun, N.; Jiang, N.; Xu, X.; Gan, Y.; Zhang, J.; Qiu, L.; Yang, C.; Shi, X.; Chang, J.; et al. Prevalence and associated factors of antenatal depression: Systematic reviews and meta-analyses. Clin. Psychol Rev. 2021, 83, 101932. [Google Scholar] [CrossRef] [PubMed]
  28. Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A.G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav. Res. Methods 2009, 41, 1149–1160. [Google Scholar] [CrossRef] [Green Version]
  29. WHO. Indicators for Assessing Infant and Young Child Feeding Practices (Part 1: Definitions): Conclusions of a Consensus Meeting Held 6–8 November 2007 in Washington D.C., USA; WHO: Geneva, Switzerland, 2008.
  30. De la Mora, A.; Russell, D.W. The Iowa Infant Feeding Attitude Scale: Analysis of reliability and validity. J. Appl. Soc. Psychol. 1999, 29, 2362–2380. [Google Scholar] [CrossRef]
  31. Dai, H.X.; Guan, X.D.; Li, X.M.; You, L.M.; Lau, Y. Psychometric properties of a mainland Chinese version of the Iowa Infant Feeding Attitude Scale among postpartum women in China. Contemp. Nurse 2013, 44, 11–20. [Google Scholar] [CrossRef]
  32. Cox, J.L.; Holden, J.M.; Sagovsky, R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 1987, 150, 782–786. [Google Scholar] [CrossRef] [Green Version]
  33. Lee, D.T.; Yip, S.K.; Chiu, H.F.; Leung, T.Y.; Chan, K.P.; Chau, I.O.; Leung, H.C.; Chung, T.K. Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. Br. J. Psychiatry J. Ment. Sci. 1998, 172, 433–437. [Google Scholar] [CrossRef]
  34. Wang, Y.; Guo, X.; Lau, Y.; Chan, K.S.; Yin, L.; Chen, J. Psychometric evaluation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale. Int. J. Nurs. Stud. 2009, 46, 813–823. [Google Scholar] [CrossRef]
  35. Chen, C.H.; Huang, H.L.; Ke, J.K. Psychological stressors perceived by high-risk and normal pregnant women during third trimester. J. Nurs. 1991, 38, 91–97. [Google Scholar]
  36. Tanglakmankhong, K.; Perrin, N.A.; Lowe, N.K. Childbirth Self-Efficacy Inventory and Childbirth Attitudes Questionnaire: Psychometric properties of Thai language versions. J. Adv. Nurs. 2011, 67, 193–203. [Google Scholar] [CrossRef] [PubMed]
  37. Wei, J.; Liu, J.; Zhang, L.; Wu, Y.; Fu, C. Reliability and validity of the Chinese version of childbirth attitudes questionnaire. J. Nurs. Sci. 2016, 31, 81–83. [Google Scholar]
  38. Zhao, M. Factors Associated With Breastfeeding Self-Efficacy among Beijing New Mothers; Peking Union Medical College: Beijing, China, 2008. [Google Scholar]
  39. Zimet, G.D.; Dahlem, N.W.; Zimet, S.G.; Farley, G.K. The Multidimensional Scale of Perceived Social Support. J. Personal. Assess. 1988, 52, 30–41. [Google Scholar] [CrossRef] [Green Version]
  40. Chou, K.L. Assessing Chinese adolescents’ social support: The multidimensional scale of perceived social support. Personal. Individ. Differ. 2000, 28, 299–307. [Google Scholar] [CrossRef]
  41. Holbrook, K.E.; White, M.C.; Heyman, M.B.; Wojcicki, J.M. Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: A prospective cohort study. Int. Breastfeed. J. 2013, 8, 7. [Google Scholar] [CrossRef] [Green Version]
  42. Twells, L.K.; Midodzi, W.K.; Ludlow, V.; Murphy-Goodridge, J.; Burrage, L.; Gill, N.; Halfyard, B.; Schiff, R.; Newhook, L.A. Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale. J. Hum. Lact. 2016, 32, Np9–Np18. [Google Scholar] [CrossRef]
  43. Chen, Y.; Shi, B. Study of influencing factors on attitude of infant feeding of pregnant women. Chin. J. Fam. Plann. 2018, 26, 189–194. [Google Scholar]
  44. Davie, P.; Bick, D.; Chilcot, J. To what extent does maternal body mass index predict intentions, attitudes, or practices of early infant feeding? Matern. Child Nutr. 2019, 15, e12837. [Google Scholar] [CrossRef] [Green Version]
