A multicentre survey to assess exclusive breastfeeding practices in Bhutan

Background: Exclusive breastfeeding (EBF) can reduce illnesses and death in infants. Globally, there has been a slow uptake in EBF despite 30 years of evidence on the benefits of breastfeeding for both infants and mothers. The Royal Government of Bhutan has committed to rising the EBF rate, which was 51.4 % in 2015. Therefore, we seek to investigate the current situation of EBF in Bhutan and identify the underlying factors that influence breastfeeding practices. Methods: This cross-sectional survey was conducted on mothers with children aged 0-6 months, who visited one of the participating referral hospitals. Participants were divided into the EBF group if they fed their infant only breast milk, or the non-EBF group if their infant was fed other liquids or solids in addition to breast milk. The nutrition-related knowledge, attitude, and practice questionnaire; the Iowa infant feeding attitude scale; and the Breastfeeding Self-Efficacy Scale - Short Form were used to assess breastfeeding practices. Results: Of the 483 mothers included, 324 (67 %) exclusively breastfed their babies. The EBF and non-EBF groups displayed significant differences for referral hospitals (p = 0.002) and for the duration of maternity leave (p = 0.002). Although knowledge of EBF was significantly lower in the EBF group (p = 0.040), self-efficacy was significantly higher (p = 0.028). Conclusion: This study revealed an increase in the EBF rate compared to the 2015 report. Further propagation and strengthening of EBF practices might be accomplished through improvements in the self-efficacy of the mother.