Trends and Determinants of Exclusive Breastfeeding in Turkey: A Trend Analysis and Determinants Analysis of Four Demographic and Health Surveys,2003

Abstract

Turkish

Background;

This study aimed to examine temporal trends in exclusive breastfeeding (EBF) rates among infants aged 0–5 months in Turkey and to identify determinants of EBF using a comprehensive national-level approach.

Methods;

The research was based on a pooled secondary analysis of data from the 2003, 2008, 2013, and 2018 Turkish Demographic and Health Surveys.

Results:

Analyses revealed that EBF rates in Turkey showed an increasing trend over time, but when 2018 was taken as a reference, the likelihood of EBF in 2003 was significantly lower (adjusted odds ratio [aOR] = 0.37, 95% CI 0.22–0.64). The likelihood of EBF was higher among second-born infants than among firstborns (aOR = 1.85, 95% CI 1.17–2.92) and among mothers who gave birth for the first time between the ages of 25 and 34 years compared with those aged 18–24 years (aOR = 1.97, 95% CI 1.19–3.26). In contrast, the likelihood of EBF was lower in infants perceived as very large or larger than average compared with those perceived as average or smaller than average (aOR = 0.51, 95% CI 0.29–0.90) and among those living in the southern region compared with the West (aOR = 0.47, 95% CI 0.27–0.84). No significant association was found with socioeconomic status or mode of delivery.

Conclusions:

Although EBF rates in Turkey have increased, gains remain inconsistent and below World Health Organization targets. Findings demonstrate that breastfeeding success is shaped by maternal experience, maternal age, and regional inequalities. Strategies targeted specifically for primiparous mothers, younger age groups, and high-risk regions are essential.

Keywords

breastfeeding duration cross-sectional study exclusive breastfeeding health policy Turkey

Background

Breast milk contains all the nutrients a baby needs during the first 6 months of life. Exclusive breastfeeding (EBF) is defined by the World Health Organization (WHO) as the practice of not giving any other liquids (including water) or solids, except for oral rehydration solutions, vitamins, minerals, or medicinal drops/syrups (World Health Organization [WHO] & United Nations Children’s Fund [UNICEF], 2021). Breast milk is of great importance not only for growth and development but also for a child’s health. Meta-analyses have found that the risk of death during the first 6 months of life is 88% lower in breastfed children. Breast milk reduces the risk of diarrhea and respiratory infections and lowers the risk of obesity and type 2 diabetes. For mothers, breastfeeding may lengthen birth intervals and reduce the risk of breast and ovarian cancers and type 2 diabetes (Victora et al., 2016).

In Turkey, according to data from the Turkish Demographic and Health Surveys (TDHS) from 2003 to 2018, the rate of EBF was 20.9% in 2003, rising to 42.3% in 2008, falling to 30.7% in 2013, and reaching 41.3% in 2018. Although this trend has fluctuated, it is similar to the slow but steady increase observed globally. This increase was largely driven by the Breastfeeding Promotion and Baby-Friendly Health Facilities Program, launched in 1991 and expanded to primary healthcare in 2002 (Çaylan et al., 2019; Hacettepe University Institute of Population Studies et al., 2004, 2009, 2014, 2019).

In studies conducted worldwide, the most prominent factors directly affecting EBF include birth weight, mode of delivery, ethnicity, income level, maternal education, maternal health status, and employment status (Kalhor et al., 2025; Odar Stough et al., 2019; Singh et al., 2024). In Turkey, a study in a Baby-Friendly hospital found that EBF was associated with prenatal breastfeeding education, parental education, delivery mode, planned pregnancy, pacifier and bottle use, nipple problems, and social support (Yılmaz et al., 2017). However, no national study in Turkey has comprehensively examined EBF trends and determinants over time. Therefore, identifying the factors underlying changes in EBF and comparing them with other countries have become necessary.

Key Messages

National evidence on trends and determinants of exclusive breastfeeding in Turkey is limited. This pooled analysis of four rounds of the Turkey Demographic and Health Surveys provides national-level evidence on EBF trends and determinants in Turkey.

Exclusive breastfeeding among infants aged 0–5 months increased but remained variable across survey years (20.9% in 2003, 42.3% in 2008, 30.7% in 2013, and 41.3% in 2018) and below World Health Organization targets.

Exclusive breastfeeding was higher among second-born infants and among mothers whose age at first birth was 25–34 years but lower when infants were perceived as larger than average and among households in the southern region.

No association was observed with socioeconomic status or mode of delivery, suggesting that interventions should prioritize first-time mothers and regions with persistently lower rates.

Research Aim

Accordingly, this study aimed to examine the temporal trend in EBF rates among infants aged 0–5 months and to identify factors associated with these rates using TDHS data collected between 2003 and 2018.

Methods

Study Design and Data Source

This study was a pooled secondary analysis of microdata from the 2003, 2008, 2013, and 2018 TDHS, which are conducted every 5 years by the Hacettepe University Institute of Population Studies (Hacettepe University Institute of Population Studies et al., 2004, 2009, 2014, 2019). Surveys conducted during these periods used a multistage, stratified cluster sampling design that ensured national representativeness. First, a household questionnaire was administered, followed by face-to-face structured interviews with women aged 15–49 years. Because the definition and measurement of EBF indicators have been consistent since 2003, the analysis was limited to these four survey periods.

Sample and Inclusion Criteria

The study population consisted of children born in the 6 months (0–5 months) preceding the survey date during each of the four TDHS survey periods (2003–2018) who were alive at the time of the interview and living with their mothers. Only singleton births were included in the analyses. Infant feeding information was collected using the 24-hour recall method, which is the standard approach in the TDHS. Women were asked whether their children had consumed specific foods in the last 24 hours. Certain observations were excluded from the study based on the selection criteria. An inclusion/exclusion flowchart is presented in Figure 1.

Variables

The dependent variable of the study was exclusive breastfeeding (EBF) in the 24 hours preceding the interview among infants aged 0–5 months, as defined by the WHO and assessed via the standard 24-hour recall method used in the TDHS. If the infant was exclusively breastfed, it was coded as “Yes”; if the infant had consumed any liquid or solid food other than breast milk (e.g., breastfeeding and consuming plain water only, breastfeeding and consuming nonmilk liquids such as fruit juice or tea, breastfeeding and consuming other milk, or breastfeeding and consuming complementary foods) or was not breastfed, it was coded as “No” and classified as non-EBF.

