Exclusive breastfeeding practices among socioeconomically disadvantaged Turkish and refugee mothers in Türkiye: a cross-sectional study
This cross-sectional study in Istanbul reveals that socioeconomically disadvantaged refugee mothers in Türkiye exclusively breastfeed their infants at significantly higher rates and for longer durations than their Turkish counterparts, despite receiving less professional counseling, suggesting that cultural and behavioral factors play a crucial role in breastfeeding practices independent of socioeconomic status.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Breastfeeding is one of the most powerful tools for keeping infants healthy and helping mothers recover after birth. For the first six months of a baby's life, health experts recommend feeding them nothing but breast milk, a practice that protects against infection, supports growth, and builds a strong bond between mother and child. Yet, in many parts of the world, families face barriers that make this difficult. Poverty, lack of education, and limited access to medical advice often push mothers toward formula or mixed feeding, even when they wish to breastfeed. This is especially true for refugee families, who have fled their homes and must navigate new languages, unstable housing, and unfamiliar healthcare systems. Usually, when researchers look at these challenges, they assume that difficult economic conditions are the main reason breastfeeding rates drop. But this assumption leaves out a crucial question: do cultural traditions and family habits play a role that money alone cannot explain?
To find the answer, a researcher named Ömer Akçağıl conducted a study in Istanbul, Türkiye, focusing on two groups of mothers who were already struggling with similar financial hardships. One group consisted of Turkish mothers, and the other consisted of refugee mothers, mostly from Syria. Both groups were registered with social assistance programs because they had low incomes and needed government support. By choosing families who were already in the same economic boat, the researcher could see if being a refugee changed how they fed their babies, independent of their poverty. The study involved face-to-face interviews with 174 mothers who had at least one child under the age of three. The researcher asked detailed questions about how they fed their infants, whether they received advice from nurses, if they used pacifiers, and how long they breastfed.
The results revealed a surprising pattern. Overall, about 56 percent of all the babies in the study were fed exclusively with breast milk for the first six months. However, when the researcher looked closer at the two groups, a clear difference emerged. The refugee mothers were significantly more likely to stick to exclusive breastfeeding than the Turkish mothers. Nearly 68 percent of the refugee mothers fed their babies only breast milk for the first six months, compared to just 47 percent of the Turkish mothers. The refugee mothers also breastfed exclusively for a longer time, with a median duration of five months, while the Turkish mothers stopped exclusive breastfeeding after about four months. This difference was not a small fluctuation; it was a consistent trend that held true even after the researcher accounted for other factors.
What made this finding even more striking was the support these mothers received. The study found that refugee mothers were actually less likely to have received formal breastfeeding counseling from healthcare professionals than the Turkish mothers. Only about 68 percent of the refugee mothers said they had been taught how to breastfeed by a nurse, whereas 82 percent of the Turkish mothers had received such guidance. If lack of advice were the main problem, the refugee mothers should have struggled more. Instead, they succeeded more. The researcher also looked at the use of pacifiers, which are sometimes linked to shorter breastfeeding durations. Refugee mothers were much less likely to give their babies a pacifier in the first month of life, with only 8 percent doing so, compared to 25 percent of the Turkish mothers. This suggests that the refugee mothers might have relied more on traditional family habits and cultural norms that favor breastfeeding without the need for extra medical instruction.
The study did not find that these advantages lasted forever. When the researcher looked at whether mothers continued to breastfeed after two years, there was no difference between the two groups. About 32 percent of the refugee mothers and 28 percent of the Turkish mothers were still breastfeeding at that age. This indicates that while cultural traditions and family support might help a mother start and maintain exclusive breastfeeding in the early months, keeping that practice going for years depends on other factors, such as returning to work or finding childcare, which affect both groups equally.
The main takeaway from this work is that money and poverty are not the only things that decide how a baby is fed. Even when families face the same economic struggles, their cultural background and family habits can lead to very different outcomes. The refugee mothers in this study managed to breastfeed more successfully than their Turkish neighbors, despite having less access to professional advice and facing the added stress of displacement. This suggests that strong cultural beliefs about breastfeeding can act as a powerful support system, helping mothers succeed even when the system around them is difficult to navigate. The study does not prove that one group is better than the other, but it does show that public health efforts need to look beyond just providing money or medical advice. To help all vulnerable families, health programs must understand and respect the cultural strengths that families already bring with them, using those traditions as a foundation for better health.
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