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Original Research
SAGE Open
October-December 2024: 1–11
ÓThe Author(s) 2024
DOI: 10.1177/21582440241299154
journals.sagepub.com/home/sgo
Predictors and Barriers to Breastfeeding
Practices Among Jordanian Mothers:
A Cross-Sectional Study
Sajeda Reyad Al-Mawajdeh
1
, Hala Mahmoud Obeidat
1
,AlaaAhmad
Ababneh
2
, Kholoud Ghaleb Al-Ajarmeh
2,3
, Abdullah Mousa Saeed
Khamaiseh
1
, Reham Mohammed Khresheh
1
, and Asma Sa’d Basha
4
Abstract
Breastfeeding, endorsed by religious, cultural, and scientific evidence, experiences divergent rates in Jordan due to substantial
sociodemographic and cultural variations. Our aim is to explore the predictors and barriers that affect BF practices among
mothers in Southern Jordan, in order to insight the healthcare providers to identify these barriers in order to increase
awareness for the initiation and continuation of breastfeeding. A cross-sectional study was conducted among 380 mothers
with infant 2 weeks to 6 months old. Data were analyzed using descriptive statistics and multinomial logistic regression.
Findings revealed exclusive breastfeeding at 24%, mixed feeding at 57.63%, and artificial feeding at 18.42%. The study illumi-
nated pronounced barriers in socio-environmental factors (1.65 60.32), infant factors (1.63 60.37), and maternal
(1.59 60.27). Predictors encompassed maternal age, education, employment, province, income, family member, delivery
mode, and prior breastfeeding experience. In South Jordan, mixed feeding was the commonest way. Mothers’ work and lack
of nursery at the workplace was the most noticeable factor. This study equips healthcare providers to recognize barriers
hampering breastfeeding among Jordanian mothers, enabling informed strategies to enhance awareness and sustain breast-
feeding initiation and continuation.
Plain language summary
Breastfeeding, endorsed by religious, cultural, and scientific evidence, experiences divergent rates in Jordan due to
substantial sociodemographic and cultural variations. Our aim is to explore the predictors and barriers that affect BF
practices among mothers in Southern Jordan, in order to insight the healthcare providers to identify these barriers in
order to increase awareness for the initiation and continuation of breastfeeding. A cross-sectional study was conducted
among 380 mothers with infant two weeks to six months old. Data were analyzed using descriptive statistics and
multinomial logistic regression. Findings revealed exclusive breastfeeding at 24%, mixed feeding at 57.63%, and artificial
feeding at 18.42%. The study illuminated pronounced barriers in socio-environmental factors (1.65 60.32), infant
factors (1.63 60.37), and maternal (1.59 60.27). Predictors encompassed maternal age, education, employment,
province, income, family member, delivery mode, and prior breastfeeding experience. In South Jordan, mixed feeding
was the commonest way. Mothers’ work and lack of nursery at the workplace was the most noticeable factor. This
study equips healthcare providers to recognize barriers hampering breastfeeding among Jordanian mothers, enabling
1
Mutah University, Al-Karak, Jordan
2
Mutah University, Amman, Jordan
3
Royal Medical Services, Amman, Jordan
4
The University of Jordan and Jordan University Hospital, Amman, Jordan
Corresponding Author:
Sajeda Reyad Al-Mawajdeh, Mutah University, Al-Karak 61710, Jordan.
Email: sajeda_b@outlook.com
Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License
(https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of
the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages
(https://us.sagepub.com/en-us/nam/open-access-at-sage).
informed strategies to enhance awareness and sustain breastfeeding initiation and continuation. Our study has several
limitations. Firstly, its cross-sectional design relies on retrospective reporting of BF practices, potentially introducing
bias. Additionally, despite employing random sampling of health centers, the generalizability of our findings is restricted
by the use of convenience sampling.
Keywords
breastfeeding, exclusive breastfeeding, barriers, Jordanian mothers, predictors
Introduction
Breastfeeding stands as a cornerstone of infant health
and well-being, an assertion bolstered by the World
Health Organization’s (WHO, 2021a) recognition of it as
the paramount means to ensure a child’s health and sur-
vival. Nevertheless, despite its paramount importance,
diverse impediments exist that undermine the seamless
practice of BF. Rooted in its physiological advantages,
BF emerges as not only the optimal sustenance for new-
borns but a practice that bestows enduring benefits upon
both infants and mothers. It provides a wide range of
benefits for infant growth, immunity, development, and
quality of life that extends to adulthood, like reducing
the risk of developing obesity (Horta et al., 2015; Pang
et al., 2019; WHO, 2021b), in addition to maternal
health; it may aid in reducing the risk of postpartum
hemorrhage and postpartum depression with the reduc-
tion of breast and ovarian cancers and type 2 diabetes
mellitus (Chowdhury et al., 2015; UNICEF, 2018).
