Breastfeeding determinants at four months after birth: a case-control study in Maluku, Democratic Republic of Congo

Abstract Background Exclusive breastfeeding during the first six months of life yields enormous health outcomes for children, mothers and their families. With only 35% of exclusive breastfeeding (EBF) under six months, women in Kinshasa lag behind national and international goals. The drop in EBF is sharpest between three and four months postnatal. This exploratory study aimed at identifying and understanding the determinants of EBF at four months after birth. Methods This case-control study involved 80 EBF and 320 non-EBF women and applied bivariate and multivariate analysis to determine the association between independent variables and EBF. Results In multivariate analysis, the following maternal predictors were associated with EBF at four months postnatal: being in a union (aOR = 4.55; 95% CI: 1.30–11.27), early initiation of breastfeeding (aOR = 3.15; 95% CI: 1.29–7.70), breastfeeding information, education and counseling during antenatal care, after delivery, and at discharge (aOR = 2.96; 95% CI: 1.35–6.51), having planned for at least five months of EBF (aOR = 16.87; 95% CI: 7.11–40.03), favorable attitude to breastfeeding in public (aOR = 2.45; 95% CI: 1.12–5.37), and the absence of depression (aOR = 2.55; 95% CI: 1.17–5.54). Also significant was being the firstborn child (aOR: 4.53; IC à 95%: 1.20–17.02). Conclusions Policies and interventions aimed at improving the provision of EBF information, education and counseling during antenatal care and after childbirth, supporting mothers in planning for EBF, encouraging early initiation of breastfeeding right after birth, and identifying mental health issues, such as depression, could be beneficial in improving exclusive breastfeeding among mothers in Kinshasa and other provinces and communities lagging behind national and international breastfeeding goals.