Breastfeeding Efficacy among Primiparous Mothers: A Survey from Lahore

Background: Breastfeeding is the natural process of infant feeding on milk produced by mothers. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months and continued breastfeeding until at least 24 months to support optimal growth. A mother’s belief in her ability to breastfeed, known as breastfeeding self-efficacy, significantly impacts her breastfeeding experience and success. Objective: To determine the level of breastfeeding self-efficacy among primiparous mothers in Lahore. Methods: A descriptive cross-sectional study was conducted over six months, from June 2023 to December 2023, in various hospital settings. Data were collected from 150 primiparous mothers selected through nonprobability convenient sampling. Inclusion criteria were primiparous mothers aged 20 to 35 years who had been breastfeeding for at least three months. Exclusion criteria included mothers with a history of cancer or hepatitis and those unable to provide informed consent. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was used to collect data, which was then entered and analyzed using SPSS version 25. BSES-SF is a 14-item self-administered questionnaire with a 5-point rating scale, where a score of 1 indicates “no confidence at all” and a score of 5 represents “very confident.” Total scores range from 14 to 70, with higher scores reflecting higher self-efficacy. Scores were categorized into low (14-33), medium (33-53), and high (53-70) self-efficacy. Results: Out of 150 primiparous mothers, 4 (2.7%) had low breastfeeding self-efficacy, 93 (62.0%) had medium self-efficacy, and 53 (35.3%) had high self-efficacy. The age of participants ranged from 20 to 34 years, with a mean age of 25.02 years (SD = 3.18). Education levels were 42.2% intermediate, 32.7% undergraduate, and 24.7% postgraduate. Employment status showed 27.0% employed and 73.0% unemployed. Conclusion: The majority of primiparous mothers reported a moderate level of breastfeeding self-efficacy. These findings highlight the need for targeted interventions to enhance breastfeeding confidence among new mothers.


INTRODUCTION
Breastfeeding, the natural process of infant feeding on milk produced by mothers, is universally recognized for its health benefits.The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life and continued breastfeeding up to at least 24 months to ensure optimal growth and development (1).Breast milk provides essential nutrients and antibodies, strengthening the infant's immune system and reducing the risk of infections, allergies, and chronic diseases (2).For mothers, breastfeeding promotes postpartum recovery through uterine contractions and reduced postpartum bleeding, and it is associated with a lower risk of breast and ovarian cancers (3).A critical factor influencing a mother's breastfeeding experience is her breastfeeding self-efficacy, defined as her confidence in her ability to successfully breastfeed her baby (4).High levels of breastfeeding self-efficacy are associated with more positive breastfeeding outcomes, both for the mother and the infant (5).Strategies to enhance self-efficacy are vital in improving the quality of care provided by healthcare professionals (6).Primiparous mothers, or first-time mothers, often face unique challenges and uncertainties regarding breastfeeding (7).These challenges can include lack of information, inadequate family support, difficulties with latch and positioning, pain or discomfort, maternal stress or anxiety, and limited access to lactation support services (8).The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) is a reliable tool used to measure a mother's confidence in her breastfeeding abilities.This 14-item questionnaire, scored on a 5-point Likert scale, assesses various aspects of breastfeeding selfefficacy, with higher scores indicating greater confidence (10).Scores range from 14 to 70, with scores of 14-33 indicating low selfefficacy, 33-53 indicating medium self-efficacy, and 53-70 indicating high self-efficacy.The BSES-SF has demonstrated strong internal consistency, with a Cronbach's alpha of 0.94 (9)(10)(11)(12).In Pakistan, there is a notable lack of information and support during the postpartum phase, which can impede maternal recovery and breastfeeding success.Addressing these gaps through targeted educational and support programs can significantly improve maternal and infant health outcomes during this critical period.This study aims to assess the level of breastfeeding efficacy among primiparous mothers in Lahore.By understanding their experiences and confidence levels, we can better tailor interventions to support these mothers and promote successful breastfeeding practices.The study was conducted using a descriptive cross-sectional design over six months, with data collected from 150 primiparous mothers who met the inclusion criteria.The BSES-SF was utilized to gauge breastfeeding self-efficacy, and data analysis was performed using SPSS version 25. Results indicated that the majority of primiparous mothers reported moderate levels of breastfeeding efficacy, highlighting the need for enhanced support and education to boost their confidence and success in breastfeeding ( 13).This research contributes to the growing body of evidence on the importance of breastfeeding self-efficacy and the need for comprehensive support systems for new mothers.By fostering a supportive environment and providing adequate resources, healthcare providers can help primiparous mothers overcome challenges and achieve their breastfeeding goals, ultimately benefiting both mothers and their infants.

