Comparison of Breastfeeding Behaviors of Mothers Toward Infants by Ethnic Groups: An Example of a Multicultural City

Abstract

Introduction:

Breastfeeding practices vary widely among different ethnic groups and are influenced by cultural, social, economic, and educational factors. The aim of this study was to compare the breastfeeding behaviors of mothers toward infants in different ethnic groups.

Methods:

This descriptive cross-sectional study included women of four ethnic groups (Assyrian, Turkish, Arab, and Kurdish) living in Mardin, Turkey. The study was completed with 180 Assyrian, 184 Turkish, 175 Arab, and 169 Kurdish women. In total, 708 women participated in this study. Data were collected between August 12, 2024, and September 22, 2024.

Results:

The highest rate of traditional breastfeeding practices was seen in Kurdish (99.4%), whereas this rate was 97.3% in Turkish, 96% in Arab, and 84.4% in Assyrian. The highest rate of giving breast milk immediately after birth was in Assyrian (71.7%), while this rate was 69.3% in Turkish, 61.9% in Kurdish, and 47% in Arab (p = 0.000). The rate of those who waited for three calls to prayer to feed the baby was 13.1% in Kurdish, 11.3% in Arab, 9.5% in Turkish, and 7.9% in Assyrian. The rate of those who did not give the first milk (colostrum) to the baby was 15.8% in Assyrian, 11.7% in Turkish, 6.5% in Kurdish, and 6% in Arab. The rate of those who give sugared water as the baby’s first nutrient was 37.5% in Arab, 20.8% in Kurdish, 11.7% in Turkish, and 9.2% in Assyrian. Increased education levels were associated with decreased rates of the presence of traditional practices.

Conclusion:

This study provides novel results regarding the comparison of breastfeeding behaviors among ethnic groups living in the same city. Comparing breastfeeding practices across the four ethnic groups allowed us to better understand different breastfeeding practices, which could lead to the development of culturally sensitive interventions to improve the health of children and mothers. Educating the community about the benefits of breastfeeding and the risks associated with some traditional practices could contribute to public health.

Introduction

Breastfeeding plays a crucial role in infant nutrition and development, thereby significantly affecting maternal and child health. Breastfeeding has nutritional, immunological, developmental, psychological, social, economic, and environmental benefits for infants, mothers, families, and society.^1,2 However, breastfeeding practices vary widely among different ethnic groups, and they are influenced by cultural, social, economic, and educational factors.

Cultural beliefs play an important role in shaping breastfeeding behaviors. Cultural beliefs significantly influence breastfeeding initiation and duration, with specific practices observed among different ethnic groups.^3,4 Additionally, sociodemographic factors, including education, occupation, and economic status, significantly shape mothers’ knowledge and practices regarding breastfeeding.^5,6 Furthermore, understanding how acculturation affects breastfeeding behaviors can inform the development of culturally sensitive interventions that support mothers in maintaining their breastfeeding practices.⁷

The aim of this study was to compare the breastfeeding behaviors of mothers toward infants in different ethnic groups. Understanding the breastfeeding behaviors of mothers from various ethnic backgrounds is crucial for developing effective public health interventions aimed at promoting breastfeeding practices and improving maternal and child health outcomes. By examining these differences, this study could identify potential barriers to and facilitators of breastfeeding within each group, as well as common trends that may inform broader public health strategies.

Background information about the study area (Mardin)

Mardin is a metropolitan city with a population of approximately 850,000 and is located in southeast Turkey. Mardin is a multicultural city with various ethnic and religious communities. Mardin has a much more heterogeneous population in terms of culture and ethnicity than any other cities in Turkey. There are four different ethnic groups that predominantly live in Mardin. These ethnic groups are Assyrian, Turkish, Arab, and Kurdish. The city of Mardin has long been home to Assyrian, Turkish, Arab, and Kurdish, all of whom have contributed to Mardin’s multicultural landscape. With regard to the religion of these ethnic groups, while Turkish, Arab, and Kurdish participants were Muslim, Assyrian participants were Christian.

Methods

Design

This study is a descriptive cross-sectional study.

Participants, sampling, and settings

The study population consists of women of four ethnic groups (Assyrian, Turkish, Arab, and Kurdish) living in Mardin. The population of the study consists of women who lived in Mardin and breastfed at least one child. The sample size was calculated according to the formula determined by Salant and Dillman.⁸ Using the sampling formula, the required sample size was calculated as 384 with a sampling error of 5% at the 95% confidence interval. The sample comprised women from four different ethnic groups who volunteered to participate in the study. Snowball and convenience sampling methods were used to recruit participants. Women who live in the city center of Mardin, have communication skills, are willing to participate in the study, and have at least one child were included in the study. The study was completed with 180 Assyrian, 184 Turkish, 175 Arab, and 169 Kurdish women. In total, 708 women participated in this study.