Aligned with these imperatives, WHO and the United
Nations Children’s Fund (UNICEF) underscore the sig-
nificance of early initiation of BF and exclusive breast-
feeding (EBF) for up to 6 months. This commitment has
been reinforced through initiatives such as the Ten Steps
to Successful Breastfeeding (TSSB) program, advocating
for comprehensive breastfeeding practices within health-
care institutions (Ducharme-Smith et al., 2021; UNICEF,
2018; WHO, 2018).
The Ten Steps are a set of recommendations and prac-
tices with a strong emphasis on obstetrics hospitals to
prevent free and reduced-price milk substitutes in these
facilities; inform pregnant women about the importance
of BF with early start of skin-to-skin contact; not to
introduce any additions of milk or other drinks to the
newborn during a stay in the hospital; not to separate
the it from his mother by cohabitation within 24 hr; BF
on demand and without a schedule. Implementation of
these steps will simplify and increase mothers’ insistence
on initiation and continuation of BF (WHO, 2018).
Globally, approximately 44% of newborns between
the ages of 1 to 6 months are exclusively breastfed,
however few have access to safe and nutrient-dense com-
plementary foods (WHO, 2021b). Against this global
backdrop, the scope of BF practices in Jordan warrants
exploration. Within a nation where over 9 out of 10
infants are breastfed in their first year, exclusive BF
remains a practice by only 26% of mothers, stressing the
need for deeper insights (Department of Statistics and
ICF International, 2018; UNICEF, 2020). Previous
research has shown that BF barriers play an important
role in mothers’ initiation and continuation of BF at
6 months. The route of birth, as well as the knowledge
and attitude of the mother also affect BF (Hasan et al.,
2021). Also a suitable place for lactation and breast milk
storage are significant factors for facilitating breastfeed-
ing (Elyas et al., 2017; Evangelista, 2020).
The social-cultural practices and beliefs impact moth-
ers’ knowledge and attitudes toward BF are known to
influence infant feeding (Amanya Mutuli, 2016).
Introducing pre-lacteal feeds and providing water mixed
with sugar are challenges rooted in cultural traditions
that have persisted over time (Hamlan et al., 2015; Jarrah
& Bond, 2007).According to previous studies, BF former
experiences plays a major role in selecting feeding pat-
terns and can add in difficulties impeding BF initiation
and continuation later (Asiodu et al., 2016; Hinson et al.,
2018; Huang et al., 2019; Khasawneh & Khasawneh,
2017). One of the most common barriers in Arab coun-
tries is the embarrassment to breastfeed in a public place
which result in early cessation or choosing not to breast-
feed at all (Asiodu et al., 2016; Huang et al., 2019;
Nguyen et al., 2021); Conversely, insufficient familial
support from perspectives such as husbands, grand-
mothers, and mothers-in-law can overcome barriers and
influence initiation and continuity of BF significantly
(AL-Sagarat et al., 2017; Joseph & Earland, 2019;
Hinson et al., 2018; Okafor et al., 2017). Thus, under-
standing present BF practices and barriers becomes
imperative. This study aimed to explore predictors and
barriers that affect breastfeeding practices among moth-
ers in southern Jordan in order to insight the healthcare
providers to identify these barriers and to increase aware-
ness for the initiation and continuation of breastfeeding.
2SAGE Open
Materials and Methods
Research Design
This study used a cross-sectional descriptive design
because it is the most appropriate one to explore a large
sample from different areas at a certain time to explore
the predictors and barriers that affect breastfeeding prac-
tice in south Jordan.
Setting and Relevant Contexts
This study was conducted in the southern region of
Jordan, encompassing five comprehensive governmental
health centers situated within four distinct rural and
semi-rural provinces: Al-Karak, Al-Tafila, Ma’an, and
Al-Aqaba. The demography of these provinces encom-
passes women of reproductive age (aged 18–49 years),
and the health service infrastructure includes comprehen-
sive governmental health centers that cater to maternal
and child health needs. These centers offer services such
as vaccination, infants, and children growth and develop-
mental assessments. The study conducted by Altamimi
et al. (2017) reported that within the Al-Karak province,
71.2% of participants had attempted BF, yet only 51
(20.9%) had exclusively breastfed during the first
6 months.
