Determinants of Suboptimal Breastfeeding Techniques and Maternal Knowledge in Northwest Ethiopia: A Cross-Sectional Observational Study

Abstract

Background: Ineffective breastfeeding techniques are associated with nipple trauma and the early discontinuation of exclusive breastfeeding. Despite frequent contact with healthcare services, many mothers do not acquire the practical skills needed for effective breastfeeding techniques. This study assessed the prevalence of ineffective breastfeeding techniques, identified associated factors, and evaluated maternal knowledge among lactating mothers attending public hospitals in northwest Ethiopia. Methods: A facility-based cross-sectional study was conducted among 420 systematically selected lactating mothers attending public hospitals . Data were collected using interviewer-administered questionnaires to assess sociodemographic characteristics, obstetric history, prior breastfeeding counseling, and maternal knowledge of breastfeeding practices. Breastfeeding techniques were evaluated through direct observation using the World Health Organization (WHO) B-R-E-A-S-T Feed tool, assessing positioning, attachment, and effective suckling. Ineffective breastfeeding technique was defined as failure to meet criteria in any of these domains. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with ineffective breastfeeding, and statistical significance was set at p < 0.05. Results: The prevalence of ineffective breastfeeding techniques was 54.3% (95% CI [49.9%, 59.8%]), while 56% (95% CI [51.3%, 60.7%]) of the mothers demonstrated poor knowledge of optimal breastfeeding practice. Although 85% of mothers attended antenatal care (ANC), only 19% received counseling on breastfeeding techniques. Lack of ANC follow-up (AOR = 3.09), absence of prior breastfeeding information (AOR = 1.94), being primiparous woman (AOR = 2.16), and having no formal education (AOR = 1.74) were significantly associated with ineffective breastfeeding techniques. In contrast, mothers aged 21–30 years were more likely to demonstrate effective breastfeeding techniques compared with those aged ≤ 20 years. Conclusion: Ineffective breastfeeding techniques and poor maternal knowledge remained common despite high antenatal care (ANC) attendance. Several sociodemographic and obstetric factors were associated with ineffective breastfeeding techniques. Strengthening practical, skill-based breastfeeding support during ANC and the early postnatal period is essential, particularly for first-time and less-educated mothers.