The Prevalence and Social Determinants of Exclusive Breastfeeding and Implications for Infant Growth in Rural Haiti: A Mixed-Methods Study

Background: While exclusive breastfeeding is known to protect against infant morbidity and mortality, its effects on growth are not well understood. This study aimed to identify individual and household characteristics associated with exclusive breastfeeding in a rural population in Haiti, and to test the association between duration of exclusive breastfeeding and infant height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ). In addition, qualitative methods were employed to identify community perceptions of exclusive breastfeeding and barriers to its adoption. Methods: A household survey was conducted to assess breastfeeding practices and maternal and infant nutritional status in rural Léogâne Commune (N=119), and linear regression was used to estimate the associations between duration of exclusive breastfeeding and infant HAZ, WHZ and WAZ. In addition, 32 community health workers completed a written survey and participated in focus group discussions of the benefits of exclusive breastfeeding and barriers to its adoption in their communities. Results: Survey variables associated with shorter duration of exclusive breastfeeding (α=0.10) included preterm birth, late initiation of breastfeeding, maternal employment and the practice of giving infants tea. The community health workers identified several additional socio-cultural and institutional barriers to exclusive breastfeeding in their communities, including the advice of community elders, poverty and food insecurity. Duration of exclusive breastfeeding was positively associated with both HAZ and WAZ (α=0.05), but not significantly associated with WHZ. Conclusions: This study provides evidence that duration of exclusive breastfeeding is positively associated with infant height-for-age and weight-for-age in a rural, resource-limited setting, suggesting that promotion of exclusive breastfeeding may be effective as part of a package of interventions to prevent underweight and stunting among infants at risk of malnutrition. In addition, qualitative findings suggest that efforts to promote exclusive breastfeeding should pay attention to underlying issues of poverty and food security, and the effects of the physical and social environment on the choices women make regarding infant feeding in Haiti.