Sample
Mothers seeking healthcare services at comprehensive
health centers situated within the southern region of
Jordan, whose infants age is between 2 weeks and
6 months were selected during their routine visits for
infant’s vaccination, growth, and development clinics,
utilizing a convenience sampling approach. Convenience
sampling was chosen due to its practicality and accessi-
bility in our specific research context, allowing us to effi-
ciently gather data from a readily available population.
Inclusion criteria encompassed Jordanian nationality,
maternal age exceeding 18 to 45years, absence of chronic
medical conditions, residency in the designated cities,
with healthy singleton infants, and willingness to actively
participate in the research. Exclusion criteria involved
mothers who delivered infants prematurely, with multi-
ple gestations, and those with newborns admitted to neo-
natal intensive care or hospitalization. These exclusions
aimed to mitigate potential factors that could impact the
standard breastfeeding practices.
The determination of the sample size was conducted
utilizing the model proposed by Steven Thompson,
resulting in a sample size of 380 participants. This calcu-
lation was predicated on the volume of visitors to com-
prehensive health centers in the southern region of
Jordan throughout the year 2020.
Data Collection
Face-to-face structured questionnaires to verifying parti-
cipant eligibility was performed in a private setting to
ensure confidentiality and was in the Arabic language.
Data collection occurred from February 2022 till May
2022 by the researchers. A written consent was secured
from all participating mothers and were informed that
the duration of the questionnaire is about 15 to 20 min.
Measurement
The study questionnaire developed by the researcher
constructed in alignment with prevalent BF barriers
identified in previous literature for both maternal demo-
graphic details, a comprehensive assessment of BF bar-
riers including maternal, infant, and socio-environmental
factors. A total of 22 items were identified (Balogun
et al., 2015; Nguyen et al., 2021) across three distinct
dimensions, each offering two response options including
maternal-related barriers (12 items), infant-related bar-
riers (4 items), and socio-environmental-related barriers
(6 items). To ensure face validity, the questionnaire items
underwent rigorous review by three experts. The internal
consistency assessment was undertaken by calculating
Cronbach’s alpha coefficient, yielding a value of 0.846
for BF-associated barriers.
Ethical Consideration
Ethical clearance from the Ministry of Health under ref-
erence number 2022/1557 was taken.
Data Analysis
Statistical analyses were conducted Utilizing IBM SPSS
Statistics (version 26). Using descriptive statistics were
employed to synthesize the sociodemographic character-
istics of the participants, alongside detailing the preva-
lence of artificial, BF, and mixed feeding practices.
Descriptive statistics, in the form of mean 6SD, were
applied to both individual item scores and the aggre-
gated mean score. Subsequently, the scale scores under-
went classification into two discrete categories based on
their mean values representing either low perceived bar-
riers or high perceived barriers. This categorization was
presented in terms of both frequency and percentage,
enhancing the clarity of interpretation.
Following the identification of breastfeeding barriers,
a multinomial regression model was deployed, integrating
nine sociodemographic variables. These variables were
treated categorically, with the highest category within
each variable serving as the reference point. Marital status
was purposefully excluded from this analysis due to singu-
larities in the matrix. The aim of this selective reporting
Al-Mawajdeh et al. 3
was to streamline the presentation of results, highlighting
solely those predictors that bore statistical significance
within the context of the outcomes table.
Operational Definition of Study Variables
The concept of BF practice encompasses the classifica-
tion of infants based on their feeding regimen, which
includes exclusive BF, formula feeding, or a combination
of both. This classification is determined by the propor-
tions of infants exclusively breastfed, those solely for-
mula-fed, and those on mixed feeding regimens.
The breastfeeding barriers are defined as the factors
restricting the mother’s breastfeeding behaviors. The bar-
riers measured by 22 items covered infant, maternal, and
socio-environmental factors adopted by previously pub-
lished studies (Balogun et al., 2015; Nguyen et al., 2021).
Breastfeeding predictors from demographic data refer
to characteristics or factors related to a mother’s back-
ground or socio-economic status that are believed to
influence her likelihood or ability to breastfeed her infant
(Khasawneh & Khasawneh, 2017).
Results
Participant’s Socio-demographic Characteristics
A total of 380 mothers from four provinces in Southern
Jordan participated in the current study. More than half
of the sample, specifically 207 (54.5%), fell within the age
range of 25 to 35 years. The vast majority of participants,
precisely 374 (98.4%), reported their marital status as
married. Among the mothers, 354 (93.2%) identified as
non-smokers, and approximately 142 (37.4%) resided in
the Al-Karak province.
