A Study to Identify the Most Common Reasons to Wean among Breastfeeding Mothers in UAE.

BACKGROUND: Despite the great benefits of breastfeeding for the mother and the child, many mothers face a lot of challenges and issues during lactation, which might lead to early weaning. AIM: The aim of this study was to assess the factors that can lead to early weaning and to identify the most common reasons to early weaning among breastfeeding mothers.
MATERIALS AND METHODS: This was a cross-sectional, questionnaire-based survey study. Eight hundred and fifty questionnaires were distributed to lactating mothers, but only 820 were returned making the response rate of 96.5%. Breastfeeding mothers in Ajman and Sharjah, United Arab Emirates (UAE) participated in the study. STATISTICAL ANALYSIS: The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics were used to summarize the data concerning the demographic characteristics. Categorical variables (such as nationality and educational level) were described by using frequency, percentages, bar chart, and pie chart.
RESULTS: The results revealed that 29% of respondents stopped breastfeeding for some reason. The main reasons stated by the participants were low milk supply (25.8%) and pain, congestion, and abscess (19.22%) followed by new pregnancy (17.5%), which were the most identified reasons for early discontinuation of breastfeeding.
CONCLUSION: Our study indicated that the misconception of weaning because of a new pregnancy has declined in the UAE compared to a study conducted 3 years ago. A positive improvement was also observed in terms of weaning due to personal desire compared to previous years among mothers as they became more aware of the benefits of breastfeeding. Copyright:

INTRODUCTION

The health-care providers’ abilities should be improved to effectively promote widespread breastfeeding as they can be a key component in the promotion and support of breastfeeding.[1] However, concern about maternal medications is considered as one of the main reasons to recommend lactating mothers to wean due to various health risk factors associated with the breastfeeding during the medication period. Most of the evidence shows and supports the health benefits of mother’s milk and breastfeeding in addition to the negative side effects and risk factors that may result from early weaning.[2] Despite the great benefits of breastfeeding for the mother and the child, many mothers face a lot of challenges and issues during lactation, which might lead to early weaning. Therefore, the current study aims to assess the factors and the reasons that can lead to early weaning among breastfeeding mothers in order to take steps in overcoming this issue.

MATERIALS AND METHODS

This cross-sectional, questionnaire-based survey study was conducted from November 2015 to April 2016, and it was carried out in the United Arab Emirates (UAE), in which 850 questionnaires were distributed to lactating mothers but only 820 were returned, making the response rate of 96.5%. Breastfeeding mothers from two emirates, Ajman and Sharjah, were enrolled in the study. Participants were from different nationalities and different age-groups, regardless of their income or educational level. A self-administered bilingual questionnaire was used as a tool to collect data from the participants. It was distributed to mothers matching with the specified inclusion criteria in female community gatherings and assemblies as well as waiting rooms in some primary health-care centers.

Inclusion and exclusion criteria

Lactating mothers willing to participate and who understand English or Arabic from any age-group, and with or without diseases were enrolled. The breastfeeding mother also must be a resident of Ajman or Sharjah only. Pregnancy, language barrier, and lactating mothers from other emirates were not enrolled in this study.

Pretesting and validation of the questionnaire

Following a review of relevant literature, an eight-question questionnaire was created.[34] This questionnaire then underwent testing by experts in the subject regarding relevance, design, and content. A trio of lecturers in medical and clinical pharmacy from Ajman University scrutinized the questionnaire for appropriateness and relevance of content, and they validated the instrument. Their feedback led to some small modifications. The validity of the instrument was further assessed in a pilot study in which 50 mothers participated. Those who were part of this pilot study were not included in the main research. The Cronbach α value was calculated for the assessment of how reliable the instrument was; the questionnaire showed a Cronbach alpha value of 0.71, which indicates that its level of internal consistency was adequate.

Ethical considerations

Before the administration of the questionnaires, the intentions of the survey were explained and the participants were encouraged to participate without any undue pressure. Participation was voluntary, and all respondents joined in with no incentives and signed the informed consents to take part of this study. The research assured that anonymity would be maintained and ethical principles would be followed. The participant’s personal information would be kept in a closed closet for a certain period with full privacy.

Statistical analysis

The results were analyzed using the Product and Service Solutions, initially known as the Statistical Package for the Social Sciences (SPSS) software, version 20.0. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics were used to summarize the data concerning the demographic characteristics and breastfeeding. Categorical variables (such as age-groups, nationality, and educational level) were described by using frequency, percentages, and pie chart. A simple binary logistic regression was used to investigate the association between wean or discontinue breastfeeding and other significant risk factors.

