Strengthening our understanding of enablers and barriers for breastfeeding to the WHO recommended guidelines of two years and beyond – a global sample using a cross-sectional design

Abstract Background There are major global disparities for women breastfeeding to the WHO recommendations of two years and beyond for optimal health benefits. This could be explained by multifaceted enablers and barriers within diverse cultural and social spheres. However, the majority of research examining continued breastfeeding is conducted with women breastfeeding under one year. Research which has explored the experiences of women breastfeeding longer is limited to a small homogenous sample. Therefore, this study aimed to strengthen the knowledge, specifically for women breastfeeding beyond one year, of enablers and barriers for continuing to breastfeed to the recommended age of two years and beyond. Methods A cross-sectional online questionnaire recruited 19,006 participants using social media. The statistical analysis and null hypothesis testing were conducted using non-parametric statistics and a multivariate logistical regression to explore relationships between the independent variables (enablers and barriers) against the dependent variable (duration of breastfeeding). Results The results indicated that mothers with multiple children appeared to be breastfeeding for a longer duration. Where the participants resided globally did not make a significant difference, participants belonging to different ethnic groups did. Those participants who identified as Asian, First Nation, Indigenous or Pacific Islander or were from the religious group Hindu were more likely to breastfeed to the recommend age. Participants who identified as Black (African or Caribbean decent) or were from the religious group Jewish were less likely to breastfeed to the recommend age. Age, level of education, geographic location, initial breastfeeding experience, multiple births, partner, family, social support, healthcare support and experience of breastfeeding in public were not significant when all other variables were considered. Those tandem feeding, Muslim ethnic group and views on specific health support where retained as covariates and confounders due to sensitivity to the other variables. Conclusions This study is the first to look at variables across different demographic groups and geographical location specifically of those breastfeeding beyond one year. It highlights that different ethnic and religious groups continue to have different outcomes for breastfeeding duration. These differences cannot be ignored when planning in national policy and intervention design.