Conversely, a notable proportion, 165 (43.0%), held
higher diploma and university degrees. In terms of
maternal occupation, almost half of the sample, 192
(50.5%), identified as housewives. Family size distribu-
tion revealed that 191 (50.3%) of the mothers had 2 to 3
children in their households. Furthermore, 172 (45.3%)
reported a monthly income falling within the range of
400 to 600 Jordanian Dinars.
Regarding childbirth, the majority, 235 (61.8%), deliv-
ered their infants through vaginal route, 225 mothers
(59.2%) had prior BF experience. A detailed overview of
the study participants’ characteristics is presented in
Table 1.
Breastfeeding Practices in Southern Jordan
The findings presented in Figure 1 depict the distribution
of feeding practices among the participants. From the
total participants, 91 individuals (23.95%) exclusively
practiced BF, while 70 of them (18.42%) opted for artifi-
cial feeding. The majority of the sample, encompassing
219 (57.63%), embraced mixed methods.
Barriers to Breastfeeding Items Analysis
The barrier items were divided into three dimensions
with two answer options (yes or no): Specifically, these
dimensions comprised maternal-related barriers, com-
prising 12 items; infant-related barriers, comprising 4
items; and socio-environmental barriers, comprising 6
items. The scale scores were divided based on the mean
score into two categories (perceived low and high bar-
riers) and expressed in frequency as a percentage.
Table 1. Participant’s Socio-demographic Characteristics
N= 380.
Variables Frequency %
Mother’s age
Less than 25 years old. 77 20.2
25–35 years old. 207 54.5
30 years and older 96 25.3
Marital status
Married 374 98.4
Widowed 5 1.3
Divorced 1 0.3
Province
Al-Karak 142 37.4
Al-Tafila 80 21.1
Al-Aqaba 80 21.0
Ma’an 78 20.5
Educational level
Secondary or illiterate 109 28.7
Diploma 106 27.9
Higher diploma and university 165 43.4
Mother’s work
Housewife 192 50.5
Worker 177 46.6
Student 11 2.9
Family members
One child 109 28.7
2–3 children 191 50.3
4 or more children 80 21.0
Family income/month
Less than 400 JD 113 29.7
400–600 JD 172 45.3
601–800 JD 68 17.9
More than 800 JD 27 7.1
Mode of delivery
Normal 235 61.8
Cesarean delivery 145 38.2
Smoking
Yes 26 6.8
No 354 93.2
Previous breastfeeding experiences
Yes 225 59.2
No 155 40.8
4SAGE Open
The Maternal-Related Barriers
As shown in Table 2 result shows that the mother’s related
factors dimension had the lowest mean (1.59 60.27).
Perceiving breast problems like sores or painful nipples
and mastitis and shying from feeding in front of others
were a mother’s barriers to breastfeeding with a mean of
(1.69 60.46) and (1.68 60.47), respectively. In contrast,
mothers who did not get the desire to BF, had the least
barrier (1.41 60.49); after categorizing the scale mean
score, the results showed that more than half of the sam-
ple, 200(52.6%), had low perceived barriers compared
with 180(47.4%) who perceived a high barrier.
The Infant-Related Barriers
Table 3 result shows the presence of a congenital infant
abnormality such as cleft lip or palate had the highest
infant barrier to feeding (1.67 60.47). At the same time,
babies rejecting breast milk accounted for the lowest per-
ceived infant barrier (1.59 60.49) after categorizing the
scale mean score; the results showed that more than half
of sample 216 (56.8%) have high perceiving barriers com-
pared with 164 (43.2%) perceiving a low barrier.
Socio-Environment Related Barriers
The results in Table 4 show that mothers’ work and lack
of nursery at the workplace had the highest two barriers
(1.79 60.41) and (1.79 60.40), respectively, while vig-
orous promotion of infants’ formula milk, powder, and
other breast milk substitutes had the lowest socio-
environment barriers for breastfeeding (1.52 60.50).
After categorizing the scale mean score, the results
showed that 140(36.0%) participants had low perceived
barriers compared to 240 (63.2%) participants who per-
ceived a high barrier.
The Predictors Associated With BF Practices Among
Mothers in Southern Jordan
The study investigated the predictors associated with
breastfeeding practices among mothers in Southern
Jordan. Nine socio-demographic variables were included
in the multinomial regression model, treating them as
categorical variables with the highest category as the
Figure 1. Pattern of feeding.
Table 2. Descriptive Statistics for Maternal Factors-Related Barriers Toward Breastfeeding.
