Intention to breastfeed and association with subsequent breastfeeding duration, a linked population level routine data study - The Born in Wales cohort 2018-2021

Objective: The World Health Organisation recommends exclusive breastfeeding for the first six months of life. This study aimed to examine 1) If intention to breastfeed is associated with higher levels of breastfeeding, and 2) If the pandemic impacted the intention to breastfeed and the breastfeeding rates in Wales. Methods: This was a cohort study utilising routinely collected, linked healthcare data from the Secure Anonymised Information Linkage databank (SAIL). SAIL combines data from the National Community Child Health (NCCH) and Maternal Indicators (MIDS) datasets. All women that gave birth between 2018 and 2021 recorded in the NCCH dataset and MIDS dataset were included. Results: Intention to breastfeed was associated with being 27.5 times more likely to continue to breastfeed for six months compared to those who did not intend to breastfeed (OR 27.5, 95% CI: 24.8-30.5). 57.8% of expectant mothers intended to breastfeed pre-pandemic and 58.7% intended to breastfeed in 2020. Exclusive breastfeeding rates to six months were 16.6% pre-pandemic, 20.5% in 2020 and 19.7% in 2021. Those aged 30-39 were 3.91 times more likely to breastfeed. Conclusion: The biggest predictor of exclusive breastfeeding at six months was intention to breastfeed. During the pandemic those who intended to breastfeed were more likely to breastfeed exclusively for six months compared to before and after the pandemic, suggesting time at home may facilitate breastfeeding. Therefore, targeted interventions during pregnancy planning and early pregnancy to promote and encourage intention to start breastfeeding and promoting home working could improve breastfeeding rates and duration.