Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates

Figures & data

Table 1 Operational Definitions

Variables	Operational Definitions
Maternal age	Maternal age in years at the time of interview
Maternal education	Maternal higher level of education categorized <Secondary level and ≥Secondary level
Father education	Maternal higher level of education categorized <Secondary level and ≥Secondary level
Nationality	Arab nationality: included all Emirati mothers and other Arab. Non-Arab nationality: included Asian mothers and other nationalities.
Marital status	Married and unmarried
Pre-pregnancy BMI	The weight in kilograms divided by the square of the height in metres (kg/m2) (1). Based on the index, it was subcategorized to normal between 18.50 and 24.99, and abnormal (underweight <18.5, overweight 25–29.9 and obese ≥30)
Income rating	The mother rating the family’s overall financial well-being as excellent, very good, good, fair, and poor
Received breastfeeding advice during pregnancy	Any received information, positive or negative things, about breastfeeding before or after delivery.
Mode of delivery	Vaginal or caesarian
Child gender	Male or female
Child order	1st child order and ≥ 2
Rooming-in	Mother and infant being placed in the same room immediately after leaving the delivery suite, and, in the case of CS, when the mother was able to respond to her infant. Not rooming-in: babies who were not in the same room with mother since the delivery time, or those who required separation out of rooming-in in the middle of the course due to poor condition of babies or due to maternal condition.
Exclusive breastfeeding	The infant being fed only breast milk without any other oral intake, except medications and vitamins, for the first six months of life.
Cessation of breastfeeding	The mother was asked during the interview direct question if the index child “is breastfeeding”, yes or no was indication for stopping exclusive breastfeeding for children below 6 months and continued breastfeeding for others.
Initiation of breastfeeding	Early initiation of breastfeeding: Provision of mother’s breast milk to infants within one hour of birth. Delayed initiation of breastfeeding: when the infant initiated breastfeeding within more than one hour after birth.
Gestational age at delivery	The duration of pregnancy in weeks, any baby delivered before 37 weeks of pregnancy was considered as preterm and ≥37 weeks as full-term baby.
Childbirth weight at delivery	The baby weight in grams immediately after delivery, any baby delivered with weight <2500 grams was considered as LBW; and ≥2500 grams as normal weight.

Table 2 Sociodemographic Characteristics of the Studied Participants in Abu Dhabi, the United Arab Emirates (N=606)