Items Mean SD
Maternal factors
1. The mother does not have the desire to breastfeed 1.41 0.49
2. Women’s workloads 1.67 0.47
3. Breastfeeding is a tiring and stressful process 1.55 0.50
4. Insufficient breast milk 1.65 0.48
5. Breast issues such as sores or painful nipples, as well as mastitis 1.69 0.46
6. Presence of a mother’s illness that prevents breast feeding 1.67 0.47
7. Pregnancy before completing the duration of breastfeeding 1.62 0.49
8. Breastfeeding practice could disturb body image and breast shape 1.62 0.49
9. The mother’s lack of motivation as a result of her previous breastfeeding failure 1.45 0.50
10. The mother lacks the necessary skills to practice breast feeding 1.52 0.50
11. Breastfeeding is an embarrassing process in front of family members 1.68 0.47
12. Lack of knowledge about the benefits of breastfeeding for both the mother and the child 1.57 0.50
Mother’s barriers mean score 1.59 0.27
Level of mother-related barriers Perceived low barriers 200 (52.6%)
Perceived high barriers 180 (47.4%)
Al-Mawajdeh et al. 5
reference. Marital status was excluded from the analysis
due to singularities in the matrix, aimed at enhancing the
interpretability of the output. Only significant predictors
are presented in Table 5. The results demonstrate that
the model with the complete set of predictors outper-
forms the null model (X
2
[10] = 536.064, p\.001).
Table 3. Descriptive Statistics for Infant Factors-Related Barriers Toward Breastfeeding.
Infant factors Mean SD
1. The infant rejects breast milk 1.59 0.49
2. The infant feels hungry after breastfeeding 1.63 0.48
3. The baby is not gaining sufficient weight from breastfeeding 1.63 0.48
4. The presence of infant congenital abnormality that prevents
breastfeeding such as cleft lip or palate
1.67 0.47
Total mean score 1.63 0.37
Level of infant-related barriers Perceived low barriers 164 (43.2%)
Perceived high barriers 216 (56.8%)
Table 4. Descriptive Statistics for Socio-Environment Factors Related Barriers Toward Breastfeeding.
Items Mean SD
1. A lack of support from family or a partner 1.52 0.50
2. Inadequate support in health care facilities and in the community 1.60 0.49
3. Feeling of embarrassed about lactation in public places 1.76 0.43
4. A mother’s returning to work affects breastfeeding adversely 1.79 0.41
5. A lack of a nursery at workplace 1.79 0.40
6. Vigorous marketing of infant formula, milk powder, and other breast milk substitutes 1.42 0.49
Total mean score 1.65 0.32
Level of socio-environmental barriers Perceived low barriers 140 (36.8%)
Perceived high barriers 240 (63.2%)
Table 5. The Predictors Associated With Breastfeeding Practices.
Pattern of feeding Predictors BSEWald test
Adj odds
ratio pValue
95% CI for odds
ratio [lower, upper]
Mixed feeding Al-Karak province 21.029 0.403 6.538 0.357 .011 [0.162, 0.786]
Ma’an Reference
Secondary level or illiterate 20.940 0.453 4.305 0.391 .038 [0.161, 0.949]
Diploma 20.955 0.353 7.241 0.385 .007 [0.192, 0.771]
Higher diploma and university Reference
Housewives 2.227 0.872 6.516 9.268 .011 [1.677, 51.224]
Worker 1.797 0.879 4.176 6.032 .041 [1.076, 33.807]
Student Reference
Previous breastfeeding 1.139 0.434 6.867 3.122 .009 [1.332, 7.317]
No Reference
formula Feeding Diploma 21.380 0.462 8.905 0.252 .003 [0.102, 0.623]
Income \400 JD 21.529 0.773 3.910 0.217 .048 [0.048, 0.987]
600–800 JD 22.022 0.744 7.394 .132 .007 [0.031, 0.569]
.800 JD Reference
Having 2–3 children in the family 1.112 0.557 3.982 3.039 .046 [1.020, 9.054]
Having .4 children in the family Reference
NV delivery 21.716 0.383 20.116 0.180 .001 [0.085, 0.380
CS delivery Reference
Previous breastfeeding 21.142 0.498 5.248 0.319 .022 [0.120, 0.848]
Note. CI= confidence interval; OR = odds ratio.
**Statistically significant at level p\.05: The reference category is ‘‘exclusive breastfeeding.’’
6SAGE Open
Approximately 21.2% of the variance in the dependent
variable is collectively explained by mother’s age, educa-
tion level, work status, province of residence, family
income, family size, mode of delivery, smoking status,
and previous breastfeeding experience.