  45. Iliadou, M.; Lykeridou, K.; Prezerakos, P.; Tzavara, C.; Tziaferi, S.G. Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women. Mater. Socio-Med. 2019, 31, 160–165. [Google Scholar] [CrossRef]
  46. Ho, Y.J.; McGrath, J.M. Predicting breastfeeding duration related to maternal attitudes in a taiwanese sample. J. Perinat. Educ. 2011, 20, 188–199. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  47. Wen, J.; Yu, G.; Kong, Y.; Liu, F.; Wei, H. An exploration of the breastfeeding behaviors of women after cesarean section: A qualitative study. Int. J. Nurs. Sci. 2020, 7, 419–426. [Google Scholar] [CrossRef] [PubMed]
  48. Liu, L.; Zhou, M.; Xiao, G.; Zhang, T.; Li, X.; Owusua, T.; He, W.; Qin, C. The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis. Midwifery 2023, 116, 103551. [Google Scholar] [CrossRef] [PubMed]
  49. Feng, G.; Peng, J.; Tu, D.; Zheng, J.Z.; Feng, C. Two Paradoxes in Linear Regression Analysis. Shanghai Arch. Psychiatry 2016, 28, 355–360. [Google Scholar] [CrossRef]
  50. Wilkins, C.; Ryan, K.; Green, J.; Thomas, P. Infant feeding attitudes of women in the United Kingdom during pregnancy and after birth. J. Hum. Lact. 2012, 28, 547–555. [Google Scholar] [CrossRef]
  51. Liu, C.; Huang, N.; Ahmed, F.; Shahid, M.; Wang, X.; Guo, J. The reverse buffering effects of social support on the relationships between stresses and mental health: A survey of Chinese adults during the COVID-19 lockdown. Eur. J. Psychotraumatol. 2021, 12, 1952777. [Google Scholar] [CrossRef]
  52. Batson, C.D.; Powell, A.A. Altruism and Prosocial Behavior. In Handbook of Psychology; John Wiley & Sons: New York, NY, USA, 2003; pp. 463–484. [Google Scholar]
  53. Nahum-Shani, I.; Bamberger, P.A.; Bacharach, S.B. Social support and employee well-being: The conditioning effect of perceived patterns of supportive exchange. J. Health Soc. Behav. 2011, 52, 123–139. [Google Scholar] [CrossRef]
  54. Nahum-Shani, I.; Bamberger, P.A. Explaining the Variable Effects of Social Support on Work-Based Stressor-Strain Relations: The Role of Perceived Pattern of Support Exchange. Organ. Behav. Hum. Decis. Process. 2011, 114, 49–63. [Google Scholar] [CrossRef] [Green Version]
  55. Withers, M.; Kharazmi, N.; Lim, E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery 2018, 56, 158–170. [Google Scholar] [CrossRef]
  56. Fadzil, F.; Shamsuddin, K.; Wan Puteh, S.E. Traditional Postpartum Practices Among Malaysian Mothers: A Review. J. Altern. Complement. Med. 2016, 22, 503–508. [Google Scholar] [CrossRef]
  57. Zhang, L. Research on Moral Relationship between Mother-in-Law and Daughter-in-Law in Cities of Present China. Master’s Thesis, Shenyang Normal University, Shenyang, China, 2016. [Google Scholar]
  58. Nisar, A.; Yin, J.; Waqas, A.; Bai, X.; Wang, D.; Rahman, A.; Li, X. Prevalence of perinatal depression and its determinants in Mainland China: A systematic review and meta-analysis. J. Affect. Disord. 2020, 277, 1022–1037. [Google Scholar] [CrossRef] [PubMed]
  59. Yu, Y.; Zhu, X.; Xu, H.; Hu, Z.; Zhou, W.; Zheng, B.; Yin, S. Prevalence of depression symptoms and its influencing factors among pregnant women in late pregnancy in urban areas of Hengyang City, Hunan Province, China: A cross-sectional study. BMJ Open 2020, 10, e038511. [Google Scholar] [CrossRef] [PubMed]
  60. Ozkaya, M.; Korukcu, O.; Aune, I. Breastfeeding attitudes of refugee women from Syria and influencing factors: A study based on the transition theory. Perspect. Public Health 2022, 142, 46–55. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Sample characteristics, n = 124.
