Abuidhail J, Al-Modallal H, Yousif R, Almresi N. Exclusive breast feeding (EBF) in Jordan: prevalence, duration, practices, and barriers. Midwifery. 2014; 30:(3)331-337

Al Ketbi MI, Al Noman S, Al Ali A, Darwish E, Al Fahim M, Rajah J. Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. Int Breastfeeding J. 2018; 13:(1)

Alnasser Y, Almasoud N, Aljohni D Impact of attitude and knowledge on intention to breastfeed: can mHealth based education influence decision to breastfeed exclusively?. Ann Med Surg. 2018; 35:6-12

Al-Rawashdeh I, Kharboush I, Al-Kubaisy W. Disparities in cesarean section among women in Jordan: analysis of the 2017-2018 Jordan Population and Family Health Survey (JPFHS) data. J Mater-Fetal Neonat Med. 2022; 35:(25)5168-5176

Alshebly M, Sobaih B. Attitudes of Saudi mothers towards breastfeeding. Sudanese J Paediatr. 2016; 16:(1)

Cai X, Wardlaw T, Brown DW. Global trends in exclusive breastfeeding. Int Breastfeeding J. 2012; 7:(1)

Centers for Disease Control and Prevention. Questionnaires: breastfeeding and infant feeding practices. 2021. (accessed 1 March 2023)

Champeny M, Pries AM. Predictors of breast milk substitute feeding among newborns in delivery facilities in urban Cambodia and Nepal. Matern Child Nutr. 2019; 15

Dasoqi KA, Safadi R, Badran E, Basha AS, Jordan S, Ahmad M. Initiation and continuation of breastfeeding among Jordanian first-time mothers: a prospective cohort study. Int J Womens Health. 2018; 10:571-577

Esteves TM, Daumas RP, Oliveira MI, Andrade CA, Leite IC. Factors associated to breastfeeding in the first hour of life: systematic review. Rev Saude Publica. 2014; 48:(4)697-708

Gedefaw G, Goedert MH, Abebe E, Demis A. Effect of cesarean section on initiation of breast feeding: findings from 2016 Ethiopian demographic and health survey. PLoS One. 2020; 15:(12)

Hu L, Ding T, Hu J, Luo B. Promoting breastfeeding in Chinese women undergoing cesarean section based on the health belief model: a randomized controlled trial. Med (Baltimore). 2020; 99:(28)

Islam MA, Mamun A, Hossain MM Prevalence and factors associated with early initiation of breastfeeding among Bangladeshi mothers: a nationwide cross-sectional study. PloS One. 2019; 14:(4)e0215733-e0215733

Kandeel WA, Rabah TM, Zeid DA Determinants of Exclusive breastfeeding in a sample of Egyptian infants. Macedonian J Med Sci. 2018; 6:(10)1818-1823

Khan J, Vesel L, Bahl R, Martines JC. Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity--a systematic review and meta-analysis. Matern Child Health J. 2015; 19:(3)468-479

Khasawneh W, Khasawneh AA. Predictors and barriers to breastfeeding in north of Jordan: could we do better?. Int Breastfeed J. 2017; 12

Khasawneh W, Kheirallah K, Mazin M, Abdulnabi S. Knowledge, attitude, motivation and planning of breastfeeding: a cross-sectional study among Jordanian women. Int Breastfeed J. 2020; 15:(1)

Meek JY, Noble L. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022; 150:(1)

Moberg KU, Ekström-Bergström A, Buckley S Maternal plasma levels of oxytocin during breastfeeding - a systematic review. PLoS One. 2020; 15

Mohd Shukri NH, Wells J, Fewtrell M. Differences in maternal characteristics and their associations with breastfeeding attitudes among primiparous mothers. Midwifery. 2021; 95

Mosher C, Sarkar A, Hashem AA Self-reported breast feeding practices and the baby friendly hospital initiative in Riyadh, Saudi Arabia: prospective cohort study. BMJ Open. 2016; 6:(12)

Naja F, Chatila A, Ayoub JJ Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar. Int Breastfeeding J. 2022; 17:(1)

Namasivayam V, Dehury B, Prakash R Association of prenatal counselling and immediate postnatal support with early initiation of breastfeeding in Uttar Pradesh, India. Int Breastfeed J. 2021; 16:(1)

Raheel H, Tharkar S. Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia. Sudan J Paediatr. 2018; 18:(1)28-38

