Relationship and Determinants of Breastfeeding Self-Efficacy Among Postpartum Mothers and Fathers in Malawi: A Cross-Sectional Study

Abstract

Background:

Breastfeeding self-efficacy among both mothers and fathers is critical in enhancing exclusive breastfeeding rates. However, the interrelationship between maternal and paternal breastfeeding self-efficacy and their determinants remains unknown.

Research Aims:

We aimed to (a) investigate the relationship between breastfeeding self-efficacy scores postpartum for mothers and fathers; (b) explore factors associated with breastfeeding self-efficacy in this group; and (c) examine determinants of combined self-efficacy scores among breastfeeding parents in Malawi.

Methods:

We conducted a cross-sectional study on postpartum mother–father couples at a tertiary maternity facility in central Malawi. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale Short-Form. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. A structured questionnaire was used to collect demographic and health variables. Data were analyzed using multivariable logistic regression and multinomial logistic regression.

Results:

Mothers demonstrated a higher score of self-efficacy (M = 55.7, SD = 6.5) in comparison to fathers (M = 50.2, SD = 11.9). A significant moderate positive correlation was identified between mothers’ and fathers’ breastfeeding self-efficacy (r = 0.32). Age, employment status, mode of birth, and practicing exclusive breastfeeding were significantly associated with maternal and paternal breastfeeding self-efficacy. Factors including advanced age, Cesarean delivery, and depressive symptoms emerged as significant determinants of combined breastfeeding self-efficacy scores among couples.

Conclusion:

Breastfeeding self-efficacy is highly correlated between mothers and fathers, with a relatively higher score in mothers. Importantly, sociodemographic, obstetric, and psychological determinants play a substantial role in influencing parental breastfeeding efficacy. This highlights the necessity of incorporating both mothers and fathers into future breastfeeding promotion strategies.

Keywords

breastfeeding self-efficacy scale cross-sectional study exclusive breastfeeding lactation Malawi maternal paternal postpartum depression self-efficacy

Get full access to this article

View all access options for this article.

References

Abbass-Dick

Stern

S. B.

Nelson

L. E.

Watson

Dennis

C. L.

(2015). Coparenting breastfeeding support and exclusive breastfeeding: A randomized controlled trial. Pediatrics, 135(1), 102–110. https://doi.org/10.1542/peds.2014-1416

Ahmadinezhad

G. S.

Karimi

F. Z.

Abdollahi

NaviPour

(2024). Association between postpartum depression and breastfeeding self-efficacy in mothers: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 24(1), Article 273. https://doi.org/10.1186/s12884-024-06465-4

Ahmed

A. A.

Hassan

A. K.

Mohamed

S. H.

Hamad

M. A. E.

(2020). Self-efficacy of postpartum mothers toward breastfeeding and the affecting factors. American Journal of Nursing Research, 8(3), 352–360. https://doi.org/10.12691/ajnr-8-3-5

Amini

Omani-Samani

Sepidarkish

Almasi-Hashiani

Hosseini

Maroufizadeh

(2019). The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF): A validation study in Iranian mothers. BMC Research Notes, 12(1), Article 622. https://doi.org/10.1186/s13104-019-4656-7

Bandura

(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1016/0146-6402(78)90002-4

Brockway

Benzies

Hayden

K. A.

(2017). Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: A systematic review and meta-analysis. Journal of Human Lactation, 33(3), 486–499. https://doi.org/10.1177/0890334417707957

Buran

Ozyazicioglu

Aydin

A. I.

Atak

(2022). Evaluation of breastfeeding success and self-efficacy in mothers giving birth via vaginal delivery or cesarean section: A cross-sectional study. Women Health, 62(9–10), 788–798. https://doi.org/10.1080/03630242.2022.2146832

Bwanali

Parveen

Pennington

(2021). How-to guide: Implementing the baby-friendly hospital initiative in Malawi. Palladium, Health Policy Plus. https://pdf.usaid.gov/pdf_docs/PA00XSX1.pdf

Campbell

O. M.

Cegolon

Macleod

Benova

(2016). Length of stay after childbirth in 92 countries and associated factors in 30 low- and middle-income countries: Compilation of reported data and a cross-sectional analysis from nationally representative surveys. PLoS Medicine, 13(3), Article e1001972. https://doi.org/10.1371/journal.pmed.1001972

10.