In our study, independent variables were selected from indicators commonly measured in the four rounds of the TDHS conducted between 2003 and 2018. These variables reflect key factors frequently highlighted in the literature as associated with breastfeeding practices. They were grouped into three main categories in the analysis. Characteristics related to birth and the infant included mode of delivery, birth order, infant sex, size at birth, place of birth, number of antenatal care visits, birth weight, and breastfeeding initiation within the first hour after birth. Maternal characteristics were defined by the mother’s age, educational level, native language, employment status, body mass index, and age at first birth. Household characteristics included household size, smoking status in the household, household wealth index, place of residence (i.e., urban/rural), and region.

Data Harmonization and Weighting

This study used data from four surveys conducted at 5-year intervals between 2003 and 2018 as part of the TDHS. These demographic surveys aimed to collect detailed information on fertility levels, infant and child mortality rates, maternal and child health, and family planning. Women aged 15–49 years who usually live in the household or were present the night before the interview were regarded as eligible, and detailed information was collected on all their live births. The samples for these surveys were designed to be nationally representative, and a complex, multistage, stratified, and cluster sampling approach was used. For statistical inferences based on these survey data to be valid, sample representativeness must be accounted for. To this end, sample weights were applied in all analyses to ensure that the sample represented the target population. When combining data from different years, these standard weight variables must be renormalized (ICF International, 2012). This normalization was calculated for each study by multiplying the weights of female observations by the female population aged 15–49 years in Turkey at the time of each survey and then dividing by the total number of observations in that study (Keskin & Yayla Enfiyeci, 2024). Formally, the normalized weight for each observation was calculated as V005* = V005 × Nₙ/nₙ, where V005 is the original DHS sample weight, Nₙ is the total female population aged 15–49 years in Turkey at the time of survey round n, and nₙ is the total number of women aged 15–49 years interviewed in that round. During the data-merging phase for the four studies, the primary sampling units and strata were renamed in the merged dataset to accommodate complex sampling characteristics and prepare the data for use with complex sampling design parameters.

The variables used in the study were those collected in the four surveys. Although the basic variables related to women and their children were collected using standard categories in all studies, the formats of variables such as smoking status in the household or the woman’s employment status were updated over the years. For this reason, the categories were organized in a comparable manner so that the variables could be used in the combined dataset when necessary. Categories with low numbers of observations were combined in accordance with the literature to maintain statistical power.

Ethics

The study was approved by the Health Sciences Ethics Committee of Canakkale Onsekiz Mart University by a decision dated September 1, 2025 and numbered 01/37. The required permissions for the use of the 2003–2018 TDHS data were obtained from the Hacettepe University Institute of Population Studies. The entire process was conducted in accordance with the relevant institutional and national research ethics guidelines and in alignment with the principles of the Declaration of Helsinki.

Statistical Analysis

In all analyses, the TDHS sampling design was taken into account; sampling weights calculated for the combined dataset were applied, and complex survey design parameters were used. First, EBF prevalence among infants aged 0–5 months was presented as percentages by survey year, region, and key sociodemographic characteristics. To identify factors associated with EBF, we first estimated crude odds ratios through univariate logistic regression for each independent variable to examine unadjusted associations. All prespecified independent variables—selected a priori on the basis of their theoretical relevance and established associations with breastfeeding practices in the literature—were subsequently entered simultaneously into the multivariate logistic regression model regardless of univariate significance level. This approach ensured comprehensive adjustment for potential confounders across the birth-related, maternal, and household domains. Adjusted odds ratios (aORs) and 95% CIs were estimated using a logistic regression model with complex survey design parameters. A significance level of p < .05 was used for all statistical tests, and the analyses were performed using IBM SPSS Statistics, version 23.

Results

The total number of mother–infant pairs meeting the inclusion criteria for the study was 1,364 (n = 409 in 2003, n = 371 in 2008, n = 327 in 2013, and n = 257 in 2018). The number of infants who were EBF was 432. Slightly more than half the infants (50.3%) were female. Although the cesarean delivery rate increased over the years, it was 42.2% overall. Overall, 34.0% of infants were firstborns. The proportion of births occurring in health facilities increased from 81.8% in TDHS 2003 to 99.4% in TDHS 2018. The proportion of women with four or more antenatal care visits increased from 54.3% in 2003 to 89.9% in 2018. The proportion of infants breastfed within the first hour after birth increased from 52.6% in 2003 to 70.2% in 2018 (Table 1).

Table 1.

Distribution of Exclusive Breastfeeding Among Infants by Birth-Related Characteristics, Turkish Demographic and Health Surveys (TDHS) 2003–2018.

Variable	TDHS2003(n = 409)	TDHS2008(n = 371)	TDHS2013(n = 327)	TDHS2018(n = 257)	Exclusive breastfeeding		Total(n = 1,364)
Variable	TDHS2003(n = 409)	TDHS2008(n = 371)	TDHS2013(n = 327)	TDHS2018(n = 257)	No(n = 932)	Yes(n = 432)	Total(n = 1,364)
Infant sex
Male	51.9%	45.8%	57.6%	44.3%	49.8%	49.5%	49.7%
Female	48.1%	54.2%	42.4%	55.7%	50.2%	50.5%	50.3%
Cesarean section
No	74.3%	62.9%	49.3%	47.1%	58.5%	56.6%	57.8%
Yes	25.7%	37.1%	50.7%	52.9%	41.5%	43.4%	42.2%
Birth order
1	36.1%	36.1%	30.8%	33.1%	36.7%	28.6%	34.0%
2	25.3%	27.9%	36.1%	32.1%	28.0%	35.1%	30.5%
3	17.4%	17.4%	17.4%	23.1%	18.8%	19.3%	19.0%
4+	21.2%	18.6%	15.7%	11.8%	16.5%	16.9%	16.6%
Size at birth
Very large or larger than average	12.5%	11.5%	10.1%	7.7%	11.9%	7.2%	10.3%
Average or smaller than average	77.3%	78.5%	84.3%	86.4%	78.9%	87.4%	81.8%
Very small	10.2%	10.0%	5.5%	5.9%	9.2%	5.3%	7.9%
Place of delivery
Home or other place	18.2%	2.9%	1.4%	.6%	6.3%	4.0%	5.5%
Health facility	81.8%	97.1%	98.6%	99.4%	93.7%	96.0%	94.5%
Antenatal care visits
0	18.5%	4.3%	2.2%	5.5%	7.9%	6.7%	7.5%
1–3	27.1%	21.1%	6.0%	4.6%	14.9%	13.0%	14.2%
4+	54.3%	74.6%	91.8%	89.9%	77.3%	80.4%	78.3%
Birth weight
Low birth weight (<2,500 g)	7.9%	5.3%	4.8%	9.4%	8.3%	4.3%	6.9%
Normal birth weight (≥2,500 g)	92.1%	94.7%	95.2%	90.6%	91.7%	95.7%	93.1%
Breastfed in the first hour
No	47.4%	44.5%	34.5%	29.8%	40.9%	34.2%	38.6%
Yes	52.6%	55.5%	65.5%	70.2%	59.1%	65.8%	61.4%

Note. All estimates are weighted and account for the complex survey design.

