Factors associated with the pattern of breastfeeding in the north of Iran

Background: The health benefits of breastfeeding to infants and mothers have been well established. Its pattern varies between populations and the differences may originate from varying social and cultural factors. Aims: The aims of this study were to determine the pattern of breastfeeding and to assess its determinants in a population-based study in Babol, in the north of Iran. Subjects and methods: A cross-sectional study of 600 randomly selected mothers with infants 12-24 months old was conducted in the north of Iran in 1998. Data concerning breastfeeding status, breastfeeding duration and social and demographic factors were collected through interviews with the mothers. The probability of continuation of breastfeeding (i.e. survival probability) was estimated by using the non-parametric Kaplan-Meier method of survival analysis. The Cox regression analysis was applied to determine the factors associated with duration of breastfeeding. Results: The results showed that the incidence of breastfeeding was 87 and 89% at 12 months in urban and rural areas and 18 and 53% at 24 months, respectively. The difference in the pattern of breastfeeding between urban and rural areas was significant after 12 months (p = 0.04). The Cox regression model analysis showed that living in a rural area, increment of birth order, higher education level of mothers, and being housewife mothers were associated with longer duration of breastfeeding. Although, in the univariate analysis, women with high education appeared to have shorter duration of breastfeeding in comparison with illiterate mothers, after controlling the effect of mother's working status and other variables using the Cox regression model, high level of education had a positive association with longer duration of breastfeeding, i.e. the risk of weaning was decreased in comparison with illiterate women. Also, the risk of shorter duration of breastfeeding was increased significantly among mothers with a high level of stress. The results did not show a significant difference in pattern of breastfeeding in relation to age of mothers and sex of infants. Conclusion: Although the rate of breastfeeding among mothers in Babol was increasing, greater health education efforts are needed to support and promote the healthy practice of breastfeeding, especially among the young, less educated, nullipara, in urban areas and among women who are employees.