Data collection

Data were collected between August 12, 2024, and September 22, 2024. The study data were collected face to face using a questionnaire. The time it took to complete the questionnaire was about 5 minutes. Before starting to fill out the questionnaire, the women who volunteered to participate in the study were informed about the aim of the study, and consent forms were signed by the participants. The data collection form included two parts. Part 1 was the individual introduction form consisting of 15 questions including mother’s age, income status, age at first pregnancy, and duration of marriage. Part 2 comprised questions related to traditional practices for infants (18 questions) including the status of the presence of traditional practices, traditional breastfeeding practices such as “waiting for three calls to prayer to feed the baby,” “not giving the first milk (colostrum) to the baby,” “giving breast milk immediately after the baby is born,” and “giving sugared water as the baby’s first nutrient.”

Data analysis

The data were analyzed using SPSS (Statistical Package for Social Sciences) for Windows 22.0. In the analysis of the data, the number, percentage, mean, and standard deviation were used as descriptive statistical methods. Differences between the ratios of categorical variables in independent groups were analyzed using chi-square tests. A one-way ANOVA test was used to compare quantitative continuous data between groups. The Scheffe test was used as a complementary post hoc analysis to determine differences after the ANOVA test.

Ethical considerations

Ethical approval was obtained from the Mardin Artuklu University Non-Interventional Research Ethics Committee (Date: 06.08.2024, REF: 2024/8-15). Informed consent forms were obtained from all participants. The research was carried out in accordance with the principles of the Declaration of Helsinki.

Results

It was observed that there were some demographic and socioeconomic differences between ethnic groups. It was determined that there were significant statistical differences in marital status (p = 0.001) and educational status variables (p = 0.003). Although there was no significant difference between the groups in terms of employment status (p = 0.461), it is noteworthy that the rate of those who said “I am not working” was between 70% and 76% in all groups. Significant differences were found between the groups in terms of the number of children (p = 0.000). In particular, the rate of having —one to two children was the highest in the Kurdish group (60.4%) and the lowest in the Assyrian group (35.0%). However, the rate of having five or more children was the highest, at 33.9%, in the Assyrian group. Further characteristics of the participants were provided in Table 1.

Table 1.

Descriptive Characteristics of the Participants

	Assyrian		Turkish		Arab		Kurdish		Total		p
	n (180)	%	n (184)	%	n (175)	%	n (169)	%	n (708)	%	p
Marital status											χ² = 16.237p = 0.001^a
Married	137	76.1	161	87.5	153	87.4	152	89.9	603	85.2
Divorced, widow	43	23.9	23	12.5	22	12.6	17	10.1	105	14.8
Education status											χ² = 30.008p = 0.003^a
Illiterate	27	15.0	23	12.5	18	10.3	19	11.2	87	12.3
Literate	31	17.2	27	14.7	14	8.0	20	11.8	92	13.0
Primary school	47	26.1	44	23.9	60	34.3	37	21.9	188	26.6
High school	58	32.2	51	27.7	43	24.6	49	29.0	201	28.4
Bachelor’s degree	17	9.4	39	21.2	40	22.9	44	26.0	140	19.8
Family type											χ² = 7.215p = 0.301^a
Extended family	42	23.3	43	23.4	44	25.1	54	32.0	183	25.8
Nuclear family	133	73.9	130	70.7	121	69.1	108	63.9	492	69.5
Separated family	5	2.8	11	6.0	10	5.7	7	4.1	33	4.7
Number of children											χ² = 36.516p = 0.000^a
1–2	63	35.0	93	50.5	81	46.3	102	60.4	339	47.9
3–4	56	31.1	63	34.2	59	33.7	32	18.9	210	29.7
5 and more	61	33.9	28	15.2	35	20.0	35	20.7	159	22.5
Employment status											χ² = 2.579p = 0.461^a
Working	45	25.0	55	29.9	41	23.4	40	23.7	181	25.6
Not working	135	75.0	129	70.1	134	76.6	129	76.3	527	74.4
Income											χ² = 8.225p = 0.222^a
Income is less than expenses	82	45.6	74	40.2	69	39.4	61	36.1	286	40.4
Income equal to expenditure	71	39.4	72	39.1	81	46.3	70	41.4	294	41.5
Income is more than expenses	27	15.0	38	20.7	25	14.3	38	22.5	128	18.1
Occupation											χ² = 19.117p = 0.209^a
Civil servant	26	14.4	17	9.2	15	8.6	15	8.9	73	10.3
Healthcare staff	17	9.4	25	13.6	15	8.6	16	9.5	73	10.3
Self-employment	9	5.0	12	6.5	17	9.7	10	5.9	48	6.8
Worker	5	2.8	10	5.4	5	2.9	3	1.8	23	3.2
Housewife	121	67.2	117	63.6	116	66.3	122	72.2	476	67.2
Student	2	1.1	3	1.6	7	4.0	3	1.8	15	2.1
Social security status											χ² = 84.593p = 0.000^a
Not available	67	37.2	98	53.3	148	84.6	92	54.4	405	57.2
Available	113	62.8	86	46.7	27	15.4	77	45.6	303	42.8
Duration of marriage											χ² = 20.202p = 0.003^a
1–5 years	38	21.1	63	34.2	46	26.3	52	30.8	199	28.1
6–9 years	48	26.7	60	32.6	40	22.9	51	30.2	199	28.1
10 years and more	94	52.2	61	33.2	89	50.9	66	39.1	310	43.8
First gestational age											χ² = 10.685p = 0.099^a
18 years and younger	38	21.1	45	24.5	53	30.3	38	22.5	174	24.6
19–29	130	72.2	123	66.8	114	65.1	126	74.6	493	69.6
30 years and older	12	6.7	16	8.7	8	4.6	5	3.0	41	5.8
	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD	F/p
Age	41.070	11.393	35.230	10.721	33.470	9.533	33.530	10.835	35.88	11.072	20.181/0.000

