Abstract

Background: Breastfeeding promotes children's health and is associated with positive effects to maternal physical and mental health. Uncertainties regarding SARS-CoV-2 transmission led to worries experienced by women and health professionals which impacted breastfeeding plans. We aimed to investigate the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic. Methods: This study is part of a broader international prospective cohort study about the impact of the COVID-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19). We analysed data from 5612 women, across 12 countries. Potential covariates of breastfeeding (sociodemographic, perinatal, physical/mental health, professional perinatal care, changes in healthcare due to the pandemic, COVID-19 related, breastfeeding support, governmental containment measures and countries’ inequality levels) were studied by Generalized Linear Mixed-Effects Models. Results: A model encompassing all covariates of interest explained 24% of the variance of breastfeeding rates across countries (first six months postpartum). Overall, first child (? = -0.27), age of the child (? = -0.29), preterm birth (? = -0.52), admission to the neonatal/pediatric care (? = -0.44), lack of breastfeeding support (? = -0.18), current psychiatric treatment (? = -0.69) and inequality (? = -0.71) were negatively associated with breastfeeding (p <.001). Access to postnatal support groups was positively associated with breastfeeding (? = 0.59; p <.001). In countries with low-inequality, governmental measures to contain virus transmission had a deleterious effect on breastfeeding (? = -0.16; p <.05) while access to maternity leave protected breastfeeding (? = 0.50; p <.001). Discussion: This study shows that mother's COVID-19 diagnosis and changes in healthcare and birth/postnatal plans did not influence breastfeeding rates. Virtual support groups help women manage breastfeeding, particularly when their experiencing a first child and for those under psychiatric treatment. The complex associations between covariates and breastfeeding vary across countries, suggesting the need to define context-specific measures to support breastfeeding. © 2023 Elsevier Ltd