Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda

ABSTRACT

Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.

KEYWORDS:

• Caregiver resources
• exclusive breastfeeding
• HIV
• self-efficacy
• social support

Acknowledgments

This paper is dedicated to the memory of Dr. Barnabas Natamba. We are grateful to the study team, including Cord Ojok, Harriet Achola, and Abwola Geoffrey, as well as the staff and administration at Gulu Regional Referral Hospital who provided space for the study within the hospital building, and the nurses at the hospital who assisted with identification and recruitment of participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

EMW was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K99/R00 HD086304) and the National Institute of Diabetes and Digestive and Kidney Diseases (T32DK091227 and T32DK007559). SLM received support from NICHD of the National Institutes of Health under award number P2C HD050924. SLY was supported by the National Institutes of Health (K01 MH098902). Data collection was supported by USAID under Coop. Agreement AID-OAA-L-10-00006 and Cornell University-Weill Medical College Intercampus Seed Funds.