Chi-square analysis, one-way analysis of variance.

Table 2 presents participants’ perceptions of traditional methods. In this study, in terms of family type, the proportion of those living in extended families was the highest in the Kurdish group (32.0%) and the lowest in the Assyrian group (23.3%). However, this difference was not statistically significant (p = 0.301).

Table 2.

Participants’ Perception of Traditional Methods

	Assyrian		Turkish		Arab		Kurdish		Total		p
	n (180)	%	n (184)	%	n (175)	%	n (169)	%	n (708)	%	p
Conception method											χ² = 38.874p = 0.000
Planned	77	42.8	99	53.8	55	31.4	104	61.5	335	47.3
Unplanned	95	52.8	82	44.6	113	64.6	58	34.3	348	49.2
With assisted reproductive techniques	8	4.4	3	1.6	7	4.0	7	4.1	25	3.5
What is done first in the health problem											χ² = 2.008p = 0.571
I go to the doctor	154	85.6	149	81.0	146	83.4	145	85.8	594	83.9
I will try to solve it with traditional practices	26	14.4	35	19.0	29	16.6	24	14.2	114	16.1
Importance of traditional methods											χ² = 30.251p = 0.000
Not important	14	7.8	23	12.5	9	5.1	22	13.0	68	9.6
Somewhat important	102	56.7	133	72.3	130	74.3	107	63.3	472	66.7
Very important	64	35.6	28	15.2	36	20.6	40	23.7	168	23.7
Source of information about traditional methods											χ² = 67.283p = 0.000
I have never received it	8	4.4	35	19.0	17	9.7	39	23.1	99	14.0
Internet, TV	10	5.6	33	17.9	34	19.4	27	16.0	104	14.7
Grandparents	154	85.6	104	56.5	105	60.0	98	58.0	461	65.1
Neighbors	8	4.4	12	6.5	19	10.9	5	3.0	44	6.2

Significant differences were also found between the groups regarding the variable of conception method (p = 0.000). The rate of conception by planned normal methods was the highest in the Kurdish group (61.5%) and the lowest in the Arab group (31.4%). The rate of conception through unplanned was the highest in the Arab group (64.6%) and the lowest in the Kurdish group (34.3%).

The rate of those who visited the doctor in case of health problems was quite high in all groups, and this rate was found to be the highest in the Kurdish group (85.8%). However, this difference was not statistically significant (p = 0.571). In terms of the importance given to traditional methods, significant differences were observed between the groups (p = 0.000). The proportion of those who stated that traditional methods were somewhat important was the highest in the Arab group at 74.3% and the lowest in the Assyrian group at 56.7%. The proportion of those who said that traditional methods were very important was found to be higher in the Assyrian group, at 35.6%, than in the other groups.

Significant differences were observed between the groups among the sources from which information about traditional methods was obtained (p = 0.000). The percentage of those who received information from their family elders was the highest in the Assyrian group (85.6%). In addition, the proportion of those who did not receive any information about traditional methods was the highest in the Kurdish group (23.1%).

Table 3 examines the distribution of traditional breastfeeding practices among different ethnic groups. In terms of the presence of traditional practices, the highest rate was observed in the Kurdish group (99.4%). This difference was statistically significant (p = 0.000). Although traditional breastfeeding practices are less common in the Assyrian group, it is seen that these practices were applied by almost all participants in the Kurdish group.

Table 3.

