Determinants and Prevalence of Exclusive Breastfeeding Among Thai Muslim Mothers: A Cross-sectional Analysis


  • Sirinporn Sukarawan PhD (Candidate), Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Darawan Thapinta Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Piyanut Xuto Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Nonglak Chaloumsuk Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.



Breastfeeding self-efficacy, Exclusive breastfeeding, Muslim mothers, Predicting factors, Thailand


Exclusive breastfeeding is pivotal for the health and development of infants and offers numerous benefits to mothers. However, unique cultural beliefs and practices, particularly among Muslim communities, can significantly influence breastfeeding behaviors. This study sought to elucidate the factors influencing exclusive breastfeeding among Thai Muslim mothers. The sample was 168 postpartum Muslim mothers from well-baby clinics in southern Thailand, selected through multi-stage random sampling. Data were collected from June to December 2022 employing the Demographic Data Form, Infant Feeding Intentions Scale, Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale, Breastfeeding Self-Efficacy Scale -Short Form, Maternal Health Literacy Scale, Islamic Belief Scale, Exclusive Breastfeeding Social Support, and Breastfeeding Practices Questionnaire. Data were analyzed using descriptive statistics, Spearman rank’s correlation, and binary logistic regression analysis.

The study found that the rate of exclusive breastfeeding among Thai Muslim mothers at six months postpartum was 54.8%. Notably, breastfeeding self-efficacy emerged as the sole predictor of exclusive breastfeeding, accounting for 11% of the variance in this practice. These findings underscore the critical role of breastfeeding self-efficacy in promoting exclusive breastfeeding. It is recommended that nurses and healthcare professionals develop culturally tailored support programs that enhance breastfeeding self-efficacy, aligned with Islamic beliefs, to improve breastfeeding practices among Muslim mothers.


World Health Organization. Indicators for assessing infant and young child feeding practices: definitions and measurement methods. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF); 2021. Available from:

Krbavčić IP, Vukomanović A. Breastfeeding: health benefits and dietary recommendations. Croatian J Food Technology Biotechnology Nutrition. 2021; 16(1-2):3-10. doi: 10.31895/hcptbn.16.1-2.1 DOI:

Couto GR, Dias V, Oliveira IDJ. Benefits of exclusive breastfeeding: an integrative review. Nurs Pract Today. 2020;7(4): 245–54. doi:10.18502/npt.v7i4.4034. DOI:

Walters DD, Phan LTH, Mathisen R. The cost of not breastfeeding: global results from a new tool. Health Policy Plan. 2019;34(6):407-17. doi: 10.1093/heapol/czz050. DOI:

World Health Organization, United Nations Children’s Fund. Global breastfeeding scorecard, 2019: increasing commitment to breastfeeding through funding and improved policies and programmes. 2019 July 23 [cited 2023 Aug 19]. Available from:

World Health Organization. Infant and young child feeding. 2021 June 9 [cited 2023 Aug 19]. Available from:

National Statistical Office of Thailand. Thailand multiple indicator cluster survey 2019, Survey findings report. Bangkok, Thailand: National Statistical Office of Thailand; 2020 Aug [cited 2023 Aug 19]. Available from:

Bensaid B. Breastfeeding as a fundamental Islamic human right. J Relig Health. 2021;60(1):362-73. doi: 10.1007/s10943-019-00835-5. DOI:

Khasawneh W. Breastfeeding practices, facilitators, and barriers among immigrant Muslim Arab women living in a metropolitan area of the Southwest of United States [dissertation]. [Phoenix]: Arizona State University; 2017.100 p.

Budiati T, Setyowati S. The influence culture and maternal care on exclusive breastfeeding practice in post caesarean section mothers. Enferm Clin. 2019;29(Suppl2):808–14. doi: 10.1016/j.enfcli.2019.04.121. DOI:

Bandura A. National Institute of Mental Health. Social foundations of thought and action: a social cognitive theory. New Jersey, USA: Prentice-Hall; 1986.

Nommsen-Rivers LA, Dewey KG. Development and validation of the Infant Feeding Intentions Scale. Matern Child Health J. 2009;13(3):334-42. doi: 10.1007/s10995-008-0356-y. DOI:

Bandura A. Toward a psychology of human agency. Perspect Psychol Sci. 2006;1(2):164-80. doi: 10.1111/j.1745-6916.2006.00011.x. DOI:

Alyousefi NA. Determinants of successful exclusive breastfeeding for Saudi mothers: social acceptance is a unique predictor. Int J Environ Res Public Health. 2021; 18(10):5172. doi: 10.3390/ijerph18105172. DOI:

Guttersrud Ø, Naigaga MD, Pettersen KS. Measuring maternal health literacy in adolescents attending antenatal care in Uganda: exploring the dimensionality of the health literacy concept studying a composite scale. J Nurs Meas. 2015; 23(2):50E-66. doi: 10.1891/1061-3749.23.2.E50. DOI:

Chanapai S, Sinsuksai N, Thananowan N, Phahuwatanakorn W. Knowledge, attitude, self-efficacy, spousal and nurse support predicting 6-weeks exclusive breastfeeding. Nurs Sci J Thail. 2014;32(1):51-60 (in Thai).

Alfianrisa A, Salimo H, Poncorini E. Factors associated with exclusive breastfeeding: application of PRECEDE-PROCEED model and theory of planned behavior. JMCH. 2017;2(1):42–53. doi: 10. 26911/thejmch.2017.02.01.05. DOI:

Tangsuksan P, Ratinthorn A, Sindhu S, Spatz DL, Viwatwongkasem C. Factors influencing exclusive breastfeeding among urban employed mothers: a case-control study. Pacific Rim Int J Nurs Res. 2020;24(1): 54–72.

