Breastfeeding at one year after birth: duration and associated factors in primiparous women in Sweden - a longitudinal study

Background: Exclusive breastfeeding during the first six months of life is a global public health recommendation and offers well-established and significant benefits for infant health and development, as well as health benefits for women. Most breastfeeding research focuses on the early postpartum period, despite the WHO recommendations to continue breastfeeding for up to two years or longer. Investigating factors associated with breastfeeding at one year may inform healthcare practices aimed at supporting women to sustain breastfeeding over time. Therefore, the aim of this study was to explore breastfeeding duration and factors associated with breastfeeding at one year after birth, in primiparous women given birth vaginally. Methods: This study is a longitudinal cohort based on follow-up data from a multicentre randomized controlled trial at five obstetric units in Sweden. Data were derived from questionnaires sent to women at one month and one year postpartum. Multivariable logistic regression analysis was used to analyze factors associated with breastfeeding at one year after birth, and Kaplan-Meier analysis estimated breastfeeding duration. Results: The prevalence of breastfeeding at one year after birth was 31% in this cohort of 1739 women who gave birth vaginally to their first child. The mean duration of breastfeeding was 5.62 months. Exclusive breastfeeding during the first four months (aOR; 2.85; 2.25–3.62), not having Swedish as native language (aOR; 1.69; 1.30–2.18), experiencing a very positive first breastfeeding session (aOR; 1.67; 1.34–2.08) and having a university education (aOR; 1.53 1.17–1.99), were associated with breastfeeding at one year. Conclusions: This study highlights the importance of providing breastfeeding support to ensure a very positive first breastfeeding experience, avoiding introduction of formula or solids before four months of age unless medically indicated and including social background factors. Knowledge about factors associated with breastfeeding at one year can inform healthcare interventions aiming to increase breastfeeding in line with national and international recommendations. These factors should be implemented in future breastfeeding support strategies.