Chipojola

Dennis

C. L.

Kuo

S. Y.

(2023). Psychometric assessment of the breastfeeding self-efficacy scale-short form: A confirmatory factor analysis in Malawian Mothers. Journal of Human Lactation, 39(3), 397–405. https://doi.org/10.1177/08903344221127

11.

Cook

E. J.

Powell

Ali

Penn-Jones

Ochieng

Randhawa

(2021). Improving support for breastfeeding mothers: A qualitative study on the experiences of breastfeeding among mothers who reside in a deprived and culturally diverse community. International Journal for Equity in Health, 20, 1–14. https://doi.org/10.1186/s12939-021-01419-0

12.

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry: The Journal of Mental Science, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782

13.

Deif

Burch

E. M.

Azar

Yonis

Abou Gabal

El Kramani

DakhlAllah

(2021). Dysphoric milk ejection reflex: The psychoneurobiology of the breastfeeding experience. Frontiers in Global Women’s Health, 2, Article 669826. https://doi.org/10.3389/fgwh.2021.669826

14.

Dennis

C. L.

(1999). Theoretical underpinnings of breastfeeding confidence: A self-efficacy framework. Journal of Human Lactation, 15(3), 195–201. https://doi.org/10.1177/089033449901500303

15.

Dennis

C. L.

(2003). The breastfeeding self-efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6), 734–744. https://doi.org/10.1177/0884217503258459

16.

Dennis

C. L.

(2006). Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period. Research in Nursing & Health, 29(4), 256–268. https://doi.org/10.1002/nur.20140

17.

Dennis

C. L.

Brennenstuhl

Abbass-Dick

(2018). Measuring paternal breastfeeding self-efficacy: A psychometric evaluation of the Breastfeeding Self-Efficacy Scale-Short Form among fathers. Midwifery, 64, 17–22. https://doi.org/10.1016/j.midw.2018.05.005

18.

Dennis

C. L.

Faux

(1999). Development and psychometric testing of the Breastfeeding Self-Efficacy Scale. Research in Nursing & Health, 22(5), 399–409. https://doi.org/10.1002/(sici)1098-240x(199910)22:5<399::aid-nur6>3.0.co;2-4

19.

Dennis

C. L.

Heaman

Mossman

(2011). Psychometric testing of the breastfeeding self-efficacy scale-short form among adolescents. Journal of Adolescent Health, 49(3), 265–271. https://doi.org/10.1016/j.jadohealth.2010.12.015

20.

Dormann

C. F.

Elith

Bacher

Carré

G. C. G.

García Márquez

J. R.

Gruber

Lafourcade

Leitao

P. J.

Münkemüller

McClean

C. J.

Osborne

P. E.

Reneking

Schröder

Skidmore

A. K.

Zurell

Lautenbach

(2013). Collinearity: A review of methods to deal with it and a simulation study evaluating their performance. Ecography, 36(1), 27–46. https://doi.org/10.1111/j.1600-0587.2012.07348.x

21.

N. T.

Lee-Sarwar

K. A.

Tun

H. M.

Brown

B. P.

Pannaraj

P. S.

Bender

J. M.

Azad

M. B.

Thompson

A. L.

Weiss

S. T.

Azcarate-Peril

M. A.

Litonjua

A. A.

Kozyrskyj

A. L.

Jaspan

H. B.

Aldrovandi

G. M.

Kuhn

(2018). Meta-analysis of effects of exclusive breastfeeding on infant gut microbiota across populations. Nature Communications, 9(1), Article 4169. https://doi.org/10.1038/s41467-018-06473-x

22.

International Labour Organization. (2024). ILO database of conditions of work and employment laws - Maternity protection. https://www.ilo.org/media/334136/download

23.