Nearly half the mothers (50.2%) were in the 25- to 34-year age group, and this age group accounted for a higher proportion among mothers of EBF infants (56.0%). Approximately 56.0% of mothers had a primary school education or below. The age at first birth was concentrated primarily in the 18- to 24-year age group (64.0%), whereas the proportion of mothers who had their first birth between the ages 25 and 34 years was higher among those who breastfed exclusively compared with those who did not (29.1% vs. 20.3%). Household tobacco use showed a downward trend between 2003 and 2018, with an overall prevalence of 43.9% across the entire period. Although household income levels generally were evenly distributed, those in the highest income bracket represented the lowest share at 14.6%. The vast majority of the study group (73.1%) lived in urban areas. Detailed distributions of maternal and household characteristics are presented in Table 2.

Table 2.

Descriptive Profile of Maternal and Household Characteristics, Turkish Demographic and Health Surveys (TDHS) 2003–2018.

Variable	TDHS2003(n = 409)	TDHS2008(n = 371)	TDHS2013(n = 327)	TDHS2018(n = 257)	Exclusive breastfeeding		Total(n = 1,364)
Variable	TDHS2003(n = 409)	TDHS2008(n = 371)	TDHS2013(n = 327)	TDHS2018(n = 257)	No(n = 932)	Yes(n = 432)	Total(n = 1,364)
Maternal characteristics
Age of mother, years
15–19	9.3%	7.0%	6.6%	5.8%	8.2%	5.0%	7.1%
20–24	36.7%	31.3%	21.8%	27.1%	31.1%	25.3%	29.1%
25–34	45.0%	51.9%	53.7%	49.9%	47.1%	56.0%	50.2%
35–49	9.0%	9.7%	17.9%	17.2%	13.6%	13.8%	13.6%
Maternal education
No education/primary incomplete	23.3%	22.1%	18.7%	11.3%	20.4%	15.0%	18.5%
First-level primary	52.5%	45.4%	28.5%	25.6%	37.1%	38.0%	37.4%
Second-level primary	9.9%	12.2%	22.5%	23.6%	18.1%	15.9%	17.3%
High school and higher	14.4%	20.3%	30.3%	39.5%	24.4%	31.1%	26.7%
Mother tongue
Turkish	69.1%	71.8%	67.8%	70.3%	68.3%	72.6%	69.8%
Kurdish	26.5%	23.7%	27.4%	21.1%	25.7%	22.3%	24.5%
Other	4.5%	4.5%	4.7%	8.6%	6.0%	5.1%	5.7%
Maternal employment status^a
Works with social security	6.8%	11.3%	18.5%	18.6%	12.2%	17.5%	14.0%
Works without social security	22.3%	14.6%	7.3%	6.0%	13.3%	10.6%	12.4%
Does not work	70.8%	74.1%	74.2%	75.3%	74.6%	71.9%	73.7%
Maternal body mass index category, kg/m²
Underweight (<18.5)	1.2%	0.6%	2.4%	1.6%	2.0%	0.4%	1.5%
Normal (18.5–24.99)	40.5%	43.5%	27.8%	32.6%	37.3%	34.1%	36.2%
Overweight (25–29.99)	36.7%	34.0%	46.1%	34.6%	37.2%	38.2%	37.5%
Obese (>29.99)	21.6%	21.8%	23.6%	31.2%	23.5%	27.3%	24.8%
Age of mother at first birth, years
<18	15.2%	13.2%	8.9%	8.1%	12.4%	8.9%	11.2%
18–24	68.9%	68.9%	59.5%	59.4%	65.5%	61.1%	64.0%
25–34	15.4%	16.7%	30.0%	29.8%	20.3%	29.1%	23.3%
35–49	0.5%	1.2%	1.5%	2.7%	1.9%	0.9%	1.5%
Household characteristics
Number of household members
3–4	32.5%	33.5%	43.2%	41.5%	37.4%	38.8%	37.9%
5+	67.5%	66.5%	56.8%	58.5%	62.6%	61.2%	62.1%
Smoking in the household
No	48.2%	41.7%	65.9%	66.8%	55.0%	58.3%	56.1%
Yes	51.8%	58.3%	34.1%	33.2%	45.0%	41.7%	43.9%
Household wealth quintile
Lowest	26.2%	22.2%	20.8%	19.7%	23.9%	18.5%	22.1%
Second	23.4%	24.3%	20.1%	22.8%	22.7%	22.4%	22.6%
Middle	18.6%	22.6%	25.1%	20.2%	21.2%	22.4%	21.6%
Fourth	19.0%	18.4%	17.0%	21.6%	18.5%	20.3%	19.1%
Highest	12.8%	12.5%	17.1%	15.7%	13.6%	16.4%	14.6%
Place of residence
Urban	64.6%	71.1%	78.8%	77.2%	71.2%	76.9%	73.1%
Rural	35.4%	28.9%	21.2%	22.8%	28.8%	23.1%	26.9%
Region
West	31.0%	35.2%	36.2%	38.0%	33.7%	38.3%	35.3%
South	12.4%	10.5%	13.8%	14.6%	14.2%	10.4%	12.9%
Central	20.0%	24.2%	15.9%	16.4%	18.4%	20.2%	19.0%
North	6.9%	5.1%	5.5%	3.7%	5.5%	4.6%	5.2%
East	29.6%	25.0%	28.6%	27.2%	28.1%	26.5%	27.6%
Total	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%

Mothers by employment status in the 12 months preceding the survey.

The overall EBF prevalence among all infants aged 0–5 months was 34.2%, showing a fluctuating but increasing trend over the years. The proportion of infants who were never breastfed was 6.3% for the entire period. The most common feeding patterns other than EBF were breastfeeding plus milk (BF + milk, 23.9%) and breastfeeding plus water (BF + water, 20.4%). The proportion of feeding with other water-based liquids (BF + water-based) decreased substantially throughout the period, falling from 14.3% in 2003 to 1.5% in 2018. Detailed distributions by year and feeding pattern are presented in Table 3.

