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.