Determinants of exclusive breastfeeding for wāhine Māori.

Aim: Breastfeeding is a fundamental aspect of tikanga Māori (Māori cultural traditions/practices) requiring protection and promotion. This study identifies determinants of exclusive breastfeeding in wāhine Māori.

Methods: Wāhine Māori enrolled in the Growing Up in New Zealand child cohort study participated (n=1060). Exclusive breastfeeding duration was self-reported. Hierarchical regression analyses were framed by a model of Māori health and wellbeing.

Results: Most wāhine Māori initiated breastfeeding (96%), with 12% exclusively breastfeeding for six or more months. Wāhine Māori had increased odds of exclusively breastfeeding for six or more months if they: thought it best to breastfeed for >6 months (adjusted odds ratio (aOR)=1.94, 95% confidence interval (CI)=1.05-3.78); thought returning to work would not (aOR=2.17, 95% CI=1.17-4.24) or may (aOR=4.25, 95% CI=1.86-9.85) limit breastfeeding; were experienced mothers (aOR=2.55, 95% CI=1.35-5.06); or were undecided about vaccination (aOR=3.16, 95% CI=1.55-6.39). Exclusive breastfeeding for six or more months was less likely if mothers experienced depression during pregnancy (aOR=0.47, 95% CI=0.20-0.99) or viewed cultural traditions/practices as "fairly important" (aOR=0.53, 95% CI=0.27-0.99), compared to "very important".

Conclusion: Determinants of exclusive breastfeeding in wāhine Māori are knowledge of breastfeeding recommendations, return to work, motherhood experience, connection to Te Ao Māori (Māori worldview) and tikanga Māori, antenatal depression and vaccine indecision. Interventions delivered within a Kaupapa Māori framework will best address breastfeeding inequities in Aotearoa New Zealand.