Table 3.

Distribution of Feeding Patterns Among Infants Aged 0–5 Months, Turkish Demographic and Health Surveys (TDHS) 2003–2018.

Variable	THDS 2003 (n = 409)		THDS 2008 (n = 371)		THDS 2013 (n = 327)		THDS 2018 (n = 257)		Overall (n = 1,364)
Variable	n	%	n	%	n	%	n	%	n	%
Not breastfed	34	7.8	13	3.1	21	6.4	22	7.6	90	6.3
EBF	85	20.9	150	42.3	93	30.7	104	41.3	432	34.2
BF + water	111	25.1	73	18.9	76	23.3	42	15.2	302	20.4
BF + water-based liquids	55	14.3	7	2.7	2	0.6	4	1.5	68	4.6
BF + milk	86	22.8	95	25.7	92	26.5	52	21.0	325	23.9
BF + food	38	9.1	33	7.3	43	12.4	33	13.5	147	10.7

Note. EBF; exclusive breastfeeding; BF, breastfeeding. Weighted percentages were given.

According to multivariate logistic regression analysis, the likelihood of EBF in 2003 was statistically significantly lower than in 2018 (aOR = 0.37, 95% CI 0.22–0.64). Among birth-related variables, the odds of EBF were significantly higher for second-born children compared with firstborns (aOR = 1.85, 95% CI 1.17–2.92). Although higher birth order was associated with increased odds of EBF, the trend was not statistically significant. In terms of birth size, the likelihood of EBF was lower among infants classified as very large or larger than average compared with those classified as average or smaller than average (aOR = 0.51, 95% CI 0.29–0.90). No significant association was found between EBF and low birth weight, cesarean delivery, place of birth, number of antenatal care visits, initiation of breastfeeding within the first hour after birth, or infant sex. When maternal characteristics were evaluated, no significant association was found between EBF and maternal age, education, native language, employment status, or body mass index. However, the likelihood of EBF was significantly higher among mothers who had their first birth between the ages of 25 and 34 years compared with those who had their first birth between the ages of 18 and 24 years (aOR = 1.97, 95% CI 1.19–3.26). No statistically significant differences were observed for mothers younger than 18 years or those 35 years and older. At the household level, no significant relationship was found between EBF and household size, smoking within the household, household wealth status, or place of residence. Among regions, only mothers living in the South had a significantly lower likelihood of EBF compared with those in the West (aOR = 0.47, 95% CI 0.27–0.84; Table 4).

Table 4.

Associations Between Exclusive Breastfeeding and Birth-Related, Maternal, and Household Characteristics: Logistic Regression Model, Turkish Demographic and Health Surveys (TDHS) 2003–2018.

	Rates	Odds ratio	95% CI		Adjusted odds ratio	95% CI
Survey year
2003	20.9%	0.377	0.250	0.568	0.374	0.218	0.643
2008	42.3%	1.042	0.704	1.542	1.166	0.723	1.881
2013	30.7%	0.631	0.415	0.961	0.622	0.383	1.010
2018	41.3%	1.000			1.000
Birth-related characteristics
Infant sex
Male	34.1%	1.000			1.000
Female	34.3%	1.011	0.770	1.327	0.815	0.581	1.144
Cesarean section
No	33.4%	1.000			1.000
Yes	35.2%	1.083	0.814	1.441	0.993	0.682	1.444
Birth order
1	28.8%	1.000	.	.	1.000	.	.
2	39.4%	1.608	1.125	2.300	1.848	1.169	2.922
3	34.9%	1.325	0.886	1.982	1.475	0.771	2.823
4+	34.8%	1.323	0.898	1.950	1.755	0.780	3.950
Size at birth
Very large or larger than average	23.9%	0.548	0.327	0.917	0.509	0.286	0.904
Average or smaller than average	36.5%	1.000			1.000
Very small	23.2%	0.525	0.335	0.825	0.675	0.326	1.397
Place of delivery
Home or other place	24.8%	1.000			1.000
Health facility	34.7%	0.619	0.358	1.071	1.705	0.259	11.214
Antenatal care visits
0	30.6%	0.814	0.489	1.354	1.665	0.706	3.927
1–3	31.2%	0.839	0.592	1.190	1.350	0.795	2.294
4+	35.1%	1.000			1.000
Birth weight
Low birth weight (<2,500 g)	21.8%	0.493	0.259	0.938	0.614	0.277	1.360
Normal birth weight (≥2,500 g)	36.2%	1.000			1.000
Breastfed in the first hour
No	30.7%	1.000			1.000
Yes	37.1%	1.333	1.001	1.777	1.090	0.768	1.547
Maternal characteristics
Age of mother, years
15–19	23.9%	0.508	0.269	0.962	0.916	0.398	2.107
20–24	29.7%	0.685	0.495	0.949	1.023	0.615	1.701
25–34	38.1%	1.000			1.000
35–49	34.6%	0.858	0.535	1.375	0.755	0.406	1.406
Maternal education
No education/primary incomplete	27.7%	0.722	0.505	1.031	0.677	0.396	1.159
First-level primary	34.7%	1.000			1.000
Second-level primary	31.3%	0.857	0.564	1.303	0.950	0.562	1.605
High school and higher	39.9%	1.249	0.871	1.791	1.097	0.643	1.871
Mother tongue
Turkish	35.6%	1.000			1.000
Kurdish	31.1%	0.818	0.615	1.088	0.828	0.513	1.336
Other	30.5%	0.795	0.354	1.787	0.834	0.325	2.143
Maternal employment status
Works with social security	42.2%	1.487	0.949	2.331	1.216	0.681	2.171
Works without social security	28.9%	.831	0.530	1.302	0.865	0.482	1.551
Does not work	32.9%	1.000			1.000
Maternal body mass index category, kg/m²
Underweight (<18.5)	10.0%	0.239	0.052	1.107	0.276	0.050	1.524
Normal (18.5–24.99)	31.8%	1.000			1.000
Overweight (25–29.99)	34.3%	1.121	0.803	1.565	1.034	0.685	1.562
Obese (>29.99)	37.1%	1.268	0.868	1.853	1.166	0.727	1.870
Age of mother at first birth, years
<18	27.1%	0.766	0.491	1.195	0.806	0.451	1.441
18–24	32.7%	1.000			1.000
25–34	42.7%	1.537	1.103	2.142	1.967	1.187	3.259
35–49	19.8%	0.509	0.124	2.080	0.381	0.050	2.914
Household characteristics
Number of household members
3–4	35.0%	1.000			1.000
5+	33.7%	0.942	0.702	1.263	0.980	0.643	1.493
Smoking in the household
Yes	35.5%	0.876	0.667	1.149	0.949	.668	1.347
No	32.5%	1.000			1.000
Wealth quintile of household
Lowest	28.7%	1.000			1.000
Second	33.8%	1.270	0.845	1.908	1.262	0.714	2.229
Middle	35.4%	1.360	0.912	2.026	1.176	0.631	2.193
Fourth	36.3%	1.418	0.906	2.218	1.156	0.576	2.318
Highest	38.5%	1.556	0.972	2.491	1.198	0.500	2.869
Place of residence
Urban	35.9%	1.000			1.000	.	.
Rural	29.4%	0.741	0.556	0.987	0.975	0.623	1.526
Region
West	37.1%	1.000			1.000
South	27.5%	0.641	0.409	1.007	0.473	0.266	0.842
Central	36.3%	0.963	0.642	1.445	0.867	0.546	1.377
North	30.4%	0.740	0.437	1.253	0.694	0.384	1.255
East	32.8%	0.826	0.577	1.182	1.067	0.665	1.712