RESULTS AND DISCUSSION

The American Academy of Pediatrics recommends that exclusive and continuous breastfeeding during the first 6 months has many benefits to the child.[5] Several studies revealed that children who are not breastfed for at least 6 months are more prone for several infections as well as to become overweight during childhood.[67]

Different factors associated with the discontinuation of breastfeeding were identified in previous studies, including psychological factors, illnesses, and others.[8]

The majority of participants were young and educated with a high educational level and a medium family income [Figure 1]. Most of the participants were Arabs [Figure 2] and most of them were nonsmokers and not working [Table 1].

Figure 1

Demographic distribution of respondents based on nationality. The results show the demographic distribution of respondents based on nationality and the majority of respondents were Arabs (43%) followed by locals (32%) and Asians and other nationalities (25%)

Figure 2

Demographic distribution of respondents based on family income. The results show that the majority of respondents (87.40%) had a medium family income

Table 1

Demographic data

Variable (n = 820)	Frequency	%
Family income:
Low	34	4.2%
Medium	717	87.4%
High	69	8.4%
Do you work (employee):
Yes	309	37.7%
No	511	62.3%
Age-group (years):
≤25	279	34%
26–30	246	30%
31–35	133	16.2%
≥36	162	19.8%
Do you smoke:
Yes	15	1.8%
No	805	98.2%
Educational level:
Housewife	188	22.9%
High school	349	42.6%
University	283	34.5%

Regarding the common reasons to wean or stop breastfeeding among lactating mothers, several studies showed that the most commonly reported reasons for the discontinuation were insufficient milk, sore nipples, and difficulty in lactation as well as other reasons.[9]

Our study results revealed that of 820 surveyed mothers, 35% (n = 286) stopped breastfeeding for different reasons [Table 2].

Table 2

The common reasons for early discontinuation of breastfeeding

	Frequency	%
Wean/discontinue breastfeeding
Yes	286	35%
No	534	65%
Reasons of discontinuation
Low milk	74	25.8%
Pain, congestion, and abscess	55	19.22%
Pregnancy	50	17.5%
Working mother	28	9.8%
Personal decision	23	8.04%
Taking medications	22	7.7%
Doctor/pharmacist advice	17	6%
Psychological/family issues	13	4.54%
Artificial milk advertisements (media)	4	1.4%

The study revealed that 29% of respondents weaned/stopped breastfeeding. The main reasons stated by the mothers were the following: low milk supply (31.1%) followed by pain, congestion, and abscess (23.1%) and pregnancy (21%)

The first and the most common reason stated by our study participants was low milk supply (25.8%), then pain, congestion, and abscess (19.22%), followed by pregnancy (17.5%), which were the most identified reasons to stop or discontinue breastfeeding.

Other reasons were identified as well, such as work (9.8%), personal decision (8.04%), taking medications (7.7%), health-care provider’s advice (6%), psychological/family issues (4.54%), and artificial milk advertisements (1.4%) [Table 2].

The same pattern of results was observed in a recent study carried out in 2015 on the practices of breastfeeding among Arab mothers living in the United States, where the most frequent reason for the discontinuation of breastfeeding was breast milk insufficiency (36.8%), which was in accordance to our study results.[10]

Similar results were observed as well in a study held in Mauritius in 2013, which revealed that 33.9% participants who used infant formula highlighted milk insufficiency as being the major reason to bottle-feed and discontinue lactation.[11]

Our study findings were parallel to a study held in Kuwait in 1989, evaluating infant feeding patterns and weaning practices, which revealed that the first reason for weaning was insufficient milk (30.7%), which was similar to our study result (25.8%).[12]

Similar results were observed in another study held in Iran (in 1993) in which the reasons for early weaning among mothers in Tehran were studied, and 39% of those who had completely stopped breastfeeding blamed milk insufficiency.[4]

The psychological issues including depression represented 4.54%, and this could be related to several societal factors as well as other factors such as postnatal depression and other indirect possible reasons such as vitamin D deficiency, as United Arab Emirates is known for the high deficiency level of this vitamin among its population due to several factors. A recent study held in UAE in which 75.61% of participants were women showed that 27.2% of the participants had depression, and many studies found that vitamin D deficiency was prevalent among breastfeeding women, and a multiple binary logistic regression analysis showed that breastfeeding women had a fourfold higher odds ratio (OR) for vitamin D deficiency than non-breastfeeding women.[1314]

