**1. Introduction**

Breastfeeding is an unequalled way to feed an infant. In addition to its unique nutritional properties, human breast milk contains a wide-variety of immunoprotective factors that augment the immature immune system of the infant [1]. Infants who are formula fed are at greater risk of infections common to infancy including gastroenteritis, respiratory infection and otitis media [2]. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that infants be exclusively breastfed for the first six months of life with breastfeeding continuing for up to two years of age or beyond [3]. The wide-spread practice of delayed initiation of breastfeeding and prelacteal feeding [4–8], along with the early introduction of complementary feeding [9] in the Middle Eastern region however, mean that very few infants in this region are exclusively breastfed from birth for six months as recommended.

Breastfeeding practices are influenced by a complex mix of factors which are related to maternal and family socio-demographic characteristics, biomedical factors, health-care practices, psychosocial factors, social support, community attitudes, and public policy factors [10,11]. The direction of effect of these factors is not consistent across all cultures. For instance, in industrialised countries, better educated women are more likely to initiate breastfeeding and to breastfeed for longer than their less educated counterparts, whereas in poorer countries the opposite tends to be the case. In common with industrialised countries [10–12], amongst Middle Eastern women breastfeeding duration has been positively associated with maternal age [13–16] and parity [14,17,18]. Whereas inconsistent associations have been reported for level of maternal education with breastfeeding duration being associated both negatively [16,19,20] and positively [17] with a higher level of maternal education. Other factors reported to be negatively associated with duration of breastfeeding include maternal employment [17,19–22], mode of delivery [21,23–25] and the use of infant formula while in hospital [24–26].

Regular breastfeeding surveillance is essential to determine the extent to which national breastfeeding targets are being met, the impact of breastfeeding promotion interventions and how breastfeeding practices are changing over time. In addition, it is important to investigate the determinants of infant feeding practices so that breastfeeding interventions can be targeted at the most vulnerable population groups and address potentially modifiable risk factors which adversely affect breastfeeding practices. Relatively few studies have investigated infant feeding practices in Kuwait [27–29] and none have been longitudinal in nature. The reported mean duration of breastfeeding appears to have declined from 6.4 months in 1988 [27] to 4.9 months in 1997 [28] and there is a lack of more recent data to determine if this downward trend has continued. The aim of the Kuwait Infant Feeding Study (KIFS) was to identify the incidence and prevalence of breastfeeding up to 26 weeks postpartum among a population of women living in Kuwait and to identify the factors associated with the initiation and duration of breastfeeding. The determinants of breastfeeding initiation have been reported previously [30] and the purposes of this paper, therefore, are to report the prevalence of breastfeeding to six months and to determine the factors that are associated with the duration of breastfeeding.