Discussion

This study examined the dynamics of EBF based on TDHS data and interpreted the findings in light of global targets and the international literature. EBF rates in Turkey fluctuated between 2003 and 2018, reflecting sensitivity to shifts in health policies. Although the 41.3% rate achieved in 2018 indicates a recovery, it remains below the WHO 2025 target of 50% and UNICEF’s ideal benchmarks (UNICEF & WHO, 2023; Yalçın et al., 2020). In low- and middle-income countries, including Turkey, 37% of infants under 6 months of age are exclusively breastfed. Turkey’s EBF prevalence is lower than that of its neighbors (Iran 53% and Georgia 54%) but higher than that of Iraq (19%), Azerbaijan (11%), and Armenia (34%) (Victora et al., 2016). Turkey’s EBF prevalence is also similar to that of Brazil (36%), which is undergoing a comparable economic transition (Boccolini et al., 2017). It also ranks higher than some European countries, where EBF prevalence is ~30% (UNICEF & WHO, 2023). Turkey’s health policies appear to be successful in initiating breastfeeding, but it struggles to meet global standards in sustaining EBF during the first 6 months (Yalçın et al., 2020).

One of the strongest determinants in our study, the parity effect, was highly consistent with findings from the international literature. In a U.S. study, breastfeeding-related problems were observed in 35% of first-time mothers within the first 48 hours after birth, whereas the corresponding proportion was 20% among mothers who had previously given birth (Hackman et al., 2015). Primiparous mothers often exhibit delayed breastfeeding initiation, lower self-efficacy, and unrealistic expectations. These factors contribute to shorter breastfeeding durations compared with multiparous peers. After discharge, primiparas report higher anxiety and perceive professional support as inadequate. Consequently, the perception of insufficient milk supply frequently leads to premature formula introduction (Buckman et al., 2020; Huang et al., 2022; Lindblad et al., 2022). The inexperience disadvantage of primiparous mothers necessitates integrating psychosocial and practical breastfeeding support into Turkish postnatal care. Specialized nurse-led home visits are recommended to improve outcomes for all mothers, particularly primiparous women.

Descriptively, younger mothers (aged 20–24 years) had lower EBF rates (29.7%) than mothers aged 25–34 years (38.1%), but current maternal age was not a significant independent predictor in the adjusted model. The significant maternal age-related finding in this study concerns age at first birth: Mothers whose first birth occurred between the ages of 25 and 34 years were significantly more likely to exclusively breastfeed compared with those whose first birth occurred at the ages of 18–24 years (aOR = 1.97, 95% CI 1.19–3.26). Studies have shown that younger maternal age is associated with lower rates of both initiation and continuation of breastfeeding (Taveras et al., 2003). Studies conducted in Turkey have similarly found that adolescent and young mothers have lower breastfeeding self-efficacy scores and breastfeeding success rates (Gözüyeşil et al., 2020; Özsoy, 2014). Lower breastfeeding performance among young mothers may be linked to ongoing education, psychosocial unpreparedness, body image concerns, and limited peer support (Cota-Robles et al., 2017; Dykes et al., 2003; Grassley, 2010).

The relationship between maternal education and EBF is one of the most controversial topics in the literature. Some studies have reported that as educational level increases, the time to initiate breastfeeding decreases, breastfeeding duration increases, and the likelihood of exclusive breastfeeding during the first 6 months rises (Acharya & Khanal, 2015; Laksono et al., 2021). In low- and middle-income countries, less educated mothers historically breastfeed longer. More educated mothers face earlier workforce reentry and nonconducive breastfeeding conditions. Recently, breastfeeding metrics deteriorated among mothers lacking formal education. Conversely, these parameters improved among those with at least a primary education (Neves et al., 2021). Education level was not statistically significant. This suggests that Turkey represents a transitional society. Notably, mothers who remain at home for 6 months exhibit longer breastfeeding durations than those reported in previous national studies (Yılmaz et al., 2021). Our findings, supported by evidence from Chai et al. (2018), suggest that Turkey’s 16-week maternity leave is inadequate. Returning to work remains a significant barrier to EBF goals. Proposed reforms intend to extend paid leave to 1 year and unpaid leave to 1.5 years. These measures, along with flexible work, represent a positive maternal health policy shift (Oksijen, 2025).

The most notable finding in our study that diverges from previous evidence is that we did not detect a statistically significant negative effect of cesarean delivery on EBF (aOR = 0.99, 95% CI 0.68–1.44). Cesarean delivery impairs breastfeeding initiation and maintenance. Key factors include delayed lactogenesis and disrupted skin-to-skin contact (Li et al., 2021). Despite Turkey’s high cesarean rates among Organisation for Economic Co-operation and Development (OECD) countries, no significant negative association with EBF was observed (OECD, 2019). Two mechanisms likely explain this. First, Baby-Friendly Hospital initiatives mitigate the impact of surgery through early skin-to-skin contact. Second, mothers who resume breastfeeding after discharge are categorized as EBF using the 24-hour recall methodology.