Distribution of Traditional Breastfeeding Practices

	Assyrian		Turkish		Arab		Kurdish		Total		p
	n (180)	%	n (184)	%	n (175)	%	n (169)	%	n (708)	%	p
Presence of traditional practices											χ² = 44.047p = 0.000
Yes	152	84.4	179	97.3	168	96.0	168	99.4	667	94.2	χ² = 44.047p = 0.000
Waiting for three calls to prayer to feed the baby											χ² = 2.612p = 0.455
Yes	12	7.9	17	9.5	19	11.3	22	13.1	70	10.5	χ² = 2.612p = 0.455
Not giving the first milk (colostrum) to the baby											χ² = 11.641p = 0.009
Yes	24	15.8	21	11.7	10	6.0	11	6.5	66	9.9	χ² = 11.641p = 0.009
Giving breast milk immediately after the baby is born											χ² = 26.158p = 0.000
Yes	109	71.7	124	69.3	79	47.0	104	61.9	416	62.4	χ² = 26.158p = 0.000
Giving sugared water as the baby’s first nutrient											χ² = 51.050p = 0.000
Yes	14	9.2	21	11.7	63	37.5	35	20.8	133	19.9	χ² = 51.050p = 0.000

Chi-square analysis.

There were no significant differences between the groups in terms of a specific traditional practice, such as waiting for three calls to prayer to feed the baby (p = 0.455). However, the tradition of not giving the baby the first milk (colostrum) was more common in the Assyrian group (15.8%) than in the other groups, and this difference was statistically significant (p = 0.009). This practice was less common among Turkish, Arab, and Kurdish groups.

In terms of giving breast milk immediately after the birth of the baby, it was observed that this practice was at the lowest level, at 47.0%, in the Arab group. In contrast, in the Assyrian group, 71.7% of the Assyrians were immediately breastfed, and this difference was statistically significant (p = 0.000).

The practice of giving sugared water to the baby as the first food nutrient was the highest in the Arab group (37.5%), while it was the lowest in the Assyrian group (9.2%). This difference was found to be statistically significant (p = 0.000). These data reveal that traditional practices vary greatly between ethnic groups. It is noteworthy that while traditional practices are more common in the Kurdish and Arab groups, such practices are less common in the Assyrian group. These differences demonstrate that cultural practices are closely related to ethnic identity and indicate that these cultural differences should be considered in the provision of health services.

Table 4 shows the distribution of traditional breastfeeding practices by education level. According to Table 4, there are significant differences in the distribution of traditional breastfeeding practices within the education level groups. Among the illiterate, the presence of traditional breastfeeding practices has a high rate of 87.4%. In this group, the rate of waiting for three calls to prayer to feed the baby was 21.1%, the rate of not giving the first milk (colostrum) was 14.5%, and the rate of giving sugared water to the baby as the first nutrient was 36.8%. When the p values for this group were examined, it was found that p = 0.012 for the presence of general traditional breastfeeding practice, p = 0.009 for waiting for three calls to prayer, p = 0.002 for not giving colostrum, and p = 0.000 for giving sugared water. This shows that the differences were statistically significant.

Table 4.

Distribution of Traditional Breastfeeding Practices by Education Level

	Illiterate		Literate		Primary school		High school		Bachelor’s degree		Total		p
	n	%	n	%	n	%	n	%	n	%	n	%	p
Presence of traditional practices													χ² = 12.893p = 0.012^a
Yes	76	87.4	88	95.7	177	94.1	188	93.5	138	98.6	667	94.2
No	11	12.6	4	4.3	11	5.9	13	6.5	2	1.4	41	5.8
Waiting for three calls to prayer to feed the baby													χ² = 13.409p = 0.009^a
Yes	16	21.1	8	9.1	22	12.4	13	6.9	11	8.0	70	10.5
No	60	78.9	80	90.9	155	87.6	175	93.1	127	92.0	597	89.5
Not giving the first milk (colostrum) to the baby													χ² = 17.340p = 0.002^a
Yes	11	14.5	17	19.3	12	6.8	10	5.3	16	11.6	66	9.9
No	65	85.5	71	80.7	165	93.2	178	94.7	122	88.4	601	90.1
Giving breast milk immediately after the baby is born													χ² = 31.343p = 0.000^a
Yes	28	36.8	58	65.9	102	57.6	130	69.1	98	71.0	416	62.4
No	48	63.2	30	34.1	75	42.4	58	30.9	40	29.0	251	37.6
Giving sugared water as the baby’s first nutrient													χ² = 28.650p = 0.000^a
Yes	28	36.8	8	9.1	45	25.4	35	18.6	17	12.3	133	19.9
No	48	63.2	80	90.9	132	74.6	153	81.4	121	87.7	534	80.1

Chi-square analysis.