The findings in Table 5 reveal that individuals residing
in the Al-Karak province were 64.3% less likely to opt
for mixed feeding methods compared to those in the
Ma’an province (Adjusted Odds Ratio [AOR] 0.357,
95% Confidence Interval [CI] [0.162, 0.786]).
Additionally, individuals with secondary or lower educa-
tional levels (AOR 0.391, [0.161, 0.949]) and diploma
holders (AOR 0.385, [0.192, 0.771]) were 60.9% and
61.5% less likely, respectively, to choose mixed feeding
methods over breastfeeding when compared to those
with a higher diploma or university education.
Furthermore, housewives (AOR 9.268, 95% CI
[1.677, 51.224]) and working mothers (AOR 6.032,
[1.076, 33.807]) were more likely to select mixed feeding
methods over breastfeeding when compared to mothers
who are students. Additionally, mothers with prior
breastfeeding experience were 3.12 times ([1.332, 7.317])
more likely to choose mixed feeding methods.
Conversely, neither maternal age, family income, family
size, mode of delivery, nor smoking status emerged as
significant predictors (p..05).
On a different note, the likelihood of opting for artifi-
cial feeding over breastfeeding showed a 74.8% decrease
for diploma holders (AOR 0.252, 95% CI [0.102, 0.623])
compared to those with a higher diploma or university
education. Similarly, individuals with a monthly income
of \400 JD (AOR 0.217, [0.048, 0.987]) and 400 to
800 JD (AOR 0.132, [0.031, 0.569]) were 78.3% and
86.8% less likely, respectively, to choose artificial feeding
compared to those with an income .800 JD.
Regarding family size, mode of delivery, and previous
breastfeeding experience, the results indicate that moth-
ers with 2 to 3 children in the family were 3.03 times
(95% CI [1.020, 9.054]) more likely to opt for artificial
feeding over breastfeeding compared to those with .4
children. Mothers who had a vaginal delivery were
82.0% less likely to choose artificial feeding (AOR 0.180,
[0.085, 0.380]) compared to those who underwent a
cesarean section. Similarly, mothers with breastfeeding
experience were 68.1% less likely to opt for artificial
feeding (AOR 0.319, [0.120, 0.848]) compared to those
without. However, maternal age, work status, province
of residence, and smoking status did not emerge as sig-
nificant predictors (p..05).
Discussion
Our study delves a comprehensive discussion for the
observed BF practices and the array of factors
influencing these practices among mothers in Southern
Jordan. The significance of BF as the optimal source of
infant nutrition is widely acknowledged, and our find-
ings further underscore the importance of understanding
the barriers that impact the prevalence of BF.
In our study, we identified several key associations.
BF prevalence was positively linked with prior BF expe-
rience and family size, but inversely correlated with
cesarean delivery, maternal education level, maternal
employment, and family income. Notably, approxi-
mately 23.9% of mothers exclusively breastfed their
infants during the study period, mirroring the national
average of 25.5% in Jordan. This aligns closely with
WHO guidelines for favorable exclusive BF rates
(Department of Statistics and ICF International, 2018).
In 2017, Altamimi et al. reported a 20.9% exclusive
BF rate up to 6 months. Meanwhile, the Aqaba region
showcased a 19.8% rate for exclusive BF for the same
period (Dabbour, 2019). Notably, the northern part of
Jordan demonstrated a higher rate, with 33% of infants
being exclusively breastfed at 6 months (Khasawneh &
Khasawneh, 2017).
When assessing breastfeeding (BF) practices across
the Middle East, our findings reveal a notable alignment
with rates observed in Iraq and Egypt, while simultane-
ously uncovering distinctions of significance. In particu-
lar, our results mirror global trends, as demonstrated by
the parallel rates found in countries like Iraq, which
reported a rate of 26.47% (Kandeel et al., 2018; Sdeeq &
Saleh, 2021). It is imperative to underscore the variances
within this regional context. For instance, Iran boasts the
highest rate at 56.4%, a phenomenon potentially attribu-
table to its extended maternity leave policy, affording
mothers a generous 6 months compared to Jordan’s
3 months, supplemented by 2 weeks of paternity leave
(Alzaheb, 2017; Behzadifar et al., 2019). Conversely, Abu
Dhabi reported the lowest rate at 16.9%. This divergence
could be attributed to shorter paid maternity leave peri-
ods during the study; however, it is noteworthy that
recent legislation in the United Arab Emirates has intro-
duced extended fully paid maternity leave periods, rang-
ing from 2 to 3 months (Al Ketbi et al., 2018).
