Maternal prenatal attitudes and postnatal breast-feeding behaviours in rural Bangladesh

Objective: To assess the relationships between maternal breast-feeding intention, attitudes, self-efficacy and knowledge at 7 months' gestation with exclusive or full breast-feeding at 3 months postpartum. Design: Prospective cohort study with structured home interviews during pregnancy and 3 months after delivery. Setting: Two rural sub-districts of Kishoreganj district, Bangladesh. Subjects: Mother-infant dyads. Results: Over 80 % of 2178 pregnant women intended to exclusively breast-feed (EBF). Maternal positive attitudes, self-efficacy and knowledge about breast-feeding were positively associated with EBF intention (all P < 0.05). All mothers except one reported initiating breast-feeding and 99.6 % of children were still breast-fed at 3 months. According to 24 h dietary recalls, we categorized 985 (45.2 %) infants as EBF at 3 months (47.8 % among mothers with EBF intention; 31.7 % among mothers with no EBF intention; P < 0.05) and 551 (25.3 %) infants as predominantly breast-fed at 3 months (24.2 % among mothers with EBF intention; 30.8 % among mothers with no EBF intention; P < 0.05). Prenatal EBF intention was associated with EBF (OR = 1.48, 95 % CI 1.14, 1.91) and with full breast-feeding (OR = 1.34, 95 % CI 1.04, 1.72) at age 3 months. EBF at age 3 months was not associated with maternal breast-feeding knowledge, attitudes or self-efficacy. Conclusions: Despite widespread expressed maternal EBF intention and universal breast-feeding initiation, prevalence of both exclusive and full breast-feeding at 3 months remains lower than WHO recommendations. EBF intention predicts breast-feeding behaviours, suggesting the importance of prenatal counselling to improve infant feeding behaviours.