Factors Associated with Exclusive Breastfeeding at Hospital Discharge among Native-Born, Immigrant, and Refugee Women

Background: Exclusive breastfeeding is recommended through six months as it supports infant growth and development. Yet, many mothers do not exclusively breastfeed in early postpartum. Objectives: To examine factors associated with exclusive breastfeeding at hospital discharge among culturally diverse women. Methods: This cross-sectional study used data of women who gave birth at a major medical center in Israel in 2015-2017. Descriptive statistics and regression analysis were conducted to examine maternal characteristics and associated breastfeeding outcomes by hospital discharge. Results: Among 10,978 women, 17.8% (n=1958) exclusively breastfed, 57.9% (n=6357) partially breastfed, and 24.3% (n=2663) did not breastfeed. Among Israeli-born and former Soviet Union-born Jewish women, breastfeeding intention (odds ratio [OR] 19.59, 95% confidence interval [95%CI] 10.27-37.35 and OR 15.92, 95%CI 5.79-43.80, respectively) and early breastfeeding (OR 2.415, 95%CI 1.91-3.05 and OR 2.04, 95%CI 1.572.64, respectively) were associated with exclusive breastfeeding. The only significant factor associated with exclusive breastfeeding among refugees and Israeli-born Muslim women was early breastfeeding (OR 1.61, 95%CI 1.20-2.16). For Ethiopian-born Jewish women, not married (OR 0.330, 95%CI 0.114-0.955) and cesarean delivery (OR 0.481, 95%CI 0.232-0.998) were negatively associated with exclusive breastfeeding. Conclusions: Despite having access to the same hospital-based breastfeeding support, there were differences among ethno-culturally diverse women in Israel. In this study, we identified maternal characteristics associated with early breastfeeding among women of diverse ethno-cultural backgrounds. Study findings highlight the importance of ethno-cultural considerations in breastfeeding practices and inform health professionals of factors associated with exclusive breastfeeding in early postpartum.