MATERIAL AND METHODS
A descriptive cross-sectional study was conducted within the Department of Physical Therapy over a period of six months, from June 2023 to December 2023.Ethical approval was obtained from the Institutional Ethical Committee prior to the commencement of the study, ensuring adherence to the principles outlined in the Declaration of Helsinki.The sample size was determined using the census method, and data were collected from 150 primiparous mothers who met the inclusion criteria.Participants were selected through nonprobability convenient sampling.The inclusion criteria were defined as primiparous mothers aged 20 to 35 years who had been breastfeeding for at least three months.Exclusion criteria included mothers with a history of cancer or hepatitis and those unable to provide informed consent or actively participate due to language barriers or other reasons.Informed consent was obtained from all participants prior to data collection, and confidentiality was assured throughout the study.Data were collected using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), a 14-item self-administered questionnaire designed to measure breastfeeding confidence.Each item was rated on a 5-point Likert scale, ranging from 1 (not at all confident) to 5 (always confident), with total scores ranging from 14 to 70.Higher scores indicated greater breastfeeding self-efficacy.The BSES-SF has demonstrated strong internal consistency, with a Cronbach's alpha value of 0.98, and scores were categorized into three levels: low self-efficacy (14-33), medium self-efficacy (33-53), and high self-efficacy (53-70) (10)(11)(12).Participants' demographic data, including age, education level, and employment status, were also collected.The age of participants ranged from 20 to 34 years, with a mean age of 25.02 years and a standard deviation of 3.18.The education levels were categorized as intermediate, undergraduate, and postgraduate, with respective frequencies of 42.2%, 32.7%, and 24.7%.Employment status was recorded, with 73% of participants being unemployed and 27% employed (13).Data analysis was performed using SPSS version 25.Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were used to summarize the data.The primary outcome measure was the level of breastfeeding self-efficacy among the participants.Results were presented in tables and figures to illustrate the distribution of breastfeeding self-efficacy levels and demographic characteristics.Throughout the study, measures were taken to ensure the ethical treatment of participants.Confidentiality was maintained, and no harm was inflicted upon the participants during the research process.The findings of this study aim to provide insights into the breastfeeding self-efficacy of primiparous mothers, contributing to the development of targeted interventions to support and enhance breastfeeding practices (13).

RESULTS
The study included 150 primiparous mothers, with their ages ranging from 20 to 34 years.The mean age was 25.02 years, with a standard deviation of 3.18 years.The findings indicated that only 2.7% of the mothers had low breastfeeding self-efficacy, while 62% had medium self-efficacy, and 35.3% had high self-efficacy.This demonstrates that the majority of the primiparous mothers reported moderate levels of confidence in their ability to breastfeed.Figures

DISCUSSION
The study aimed to assess the breastfeeding self-efficacy among primiparous mothers in Lahore, revealing that the majority reported moderate levels of confidence in their breastfeeding abilities.These findings align with previous research that underscores the significance of breastfeeding self-efficacy in determining breastfeeding success and duration.A cross-sectional study conducted in Ethiopia found that 52.4% of women had adequate knowledge about breastfeeding, which correlates with the moderate self-efficacy levels observed in the current study (13).Another study by Mohamed et al. concluded that parity did not significantly influence the practice of exclusive breastfeeding, which supports the current study's focus on primiparous mothers and their moderate breastfeeding efficacy (14).The present study's findings are consistent with those of Al Ketbi et al., who observed that only a minority of mothers exhibited a good breastfeeding attitude, with most displaying fair to poor attitudes (15).Similarly, Awaliyah et al. identified breastfeeding selfefficacy as a dominant factor affecting maternal breastfeeding satisfaction, highlighting the importance of confidence in successful breastfeeding practices (16).However, the current study found that a small percentage of mothers (2.7%) exhibited low breastfeeding self-efficacy, suggesting that targeted interventions are necessary to support these mothers.
A key strength of this study was its focus on primiparous mothers, providing insights into their unique challenges and needs regarding breastfeeding.The use of the BSES-SF, a validated and reliable tool, ensured the accuracy and consistency of the data collected.The sample size of 150 participants was adequate to provide a comprehensive overview of breastfeeding self-efficacy in this population.However, the study had several limitations.The nonprobability convenient sampling method may limit the generalizability of the findings to the broader population of primiparous mothers.Additionally, the cross-sectional design only provided a snapshot of breastfeeding self-efficacy at one point in time, without capturing changes over the postpartum period.Future research could benefit from longitudinal studies to track breastfeeding self-efficacy and its impact on breastfeeding duration and success over time (17)(18)(19).The study highlighted the need for comprehensive breastfeeding education and support programs tailored to primiparous mothers.Healthcare professionals should focus on enhancing breastfeeding self-efficacy by providing accurate information, practical guidance, and emotional support.Strengthening family support systems and improving access to lactation consultants can also play a crucial role in boosting maternal confidence in breastfeeding (20).

CONCLUSION
In conclusion, the study revealed that most primiparous mothers in Lahore reported moderate levels of breastfeeding self-efficacy, with a minority exhibiting low confidence.These findings underscore the importance of targeted interventions to enhance breastfeeding self-efficacy, thereby improving breastfeeding practices and outcomes.Further research should explore the longitudinal impact of breastfeeding self-efficacy and evaluate the effectiveness of different support strategies in diverse populations.

Figure 1 :
Histogram of AgeFigure 2: Frequency and Percentage of Occupation of Participants Figure 3: Frequency and Percentage of Breastfeeding Efficacy Level In summary, the descriptive statistics revealed that the majority of primiparous mothers in the study had a moderate level of breastfeeding efficacy.The data suggest a need for targeted interventions to support and enhance breastfeeding confidence among new mothers.

Table 1 :
Descriptive Statistics of Age Out of the 150 participants, the education levels were categorized as intermediate, undergraduate, and postgraduate.The majority of participants had an intermediate level of education.

Table 2 :
Frequency and Percentage of Education Level of Participants Regarding employment status, the majority of the participants were unemployed.

Table 3 :
Frequency and Percentage of Occupation of Participants The primary outcome measure was the level of breastfeeding self-efficacy.The results showed that most of the mothers had medium breastfeeding self-efficacy.

Table 4 :
Frequency and Percentage of Breastfeeding Efficacy Level