The perceived size of the infant at birth emerged as another important determinant. The likelihood of EBF was significantly lower among infants perceived as larger than average or much larger than average (aOR = 0.509, 95% CI 0.286–0.904). Biologic mechanisms likely drive this association. Macrosomia-related difficult deliveries often require operative interventions. These procedures lead to mother–newborn separation (Beta et al., 2019). Sociocultural beliefs linking infant size to high nutritional demand foster perceptions of milk insufficiency. This mindset legitimizes the premature introduction of water, sugar water, or formula (Steinman et al., 2010; Twamley et al., 2011). Indeed, data from the 2018 TDHS indicate that 23% of infants received formula or other milk in addition to breast milk during the first 6 months (Hacettepe University Institute of Population Studies et al., 2019).

Our most notable regional finding was a 53% lower likelihood of EBF in southern Anatolia compared with the West (aOR = 0.473). This difference suggests that the disparity extends beyond cultural factors. The region is also characterized by intensive seasonal agricultural labor and a large refugee population following the Syrian crisis in 2011 (Hacettepe University Institute of Population Studies et al., 2019). Among migrant and temporarily protected populations, some cultural patterns are especially prominent in Syrian mothers. These include the belief that breastfeeding harms maternal health, early marriage, a preference for large families, giving anise to infants, avoiding nighttime breastfeeding, and providing other feeds before breastfeeding (Yalçın et al., 2022). Other reasons for lower breastfeeding practices among Syrian refugee mothers may include postwar displacement and post-traumatic stress (Yalçın et al., 2020).

Finally, our finding that the number of antenatal care visits does not predict greater EBF success highlights a global quality gap. Our analysis found no significant difference between mothers who received four or more antenatal care visits and those who did not. The Turkish Antenatal Care Management Guideline requires breastfeeding support during three specific visits: the first (≤14 weeks) documents previous breastfeeding history, the third (24–28 weeks) provides lactation counseling, and the fourth (36–38 weeks) includes physical breast exams and education on breastfeeding benefits. Anamnesis, physical exams, laboratory testing, and clinical treatment planning are also integrated into these visits (Republic of Türkiye Ministry of Health, Public hospitals General Directorate, 2018). Breastfeeding counseling is not always implemented in a standardized, adequate, or effective manner during antenatal follow-ups. Hospitals with high patient loads may have limited time for such counseling. In a study conducted in Turkey, 98.6% of pregnant women visited a health institution at least once for antenatal care. However, only 24.0% received breastfeeding counseling during those visits, whereas 65.3% received counseling after delivery (İnce et al., 2010). In the Turkish healthcare system, postpartum breastfeeding counseling is usually delivered once as part of discharge education. This may be inadequate for sustaining behavior change or managing lactation problems such as nipple fissures and blocked ducts. Mothers may later seek support at family health centers. (Öztürk & Demirgöz Bal, 2024).

Furthermore, the Ministry of Health launched the Baby-Friendly Hospital program to promote breastfeeding and improve maternal knowledge and practices. However, a study of 414 Baby-Friendly hospitals found that only 60.1% met all criteria, and compliance was lowest for informing pregnant women and their families about breastfeeding (Çaylan et al., 2022).

Studies in India and sub-Saharan Africa also have shown that routine medical check-ups that do not include breastfeeding counseling do not prolong breastfeeding duration (Rollins et al., 2016). Despite increased antenatal care coverage in Turkey, the lack of structured breastfeeding education may constitute a missed opportunity. Each follow-up visit, particularly in the third trimester, should include breastfeeding education. (Yalçın et al., 2020).

Strengths and Limitations

The most significant epidemiologic strength of this study is its ability to conduct secular trend analyses over an extended period, using four nationally representative TDHS survey rounds from 2003 to 2018. Unlike single-center studies, this dataset offers a macro-level perspective on policy-relevant indicators across Turkey. Furthermore, TDHS data are collected using standardized international instruments and strict quality control by trained staff, enhancing reliability through improved coverage and internal validity.

However, this study has several limitations. First, the cross-sectional design precludes establishing causal relationships, allowing only associations to be identified. Second, breastfeeding data rely on retrospective maternal reports, introducing risks of recall and social desirability bias. Third, the place-of-delivery variable was classified as health facility versus home or other setting for data harmonization purposes; consistent public/private facility coding was not available across all four TDHS waves, which may obscure structural differences between sectors. Future studies using post-2018 TDHS data should incorporate this distinction. Fourth, birth interval was not included as a covariate because it is undefined for primiparous mothers (~34% of the sample); including it would restrict the analysis to multiparous women, introducing selection bias. Birth order was retained as a structural proxy capturing the experiential dimension of parity. Fifth, the conjoint analysis approach centers contextual changes—policy, service, and culture—within a single model. Finally, the absence of psychosocial variables, such as maternal postpartum depression, breastfeeding self-efficacy, and paternal support, limits the ability to fully explain underlying behavioral mechanisms. The study is additionally limited by the temporal boundary of the available data: The 2018 TDHS is the most recently publicly available round, and the 2023 TDHS wave had not been released at the time of analysis. Subsequent events—the COVID-19 pandemic and the February 2023 earthquakes in southeastern Türkiye—may have substantially altered breastfeeding practices, particularly in the southern and eastern regions identified as having the lowest EBF prevalence; findings therefore should be interpreted as a prepandemic, pre-earthquake national baseline (Rollins et al., 2016; Victora et al., 2016; Yalçın et al., 2022). Despite these constraints, the findings provide a robust foundation for understanding long-term breastfeeding trends and their multifaceted drivers in Turkey.

Conclusion

This study shows that exclusive breastfeeding rates in Turkey have risen over the past 15 years. However, the progress was nonlinear, with periods of stagnation and recovery. Current rates remain below the WHO targets. Continued and stronger national breastfeeding policies are needed.

The principal determinants of breastfeeding behavior were identified as maternal parity, maternal age at childbirth, perceived infant birth size, and residence in the southern region of the country. From a policy perspective, policymakers should develop targeted intervention programs specifically for high-risk groups such as primiparous mothers, younger mothers, and residents of the southern region. Additionally, structured breastfeeding counseling should be incorporated into both antenatal and postnatal care services. This counseling should be delivered in a standardized, continuous, and individually tailored format. For example, providing counseling sessions at multiple points during pregnancy and after birth can help ensure consistent support. These targeted interventions and structured counseling strategies can encourage both the initiation and continuation of breastfeeding, supporting improved outcomes.

Footnotes

Acknowledgements

We thank the Hacettepe University Institute of Population Studies for granting access to the Turkish Demographic and Health Survey datasets. We also acknowledge the contribution of the field teams and participants who made the surveys possible.

