Breastfeeding knowledge, attitude, perceived behavior, and intention among female undergraduate university students in the Middle East: the case of Lebanon and Syria

Food Nutr Bull. 2014 Jun;35(2):179-90. doi: 10.1177/156482651403500204.


Background: The Middle East has one of the lowest rates of exclusive breastfeeding in the world, highlighting the need to promote breastfeeding in this region. Young adults represent a key population of interest, since decisions about infant-feeding appear to be made before children are even conceived.

Objective: To examine breastfeeding knowledge, attitude, and perceived behavior among female undergraduate students in Lebanon and Syria and determine factors associated with intention to breastfeed in this population.

Methods: This cross-sectional study was conducted in 2010/11 in Damascus and Beirut. Four universities were selected in each city. A multicomponent questionnaire was administered to a convenience sample of participants (n = 194 from Beirut and n = 199 from Damascus). The questionnaire included breastfeeding knowledge (measured by the Infant Feeding Knowledge Test Form), attitude (Iowa Infant Feeding Attitude Scale), perceived behavior (Breastfeeding Behavior Questionnaire), and intention (Infant Feeding Intention Scale). Factors associated with intention to breastfeed were examined by multivariate linear regression analysis.

Results: The participants had an average breastfeeding knowledge level (mean score, 10.39 +/- 2.09) and neutral perceived behavior (mean score, 22.00 +/- 3.68), while having relatively positive attitudes (mean score, 58.12 +/- 6.49). Knowledge gaps and negative perceptions were identified, particularly linked to breastfeeding in public and among working mothers. Breastfeeding intention was found to be significantly associated with knowledge and attitude in Lebanon (beta = 0.103 and beta = 0.230, respectively), and with perceived behavior in Syria (beta = -0.135).

Conclusions: By revealing specific knowledge gaps and misconceptions and identifying country-specific disparities in the predictors of the intention to breastfeed, the findings of this study may provide a basis for devising culture-specific interventions aimed at promoting breastfeeding.

MeSH terms

  • Adolescent
  • Adult
  • Breast Feeding* / ethnology
  • Breast Feeding* / psychology
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice* / ethnology
  • Humans
  • Intention*
  • Lebanon
  • Perception
  • Students*
  • Syria
  • Universities
  • Young Adult