De la Mora A, Russell DW, Dungy CI, Losch M, Dusdieker L. The Iowa Infant Feeding Attitude Scale: analysis of reliability and validity. J Appl Soc Psychol. 1999;29(11):2362-80. doi: 10.1111/j.1559-1816.1999.tb00115.x. DOI:

Bandura A. Social learning theory of aggression. J Commun. 1978;28(3):12-29. doi: 10.1111/j.1460-2466.1978.tb01621.x. DOI:

Syahputri RB, Pawito P, Murti B. Factors affecting exclusive breastfeeding using social cognitive theory constructs: a multilevel evidence from Madiun, East Java. J Health Promotion Behavior. 2020;5(3):169–73. doi: 10.26911/thejhpb.2020.05.03.03. DOI:

Hosseini F, Rasekhi A, Lamyian M. Investigating the relationship between breastfeeding duration and health literacy in primiparous women referring to tehran health centers: an application of Bayesian Poisson regression model. J Biostat Epidemiol. 2019;5(1):12–17. doi: 10.18502/jbe.v5i1.1902. DOI:

Hoseini F, Rasekhi A, Myandoab M. Investigating the relationship between exclusive breastfeeding and health literacy in primiparous women. Sci Res J. 2018; 26(4):31–6.

Dennis CL. The Breastfeeding Self-Efficacy Scale: psychometric assessment of the short form. J Obstet Gynecol Neonatal Nurs. 2003;32(6):734-44. doi: 10.1177/0884217503258459. DOI:

Nisman WA, Aryas D, Ratnasari E, Widya M, Yonanta N, Rahmasari S, et al. Infant feeding practices and analysis of factors affecting exclusive breastfeeding. J Keperawatan Soedirman. 2021;16(3):101–8. doi: 10.20884/1.jks.2021.16.3.1726. DOI:

Kamariyah N, Saleh NR. Islamic perspective on the effect of exclusive breastfeeding on prolactin levels and children development during 6–12 months in East Java, Indonesia. J Public Health Afr. 2019;10(S1):1192. doi: 10.4081/jphia.2019.1192. DOI:

Boateng GO, Martin SL, Collins SM, Natamba BK, Young SL. Measuring exclusive breastfeeding social support: scale development and validation in Uganda. Matern Child Nutr. 2018;14(3):e12579. doi: 10.1111/mcn.12579. DOI:

Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston, USA: Allyn & Bacon/Pearson Education; 2007.

Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psychol. 1970;1(3):185-216. doi: 10.1177/135910457000100301. DOI:

Thussanasupap B. The effects of a systematic instructional program on breastfeeding self-efficacy, nipple pain, nipple skin changes and incision pain of cesarean mothers [master's thesis]. [Bangkok]: Mahidol University; 2006.

Wiersma W, Jurs SG. Research methods in education: an introduction. 9th ed. Boston, USA: Pearson; 2009.

Plichta SB, Kelvin EA. Munro’s statistical methods for health care research. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2012.

Alam B, Rony MA, Islam MA, Hasan MK, Khan KK. Socioeconomic factors influencing breastfeeding duration in Bangladesh: an analysis of the Bangladesh demographic and health survey. medRxiv preprint. 2023 Oct 15. doi: 10.1101/2023.10.15.23297049. DOI:

Hassan SM. Religious practices of Muslim women in the UK during maternity: evidence-based professional practice recommendations. BMC Pregnancy Childbirth. 2022 19;22(1):335. doi: 10.1186/s12884-022-04664-5. DOI:

Topothai C, Topothai T, Suphanchaimat R, Waleewong O, Putthasri W, Patcharanarumol W, Tangcharoensathien V. Exclusive breastfeeding experiences of Thai mothers in Metropolitan Bangkok. Int J Womens Health. 2022;14: 155-66. doi: 10.2147/IJWH.S344389. DOI:

Mirjalili N, Ansari Jaberi A, Ansari Jaberi K, Negahban Bonabi T. The role of maternal health literacy in breastfeeding pattern. J Nurs Midwifery Sci.2018;5:53-8. doi: 10.4103/ JNMS.JNMS_21_18. DOI:

Alves MD, Almeida MA, Gomes CDB, Ferrari AP, Parada CM, Carvalhaes MA. Longer duration of exclusive breastfeeding reduces maternal weight retention: results from the CLaB study. Rev Bras Saude Mater Infant. 2020;20(1):273–84. doi: 10.1590/1806-93042020000100015. DOI:

Ngamnil N, Kaewkiatttikun K. Prevalence of exclusive breastfeeding among adolescent mothers in Bangkok. Thai J Obstet Gynaecol. 2019;27(2):79-87. doi: 10. 14456/tjog.2019.11.

Soltani S, Hosseinzadeh M, Mirghafourvand M, Aghajari P, Burns E. Breastfeeding challenges and the impact of social support in Iranian Muslim mothers: a cross-sectional study. Women Health. 2024;64(2):142-52. doi: 10.1080/03630242.2024.2304898. DOI:

Ichsan B, Probandari AN, Pamungkasari EP, Salimo H. Barriers and support to exclusive breastfeeding in Sukoharjo district, Central Java province, Indonesia: a qualitative study. J Health Res. 2021;35(6):482–92. doi: 10.1108/jhr-12-2019-0274. DOI:




How to Cite

Sukarawan S, Thapinta D, Xuto P, Chaloumsuk N. Determinants and Prevalence of Exclusive Breastfeeding Among Thai Muslim Mothers: A Cross-sectional Analysis. PRIJNR [Internet]. 2024 Mar. 21 [cited 2024 May 23];28(2):390-406. Available from: