Despite the health benefits of breastfeeding, Saudi women do not exclusively breastfeed their babies. The purpose of this article was to synthesize Saudi women’s breastfeeding knowledge, attitude, and practices and identify the factors that women reported for their breastfeeding cessation.
Methodology:
A systematic review and meta-analysis of randomized clinical trials and cross-sectional studies was undertaken.
Results:
Saudi women reported poor knowledge in managing breastfeeding challenges and had a positive attitude toward formula feeding. Giving premade formula and sugar water was a common practice. The breastfeeding initiation rate (31.5%, 95% confidence interval [CI]: [22%, 41.8%]) and exclusive breastfeeding at 6 months were low (15.15, 95% CI: [8%, 24%]). Perceived low milk supply, returning to work, and using contraception were the main reasons for early breastfeeding cessation.
Discussion:
The integration of Islamic, political, and economic cultures in Saudi Arabia can influence women’s breastfeeding practices. There is a need for culturally appropriate breastfeeding educational programs for Saudi women.
Abo El-FetohN. M.QureshiS. B.AleneziO. G.AlanaziA. F.AlanaziW. A.AlAnaziM. O.AliO. M. B. (2019). Breastfeeding practice and mothers' awareness and practice of absolute breastfeeding in Arar, Saudi Arabia. Indo American Journal of Pharmaceutical Sciences, 6(5), 8863. https://doi.org/10.5281/zenodo.2662485
2.
Al-BinaliA. M. (2012). Breastfeeding knowledge, attitude and practice among school teachers in Abha female educational district, southwestern Saudi Arabia. International Breastfeeding Journal, 7(1), 10. https://doi.org/10.1186/1746-4358-7-10
3.
AlDughaitherA.AlMutairiH. (2020). Assessment of knowledge and practice of mothers regarding breastfeeding and contraception in the postpartum period in primary care centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Middle East Journal of Family Medicine, 7(10), 41.
4.
Al-HaraziR.AlharbiN.Al-ZuraiqO.AlkhaldiR.AlmousaI.AlMulhimJ.Al-ArabM. (2019). Evaluation of current contraception methods and knowledge among females in Saudi Arabia: A cross-sectional survey. Middle East Journal of Family Medicine, 3(10), 867–872.
5.
AlharthiA. F.Al-HolaifiR. N.AlnemariB. A.AlosaimiA. A.AlamriA. D.Ahmed AyedA. A. N. (2019). Breastfeeding knowledge, attitude and practice among mothers attending Maternity Hospital at King Faisal Medical complex, Taif city, Saudi Arabia 2018. World Family Medicine Journal, 7(10), 58.
Al-JassirM.Khaja MoizuddinS.Al-BashirB. (2003). A review of some statistics on breastfeeding in Saudi Arabia. Nutrition and Health, 17(2), 123–130.
8.
Al KetbiM. I.Al NomanS.Al AliA.DarwishE.Al FahimM.RajahJ. (2018). Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. International Breastfeeding Journal, 13(1), 1–14.
9.
Al-MadaniM.VydelingumV.LawrenceJ. (2010). Saudi mothers’ expected intentions and attitudes toward breast-feeding. ICAN: Infant, Child, & Adolescent Nutrition, 2(3), 187–198. https://doi.org/10.1177/1941406410369699
10.
AlmohannaA. A.WinK. T.MeedyaS. (2020). Effectiveness of internet-based electronic technology interventions on breastfeeding outcomes: Systematic review. Journal of Medical Internet Research, 22(5), Article e17361. https://doi.org/10.2196/17361
11.
Al-MutairiN. F.Al-OmranY. A.ParameaswariP. J. (2017). Breastfeeding practice and knowledge among women attending primary health-care centers in Riyadh 2016. Journal of Family Medicine and Primary Care, 6(2), 392–398. https://doi.org/10.4103/jfmpc.jfmpc_243_17
12.
AlnasserY.AlmasoudN.AljohniD.AlmisnedR.AlsuwaineB.AlohaliR.. . .AlhezayenR. (2018). Impact of attitude and knowledge on intention to breastfeed: Can mHealth based education influence decision to breastfeed exclusively?Annals of Medicine and Surgery, 35, 6–12. https://doi.org/10.1016/j.amsu.2018.09.007
13.