Variables		Total (N=606)	Initiation of Breastfeeding			Cessation of Breastfeeding
			Early (n=389)	Delayed (n=217)	P-value	Yes (n=247)	No (n=359)	P-value
		Mean (SD)	Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)
Maternal age, years		30.9 (5.1)	30.4(5.4)	31.8 (4.5)	0.001	30.9(5.5)	30.9(4.8)	0.993
		N(%)	N(%)	N(%)	P-value	N(%)	N(%)	P-value
Maternal education	<Secondary level	24(4.0)	20(5.1)	4(1.8)	0.051	15(6.1)	9(2.5)	0.027
	≥Secondary level	582(96.0)	369(94.9)	213(98.2)		232(93.9)	350(97.5)
Paternal education	<Secondary level	16(2.6)	14(3.6)	2(0.9)	0.063	11(4.5)	5(1.4)	0.021
	≥Secondary level	590(97.4)	375(96.4)	215(99.1)		236(95.5)	354(98.6)
Nationality	Arab	418(69.0)	295(75.8)	123(56.7)	<0.001	187(75.7)	231(64.3)	0.003
	Non-Arab	188(31.0)	94(24.2)	94(43.3)		60(24.3)	128(35.7)
Marital status	Married	588(97.0)	378(97.2)	210(96.8)	0.782	237(96.0)	351(97.8)	0.195
	Unmarried	18(3.0)	11(2.8)	7(3.2)		10(4)	8(2.2)
Pre-pregnancy BMI	Normal BMI	389(64.2)	246(63.2)	143(65.9)	0.513	145()58.7	244(68.0)	0.019
	Abnormal BMI	217(35.8)	143(36.8)	74(34.1)		102(41.3)	115(32.0)
Income rating	<good	34(5.6)	24(6.2)	10(4.6)	0.423	21(8.5)	13(3.6)	0.010
	≥good	572(94.4)	365(93.8)	207(95.4)		226(91.5)	346(96.4)
Received breastfeeding advice during pregnancy	Yes	537(88.6)	339(87.1)	198(91.2)	0.128	217(87.9)	320(89.1)	0.625
	No	69(11.4)	50(12.9)	19(8.8)		30(12.1)	39(10.9)
Mode of delivery	Vaginal	430(71.0)	312(80.2)	118(54.4)	<0.001	178(72.1)	252(70.2)	0.618
	Caesarean	176(29.0)	77(19.8)	99(45.6)		69(27.9)	107(29.8)
Child gender	Male	297(49.0)	187(48.1)	110(50.7)	0.536	130(52.6)	167(46.5)	0.139
	Female	309(51.0)	202(51.9)	107(49.3)		117(47.4)	192(53.5)
Child order	1^stchild order	206(34.0)	266(68.4)	134(61.8)	0.099	75(30.4)	131(36.5)	0.118
	≥2	400(66.0)	123(31.6)	83(38.2)		172(69.6)	228(63.5)
Rooming-in	Yes	578(95.4)	381(97.9)	197(90.8)	<0.001	233(94.3)	345(96.1)	0.308
	No	28(4.6)	8(2.1)	20(9.2)		14(5.7)	14(3.9)
Exclusive breastfeeding*	Yes	83(13.9)	49(12.8)	34(15.7)	0.315	0(0.0)	83(23.2)	<0.001
	No	516(86.1)	334(87.2)	182(84.3)		242(100)	274(76.8)
Cessation of breastfeeding	Yes	247(40.8)	166(42.7)	81(37.3)	0.199	-	-	-
	No	359(59.2)	223(57.3)	136(62.7)		-	-
Initiation of breastfeeding	Early	389(64.2)	-	-	-	166(67.2)	223(62.1)	0.199
	Delayed	217(35.8)	-	-		81(32.8)	136(37.9)
Gestational age at delivery	Term (≥37 weeks)	566(93.4)	369(94.9)	197(90.8)	0.053	225(91.1)	341(95.0)	0.058
	Preterm (<37 weeks)	40(6.6)	20(5.1)	20(9.2)		22(8.9)	18(5.0)
Childbirth weight at delivery	Normal or large birth weight (≥2500 grams)	560(92.4)	372(95.6)	188(86.6)	<0.001	223(90.3)	337(93.9)	0.101
	Low birth weight (<2500 grams)	46(7.6)	17(4.4)	29(13.4)		24(9.7)	22(6.1)

Note: *Missing data.

Table 3 Multivariable Logistic Regression Analyses of Factors Associated with Delay Initiation of Breastfeeding Among Working Mothers with Children Under the Age of Two Years in Abu Dhabi, the United Arab Emirates

Variables		Delayed Initiation of Breastfeeding
		Crude Odds Ratio (OR)(95% Confidence Interval (CI)	Adjusted OR (95% CI)	P-value
Maternal age, years		1.06(1.02, 1.09)	1.04(1.01, 1.08)	0.022
Nationality	Non-Arab	2.40(1.68, 3.42)	2.24(1.53, 3.27)	<0.001
	Arab(Reference)
Mode of delivery	Caesarean delivery	3.40(2.36, 4.90)	2.70(1.84, 3.96)	<0.001
	Vaginal delivery(Reference)
Rooming-in	No	4.84(2.09, 11.18)	3.85(1.56, 9.51)	0.003
	Yes(Reference)
Child birth weight at delivery	Low birth weight (<2500 grams)	3.38(181, 6.30)	2.47(1.23, 4.94)	0.011
	Normal or large birth weight (≥2500 grams) (reference)

Table 4 Multivariable Logistic Regression Analyses of Factors Associated Cessation of Breastfeeding Among Working Mothers with Children Under the Age of Two Years in Abu Dhabi, the United Arab Emirates

Variables		Cessation of Breastfeeding
		Crude Odds Ratio (OR)(95%Confidence Interval (CI)	Adjusted OR (95% CI)	P-value
Maternal education	≥Secondary level	2.51(1.08, 5.84)	2.11(0.89, 4.98)	0.088
	<Secondary level(reference)
Paternal education	≥Secondary level	3.30(1.13, 9.62)	2.82(0.96, 8.34)	0.060
	<Secondary level(reference)
Nationality	Non-Arab	1.73(1.20, 2.48)	1.59(1.09, 2.31)	0.016
	Arab(Reference)
Pre-pregnancy BMI	Normal BMI	1.49(1.07, 2.09)	1.38(0.98, 1.95)	0.067
	Abnormal BMI (abnormal)
Income rating	≥good	2.47(1.21, 5.04)	2.79(1.36, 5.75)	0.005
	<good (reference)