ORCID iDs

Caner Baysan

Seher Palanbek Yavaş

Faruk Keskin

Ethical Considerations

This study was approved by the Health Sciences Ethics Committee of Çanakkale Onsekiz Mart University (September 1, 2025; Decision No. 01/37). Permission to use the 2003–2018 Turkish Demographic and Health Surveys microdata was obtained from the Hacettepe University Institute of Population Studies. All procedures were conducted in accordance with national regulations and the principles of the Declaration of Helsinki.

Consent to Participate

The Turkish Demographic and Health Survey datasets include anonymized population-level survey data; therefore, no additional written informed consent was required.

Author Contributions

Caner Baysan: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Writing–original draft; Writing–review & editing.

Seher Palanbek Yavaş: Conceptualization; Investigation; Resources; Writing–original draft; Writing–review & editing.

Faruk Keskin: Formal analysis; Investigation; Methodology; Validation; Visualization.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The Turkish Demographic and Health Surveys datasets analyzed during this study are publicly available on request from the Hacettepe University Institute of Population Studies (). The harmonized dataset generated for this study is available from the corresponding author on reasonable request.

References

Acharya

Khanal

(2015). The effect of mother’s educational status on early initiation of breastfeeding: Further analysis of three consecutive Nepal demographic and health surveys global health. BMC Public Health, 15(1), 1069. https://doi.org/10.1186/s12889-015-2405-y

Beta

Khan

Khalil

Fiolna

Ramadan

Akolekar

(2019). Maternal and neonatal complications of fetal macrosomia: Systematic review and meta-analysis. Ultrasound in Obstetrics and Gynecology, 54(3), 308–318. https://doi.org/10.1002/uog.20279

Boccolini

C. S.

Boccolini

P. D. M. M.

Monteiro

F. R.

Venâncio

S. I.

Giugliani

E. R. J.

(2017). Breastfeeding indicators trends in Brazil for three decades. Revista de Saúde Pública, 51, 108. https://doi.org/10.11606/S1518-8787.2017051000029

Buckman

Diaz

A. L.

Tumin

Bear

(2020). Parity and the association between maternal sociodemographic characteristics and breastfeeding. Breastfeeding Medicine, 15(7), 443–452. https://doi.org/10.1089/bfm.2019.0284

Çaylan

Kiliç

Tetik

B. K.

Armut

Tezel

(2019). Breastfeeding promotion and baby-friendly health facilities in Turkey: A systematic approach to scale up the program. Ankara Medical Journal, 18(1), 32–40. https://doi.org/10.17098/AMJ.542159

Çaylan

Kiliç

Yalçin

Tezel

Kara

(2022). Baby-friendly hospitals in Turkey: Evaluation of adherence to the ten steps to successful breastfeeding. Eastern Mediterranean Health Journal, 28(5), 352–361. https://doi.org/10.26719/emhj.22.021

Chai

Nandi

Heymann

(2018). Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries. BMJ Global Health, 3(5), e001032. https://doi.org/10.1136/bmjgh-2018-001032

Cota-Robles

Pedersen

LeCroy

C. W.

(2017). Challenges to breastfeeding initiation and duration for teen mothers. MCN: The American Journal of Maternal/Child Nursing, 42(3), 173–178. https://doi.org/10.1097/NMC.0000000000000327

Dykes

Moran

V. H.

Burt

Edwards

(2003). Adolescent mothers and breastfeeding: Experiences and support needs–An exploratory study. Journal of Human Lactation, 19(4), 391–401. https://doi.org/10.1177/0890334403257562

10.

Gözüyeşil

Tar

Ünal

(2020). Evaluation of breastfeeding self-efficacy and breastfeeding success in high risk age group women. Eurasian Journal of Health Sciences, 3, 190–198.

11.

Grassley

J. S.

(2010). Adolescent mothers’ breastfeeding social support needs. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39(6), 713–722. https://doi.org/10.1111/j.1552-6909.2010.01181.x

12.

Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget, & TUBITAK. (2009). 2008 Turkey demographic and health survey (DHS). Hacettepe University Institute of Population Studies. https://dhsprogram.com/pubs/pdf/FR351/FR351.pdf

13.

Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget, & TUBITAK. (2014). 2013 Turkey demographic and health survey (DHS). Hacettepe University Institute of Population Studies. https://dhsprogram.com/pubs/pdf/FR352/FR352.pdf

14.

Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget, & TUBITAK. (2019). 2018 Turkey demographic and health survey (DHS). Hacettepe University Institute of Population Studies. https://dhsprogram.com/pubs/pdf/FR372/FR372.pdf

15.

Hacettepe University Institute of Population Studies, T.R. Prime Ministry State Planning Organization, & European Union. (2004). 2003 Turkey demographic and health survey (DHS). Hacettepe University Institute of Population Studies. https://dhsprogram.com/pubs/pdf/FR160/FR160.pdf

16.

Hackman

N. M.

Schaefer

E. W.

Beiler

J. S.

Rose

C. M.

Paul

I. M.

(2015). Breastfeeding outcome comparison by parity. Breastfeeding Medicine, 10(3), 156–162. https://doi.org/10.1089/bfm.2014.0119

17.

Huang

Liu

X. Y.

Zeng

T. Y.

(2022). The rates and factors of perceived insufficient milk supply: A systematic review. Maternal and Child Nutrition, 18(1), e13255. https://doi.org/10.1111/mcn.13255

18.

ICF International. (2012). Demographic and health survey sampling and household listing manual. ICF International. https://dhsprogram.com/pubs/pdf/DHSM4/DHS6_Sampling_Manual_Sept2012_DHSM4.pdf

19.

İnce

Kondolot

Yalçın

S. S.

Yurdakök

(2010). Breastfeeding consultation status of mothers. Journal of Child Health and Diseases (Çocuk Sağlığı ve Hastalıkları Dergisi), 53(3), 189–197.

20.

Kalhor

Yazdkhasti

Simbar

Hajian

Kiani

Khorsandi

Sattari

Ezadi

Nazem

Jafari

(2025). Predictors of exclusive breastfeeding: A systematic review and meta-analysis. International Breastfeeding Journal, 20(1), 52. https://doi.org/10.1186/s13006-025-00744-2

21.

Keskin

Yayla Enfiyeci

(2024). The pattern of religious marriage and transition to civil marriage in Türkiye: Evidence from the Türkiye demographic and health surveys by marriage cohorts. The Turkish Journal of Population Studies, 46, 117–142. https://dergipark.org.tr/en/pub/nufusbilim/issue/90205/1628909

22.

