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 im-pact 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, physi-cal/mental health, professional perinatal care, changes in healthcare due to the pandemic, COVID-19 re-lated, 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 breastfeed-ing rates across countries (first six months postpartum). Overall, first child (fi =-0.27), age of the child (fi =-0.29), preterm birth (fi =-0.52), admission to the neonatal/pediatric care (fi =-0.4 4), lack of breastfeeding support (fi =-0.18), current psychiatric treatment (fi =-0.69) and inequality (fi =-0.71) were negatively associated with breastfeeding ( p < .001). Access to postnatal support groups was posi-tively associated with breastfeeding (fi = 0.59; p < .001). In countries with low-inequality, governmental measures to contain virus transmission had a deleterious effect on breastfeeding (fi =-0.16; p < .05) while access to maternity leave protected breastfeeding (fi = 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 treat-ment. The complex associations between covariates and breastfeeding vary across countries, suggesting the need to define context-specific measures to support breastfeeding.(c) 2023 Elsevier Ltd. All rights reserved.