Six-month exclusive breastfeeding and the impact of COVID-19 on breastfeeding practice in Hong Kong: A mixed-methods study

Abstract Background The World Health Organization recommends exclusive breastfeeding (EBF) for an infant’s first six months. Therefore, various policies were implemented to support breastfeeding in Hong Kong in the past decade. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. This study aimed to identify the associated factors of six-month EBF, and to evaluate the impact of COVID-19 on breastfeeding practice. Methods This study was conducted using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 years. Exploratory factor analysis with principal components analysis was used to identify the factors representing breastfeeding support from family and friends. Stepwise binary logistic regression analyses with forward (conditional) selection were conducted to examine factors associated with six-month EBF both in general and during the pandemic period. A thematic analysis was conducted using both deductive and inductive approaches. Results The study included 793 participants. Giving birth in a public hospital (AOR 2.015, 95% CI 1.440 to 2.821, p < 0.001) and breastfeeding support from family and friends (AOR 1.309, 95% CI 1.102 to 1.555, p = 0.002) were significantly associated with six-month EBF even during COVID-19. Our qualitative results indicated a high prevalence of breastfeeding problems in both public and private maternity wards, suggesting that neonatal support for breastfeeding in Hong Kong were generally insufficient and ineffective. Conclusions Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month EBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month EBF. Further studies should investigate the impact of hospital practice and the COVID-19 pandemic on breastfeeding behaviours.