AlotaibiA. J.AldhahiM. F.AlmosallmA. M.AlaneziA. D.AlotaibiB. M.AlmotairiI. M.AlghamdiT. S. (2019). Knowledge, attitude and practices of mothers regarding to breast feeding in Sudair and Zulfy areas, Saudi Arabia, 2015. Indo American Journal of Pharmaceutical Sciences, 6(2), 2965–2981. https://doi.org/10.5281/zenodo.2556819
14.
AlsulaimaniN. (2019). Exclusive breastfeeding among Saudi mothers: Exposing the substantial gap between knowledge and practice. Journal of Family Medicine and Primary Care, 8(9), 2803–2809. https://doi.org/10.4103/jfmpc.jfmpc_533_19
15.
AlwelaieY. A.AlsuhaibaniE. A.Al-HarthyA. M.RadwanR. H.Al-MohammadyR. G.AlmutairiA. M. (2010). Breastfeeding knowledge and attitude among Saudi women in Central Saudi Arabia. Saudi Medical Journal, 31(2), 193–198.
16.
AlzahebR. A. (2017). A review of the factors associated with the timely initiation of breastfeeding and exclusive breastfeeding in the middle east. Clinical Medicine Insights: Pediatrics, 11, Article 1179556517748912. https://doi.org/10.1177/1179556517748912
17.
AnatolitouF. (2012). Human milk benefits and breastfeeding. Journal of Pediatric and Neonatal Individualized Medicine, 1(1), 11–18.
18.
Australian Health Ministers’ Conference. (2009). Australian national breastfeeding strategy 2010–2015. Australian Government Department of Health and Ageing.
19.
AyedA. A. N. (2014). Knowledge, attitude and practice regarding exclusive breastfeeding among mothers attending primary health care centers in Abha city. International Journal of Medical Science and Public Health, 3(11), 1355–1363.
20.
AzzehF. S.AlazzehA. Y.HijaziH. H.WazzanH. Y.JawharjiM. T.JazarA. S.. . .ObeidatA. A. (2018). Factors associated with not breastfeeding and delaying the early initiation of breastfeeding in Mecca region, Saudi Arabia. Children (Basel), 5(1), 8. https://doi.org/10.3390/children5010008
21.
BalogunO. O.DagvadorjA.AnigoK. M.OtaE.SasakiS. (2015). Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: A quantitative and qualitative systematic review. Maternal Child Nutrition, 11(4), 433–451.
22.
BarkerT. H.MigliavacaC. B.SteinC.ColpaniV.FalavignaM.AromatarisE.MunnZ. (2021). Conducting proportional meta-analysis in different types of systematic reviews: A guide for synthesisers of evidence. BMC Medical Research Methodology, 21(1), 1–189. https://doi.org/10.1186/s12874-021-01381-z
23.
BonuckK.StuebeA.BarnettJ.LabbokM. H.FletcherJ.BernsteinP. S. (2014). Effect of primary care intervention on breastfeeding duration and intensity. American Journal of Public Health, 104(S1), S119–S127.
24.
BosiA. T. B.EriksenK. G.SobkoT.WijnhovenT. M.BredaJ. (2016). Breastfeeding practices and policies in WHO European region member states. Public Health Nutrition, 19(4), 753–764.
25.
BothD. (2018). The international code of marketing of breastmilk substitutes: History, content, and significance. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 61(8), 1008–1011. https://doi.org/10.1007/s00103-018-2765-4
26.
BurgioM. A.LaganaA. S.SiciliaA.PortaR. P.PorporaM. G.FrangežH. B.. . .TrioloO. (2016). Breastfeeding education: Where are we going? A systematic review article. Iranian Journal of Public Health, 45(8), 970.
27.
CohenS. S.AlexanderD. D.KrebsN. F.YoungB. E.CabanaM. D.ErdmannP.. . .TuriniM. (2018). Factors associated with breastfeeding initiation and continuation: A meta-analysis. The Journal of Pediatrics, 203, 190–196.e121.
28.
DasA.MalaG. S.SinghR. S.MajumdarA.ChatterjeeR.ChaudhuriI.MahapatraT. (2019). Prelacteal feeding practice and maintenance of exclusive breast feeding in Bihar, India–identifying key demographic sections for childhood nutrition interventions: A cross-sectional study. Gates Open Research, 3, 1. https://doi.org/10.12688/gatesopenres.12862.3
29.
DukuzumuremyiJ. P. C.AcheampongK.AbesigJ.LuoJ. (2020). Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: A systematic review. International Breastfeeding Journal, 15(1), 1–17.