In the literate group, the rate of adherence to traditional breastfeeding practices was at a high level of 95.7%. In this group, the rate of waiting for three calls to prayer decreased to 9.1%, while the rate of not giving colostrum was observed as 19.3%. Breastfeeding immediately after the baby born was at a rate of 65.9%, while giving sugared water was at a rate of 9.1%. The p values of this group were also statistically significant: p = 0.009 for waiting for three calls to prayer, p = 0.002 for not giving colostrum, and p = 0.000 for giving sugared water.

The existence of traditional breastfeeding practices among primary school graduates was at the rate of 94.1%. In this group, the rate of waiting for three calls to prayer was 12.4%, and the rate of not giving colostrum was 6.8%. Breastfeeding immediately after the baby born was at a rate of 57.6%, and the rate of giving sugared water was 25.4%. In terms of p values, three calls to prayer were found to be p = 0.009, not giving colostrum p = 0.002, and giving sugared water p = 0.000.

In the group of high school graduates, the presence of traditional breastfeeding practice rate was 93.5%. The rate of waiting for three calls to prayer decreased to 6.9%, and the rate of not giving colostrum decreased to 5.3%. The rate of breastfeeding immediately after the baby born was 69.1% and that of giving sugared water was 18.6%. p values in this group were also significant (p = 0.012): p = 0.009 for three calls to prayer, p = 0.002 for not giving colostrum, and p = 0.000 for giving sugared water.

Adherence to traditional breastfeeding practices among undergraduate graduates was at a very high rate of 98.6%. In this group, waiting for three calls to prayer was 8.0% and not giving colostrum was 11.6%. While the rate of breastfeeding immediately after the birth of the baby was 71.0%, the rate of giving sugared water decreased to 12.3%. In this group, p values were also significant: p = 0.009 for waiting for three calls to prayer, p = 0.002 for not giving colostrum, and p = 0.000 for giving sugared water.

Table 5 examines the distribution of traditional breastfeeding practices among ethnic groups according to education level. Significant differences were observed between the education level and the presence of traditional practices in general.

Table 5.

Distribution of Traditional Breastfeeding Practices in Ethnic Groups by Education Level

	Illiterate		Literate		Primary school		High school		Bachelor’s degree		p
	n	%	n	%	n	%	n	%	n	%	p
Assyrian
Presence of traditional practices	19	70.4	29	93.5	41	87.2	48	82.8	15	88.2	χ² = 6.617;p = 0.158
Waiting for three calls to prayer to feed the baby	2	10.5	2	6.9	3	7.3	4	8.3	1	6.7	χ² = 0.283;p = 0.991
Not giving the baby the first milk (colostrum)	5	26.3	6	20.7	5	12.2	4	8.3	4	26.7	χ² = 5.847;p = 0.211
Giving breast milk immediately after the baby is born	10	52.6	21	72.4	30	73.2	37	77.1	11	73.3	χ² = 4.162;p = 0.385
Giving sugared water as the baby’s first nutrient	5	26.3	1	3.4	4	9.8	3	6.2	1	6.7	χ² = 8.433;p = 0.077
Turkish
Presence of traditional practices	22	95.7	27	100.0	41	93.2	50	98.0	39	100.0	χ² = 4.984;p = 0.289
Waiting for three calls to prayer to feed the baby	3	13.6	5	18.5	6	14.6	3	6.0	0	0.0	χ² = 9.058;p = 0.060
Not giving the baby the first milk (colostrum)	2	9.1	6	22.2	4	9.8	4	8.0	5	12.8	χ² = 3.889;p = 0.421
Giving breast milk immediately after the baby is born	13	59.1	16	59.3	23	56.1	39	78.0	33	84.6	χ² = 11.789;p = 0.019
Giving sugared water as the baby’s first nutrient	5	22.7	2	7.4	9	22.0	4	8.0	1	2.6	χ² = 11.029;p = 0.026
Arab
Presence of traditional practices	16	88.9	13	92.9	58	96.7	41	95.3	40	100.0	χ² = 4.514;p = 0.341
Waiting for three calls to prayer to feed the baby	4	25.0	0	0.0	8	13.8	0	0.0	7	17.5	χ² = 11.761; p = 0.019
Not giving the baby the first milk (colostrum)	2	12.5	1	7.7	2	3.4	2	4.9	3	7.5	χ² = 2.201;p = 0.699
Giving breast milk immediately after the baby is born	0	0.0	7	53.8	29	50.0	20	48.8	23	57.5	χ² = 16.464;p = 0.002
Giving sugared water as the baby’s first nutrient	11	68.8	5	38.5	20	34.5	19	46.3	8	20.0	χ² = 13.491;p = 0.009
Kurdish
Presence of traditional practices	19	100.0	19	95.0	37	100.0	49	100.0	44	100.0	χ² = 7.494;p = 0.112
Waiting for three calls to prayer to feed the baby	7	36.8	1	5.3	5	13.5	6	12.2	3	6.8	χ² = 11.999;p = 0.017
Not giving the baby the first milk (colostrum)	2	10.5	4	21.1	1	2.7	0	0.0	4	9.1	χ² = 11.817;p = 0.019
Giving breast milk immediately after the baby is born	5	26.3	14	73.7	20	54.1	34	69.4	31	70.5	χ² = 14.817;p = 0.005
Giving sugared water as the baby’s first nutrient	7	36.8	0	0.0	12	32.4	9	18.4	7	15.9	χ² = 11.798;p = 0.019

Chi-square analysis.

