Effect of Couple-Based Breastfeeding Education and Support Intervention on Optimal Breastfeeding Practice in Hadiya Zone, Central Ethiopia: A Cluster-Randomized Controlled Trial.

Abstract

Background: Optimal breastfeeding is essential for the survival, growth, and development of children, as well as the health of mothers. Globally, optimal breastfeeding practices are still low: only 42% of newborns start breastfeeding (BF) within the first hour of birth, 41% of infants less than 6 months of age are exclusively breastfed, and only 45% of mother’s breastfeed for at least two years. Every year, it is estimated that optimal breastfeeding practices might avoid 823,000 child deaths. However, breastfeeding practices are not optimal in Ethiopia. Male partners play a vital but frequently neglected role in the promotion of breastfeeding practices, and they are currently not included in health-care providers' breastfeeding education. The effect of couple-based breastfeeding interventions on optimal breastfeeding has not been studied in the Ethiopian context. Therefore, the objective of this study was to evaluate the effect of couple-based breastfeeding education and support on optimal breastfeeding practice in Hadiya Zone, central Ethiopia. Methods: A cluster-randomized controlled trial and phenomenological qualitative study design was conducted to evaluate the effect of couple-based breastfeeding education and support on optimal breastfeeding practice compared to routine care at the community level. The intervention was provided to the mothers and male partners by trained health care workers selected from nearest health center. The mothers and male partners in the Intervention Group (IG) were received both antnatal and postnatal breastfeeding education and support starting from their 3rd trimester of pregnancy till 6 month post-delivery, but those in the Control Group (CG) was received routine care. The breastfeeding education and support intervention is comprised of three components: 1) group education, 2) providing specific take-home print materials, 3) Individual home visit. A total of 408 couples in their third trimenster pregnancy were recruited to either the intervention group (204) or a control group (204) from 16 clusters (Kebeles) and the duration of the intervention was 9 months. Epi-data version 3.1 was used to enter data, SPSS for Windows version 23 and STATA version 14.0 were used to analyze the data. DID and Generalized Estimating Equation (GEE) model was used to deteremine the effect of the intervention on optimal breastfeeding practice. P values < 0.05 were used to declare statistical significance. A thematic analysis was performed by using Atlas Ti7 software for qualitative study. Result: In the qualitative study, four themes and 9 sub-themes emerged from mothers’ and fathers’ experience of male partners’ support for optimal breastfeeding practices. The themes include the following: sociocultural barriers to male support; emotional and practical support; xii education and exposure access for fathers; and economic hardships and work-related barriers. The couple-based breastfeeding support intervention showed meaningful improvements in both parental behaviors and infant health. Mothers who received the intervention alongside their partners were significantly more likely to practice optimal breastfeeding and reported higher confidence in their ability to breastfeed. Compared to those receiving routine care, the intervention group saw a 17.5% increase in optimal breastfeeding practices and a 20.9% boost in mothers’ breastfeeding self-efficacy. Male partners also showed notable progress: their knowledge about breastfeeding improved by 25.3%, their attitudes became 24.9% more supportive, and their practical support increased by 30.9%. These changes were not only statistically significant but also practically important. Further analysis using the GEE model confirmed that mothers in the intervention group were 38% more likely to breastfeed optimally and 48% more likely to feel confident about breastfeeding. Their male partners were 61% more likely to be knowledgeable, 59% more likely to have a favorable attitude, and 78% more likely to actively support breastfeeding. Most strikingly, the intervention had a powerful effect on infant health: infants whose parents received this support experienced a 92.7% reduction in reported illness during the intervention period. These findings make it clear that when both mothers and fathers are engaged in breastfeeding support, the benefits ripple across the family, improving knowledge, changing attitudes, strengthening confidence, and ultimately protecting the health of children. Conclusion and Recommandation: The study indicated that involving fathers in breastfeeding support made a big difference. Parents who took part in the intervention saw clear improvements: mothers were optimal and felt more confident in breastfeeding, and fathers became more knowledgeable, had more positive attitudes, and gave stronger support. The study also found that when fathers were more involved, breastfeeding practices improved, and babies were much healthier, with a significant drop in illness. At the same time, the interviews with mothers and fathers showed that while many dads wanted to help, they faced challenges like cultural expectations, lack of information, work pressures, and financial strain. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT05173454, First registered on 30/12/2021