Strengths and limitations
Breastfeeding self-efficacy is a strong indicator of the duration of
breastfeeding which can be affected by a set of factors in various
situations including crises.11 In the COVID-19
pandemic, which is indeed a crisis period, planning and implementing
attempts during the prenatal period with information based on evidence
by identifying the factors affecting breastfeeding self-efficacy has
become more important compared to other periods in terms of mothers’ and
babies’ health. However, no studies have been seen which specify the
factors affecting future mothers’ prenatal breastfeeding self-efficacy
levels and their breastfeeding self-efficacy during the pandemic.
Conducted studies are generally completed during the postpartum period
as the activity of breastfeeding takes place during this period.
However, the breastfeeding self-efficacy of the mother should be
developed during the prenatal period for breastfeeding to take place as
soon as possible in the postpartum period and for successful
breastfeeding results.
Interpretation
In the study, it was found that as the pregnant women’s age increased,
so did their breastfeeding self-efficacy. In studies done before the
pandemic, it has been stated that there is a significant relationship
between age and breastfeeding self-efficacy and as age increases, so do
breastfeeding self-efficacy levels, similar to the results of this
study.13,17 As age increases, experiences and people’s
awareness soar up as well.
It was also determined in the study that as the mothers’ educational
background increased, so did their breastfeeding self-efficacy. In the
studies carried out before the pandemic, it has been found that pregnant
women holding a bachelor’s degree or above had higher PBSES mean scores
than those who were high school graduates or below, similar to the
findings of this study17,20 Sultana and Yasin (2021)
state that educational background has a significant relation to
breastfeeding practices awareness in the COVID-19
pandemic.21 In her study, Dennis (2006) states that
mothers with high educational backgrounds have higher breastfeeding
self-efficacy levels than mothers with low educational
backgrounds.8 Contrary to the results of this study,
Fauzia et al. (2020) express that educational background does not affect
breastfeeding self-efficacy in their study, and explain the reason
behind it to be the “employability of breastfeeding information”,
which is described by them as the idea that “if people with high
educational background have not obtained any information on
breastfeeding they may not know how to breastfeed, and if people with
low educational background breastfeed frequently or are knowledgeable on
breastfeeding they may have high breastfeeding
self-efficacy”.22 It has been thought that people
research about the pandemic and become knowledgeable on it more so as
their educational background increases, and as such, decide to
breastfeed their baby; therefore, their breastfeeding self-efficacy is
developed and increased.
It was determined in the study that the pregnant women visiting their
polyclinics for prenatal care checkups on time had higher PBSES mean
scores than those who did not visit their polyclinics on time. Gonzales
(2020) has found out that as the number of prenatal care checkups
increase, so does the mother’s breastfeeding
self-efficacy.12 While the majority of pregnant women
in Turkey stated that they visited their doctors for prenatal care
checkups before the pandemic,33 pregnant women
participating in studies carried out during the pandemic have stated not
to visit their doctors for their checkups, postpone their checkups, or
go to their checkups but not on time.23,24-27 In these
studies, the reason for not going to checkups, postponing checkups, or
not going to checkups on time has been stated to be “anxiety/concern
over going to prenatal care checkups.”27-29 Besides,
implemented precautions such as curfews, limitation of social life, and
social isolation practiced to be protected from the pandemic are thought
to be effective on not going to prenatal care check-ups.
The pregnant women who thought breastfeeding to be beneficial for the
baby were found to produce higher mean scores than those who did not. No
pregnant woman participating in the study thought breastfeeding to be
harmful to the baby. This result is thought to be important in that it
specifies those who need to be supported for higher prenatal
breastfeeding self-efficacy (indecisive ones).
It was found out that the pregnant women who received training on
breastfeeding during the COVID-19 pandemic had higher PBSES mean scores
than those who did not. Studies conducted before the pandemic show that
breastfeeding training received during the prenatal period increases
breastfeeding self-efficacy in the prenatal and postpartum
periods.31-32 In a systematic review and
meta-analysis, it is suggested that breastfeeding training is an
important factor to increase breastfeeding self-efficacy and should be
received based on theory, individually or in groups at a hospital from
the prenatal period up until the postpartum first
week.32
It was determined that pregnant women who were knowledgeable on COVID-19
had higher PBSES mean scores than those who were not. No study on this
subject matter has been found in the literature. According to the data
obtained from the COVID-19 related studies carried out so far and the
opinions of WHO, there is no evidence that COVID-19 infection can be
carried by breast milk. In this period in which COVID-19 has spread to
many countries and become a pandemic, it is crucial for breastfeeding
mothers to know the important points to look out for when breastfeeding
their babies in order to protect the infant’s health.
It was also found out in the study that as the gestational week
increased, the PBSES scores decreased. Studies carried out before the
pandemic claim that the gestational week does not affect PBSES
scores17 It is thought that as the relation was found
to be weak and all the pregnant women were in their third trimester, a
study with participants in different trimesters might be necessary.
According to the study, in the order of descending importance; being
knowledgeable on COVID-19, thinking breastfeeding to be beneficial for
the baby, going to prenatal care checkups on time, gestational week,
educational background, age, and receiving breastfeeding training in the
COVID-19 pandemic affect PBSES scores by 25% (p<.05). In one
of the studies carried out before the pandemic, Hamid and Zaidi (2020)
claimed that PBSES scores were affected by the variables of being a
housewife, being multiparous, and having a positive attitude toward
breastfeeding by 41%.4 Corby et al. (2019) stated
that the variables of feeling ready for giving birth, income status,
concern, duration planned to be exclusively spared for breastfeeding,
educational background, and marital status affected PBSES scores by
31.6% among primiparous women.6 Khresheh and Ahmed
(2018) expressed that there was no significant relationship between
breastfeeding self-efficacy and sociodemographic
variables.16
Conclusion
Mothers should start and continue breastfeeding by obeying health
protocols during the Covid-19 pandemic. To that end, evaluating
breastfeeding self-efficacy in the prenatal period, and planning and
implementing effective interventions to encourage and support the mother
have gained more importance in the pandemic. This study may contribute
to the published evidence on the subject matter so that health
professionals can convey suitable information and suggestions to
pregnant women in the pandemic.
Authors’ contributions: The conception and design of the study HA and
KG, data collection KMG, data analysis HA, and interpretation HA and KMG
drafting of the article interpretation HA, KMG and KG, critical revision
of the article; HA, KMG and KG, All authors read and approved the final
manuscript.