In the Assyrian group, the presence of traditional practices decreased slightly as the level of education increased; however, this was not statistically significant (p = 0.158). There were no significant differences according to the level of education in terms of certain traditional practices, such as waiting for three calls to prayer to feed the baby, not giving the baby colostrum, or giving the baby sugared water as the first nutrient.

In the Turkish group, the presence of traditional practices did not vary according to the level of education (p = 0.289). However, it was found that the practice of giving sugared water to the baby as the first nutrient was more common among those with low education levels, and this difference was statistically significant (p = 0.026). In addition, the practice of giving breast milk to the baby immediately was more common among high school and undergraduate graduates, and this difference was significant (p = 0.019).

In the Arab group, the presence of traditional practices remained high regardless of the education level (p = 0.341). However, some traditional practices, such as giving sugared water as the baby’s first nutrient, were found to be more common among those with lower levels of education, and this difference was statistically significant (p = 0.009). In addition, practice of waiting for three calls to prayer to feed the baby was more common among those with low education levels (p = 0.019).

In the Kurdish group, the presence of traditional practices was 100% at almost all education levels (p = 0.112). However, it was found that practices such as waiting for three calls to prayer to feed the baby and giving sugared water as the first nutrient to the baby were more common among those with low education levels, and these differences were statistically significant (p = 0.017 and p = 0.019).

Table 6 presents significant differences in the distribution of some traditional breastfeeding practices according to the number of children. While the rate of the presence of traditional breastfeeding practice was 97.1% in individuals with—one to two children, this rate decreased to 91.9% in those with—three to four children and to 91.2% in those with five or more children, and this difference was statistically significant (p = 0.008). The practice of waiting for three calls to prayer to feed the baby does not differ significantly according to the number of children. This practice was seen in 10.9% of those with—one to two children, 8.8% of those with—three to four children, and 11.7% of those with five or more children (p = 0.642).

Table 6.

Distribution of Traditional Breastfeeding Practices by Number of Children

	1–2		3–4		5 and more		Total		p
	n	%	n	%	n	%	n	%	p
Presence of traditional practices									χ² = 9.707p = 0.008^a
Yes	329	97.1	193	91.9	145	91.2	667	94.2
No	10	2.9	17	8.1	14	8.8	41	5.8
Waiting for three calls to prayer to feed the baby									χ² = 0.888p = 0.642^a
Yes	36	10.9	17	8.8	17	11.7	70	10.5
No	293	89.1	176	91.2	128	88.3	597	89.5
Not giving the first milk (colostrum) to the baby									χ² = 2.294p = 0.318^a
Yes	27	8.2	21	10.9	18	12.4	66	9.9
No	302	91.8	172	89.1	127	87.6	601	90.1
Giving breast milk immediately after the baby is born									χ² = 17.880p = 0.000^a
Yes	226	68.7	120	62.2	70	48.3	416	62.4
No	103	31.3	73	37.8	75	51.7	251	37.6
Giving sugared water as the baby’s first nutrient									χ² = 20.730p = 0.000^a
Yes	47	14.3	39	20.2	47	32.4	133	19.9
No	282	85.7	154	79.8	98	67.6	534	80.1

Chi-square analysis.

The practice of not giving the baby the first milk (colostrum) does not differ significantly according to the number of children. This practice was observed in 8.2% of those with—one to two children, 10.9% of those with—three to four children, and 12.4% of those with five or more children (p = 0.318). However, the practice of breastfeeding immediately after the baby was born tends to decrease as the number of children increases, and while it is 68.7% in those with one to two children, it decreases to 62.2% in those with three to four children, and to 48.3% in those with five or more children. This difference was statistically significant (p = 0.000).

In addition, the practice of giving sugared water to the baby as the first nutrient increases as the number of children increases. While it was 14.3% for those with one to two children, this rate increased to 20.2% for those with three to four children and to 32.4% for those with five or more children. This difference was found to be statistically significant (p = 0.000). In general, with the increase in the number of children, it was observed that some traditional breastfeeding practices increase, while some practices decrease. This shows that the effect of the number of children on traditional practices was statistically significant.