30.
ElburA. I.YousifM.AlbarraqA. A.AbdallahM. A. A. (2014). Attitudes of Saudi mothers towards breastfeeding: A cross–sectional survey in Taif Region, Saudi Arabia. International Journal of Child Health and Nutrition, 3(2), 79.
31.
El-HoufeyA. A.SaadK.AbbasA. M.MahmoudS. R.WadaniM. (2017). Factors that influence exclusive breastfeeding: A literature review. International Journal of Nursing Didactics, 7, 24–31.
32.
El MouzanM. I.Al OmarA. A.Al SalloumA. A.Al HerbishA. S.QurachiM. M. (2009). Trends in infant nutrition in Saudi Arabia: Compliance with WHO recommendations. Annals of Saudi Medicine, 29(1), 20–23.
GuxensM.MendezM. A.Moltó-PuigmartíC.JulvezJ.García-EstebanR.FornsJ.. . .SunyerJ. (2011). Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development. Pediatrics, 128(4), e880–e889.
38.
HanafiM. I.ShalabyS. A. H.FalatahN.El-AmmariH. (2014). Impact of health education on knowledge of, attitude to and practice of breastfeeding among women attending primary health care centres in Almadinah Almunawwarah, Kingdom of Saudi Arabia: Controlled pre-post study. Journal of Taibah University Medical Sciences, 9(3), 187–193. https://doi.org/10.1016/j.jtumed.2013.11.011
39.
HassanzadehR.Abbas-AlizadehF.MeedyaS.Mohammad-Alizadeh-CharandabiS.MirghafourvandM. (2019). Assessment of childbirth preparation classes: a parallel convergent mixed study. Reproductive Health, 16(1), 160–160. https://doi.org/10.1186/s12978-019-0826-2
40.
HegaziM. A.AllebdiM.AlmohammadiM.AlnafieA.Al-HazmiL.AlyoubiS. (2019). Factors associated with exclusive breastfeeding in relation to knowledge, attitude and practice of breastfeeding mothers in Rabigh community, Western Saudi Arabia. World Journal of Pediatrics, 15(6), 601–609. https://doi.org/10.1007/s12519-019-00275-x
41.
IchsanB.ProbandariA. N.PamungkasariE. P.SalimoH. (2020). Barriers and support to exclusive breastfeeding in Sukoharjo district, Central Java province, Indonesia: A qualitative study. Journal of Health Research, 35(6), 482–492.
42.
KelishadiR.FarajianS. (2014). The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence. Advanced Biomedical Research, 3(1), 3. https://doi.org/10.4103/2277-9175.124629
43.
LindsayA. C.LeQ.GreaneyM. L. (2018). Infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers: An integrative review of the literature. International Journal of Environmental Research and Public Health, 15(1), 21.
44.
LuoJ.PrinceD. C. J.MungaiK. F.JamesN. (2021). Knowledge, attitude, and practice of exclusive breastfeeding among mothers attending Masaka District Hospital Kigali/Rwanda: A cross-section study. Research Square. https://doi.org/10.21203/rs.3.rs-152011/v1
45.
LuptonS. J. B.ChiuC. L. P.LujicS. M.HennessyA. M. P.LindJ. M. P. (2013). Association between parity and breastfeeding with maternal high blood pressure. American Journal of Obstetrics and Gynecology, 208(6), 454.e1–454.e7. https://doi.org/10.1016/j.ajog.2013.02.014
46.
MaríasY.GlasauerP. (2014). Guidelines for assessing nutrition-related knowledge, attitudes and practices. Food and Agriculture Organization of the United Nations (FAO).
47.
MeedyaS.FahyK.KableA. (2010). Factors that positively influence breastfeeding duration to 6 months: A literature review. Women and Birth: Journal of the Australian College of Midwives, 23(4), 135–145.
48.
MeedyaS.FahyK.YoxallJ.ParrattJ. (2014). Increasing breastfeeding rates to six months among nulliparous women: A quasi-experimental study. Midwifery, 30(3), e137–e144. https://doi.org/10.1016/j.midw.2013.12.010
49.
MeedyaS.FernandezR.FahyK. (2017). Effect of educational and support interventions on long-term breastfeeding rates in primiparous women: A systematic review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports, 15(9), 2307–2332. https://doi.org/10.11124/JBISRIR-2016-002955
50.