Roostaee F, Tabatabaei SM, Zaboli M Breast-feeding continuation in South-Eastern of Iran: the associated factors. Med Arch. 2015; 69:(2)98-102

Shobo OG, Umar N, Gana A, Longtoe P, Idogho O, Anyanti J. Factors influencing the early initiation of breast feeding in public primary healthcare facilities in northeast Nigeria: a mixed-method study. BMJ Open. 2020; 10:(4)

Sodeno M, Tappis H, Burnham G, Ververs M. Associations between caesarean births and breastfeeding in the Middle East: a scoping review. East Mediterr Health J. 2021; 27:(9)931-940

Power and sample size determination. (accessed 8 March 2023)

Taha Z, Ali Hassan A, Wikkeling-Scott L. Prevalence and associated factors of caesarean section and its impact on early initiation of breastfeeding in Abu Dhabi. United Arab Emirates. 2019; 11:(11)

Temoirokomalani MD, Singh P, Khan S. Knowledge, attitude and practices of breastfeeding among mothers of children under 6 months of age in Suva, Fiji. Curr Res Nutr Food Sci. 2021; 9:(3)

Increasing commitment to breastfeeding through funding and improved policies and programmes.Geneva: World Health Organization; 2019

Victora CG, Bahl R, Barros AJ Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387:(10017)475-490

Breastfeeding and the use of human milk. Pediatrics. 2012; 129:(3)e827-e841

World Health Organization. Nutrition and food safety, 10 steps to successful breastfeeding. 2018. (accessed 8 March 2023)

World Health Organization. Global breastfeeding scorecard 2021: protecting breastfeeding through bold national actions during the COVID-19 pandemic and beyond, 12 November 2021. 2021. (accessed 8 March 2023)

World Health Organization. Early initiation of breastfeeding. 2022. (accessed 1 March 2023)

Wu Y, Wang Y, Huang J The association between caesarean delivery and the initiation and duration of breastfeeding: a prospective cohort study in China. Eur J Clin Nutrition. 2018; 72:(12)1644-1654

Yang S-F, Salamonson Y, Burns E, Schmied V. Breastfeeding knowledge and attitudes of health professional students: a systematic review. Int Breastfeeding J. 2018; 13:(1)

Yisma E, Mol BW, Lynch JW, Smithers LG. Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa. BMJ Open. 2019; 9:(9)

Predictors of early initiation of breastfeeding among women in Jordan

02 April 2023
Volume 31 · Issue 4



Early initiation of breastfeeding is recommended to reinforce breastfeeding practice. This study aimed to investigate factors that influence and predict early initiation of breastfeeding in Jordan.


A total of 400 mothers attending maternal and child health centers in Amman were selected to participate in this cross-sectional study. The Chi-squared test and logistic regression were used to assess factors that influence and predict early initiation of breastfeeding.


The early initiation of breastfeeding prevalence was 22.3%. Predictors of early initiation among the participants were vaginal birth (odds ratio=4.02, P=0.024), birthing in a government hospital (odds ratio=3.29, P=0.004), receiving breastfeeding counselling (odds ratio=2.75, P=0.007) and receiving breast milk as the first feed (odds ratio=13.69, P<0.001).


Promoting breastfeeding practice in Jordan is necessary. There is an urgent need for national efforts to provide prenatal breastfeeding counselling for pregnant women.

Breastfeeding has many benefits for infants' growth and development (United Nations Children's Fund and World Health Organization (WHO), 2019). It is widely established as a life-saving practice that reduces neonatal mortality by improving nutrition and immunity, and reducing infection (Victora et al, 2016). Early initiation of breastfeeding is defined as breastfeeding within 1 hour of birth, is especially important as it facilitates mother–child bonding, induces colostrum production, and positively affects the duration of exclusive breastfeeding (Khan et al, 2015). Consequently, the WHO (2012) and the American Academy of Pediatrics (Meek and Noble, 2022) endorse early initiation of breastfeeding and exclusive breastfeeding for 6 months (United Nations Children's Fund and WHO, 2019).

Globally, only 44% of infants under 6 months are exclusively breastfed, while the target is 70% (WHO, 2021). The last national data collected on breastfeeding in Jordan showed that only 18.6% of mothers had early initiation of breastfeeding in 2012 (WHO, 2022). A cohort study in Jordan in 2018 found that the rate of breastfeeding initiation within the first 4 hours after birth was only 13% (Dasoqi et al, 2018). This situation deprives populations of the potential improvements to population health that optimal breastfeeding can achieve.

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