A deficiency of this vitamin has been acknowledged in the literature and it has been noted to have an effect on the mental health status, especially depression, as depression was observed in some studies to be significantly higher in individuals with vitamin D deficiency compared to adults who had a normal level.[1315]

However, in other studies, breast milk insufficiency was not the first reason to wean as it was reported in a study held in UAE in 2013 on the patterns and determinants of breastfeeding and complementary feeding practices of Emirati mothers in the UAE that the main stated reason for stopping breastfeeding by the mothers was mainly new pregnancy (32.9%) and breast milk insufficiency (24.4%).[16]

It was observed that our study result of 17.5% due to new pregnancy was lower than the result interpreted in the study held 3 years ago in UAE, which indicated that this misconception has declined and the mothers are more aware of this matter, and this could be explained due to an improvement, which was observed in terms of knowledge among breastfeeding mothers as well as health-care providers’ role, which was also positively improved, in a recent study held in 2017 in UAE compared to that held in previous years.[17]

Other results were observed in other studies as well, such as a study held in Sudan in 2008, which revealed that the main reason that led the mothers to wean their infants was pregnancy (54.1%), and interestingly only 5.5% stopped breastfeeding due to insufficient milk and work.[18]

Similarly, in another study held in Pakistan in 2002, 34.5% of women stated pregnancy as the reason for discontinuation.

The second and third most common reasons were “milk dried up” and “child refusal,” for 19.1% and 12.1% of women, respectively.[19] This could be due to several misconceptions toward breastfeeding, according to a study carried out in Al Hassa, Saudi Arabia assessing breastfeeding knowledge. Several misconceptions toward breastfeeding were found as stated by the mothers surveyed, that is, over 60.0% believed that breastfeeding should be stopped once pregnancy occurs.[20] Medical advice had been taken by 2.7% of the mothers to stop lactating for reasons such as a medical operation or unsuitability of milk compared to 6% in our study.

Our study results also revealed that only 8.04% of respondents weaned because of their own desire. However, our result of 8.04% was relatively low compared to a study held in Al-Ain, UAE, in 1999, which revealed that 24.1% of infants were weaned from the breast because of their mother’s desire to do so, which would reflect the positive improvement and awareness after a couple of years among mothers regarding the benefits of breastfeeding.[21]

In this study, significantly increased risk of wean or discontinue breastfeeding was observed in the participants aged 26–35 years (OR, 1.13; 95% confidence interval [CI]: 1.03–1.24), participants aged ≥36 years (OR, 1.15; 95% CI: 1.05–1.26), UAE national (OR, 1.37; 95% CI: 1.26–1.48), housewife participants (OR, 1.22; 95% CI: 1.06–1.41), high school education (OR, 1.15; 95% CI: 1.02–1.30), employed participants (OR, 1.30; 95% CI: 1.13–1.50), medium income (OR, 1.26; 95% CI: 1.15–1.38), and low income (OR, 1.37; 95% CI: 1.25–1.50) [Table 3].

Table 3

Logistic regression analysis for wean/discontinue breastfeeding

Demographic factors	Wean/discontinue breastfeeding
	OR	95% CI		P value
Age (years) (Ref.: ≤25)
26–35	1.13	1.03	1.24	<0.01
≥36	1.15	1.05	1.26	<0.01
Smoking status (Ref.: Yes)
No	0.95	0.86	1.04	0.068
Nationality (Ref.: Non-UAE national)
UAE national	1.37	1.26	1.48	<0.001
Educational (Ref.: university)
Housewife	1.22	1.06	1.41	<0.01
High school	1.15	1.02	1.30	<0.05
Employment status (Ref.: Unemployed)
Employed	1.30	1.13	1.50	<0.001
Family income (Ref.: High)
Medium	1.26	1.15	1.38	<0.001
Low	1.37	1.25	1.50	<0.001

This table displays the results of logistic regression model applied to each demographic characteristics. It shows the results for wean or discontinue breastfeeding. The odds ratio in this table shows the magnitude of the association and their corresponding P values indicate whether the association is statistically significant or not by using the cutoff values of 0.05 as mentioned in the Materials and Methods section

CONCLUSION

Our study indicated that the misconception of weaning due to a new pregnancy has declined in the UAE compared to 3 years ago. A positive improvement was also observed among lactating mothers in terms of weaning due to their personal desire as it decreased compared to previous years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.