Laksono

A. D.

Wulandari

R. D.

Ibad

Kusrini

(2021). The effects of mother’s education on achieving exclusive breastfeeding in Indonesia. BMC Public Health, 21(1), 14. https://doi.org/10.1186/s12889-020-10018-7

23.

Wan

Zhu

(2021). Breastfeeding after a cesarean section: A literature review. Midwifery, 103, 103117. https://doi.org/10.1016/j.midw.2021.103117

24.

Lindblad

Melgaard

Jensen

Eidhammer

Westmark

Kragholm

Gommesen

(2022). Primiparous women differ from multiparous women after early discharge regarding breastfeeding, anxiety, and insecurity–A prospective cohort study. European Journal of Midwifery, 6, 1–11. https://doi.org/10.18332/ejm/146897

25.

Neves

P. A. R.

Barros

A. J. D.

Gatica-Domínguez

Vaz

J. S.

Baker

Lutter

C. K.

(2021). Maternal education and equity in breastfeeding: Trends and patterns in 81 low- and middle-income countries between 2000 and 2019. International Journal for Equity in Health, 20(1), 20. https://doi.org/10.1186/s12939-020-01357-3

26.

Odar Stough

Khalsa

A. S.

Nabors

L. A.

Merianos

A. L.

Peugh

. (2019). Predictors of exclusive breastfeeding for 6 months in a national sample of US children. American Journal of Health Promotion, 33(1), 48–56. https://doi.org/10.1177/0890117118774208

27.

Oksijen

(2025). Doğum iznine düzenleme geliyor: Süreler uzuyor [Maternity leave changes are coming: Durations are being extended]. Gazete Oksijen. https://gazeteoksijen.com/turkiye/dogum-iznine-duzenleme-geliyor-sureler-uzuyor-253939

28.

Organisation for Economic Co-operation and Development (OECD). (2019). Health at a glance 2019. OECD Publishing. https://doi.org/10.1787/4dd50c09-en

29.

Özsoy

(2014). The adolescent mothers about breastfeeding thought and practices. Florance Nightgale Hemşirelik Dergisi, 22(2), 84–93.

30.

Öztürk

Demirgöz Bal

(2024). The effect of online breastfeeding counseling given to primiparous women in the postpartum period on breastfeeding self-efficacy and time to start supplementary food. Gümüşhane University Journal of Health Sciences, 13(3), 1242–1251. https://www.randomizer.org/

31.

Republic of Türkiye Ministry of Health, Public Hospitals General Directorate. (2018). Doğum öncesi bakım yönetim rehberi [Antenatal care management guideline]. https://khgmsaglikhizmetleridb.saglik.gov.tr/TR,42839/dogum-oncesi-bakim-yonetim-rehberi.html

32.

Rollins

N. C.

Bhandari

Hajeebhoy

Horton

Lutter

C. K.

Martines

J. C.

Piwoz

E. G.

Richter

L. M.

Victora

C. G.

(2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet, 387(10017), 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2

33.

Singh

B. K.

Khatri

R. B.

Sahani

S. K.

Khanal

(2024). Determinants of exclusive breastfeeding among infants under six months in Nepal: Multilevel analysis of nationally representative household survey data. BMC Public Health, 24(1), 2456. https://doi.org/10.1186/s12889-024-19963-z

34.

Steinman

Doescher

Keppel

G. A.

Pak-Gorstein

Graham

Haq

Johnson

D. B.

Spicer

(2010). Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: An exploratory study with Somali mothers in the USA. Maternal and Child Nutrition, 6(1), 67–88. https://doi.org/10.1111/j.1740-8709.2009.00185.x

35.

Taveras

E. M.

Capra

A. M.

Braveman

P. A.

Jensvold

N. G.

Escobar

G. J.

Lieu

T. A.

(2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112(1), 108–115. http://publications.aap.org/pediatrics/article-pdf/112/1/108/1002438/pe0703000108.pdf

36.

Twamley

Puthussery

Harding

Baron

Macfarlane

(2011). UK-born ethnic minority women and their experiences of feeding their newborn infant. Midwifery, 27(5), 595–602. https://doi.org/10.1016/j.midw.2010.06.016

37.

UNICEF & WHO. (2023). Global breastfeeding scorecard 2023. https://www.unicef.org/documents/global-breastfeeding-scorecard-2023

38.

Victora

C. G.

Bahl

Barros

A. J. D.

França

G. V. A.

Horton

Krasevec

Murch

Sankar

M. J.

Walker

Rollins

N. C.

(2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387, 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7

39.

World Health Organization (WHO), & United Nations Children’s Fund (UNICEF). (2021). Indicators for assessing infant and young child feeding practices: definitions and measurement methods. https://www.who.int/publications/i/item/9789240018389

40.

Yalçın

S. S.

Çaylan

Yalçın

Eryurt

M. A.

(2020). Trends and determinants of prelacteal feeding in Turkey: Analysis of 2003-2018 demographic and health surveys. Public Health Nutrition, 23(18), 3269–3282. https://doi.org/10.1017/S1368980020002037

41.

Yalçın

S. S.

Erat Nergiz

Elci

Ö. C.

Zikusooka

Yalçın

Sucakli

M. B.

Keklik

(2022). Breastfeeding practices among Syrian refugees in Turkey. International Breastfeeding Journal, 17(1), 10. https://doi.org/10.1186/s13006-022-00450-3

42.

Yılmaz

Doğa Öcal

Vural Yılmaz

Ceyhan

Fadıl Kara

Küçüközkan

(2017). Early initiation and exclusive breastfeeding: Factors influencing the attitudes of mothers who gave birth in a baby-friendly hospital. Turkish Journal of Obstetrics and Gynecology, 14(1), 1–9. https://doi.org/10.4274/tjod.90018

43.

Yılmaz

Dinç

Günaydın

Kaçar

(2021). Breastfeeding in Turkey: A systematic review. Clinical and Experimental Health Sciences, 11(3), 604–616. https://doi.org/10.33808/clinexphealthsci.840651

Trends and Determinants of Exclusive Breastfeeding in Turkey: A Trend Analysis and Determinants Analysis of Four Demographic and Health Surveys,2003–2018

Abstract

Background;

Methods;

Results:

Conclusions:

Keywords

Background

Key Messages

Research Aim

Methods

Study Design and Data Source

Sample and Inclusion Criteria

Variables

Data Harmonization and Weighting

Ethics

Statistical Analysis

Results

Discussion

Strengths and Limitations

Conclusion

Footnotes

Acknowledgements

ORCID iDs

Ethical Considerations

Consent to Participate

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References