The impact of COVID-19 on breastfeeding rates: An international cross-sectional study

Ana Ganho-Ávila, Raquel Guiomar, Mónica Sobral, Francisca Pacheco, Rafael A. Caparros-Gonzalez, Carla Diaz-Louzao, Emma Motrico, Sara Domínguez-Salas, Ana Mesquita, Raquel Costa, Eleni Vousoura, Eleni Hadjigeorgiou, Rena Bina, Rachel Buhagiar, Vera Mateus, Yolanda Contreras-García, Claire A. Wilson, Erilda Ajaz, Camellia Hancheva, Pelin Dikmen-YildizAlejandro de la Torre-Luque

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 impact 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, physical/mental health, professional perinatal care, changes in healthcare due to the pandemic, COVID-19 related, 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 breastfeeding rates across countries (first six months postpartum). Overall, first child (β = -0.27), age of the child (β = -0.29), preterm birth (β = -0.52), admission to the neonatal/pediatric care (β = -0.44), lack of breastfeeding support (β = -0.18), current psychiatric treatment (β = -0.69) and inequality (β = -0.71) were negatively associated with breastfeeding (p <.001). Access to postnatal support groups was positively associated with breastfeeding (β = 0.59; p <.001). In countries with low-inequality, governmental measures to contain virus transmission had a deleterious effect on breastfeeding (β = -0.16; p <.05) while access to maternity leave protected breastfeeding (β = 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 treatment. The complex associations between covariates and breastfeeding vary across countries, suggesting the need to define context-specific measures to support breastfeeding.

Original languageEnglish
Article number103631
StatePublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Ltd


This study is supported by the Portuguese Foundation for Science and Technology (FCT) Grants to MS (2021.07006.BD), RG (2020.05099.BD), and AGA (2020.02059.CEECIND). Carla Díaz-Louzao was supported by the Primary Care Prevention and Health Promotion Research Network redIAPP (Instituto de Salud Carlos III-ISCIII/RD16/0007/0006/Co-funded by FEDER), and by the project ED431C 2020/20 , co-financed by the “ Consellería de Cultura Educación e Ordenación Universitaria da Xunta de Galicia ”. Rena Bina was supported by the Bar-Ilan Dangoor Centre for Personalized Medicine. Vera Mateus received financial support from CAPES/PrInt grant nº. 88887.583508/2020-00. EPIUnit - UIDB/04750/2020, ITR - LA/P/0064/2020, and HEILab - UIDB/05380/2020 are supported by Portuguese fundings through FCT - Fundação para a Ciência e a Tecnologia, IP. Raquel Costa has a Postdoctoral grant supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). Ana Mesquita was supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program - IF/00750/2015. The Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, is supported by FCT through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020). Claire A Wilson is funded by the UK's National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer. The Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences of the University of Coimbra is supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Education and Science through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement [UID/PSI/01662/2013]. This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138.

FundersFunder number
Center for Research in Neuropsychology and Cognitive and Behavioral Intervention
Instituto de Salud Carlos III-ISCIII/RD16/0007
PrIntLA/P/0064/2020, 88887.583508/2020-00
Australian German Association2020.02059
National Institute for Health and Care Research
European CommissionPSI/01662, IF/00750/2015, UIDB/PSI/01662/2020
European Cooperation in Science and TechnologyCA18138
Fundação para a Ciência e a Tecnologia2020.05099, 2021.07006
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Ministério da Educação e Ciência
European Social FundSFRH/BPD/117597/2016
Consellería de Cultura, Educación e Ordenación Universitaria, Xunta de Galicia
European Regional Development FundED431C 2020/20


    • Breastfeeding
    • COVID-19
    • Cross-countries
    • Perinatal health
    • SARS-CoV-2


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