Assessment of breastfeeding support, knowledge, attitude and practices in North Lebanon daycare centers : a cross sectional study

Abstract

Background: Exclusive breastfeeding rates in Lebanon during the first six months of life remain suboptimal. With more women in the workforce and inadequate paid maternity leave, families in Lebanon increasingly rely on child care in nurseries or daycare centers. Internationally, the extent to which daycare centers support and promote breastfeeding is one influencer of maternal decisions to (dis)continue breastfeeding. In Lebanon, little is known about which breastfeeding-related policies, if any, are implemented in daycare centers, as well as the caregivers’ level of knowledge and attitudes towards breastfeeding. This study aimed to address these gaps with particular focus on daycare centers in under-served and under-studied towns in North Lebanon. Methods: A cross sectional study using a mixed methods approach was conducted targeting licensed daycare centers in Akkar, Tripoli and Zgharta (n=30). Voice-recorded interviews with a convenience sample of daycare center directors (n=15) were conducted for an in-depth investigation of supports and constraints of breastfeeding support. A questionnaire was administered to caregivers and directors to explore knowledge, practices, and attitudes related to breastfeeding. Results: None of the daycare centers has written breastfeeding promotion and support policies. None receive frequent breastfeeding support training. Qualitatively, while directors reported being themselves supportive of breastfeeding, they highlighted a wide range of educational, sociocultural and economical barriers, especially during the COVID pandemic, that constraint women to continue breastfeeding. The decision to stop breastfeeding is reportedly taken before enrolling the infant in daycare. Quantitatively, caregivers’ breastfeeding knowledge was poor to fair, with scores ranging between 41-68 out of 100. The majority (63%) had negative attitudes towards breastfeeding. Conclusion: Caregivers and directors at daycare centers in North Lebanon could benefit from culturally sensitive training related to breastfeeding promotion and support. Providing breastfeeding support at daycare centers might be a necessary but insufficient strategy to increase breastfeeding continuation rates in Lebanon, as efforts also need to address larger societal and economic barriers.