Table 7 shows how traditional practices were distributed among different ethnic groups according to the number of children. In general, changes in the prevalence of some traditional practices were observed with an increase in the number of children, but most of these changes were not found to be statistically significant.

Table 7.

Distribution of Traditional Breastfeeding Practices in Ethnic Groups by Number of Children

	Number of children						p
	1–2		3–4		5 and more
Variables	n	%	n	%	n	%
Assyrian
Presence of traditional practices	56	88.9	44	78.6	52	85.2	χ² = 2.448; p = 0.294
Waiting for three calls to prayer to feed the baby	3	5.4	3	6.8	6	11.5	χ² = 1.515; p = 0.469
Not giving the baby the first milk (colostrum)	5	8.9	9	20.5	10	19.2	χ² = 3.166; p = 0.205
Giving breast milk immediately after the baby is born	48	85.7	29	65.9	32	61.5	χ² = 8.796; p = 0.012
Giving sugared water as the baby’s first nutrient	2	3.6	4	9.1	8	15.4	χ² = 4.501; p = 0.105
Turkish
Presence of traditional practices	91	97.8	61	96.8	27	96.4	χ² = 0.240; p = 0.887
Waiting for three calls to prayer to feed the baby	10	11.0	5	8.2	2	7.4	χ² = 0.493; p = 0.782
Not giving the baby the first milk (colostrum)	11	12.1	8	13.1	2	7.4	χ² = 0.611; p = 0.737
Giving breast milk immediately after the baby is born	68	74.7	40	65.6	16	59.3	χ² = 2.935; p = 0.230
Giving sugared water as the baby’s first nutrient	4	4.4	10	16.4	7	25.9	χ² = 11.263; p = 0.004
Arab
Presence of traditional practices	80	98.8	57	96.6	31	88.6	χ² = 6.700; p = 0.035
Waiting for three calls to prayer to feed the baby	8	10.0	8	14.0	3	9.7	χ² = 0.641; p = 0.726
Not giving the baby the first milk (colostrum)	3	3.8	4	7.0	3	9.7	χ² = 1.577; p = 0.455
Giving breast milk immediately after the baby is born	45	56.2	26	45.6	8	25.8	χ² = 8.381; p = 0.015
Giving sugared water as the baby’s first nutrient	25	31.2	20	35.1	18	58.1	χ² = 7.068; p = 0.029
Kurdish
Presence of traditional practices	102	100.0	31	96.9	35	100.0	χ² = 4.307; p = 0.116
Waiting for three calls to prayer to feed the baby	15	14.7	1	3.2	6	17.1	χ² = 3.390; p = 0.184
Not giving the baby the first milk (colostrum)	8	7.8	0	0.0	3	8.6	χ² = 2.686; p = 0.261
Giving breast milk immediately after the baby is born	65	63.7	25	80.6	14	40.0	χ² = 11.88; p = 0.003
Giving sugared water as the baby’s first nutrient	16	15.7	5	16.1	14	40.0	χ² = 9.850; p = 0.007

Chi-square analysis.

In the Assyrian group, the presence of traditional practices was not significantly different according to the number of children (p = 0.294). However, practices such as waiting for three calls to prayer to feed a baby and not giving the baby the first milk (colostrum) have become more common as the number of children increases. In contrast, the practice of breastfeeding immediately after the birth of the baby showed the highest rate, at 85.7%, in those with—one to two children, whereas this rate decreased to 61.5% in those with five or more children. This difference was statistically significant (p = 0.012).

In the Turkish group, the presence of traditional practices did not show a statistically significant difference according to the number of children (p = 0.887). However, the practice of giving sugared water to the baby as the first nutrient was found to be more common in those with five or more children (25.9%) compared with other groups, and this difference was statistically significant (p = 0.004). The rate of breastfeeding immediately after the birth of the baby tended to decrease as the number of children increased, but this difference was not statistically significant (p = 0.230).

In the Arab group, the presence of traditional practices was significantly different according to the number of children. The practice of breastfeeding immediately after birth also tended to decrease as the number of children increased, and this difference was statistically significant (p = 0.015). In addition, the practice of giving sugared water to the baby as the first food became more common as the number of children increased, and this difference was found to be statistically significant (p = 0.029).

In the Kurdish group, the presence of traditional practices changed according to the number of children, but this difference was not statistically significant (p = 0.116). However, while the rate of breastfeeding immediately after birth was the highest at 80.6% in those with—three to four children, it decreased to 40.0% in those with five or more children, and this difference was statistically significant (p = 0.003). The practice of giving sugared water to the baby as the first nutrient also increases as the number of children increases, and this difference was statistically significant (p = 0.007).

