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Abstract
Background: Skin-to-skin contact (SSC) after birth is recommended to support breastfeeding, yet exclusive breastfeeding (EBF) at six months remains low across many low- and middle-income settings, including Pakistan.
Objective: To determine the frequency of EBF at six months among mothers of infants receiving SSC after normal vaginal delivery.
Methods: This cross-sectional study was conducted at a tertiary-care hospital from October 2023 to April 2024. Healthy mothers of infants delivered vaginally at 37-41 weeks gestation who received SSC within one hour of birth were enrolled. Sociodemographic, obstetric, neonatal, and early-feeding variables were recorded at enrolment, and mothers were followed monthly by telephone for six months to ascertain EBF status.
Results: Of 115 patients, the mean maternal age was 29.0 ± 5.4 years. Breastfeeding within one hour of birth was initiated in 103 (89.6%) of neonates. There were 10 (8.7%) mothers who had an indeterminate endpoint and were excluded. Among 105 completers, EBF prevalence fell progressively across the six-monthly assessments, i.e., from 81 (77.1%) (95% CI 68.2-84.1) to 40 (38.1%) (95% CI s29.4-47.6) at six months. On multivariable analysis, maternal education of secondary or below was independently associated with substantially lower odds of EBF (adjusted odds ratio [aOR] 0.02, 95% CI 0.00-0.17).
Conclusion: Despite universal early SSC in this cohort, EBF at six months remained low and fell steadily from the first postnatal month. Maternal education, not SSC timing or duration, was the strongest independent predictor of sustained exclusive breastfeeding.