Primiparity, older maternal age, COVID-19 pandemic, twin birth, and winter birth are associated with lower exclusive breastfeeding in Japanese mothers.

Exclusive breastfeeding is essential for the health and well-being of both mothers and infants, but various factors may influence whether mothers are able to sustain exclusive breastfeeding during the early postpartum period. In this study, we explored the relationship of obstetric characteristics, the timing of delivery during the COVID-19 pandemic, and the season of birth with exclusive breastfeeding among Japanese mothers. Data included self-report survey and medical records of 5719 Japanese mothers at 1 month postpartum. We conducted path analysis on parity, maternal age, type of delivery, type of birth, pandemic-related delivery, birth season, and feeding method. The findings of a good-fit model suggested that being a first-time mother, older maternal age, having twins, giving birth during the pandemic, and delivering in winter were all associated with lower rates of exclusive breastfeeding (all P = 0.001). Mothers who were younger, had previous childbirth experience, delivered a singleton, gave birth before the pandemic, and delivered in summer, spring, or autumn were more likely to breastfeed exclusively. These findings support the need for targeted breastfeeding interventions that address obstetric, seasonal, and pandemic-related risk factors.