These results suggest that the number of children may impact the prevalence of traditional practices and that this effect may differ among ethnic groups. Practices such as breastfeeding immediately after a child is born and giving sugared water to the baby as the first nutrient become less or more common as the number of children increases. This situation reveals that the attitudes of families toward traditional practices may change depending on the number of children, and these changes may also be related to ethnic identity.

Discussion

This study revealed that the vast majority of participants applied traditional breastfeeding practices. This study revealed the existence of some traditional breastfeeding practices, including “waiting for three calls to prayer to feed the baby,” “not giving the first milk (colostrum) to the baby,” “giving breast milk immediately after the baby is born,” and “giving sugared water as the baby’s first nutrient.”

The results of this study indicated that some traditional breastfeeding practices existed across four ethnic groups. Some mothers preferred to wait for three calls to prayer to feed their babies (7.9% in Assyrian, 9.5% in Turkish, 11.3% in Arab, and 13.1% in Kurdish). In line with this study, other studies conducted in Turkey found that the rate of those who wait three calls to prayer to feed the baby was 2.8%,⁹ 20.8%,¹⁰ 23.4%,¹¹ and 64%.¹² The existing literature found that waiting for three calls to prayer before breastfeeding the infant after birth and not giving colostrum were harmful breastfeeding practices.¹³ In addition, some mothers did not give breast milk to the baby (15.8% in Assyrian, 11.7% in Turkish, 6% in Arab, and 6.5% in Kurdish). Moreover, this study revealed that some mothers prefer to give sugared water to their babies as the first food nutrient. This practice was the highest in the Arab group (37.5%), while it was the lowest in the Assyrian group (9.2%). In line with this study, other studies conducted in Turkey found that these rates were 45.5%,¹⁴ 52%,¹⁵ and 62.5%.¹¹

This study showed that the early initiation of breastfeeding was low across all ethnic groups, with rates of 28.3% in Assyrian, 30.7 in Turkish, 53 in Arab, and 38.1% in Kurdish. These results concur with the results of Berde and Yalçin,¹⁶ who found that breastfeeding was initiated within one hour of birth in 34.7% of children. Another study determined that 69.8% of mothers breastfed their babies immediately.¹³ Another study conducted in Turkey found that 50.5% of mothers breastfed their babies immediately after birth.¹⁵ Another study conducted with Syrian and Turkish mothers found that 61.4% of Syrians and 71.1% of Turkish mothers initiated breastfeeding within one hour of delivery.¹⁷ In addition, this study revealed that the practice of giving breast milk to the baby immediately was more common among high school and undergraduate graduates. This result showed that increased education level was associated with a higher rate of early initiation of breastfeeding. Concurring with these results, the existing literature found that mothers with lower socioeconomic status often encounter obstacles, including limited access to breastfeeding education and assistance, which negatively impacts their breastfeeding habits.¹⁸ Late initiation of breastfeeding, discarding colostrum, and not practicing exclusive breastfeeding were related to cultural practices.¹⁹

This study suggested that traditional practices may differ according to education level and may vary between ethnic groups. It appears that education can influence individuals’ approaches to traditional practices, and higher levels of education may decrease some traditional practices. However, this effect is not the same for all ethnic groups, and some traditional practices may continue to be prevalent regardless of the education level. This result highlights the potential for cultural traditions to change with education and the impact of communities on health behaviors. Cultural beliefs and advice from family members significantly influenced mothers’ decisions to breastfeed, indicating that cultural context plays an important role in shaping breastfeeding practices.²⁰ This study suggested that interventions aimed at improving breastfeeding rates should be culturally sensitive and tailored to the specific beliefs and practices of different ethnic groups. Culturally specific interventions can improve health-related quality of life by improving positive breastfeeding attitudes.²¹ This study also suggested improving the educational level of women regarding the harms of some traditional practices and advised them to avoid such practices. Providing education could positively affect women’s health in general and breastfeeding practices.²²

Strengths and limitations

One of the strengths of this study is to collect data from a large sample of 708 participants. Another strength of this study is to include four ethnic groups and compared their breastfeeding practices. However, this study is not without limitations. First, this study was conducted in a single city; therefore, the results may not be generalizable to other settings. However, the results of this study concur with the those of existing literature. Second, using snowball and convenience sampling methods may introduce some limitations such as risk of selection bias. To address this limitation, the researchers made efforts to ensure that the sample was as diverse as possible.

Conclusion

Footnotes

Acknowledgment

The authors thank the mothers for their participation in this study.

Authors’ Contributions

A.B.: Conceptualization, resources, data curation, software, visualization, methodology, project administration, formal analysis, writing—original draft, and writing—review and editing. V.B.D.: Conceptualization, resources, data curation, software, visualization, methodology, project administration, formal analysis, writing—original draft, and writing—review and editing.

Author Disclosure Statement

The authors declare that there are no conflicts of interest.

Funding Information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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