Table 1. Sample characteristics, n = 124.
DomainCharacteristicsn (%)
Socio-demographic
Age, years
<35121 (97.6)
≥353 (2.4)
Residence
Urban113 (91.1)
Rural11 (8.9)
Race/ethnicity a
Han110 (88.7)
Minorities14 (11.3)
Educational status
≤Junior school2 (1.6)
High school10 (8.1)
Junior college26 (20.9)
Bachelor’s degree75 (60.5)
≥Master’s degree11 (8.9)
Occupation
Staff25 (20.2)
Self-employed11 (8.9)
Medical workers8 (6.4)
Farmers 2 (1.6)
Others63 (50.8)
Unemployed15 (12.1)
Marital status
Not married6 (4.8)
Married (live with spouse)117 (94.4)
Married (live without spouse)1 (0.8)
Household income, CNY
<3000 (poor)3 (2.4)
3000–5000 (moderate)24 (19.4)
>5000 (good)97 (78.2)
Pregnancy intention
Planned pregnancy58 (46.8)
Natural pregnancy44 (35.5)
Unplanned pregnancy22 (17.7)
EBF-related
EBF intention
Exclusive breastfeeding49 (39.5)
Almost exclusive breastfeeding28 (22.6)
Partial breastfeeding44 (35.5)
Token breastfeeding2 (1.6)
Exclusive artificial feeding1 (0.8)
Spousal support for EBF
Very supportive61 (49.2)
Support53 (42.7)
Moderate10 (8.1)
Not supported0 (0.0)
Very unsupported0 (0.0)
Other family members’ support for EBF
Very supportive64 (51.6)
Support56 (45.2)
Moderate4 (3.2)
Not supported0 (0.0)
Very unsupported0 (0.0)
Note: a There are 56 ethnic groups in China. In addition to the largest number of people, the Han Chinese, there are 55 officially recognized minorities. Abbreviations: SD, standard deviation. EBF, Exclusive Breastfeeding.
Table
Table 2. Distribution of the mean scores the participants obtained from scales, n = 124.
Table 2. Distribution of the mean scores the participants obtained from scales, n = 124.
Scales MeanSDMinimumMaximum
1IIFAS56.395.694570
2EPDS6.453.99022
3PSRS19.3613.77061
4CAQ35.9010.301664
5BKQ10.564.40017
6PSSS69.8711.141684
Note: Abbreviations: SD, standard deviation. IIFAS, the Iowa Infant Feeding Attitude Scale. EPDS, Edinburgh Postnatal Depression Scale. PSRS, Pregnancy Stress Rating Scale. CAQ, childbirth attitudes Questionnaires. BKQ, Breastfeeding Knowledge Questionnaire. PSSS, Perceived Social Support Scale.
Table
Table 3. Univariate analysis of factors associated with breastfeeding attitudes, n = 124.
Table 3. Univariate analysis of factors associated with breastfeeding attitudes, n = 124.
DomainCharacteristicsMean ± SDt/Fp
Socio-demographic
Age, years 0.5290.598
<3556.43 ± 5.74
≥3554.67 ± 2.31
Residence −1.7210.088
Urban56.12 ± 5.64
Rural59.18 ± 5.64
Race/ethnicity a 1.3230.188
Han56.63 ± 5.71
Minorities54.50 ± 5.30
Educational status 7.6930.103
≤Junior school55.00 ± 0.00
High school55.10 ± 6.32
Junior college54.35 ± 5.00
Bachelor’s degree56.96 ± 5.40
≥Master’s degree58.73 ± 7.89
Occupation 4.4350.489
Staff57.16 ± 6.26
Self-employed56.55 ± 5.72
Medical workers59.88 ± 5.44
Farmers 56.50 ± 0.71
Others55.81 ± 5.60
Unemployed55.53 ± 5.44
Marital status 3.6880.158
Not married53.83 ± 4.45
Married (live with spouse)56.43 ± 5.67
Married (live without spouse)67.00 ± 0.00
Household income, CNY 5.1190.077
<3000 (poor)64.67 ± 5.13
3000–5000 (moderate)56.67 ± 5.84
>5000 (good)56.06 ± 5.52
Pregnancy intention 2.2230.329
Planned pregnancy56.55 ± 5.59
Natural pregnancy56.84 ± 5.86
Unplanned pregnancy55.05 ± 5.65
EBF-related
EBF intention 10.4170.034 *
Exclusive breastfeeding57.90 ± 5.57
Almost exclusive breastfeeding55.79 ± 5.38
Partial breastfeeding55.14 ± 5.68
Token breastfeeding51.50 ± 4.95
Exclusive artificial feeding64.00 ± 0.00
Spousal support for EBF 5.3270.070
Very supportive57.61 ± 5.79
Support55.30 ± 5.08
Moderate54.70 ± 6.99
Other family members’ support for EBF 4.4270.109
Very supportive57.39 ± 5.89
Support55.13 ± 4.95
Moderate58.00 ± 9.70
Note: a There are 56 ethnic groups in China. In addition to the largest number of people, the Han Chinese, there are 55 officially recognized minorities. Breastfeeding attitudes were measured using the Iowa Infant Feeding Attitude Scale. Abbreviations: SD, standard deviation. EBF, exclusive breastfeeding. * p < 0.05.