From a global perspective, the exclusive breastfeeding
rate in Ghana has seen an encouraging increase, with
66.0% of infants under 6 months benefitting from exclu-
sive breastfeeding (Asare et al., 2018). This upswing sig-
nals progress and emphasizes the dynamic nature of
breastfeeding practices on a global scale.
Examining the spectrum of feeding practices, we
observed an 18.42% prevalence of artificial feeding in
our sample group, a figure lower than previous studies,
which was less than that reported by Khasawneh et al.
(2017), who found that (24%) of infants received artifi-
cial feeding, and 25.4% in Aqaba, Jordan (Dabbour,
Al-Mawajdeh et al. 7
2019). However, in a recent study conducted in Erbil
city, the rate of artificial feeding was 10.1% (Sdeeq &
Saleh, 2021).
In contrast, mixed feeding, a customary practice in
many Arab nations, was observed among 57.63% of
mothers in our study. This prevalence demonstrated
slight deviations when compared to rates reported in Iraq
(63.4%) and Saudi Arabia (51%) (Orabi et al., 2017;
Sdeeq & Saleh, 2021). Conversely, in Egypt, a signifi-
cantly lower proportion (12.7%) resorted to mixed feed-
ing, with a preference for exclusive breastfeeding among
mothers (Kandeel et al., 2018).
Crucially, our study identified various barriers affect-
ing BF initiation and continuation. Cultural perceptions
and societal norms play a pivotal role. Mothers’ reluc-
tance to breastfeed in public or in the presence of family
members stems from deeply ingrained beliefs. This find-
ing resonates with similar studies conducted among dif-
ferent cultural groups like a previous study among
African-American women (Hinson et al., 2018). In addi-
tion, Jordanian culture discourages BF in a public places
(Altamimi et al., 2017; Hamlan et al., 2015). In China,
some people found it acceptable to breastfeed in public
places; however, others consider women’s breasts as sex-
ual organs and should be hidden from public view (Zhao
et al., 2017).
Breast-related issues, including sores, painful nipples,
and mastitis, emerged as frequently reported barriers by
mothers in southern Jordan in the current study, which
is consistent with previous studies (Elyas et al., 2017;
Hamlan et al., 2015; Hinson et al., 2018). Surprisingly,
even with access to medical assistance, mothers still
encounter difficulties. This highlights the need for
enhanced post-discharge support and adherence to the
Ten Steps to Successful Breastfeeding (WHO, 2018).
Regarding infant-related barriers, the primary obsta-
cle identified by mothers in Southern Jordan, based on
their perception and with the highest score, is the pres-
ence of congenital abnormalities, such as cleft lip or
palate, which can hinder breastfeeding. This finding
aligns with a study conducted in Vietnam, where it was
similarly observed that infant illness is strongly associ-
ated with suboptimal breastfeeding practices (Nguyen
et al., 2021).
It is evident that a cultural myth regarding breastfeed-
ing exists among mothers in southern Jordan. This myth
revolves around the belief that infants feel hungry after
breastfeeding and do not gain sufficient weight from it.
Such misconceptions stem from the perception that
breast milk might lack adequate nutrition, leading to
concerns about the adverse effects on the mother’s health
and subsequently prompting the initiation of artificial
feeding. These findings align with previous studies con-
ducted in the United Arab Emirates, Iraq, and Jordan,
which also identified these misconceptions as the primary
reasons for discontinuing breastfeeding (Al Ketbi et al.,
2018; Hamlan et al., 2015; Sdeeq & Saleh, 2021). To
address this issue, step 8 of successful breastfeeding
emphasizes training mothers to identify the signs of their
children’s desire for nourishment, cuddling, and rest, and
enables them to respond according to the child’s needs
(WHO, 2018).
When considering the socio-environmental aspect, the
primary reason for discontinuing breastfeeding is moth-
ers’ work obligations, coupled with the absence of work-
place nurseries. These findings align with several studies
conducted on the subject (Al Ketbi et al., 2018; Hamlan
et al., 2015).
In our study, the barrier of ‘‘Mothers who do not have
the desire to breastfeed’’ was reported the least. This
finding is consistent with a previous study conducted in
California, where mothers expressed feelings of shame
and guilt for being unable to breastfeed their infants
(Asiodu et al., 2016).
A small percentage of the mothers in our study high-
lighted the lack of family or partner support as a barrier
to breastfeeding. This finding mirrors those observed in
developed countries (Asiodu et al., 2016; Hinson et al.,
2018) and Middle Eastern countries such as Jordan,
Saudi Arabia, and Iraq (Khasawneh et al., 2020; Orabi
et al., 2017; Sdeeq & Saleh, 2021). Consequently, it is
essential to provide instructions and interventions that
encourage husbands and grandmothers to actively sup-
port breastfeeding.
