Background/Significance: Breastfeeding has been identified as the most complete form of infant nutrition in the first six months of infant life. The World Health Organization (WHO) recommends exclusive breastfeeding throughout the first six months. Adherence to the WHO recommendation of breastfeeding is important to lay a healthy foundation for infant growth and development. However, there has been a noticeable decline in the rate of exclusive breastfeeding in the Kingdom of Saudi Arabia (KSA). There is a lack of literature that examines theory-based factors associated with breastfeeding practice among Saudi Arabian mothers; thus, the causes that underlie the low rate of breastfeeding have not yet been established.Framework: The conceptual framework for this study was guided by the breastfeeding self-efficacy theory.Aims: The aims of the study were to examine: 1) the associations between perceived stress and the practice of breastfeeding among first-time Saudi Arabian mothers, 2) the association between social support and the practice of breastfeeding among first-time Saudi Arabian mothers, and 3) the association between breastfeeding self-efficacy and the practice of breastfeeding among first-time Saudi Arabian mothers at six to twelve months after birth.Methods: This study used a cross-sectional, correlational design. A non-random convenience sample of 160 first-time mothers was recruited from four primary care centers in Jeddah, KSA. Multinomial logistic regression model was employed to examine the three aims. The associations between the demographic variables in this study and the three breastfeeding categories (exclusive, partial and discontinued breastfeeding) were examined using One-way analysis-of-variance (ANOVA), Pearson's chi-square test, and Fisher's exact test. Results: The mean age of participants was 27.21 years. The proportions of exclusive, partial, and discontinued breastfeeding in the study sample were 27.5%, 30.00%, and 42.5%, respectively. Mothers who had higher levels of perceived stress were significantly more likely to discontinue breastfeeding before the recommended six months. Mothers with higher levels of social support were significantly more likely to continue breastfeeding throughout the first six months after birth. Likewise, mothers with higher levels of breastfeeding self-efficacy were more likely to continue exclusive or partial breastfeeding throughout the first six months. There were significant associations between breastfeeding practice, maternal employment status, household income, and educational level. Implications: This study indicated that mothers with lower levels of perceived stress, higher levels of social support, and higher levels of breastfeeding self-efficacy were more likely to continue breastfeeding until at least six months postpartum. Clinicians should empower mothers with psychosocial resources to promote the practice of breastfeeding. Moreover, there is a need for policy that mandates assessment of psychosocial factors during prenatal and postnatal care. Findings from this study lay the foundation for future intervention research through identifying the theory-based factors that are associated with breastfeeding.
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