Facilitators and Barriers of Exclusive Breastfeeding Up to Six Months in Epworth District, Harare Metropolitan Province, 2025

Abstract

Breastfeeding is the most cost-effective way for reducing childhood morbidity and mortality. The World Health Organization recommends that breastfeeding should be initiated within the first hour after birth and that infants should exclusively breastfeed for the first 6 months of life. Breastfeeding is free, accessible, sustainable and safe and is within reach of many rural women. The broad objective of this study was to determine the facilitators and barriers of exclusive breastfeeding up to 6 months in Epworth District, Harare Metropolitan Province. A total of 109 participants who met the inclusion criteria participated in the study. A cross-sectional analytical design was employed to assess the prevalence of exclusive breastfeeding and identify its associated barriers and facilitators. Participants were recruited from the well-baby child health services clinic at Epworth Polyclinic. Descriptive statistics were used to summarize the characteristics of the study population. Categorical variables were presented as frequencies and percentages. Continuous variables were summarized using medians and interquartile ranges. Crude odds ratios (ORs) were calculated using univariate and bivariate logistic regression to estimate the strength of association between individual predictors and exclusive breastfeeding. Multivariable logistic regression was performed to adjust for potential confounders and identify independent predictors of exclusive breastfeeding. Adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p-values were reported. Maternal belief in the nutritional adequacy of breastmilk was a strong independent facilitator of exclusive breast-feeding. Mothers who held this belief had significantly higher Prevalence Odds ratio (POR) of practicing exclusive breast-feeding and were 34.8 times more likely to practice exclusive breastfeeding than those who did not (POR = 34.8, 95% CI: 7.6–159.5, p < 0.001). Previous breastfeeding experience also facilitated exclusive breast-feeding, with mothers who had breastfed before showing nearly threefold higher odds (POR = 2.9, 5% CI: 1.3–6.4, p = 0.007). Early initiation of breastfeeding within the first hour of birth was associated with increased odds of exclusive breast-feeding (POR = 3.0, 95% CI: 1.1–8.1, p = 0.067). Skilled birth attendance showed a positive trend toward exclusive breast-feeding (POR = 2.9, 95% CI: 1.0–8.3, p = 0.130). Longer postdelivery maternal admission (≥24 hours) was associated with higher odds of exclusive breast-feeding (POR = 2.8, 95% CI: 1.2–6.6, p = 0.045). Infants admitted to a health facility within the first six months were significantly less likely to be exclusively breastfed (POR = 0.17, 95% CI: 0.04–0.74, p = 0.012). Babies born before arrival at a health facility had lower odds of exclusive breast-feeding (POR = 0.34, 95% CI: 0.130.89, p = 0.025). Lower Apgar scores (0–6 or missing) were associated with reduced odds of exclusive breast-feeding (POR = 2.7 for Apgar 7–10 vs other, 95% CI: 1.26.3, p = 0.028). There is a need to increase dissemination of breast milk adequacy to mothers, health care training and initiation of breastfeeding within the first hour postdelivery.