Junk-Wilson

J. S.

King

E. K.

Murphy

L. M.

Raza

(2024). Skin-to-skin contact during cesarean birth in the United States over the last decade. MCN: The American Journal of Maternal/Child Nursing, 49(1), 8–14. https://doi.org/10.1097/NMC.0000000000000960

24.

Kavle

J. A.

LaCroix

Dau

Engmann

(2017). Addressing barriers to exclusive breast-feeding in low-and middle-income countries: A systematic review and programmatic implications. Public Health Nutrition, 20(17), 3120–3134. https://doi.org/10.1017/S1368980017002531

25.

Kim

S. K.

Park

Kim

Ahn

(2018). Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies, 80, 94–105. https://doi.org/10.1016/j.ijnurstu.2018.01.004

26.

Kintu

Abdulla

Lubikire

Nabukenya

M. T.

Igaga

Bulamba

Semakula

Olufolabi

A. J.

(2019). Postoperative pain after cesarean section: Assessment and management in a tertiary hospital in a low-income country. BMC Health Services Research, 19, 1–6. https://doi.org/10.1186/s12913-019-3911-x

27.

Koffi

Essis

E. M. L.

Bamba

Assi

K. R.

Konan

L. L.

Aka

(2023). Factors associated with exclusive breastfeeding of children under six months of age in Cote d’Ivoire. International Breastfeeding Journal, 18(1), Article 43. https://doi.org/10.1186/s13006-023-00573-1

28.

Konukbay

Öksüz

Guvenc

(2024). Breastfeeding self-efficacy in terms of sleep quality, perceived social support, depression and certain variables: A cross-sectional study of postpartum women in Turkey. BMC Pregnancy and Childbirth, 24(1), Article 231. https://doi.org/10.1186/s12884-024-06456-5

29.

Levis

Benedetti

Ioannidis

J. P. A.

Sun

Negeri

Krishnan

Bhandari

P. M.

Neupane

Imran

Rice

D. B.

Riehm

K. E.

Saadat

Azar

Boruff

Cuijpers

Gilbody

Kloda

L. A.

, . . . Thombs

B. D.

(2020). Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: Individual participant data meta-analysis. Journal of Clinical Epidemiology, 122, 115–128.e1. https://doi.org/10.1016/j.jclinepi.2020.02.002

30.

Maleki-Saghooni

Amel Barez

Moeindarbari

Karimi

F. Z.

(2017). Investigating the breastfeeding self-efficacy and its related factors in primiparous breastfeeding mothers. International Journal of Pediatrics, 5(12), 6275–6283. https://doi.org/10.22038/ijp.2017.25656.2182

31.

Nanishi

Green

Taguri

Jimba

(2015). Determining a cut-off point for scores of the Breastfeeding Self-Efficacy Scale–Short Form: Secondary data analysis of an intervention study in Japan. PLOS ONE, 10(6), Article e0129698. https://doi.org/10.1371/journal.pone.0129698

32.

National Statistical Office (NSO) [Malawi] and ICF. (2017). Malawi Demographic and Health Survey 2015–16. Zomba, Malawi, and Rockville, Maryland, USA. NSO and ICF.

33.

Ngo

L. T. H.

Chou

H. F.

Gau

M. L.

Liu

C. Y.

(2019). Breastfeeding self-efficacy and related factors in postpartum Vietnamese women. Midwifery, 70, 84–91. https://doi.org/10.1016/j.midw.2018.12.014

34.

Ogbo

F. A.

Akombi

B. J.

Ahmed

K. Y.

Rwabilimbo

A. G.

Ogbo

A. O.

Uwaibi

N. E.

Ezeh

O. K.

Agho

K. E.

(2020). Breastfeeding in the community—how can partners/fathers help? A systematic review. International Journal of Environmental Research and Public Health, 17(2), Article 413. https://doi.org/10.3390/ijerph17020413

35.

Piro

S. S.

Ahmed

H. M.

(2020). Impacts of antenatal nursing interventions on mothers’ breastfeeding self-efficacy: An experimental study. BMC Pregnancy and Childbirth, 20, 1–12. https://doi.org/10.1186/s12884-019-2701-0

36.