Table
Table 4. Correlation analysis of the variables, n = 124.
Table 4. Correlation analysis of the variables, n = 124.
Variable12345
1Breastfeeding attitudes-
2Depressive symptoms−0.134-
3Pregnancy stress−0.1260.459 ***-
4Fear of childbirth−0.0820.354 ***0.503 ***-
5Breastfeeding knowledge0.505 ***−0.050−0.073−0.087-
6Social support0.145−0.331 ***−0.340 ***−0.106−0.233 **
Note: ** p < 0.01, *** p < 0.001.
Table
Table 5. Multiple linear regression analyses of determinants of breastfeeding attitudes, n = 124.
Table 5. Multiple linear regression analyses of determinants of breastfeeding attitudes, n = 124.
Dependent Variable BSEβTp
Breastfeeding attitudesConstant55.2125.201 10.616<0.001 ***
Residence
UrbanReference
Rural2.5981.6790.1301.5470.125
Educational status
≤Junior schoolReference
High school4.0523.8500.1951.0520.295
Junior college2.5993.5490.1870.7320.466
Bachelor’s degree4.2213.5020.3641.2050.231
≥Master’s degree6.9343.7900.3481.8290.070
Household income, CNY
<3000 (poor)Reference
3000–5000 (moderate)−3.7033.086−0.258−1.2000.233
>5000 (good)−5.7482.985−0.419−1.9260.057
EBF intention
Exclusive breastfeedingReference
Almost exclusive breastfeeding−2.2561.219−0.167−1.8510.067
Partial breastfeeding−1.6331.130−0.138−1.4460.151
Token breastfeeding−4.8784.094−0.109−1.1920.236
Exclusive artificial feeding6.8924.8090.1091.4330.155
Spousal support for EBF
Very supportiveReference
Support−1.4861.715−0.130−0.8660.388
Moderate−3.5212.311−0.169−1.5240.131
Other family members’ support for EBF
Very supportiveReference
Support0.6291.6880.0550.3730.710
Moderate8.9223.4030.2782.6220.010 *
Depressive symptoms−0.2720.114−0.191−2.3810.019 *
Breastfeeding knowledge0.5620.1130.4344.966<0.001 ***
Social support−0.0090.044−0.017−0.1950.846
Note: Abbreviations: EBF, exclusive breastfeeding. R = 0.660, R2 = 0.436, Adjusted R2 = 0.339, F = 4.507, p < 0.001. * p < 0.05, *** p < 0.001.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Liu, L.; Xiao, G.; Zhang, T.; Zhou, M.; Li, X.; Zhang, Y.; Owusua, T.; Chen, Y.; Qin, C. Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study. Children 2023, 10, 275. https://doi.org/10.3390/children10020275

AMA Style

Liu L, Xiao G, Zhang T, Zhou M, Li X, Zhang Y, Owusua T, Chen Y, Qin C. Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study. Children. 2023; 10(2):275. https://doi.org/10.3390/children10020275

Chicago/Turabian Style

Liu, Li, Gui Xiao, Tingting Zhang, Mengjia Zhou, Xingxing Li, Yu Zhang, Theresah Owusua, Yang Chen, and Chunxiang Qin. 2023. "Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study" Children 10, no. 2: 275. https://doi.org/10.3390/children10020275

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop