# Beyond Intentions: The Breastfeeding Intention-Practice Gap in Tunisia- A Cross-Sectional Analysis of Initiation and Continuation among Post-Partum Women

## TL;DR

This study explores why many Tunisian mothers who intend to breastfeed do not follow through, finding that delayed initiation and lack of education are key barriers.

## Contribution

The study identifies early initiation and obesity as significant predictors of breastfeeding duration in Tunisia, highlighting modifiable factors.

## Key findings

- Only 19.3% of mothers initiated breastfeeding within the first hour after birth.
- Early initiation was strongly associated with continued breastfeeding at 12 months.
- Obesity and lack of breastfeeding education were linked to shorter breastfeeding duration.

## Abstract

Breastfeeding is vital for maternal and child health, yet breastfeeding practices and duration vary globally. In Tunisia, data on factors influencing breastfeeding, especially initiation timing, are limited. This study assessed breastfeeding practices, initiation timing, and associated maternal and delivery factors among Tunisian women, focusing on breastfeeding duration up to 12 months postpartum.

Analytical cross-sectional study was conducted over a four-month period, from November 1, 2023, to February 29, 2024, in the Gynecology and Obstetrics Department B of Charles Nicolle Hospital in Tunis- Tunisia. Women who delivered during the study period were included. Data on sociodemographic characteristics, medical and obstetric history, breastfeeding knowledge and preparation, delivery, postpartum and breastfeeding practices were collected through a questionnaire. Breastfeeding duration was grouped into 1–3, 3–6, and >6 months. Associations with breastfeeding duration were analyzed.

In total, 400 women were included. Most women were Tunisian (99%), urban residents (91.5%), and of higher socioeconomic status (84.3%). Obesity was present in 20.5%, and cesarean delivery rate was 52.8%. Early breastfeeding initiation (within 1 hour) occurred in only 19.3%, with 80.8% delayed initiation. Breastfeeding at 12 months was 44%. Early initiation was significantly associated with longer breastfeeding duration (p < 0.001); 77.9% of women initiating within the first hour continued breastfeeding at 12 months, compared to much lower rates with delayed initiation. Obesity predicted shorter breastfeeding duration (p = 0.026). cesarean delivery showed no significant impact. Skin-to-skin contact was low (38.3%), and less than half received breastfeeding education (46%). Family support was not linked to breastfeeding duration.

Early breastfeeding initiation strongly supports sustained breastfeeding in Tunisia. Despite high breastfeeding intention, delays in initiation and modifiable barriers such as obesity and limited breastfeeding education hinder optimal breastfeeding outcomes. Interventions promoting early