Association between Maternal Health Literacy and Exclusive Breastfeeding Practices in Urban and Rural Communities

Abstract

Background: Maternal health literacy could be a factor in understanding breastfeeding advice, feeding challenges and making infant-feeding decisions. The present study aimed to determine the relationship between the exclusive breastfeeding and the health literacy of mothers in urban and rural areas.

Methods: A multicentre cross-sectional study was conducted from January 2022 to January 2023 at the Department of Obstetrics and Gynaecology, Unit III, Liaquat University of Medical and Health Sciences, Jamshoro, and the Department of Paediatrics, Khyber Teaching Hospital, Peshawar, Pakistan. One hundred mothers with their infants aged 0-5 months were selected, comprising half from rural and half from urban areas. A culturally adapted, 16-item European Health Literacy Questionnaire was used to assess maternal health literacy. The exclusive breastfeeding (EB) was evaluated using 24 hours dietary recall. Chi square and multivariable binary logistic regression were used for data analysis.

Results: The mean maternal age was 28.4 ± 5.0 years. There was adequate health literacy among 58.0% of participants, which was higher among urban than rural mothers (70.0% versus 46.0%, respectively; p=0.015). Overall, 57.0% of mothers exclusively breastfed (urban mothers 66.0%, rural mothers 48.0%). Mothers with good health literacy were more likely to exclusively breastfeed compared to those with limited health literacy (74.1% versus 33.3%, p<0.001). Good health literacy was an independent predictor of exclusive breastfeeding (aOR 4.76; 95% CI 1.86–12.17; P=0.001). Other significant predictors were breastfeeding counselling and initiation within one hour.

Conclusion: counselling, education, and access to health information were associated with urban–rural difference and maternal health literacy was found to be associated with exclusive breastfeeding.

Keywords: maternal health literacy; exclusive breastfeeding; infant feeding; urban communities; rural communities; breastfeeding counselling