MeedyaS.SheikhM. K.WinK. T.HalcombE. (2019). Evaluation of breastfeeding mobile health applications based on the persuasive system design model. In Persuasive technology: Development of persuasive and behavior change support systems (pp. 189–201). Springer International Publishing. https://doi.org/10.1007/978-3-030-17287-9_16
51.
MeedyaS.WinK.YeatmanH.FahyK.WaltonK.BurgessL.. . .HalcombE. (2021). Developing and testing a mobile application for breastfeeding support: The Milky Way application. Women and Birth: Journal of the Australian College of Midwives, 34(2), e196–e203. https://doi.org/10.1016/j.wombi.2020.02.006
52.
MejdoubiJ.van den HeijkantS. C.van LeerdamF. J.CroneM.CrijnenA.HiraSingR. A. (2014). Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: A randomized controlled trial. Midwifery, 30(6), 688–695.
53.
MogC. (2021). Knowledge, attitude and practices regarding breast feeding among primiparous and multiparous mothers in an urban slum, west Tripura: A comparative cross sectional study. Biomedical Pharmacology Journal, 14(1), 403–409.
54.
MoolaS.MunnZ.TufanaruC.AromatarisE.SearsK.SfetcuR.. . .LisyK. (2020). Chapter 7: Systematic reviews of etiology and risk. Joanna Briggs Institute reviewer's manual. The Joanna Briggs Institute. https://synthesismanual.jbi.global
55.
MosherC.SarkarA.HashemA. A.HamadahR. E.AlhoulanA.AlMakadmaY. A.. . .SenokA. (2016). Self-reported breast feeding practices and the baby friendly hospital initiative in Riyadh, Saudi Arabia: Prospective cohort study. BMJ Open, 6(12), Article e012890. https://doi.org/10.1136/bmjopen-2016-012890
56.
MunnZ.MoolaS.LisyK.RiitanoD.TufanaruC. (2020). Systematic reviews of prevalence and incidence. Joanna Briggs Institute reviewer’s manual. The Joanna Briggs Institute.
57.
MunnZ.PetersM. D. J.SternC.TufanaruC.McArthurA.AromatarisE. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143–143. https://doi.org/10.1186/s12874-018-0611-x
58.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.. . .MoherD. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Online), 372, n71. https://doi.org/10.1136/bmj.n71
59.
RadwanH.SapsfordR. (2016). Maternal perceptions and views about breastfeeding practices among Emirati mothers. Food and Nutrition Bulletin, 37(1), 73–84. https://doi.org/10.1177/0379572115624289
60.
RaheelH.TharkarS. (2018). Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia. Sudanese Journal of Paediatrics, 18(1), 28–38. https://doi.org/10.24911/SJP.2018.1.5
61.
ReinsmaK.BolimaN.FontehF.OkwenP.YotaD.MontgomeryS. (2012). Incorporating cultural beliefs in promoting exclusive breastfeeding. African Journal of Midwifery Women’s Health, 6(2), 65–70.
62.
TadeleN.HabtaF.AkmelD.DegesE. (2016). Knowledge, attitude and practice towards exclusive breastfeeding among lactating mothers in Mizan Aman town, Southwestern Ethiopia: Descriptive cross-sectional study. International Breastfeeding Journal, 11(1), 3. https://doi.org/10.1186/s13006-016-0062-0
63.
TudehopeD. I. A. M. M. F. (2013). Human milk and the nutritional needs of preterm infants. The Journal of Pediatrics, 162(3), S17–S25. https://doi.org/10.1016/j.jpeds.2012.11.049
64.
TufanaruC.MunnZ.AromatarisE.CampbellJ.HoppL. (2020). Chapter 3: Systematic reviews of effectiveness. Joanna Briggs Institute reviewer's manual. The Joanna Briggs Institute.
65.
VictoraC. G.BahlR.BarrosA. J.FrançaG. V.HortonS.KrasevecJ.. . .RollinsN. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490.
66.
VijayalakshmiP.SusheelaT.MythiliD. (2015). Knowledge, attitudes, and breast feeding practices of postnatal mothers: A cross sectional survey. International Journal of Health Sciences, 9(4), 364.
67.
WalshS. M.CordesL.McCrearyL.NorrK. F. (2019). Effects of early initiation of breastfeeding on exclusive breastfeeding practices of mothers in Rural Haiti. Journal of Pediatric Health Care, 33(5), 561–567. https://doi.org/10.1016/j.pedhc.2019.02.010
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