Cessation of exclusive breastfeeding; Australian cross-sectional survey

Exclusive breastfeeding (breast milk only) is rare in many settings. This is despite significant health benefits associated with sustained exclusive breastfeeding and the global recommendation of extended exclusive breastfeeding to ‘about’ six months(Kramer & Kakuma, 2012; World Health Organization/UNICEF, 2012).

Breastfeeding patterns are not distributed equally across populations instead they are socially patterned and complex(Bhutta & Salam, 2012). How the factors known to affect breastfeeding might impact on the early interruption of exclusive breastfeeding (through the feeding of other fluids or foods) is unclear because of knowledge gaps.

To address this we estimated the prevalence and cumulative risk of key risk factors associated with cessation of exclusive breastfeeding within the first six months using a national representative sample of 22,202 mother and infant pairs derived from the 2010 Australian Institute of Health and Welfare cross sectional survey, the Australian Infant Feeding Survey(Australian Institute of Health and Welfare (AIHW). 2010). Among those who initiated exclusive breastfeeding at birth, 49% of infants ceased exclusive breastfeeding before they had reached two months of age. In the final Cox proportional hazards multivariate model cessation of exclusive breastfeeding was most strongly associated with partners preferring bottle-feeding (HR 1.85, 95% CI 1.69 - 20.6) or having no preference (HR 1.37, 95% CI 1.33 - 1.42) regular dummy use (HR, 1.35, 95% CI 1.31, 1.39) and maternal obesity (HR 1.29, 95% CI 1.24 - 1.35).

Living within the most disadvantaged areas of Australia (quintile 1) was not strongly associated with cessation (HR 1.08, 95% CI 1.02 - 1.14) compared with least disadvantaged areas.

The prevalence of early cessation of exclusive breastfeeding is alarmingly in high in Australia with 50% of mothers interrupting exclusive breastfeeding within the first two months of an infant’s life. The greatest public health impact is most likely to be achieved when multiple risk factors are modified or prevented.