Saavedra Sanchez

Rodríguez-Gallego

Leon-Larios

Andina-Diaz

Perez-Contreras

Gonzalez-Sanz

J. D

. (2024). Influence of perceived maternal self-efficacy on exclusive breastfeeding initiation and consolidation: A systematic review. Healthcare, 12(23), Article 2347. https://doi.org/10.3390/healthcare12232347.

37.

Stewart

R. C.

Umar

Tomenson

Creed

(2013). Validation of screening tools for antenatal depression in Malawi–A comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. Journal of Affective Disorders, 150(3), 1041–1047. https://doi.org/10.1016/j.jad.2013.05.036

38.

Surjanovic

Loughin

T. M.

(2024). Improving the Hosmer-Lemeshow goodness-of-fit test in large models with replicated Bernoulli trials. Journal of Applied Statistics, 51(7), 1399–1411. https://doi.org/10.1080/02664763.2023.2272223

39.

Titaley

C. R.

Dibley

M. J.

Ariawan

Mu’asyaroh

Alam

Damayanti

T. T.

Ferguson

Htet

Sutrisna

Fahmida

(2021). Determinants of low breastfeeding self-efficacy amongst mothers of children aged less than six months: Results from the BADUTA study in East Java, Indonesia. International Breastfeeding Journal, 16, 1–15. https://doi.org/10.1186/s13006-021-00357-5

40.

United Nations Children’s Fund, & World Health Organization. (2023). Global Breastfeeding Scorecard, 2019: Increasing commitment to breastfeeding through funding and improved policies and programmes. https://www.who.int/publications/i/item/WHO-NMH-NHD-19.22

41.

Walters

C. N.

Rakotomanana

Komakech

J. J.

Stoecker

B. J.

(2021). Maternal experience of intimate partner violence is associated with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia: Insights from a DHS analysis. International Breastfeeding Journal, 16, 1–12. https://doi.org/10.1186/s13006-021-00365-5

42.

World Health Organization. (2021). Indicators for assessing infant and young child feeding practices: Definitions and measurement methods. https://www.who.int/publications/i/item/9789240018389

43.

World Health Organization. (2022). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

44.

World Health Organization & United Nations Children’s Fund. (2023). Global breastfeeding scorecard 2023. https://iris.who.int/bitstream/handle/10665/375796/WHO-HEP-NFS-23.17-eng.pdf?sequence=1

45.

World Health Organization & United Nations Children’s Fund (UNICEF). (2023). Global breastfeeding scorecard 2023: rates of breastfeeding increase around the world through improved protection and support. World Health Organization. https://www.who.int/publications/i/item/WHO-HEP-NFS-23.17

46.

Tang

Wacharasin

(2022). Factors influencing exclusive breastfeeding for 6 months postpartum: A systematic review. International Journal of Nursing Knowledge, 33(4), 290–303. https://doi.org/10.1111/2047-3095.12360

47.

Wang

Huang

Zhang

Wang

Zhou

Hao

Yang

(2018). The association between caesarean delivery and the initiation and duration of breastfeeding: A prospective cohort study in China. European Journal of Clinical Nutrition, 72(12), 1644–1654. https://doi.org/10.1038/s41430-018-0127-9

48.

Zavala-Soto

J. O.

Hernandez-Rivero

Tapia-Fonllem

(2022). Pro-lactation cesarean section: Immediate skin-to-skin contact and its influence on prolonged breastfeeding. Frontiers in Sociology, 7, Article 908811. https://doi.org/10.3389/fsoc.2022.908811

49.

Zhang

Y. D.

Shi

D. D.

Wang

(2023). Therapeutic uses of oxytocin in stress-related neuropsychiatric disorders. Cell & Bioscience, 13(1), 216. https://doi.org/10.1186/s13578-023-01173-6

50.

Zhu

Chan

W. C.

Zhou

H. G.

(2014). Predictors of breast feeding self-efficacy among Chinese mothers: A cross-sectional questionnaire survey. Midwifery, 30(6), 705–711. https://doi.org/10.1016/j.midw.2013.12.008