Our study identified some demographic characteristics
that predict success or act as barriers to BF. The mode of
delivery is one of the main factors affecting breastfeeding.
Mothers who gave birth vaginally used less artificial feed-
ing than mothers who gave birth via cesarean section,
which is consistent with previous research conducted in
China, Iran, and Jordan (Behzadifar et al., 2019; Chen
et al., 2018; Khasawneh & Khasawneh, 2017 was the
main barrier to initiation and continuation of BF among
these mothers. Therefore, these mother’s needs help and
advice after delivery (Kim et al., 2017).
In our study, mothers with previous BF experience
were less likely to choose artificial feeding than BF
explained by previous practice and their ability to bal-
ance the family’s needs with the infant’s need; which was
one of the main predictive factor for the success BF.
This finding is inconsistent with other studies (Huang
et al., 2019; Khasawneh & Khasawneh, 2017).
Mothers with diplomas and secondary levels are less
likely to select mixed feeding and artificial feeding meth-
ods as opposed to BF compared with mothers with
higher diplomas and university degrees. This is consistent
with findings from studies conducted in Iran and Ghana
(Asare et al., 2018; Behzadifar et al., 2019). And in
8SAGE Open
contrast with a study conducted in China which revealed
that higher education levels are associated with a high
prevalence of breastfeeding (Li et al., 2021). This guides
us to focus on mothers with higher educational levels to
increase their ability to breastfeed and to identify the
barriers that prevent them from practicing breastfeeding.
Mothers with lower educational levels can be educated
by conducting workshops and health education pro-
grams on breastfeeding benefits and techniques.
Finally, our study explains the complex interplay of
factors shaping breastfeeding practices among mothers
in southern Jordan. It highlights the need for targeted
interventions that consider cultural, social, and economic
determinants. Our findings offer valuable insights for
policymakers, healthcare professionals, and researchers,
emphasizing the importance of comprehensive support
systems to foster optimal breastfeeding practices.
Limitation
Our study has several limitations. Firstly, its cross-
sectional design relies on retrospective reporting of BF
practices, potentially introducing bias. Additionally,
despite employing random sampling of health centers,
the generalizability of our findings is restricted by the use
of convenience sampling.
Conclusions
In summary, this study has yielded valuable insights into
the breastfeeding practices and barriers faced by mothers
in four Provinces of South Jordan. The prevalence of dif-
ferent feeding methods was examined, with a specific
focus on identifying predictors and barriers associated
with not exclusively breastfeeding.
The findings indicate that mixed feeding is the predo-
minant method of feeding in South Jordan. The deci-
sions made by mothers to not exclusively breastfeed are
influenced by various barriers that hinder this practice.
It is crucial to address these barriers in order to promote
breastfeeding.
The implications of this research extend to healthcare
professionals, policymakers, and stakeholders.
Healthcare providers, such as nurses and midwives, can
utilize these findings to recognize the barriers that
impede exclusive breastfeeding and tailor their educa-
tional efforts accordingly. We recommend implementing
prenatal and early postpartum education programs that
enhance maternal knowledge about breastfeeding.
Additionally, integrating regular lactation consultant
counseling sessions, particularly for new mothers, is
highly recommended. Creating a supportive work envi-
ronment that provides clean, private, and safe spaces for
lactation is a critical aspect of promoting exclusive
breastfeeding. Policies that enable and encourage breast-
feeding within workplaces should be emphasized.
To ensure continuous skilled lactation support, we
advocate for the development of seamless systems that
connect hospitals and community healthcare settings.
This collaboration can significantly contribute to enhan-
cing breastfeeding practices and support.
In essence, our study highlights the importance of
addressing barriers to exclusive breastfeeding in South
Jordan. By promoting education, supportive policies,
and continuous lactation support, we can foster a culture
that prioritizes optimal infant nutrition and maternal
well-being.
Acknowledgments
I greatly appreciate the advice and encouragement of my chair-
person, Professor Hala Obeidat. Appreciation is expressed to
Mu’tah University, Al-Karak, Jordan, Jordanian Royal
Medical Services (JRMS), and Princess Muna College of
Nursing.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical Statement
This study was approved by Ministry of Health (Reference
Number 2022/1557).
ORCID iD
Sajeda Reyad Al-Mawajdeh https://orcid.org/0000-0002-
4191-2773
Data Availability Statement
The datasets generated during and/or analyzed during the cur-
rent study are available in the Zenodo repository 10.5281/
zenodo.14052087.
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