Impact of educational workshops on breastfeeding practices in traditional Chinese postpartum centres: a cohort study during the COVID-19 pandemic.

backgroundPostpartum Chinese mothers in Malaysia traditionally observe a 30-day confinement period, many choosing to stay in privately run traditional postpartum centres, known locally as confinement centres (CCs). Following a 2017 cohort study that identified gaps in breastfeeding support and hygiene practices, three participatory needs-based educational workshops were delivered to CC staff. A new cohort of mothers was recruited in 2019 to evaluate the same outcomes after the intervention.

methodsEthnic Chinese mothers with healthy term infants who intended to breastfeed were recruited at delivery and followed up until six months postpartum. Using semi-structured telephone interviews, the following data was collected: exclusive and direct breastfeeding, rooming-in, breastfeeding problems, hygiene indicators, and infant health. Comparisons were made between mothers staying in CCs and home in the current cohort, and with the 2017 cohort. Quantitative data were analysed using chi-squared tests, t-tests, and logistic regression; qualitative responses were analysed thematically.

resultsWe recruited 206 mothers (103 CC, 103 home) and excluded four who did not stay as intended (3 CC, 1 home). Data collection coincided with the COVID-19 pandemic. Fewer CC mothers reported breastfeeding problems compared to 2017. However, gaps such as limited rooming-in and preference for expressed milk remained; and exclusive breastfeeding rates at six months did not differ significantly between groups or cohorts. Some hygiene practices in CCs improved, but perceived staff hand hygiene practices remained suboptimal. Interestingly, one-month exclusive breastfeeding rates declined for both CC and home groups in 2019 compared to 2017. Direct breastfeeding in 2019 also fell, and mothers who did not directly breastfeed were less likely to sustain exclusive breastfeeding at six months. Post-hoc interviews suggested COVID-19 had limited influence on most mothers’ breastfeeding intentions, though subtle disruptions in breastfeeding support may have contributed to lower exclusive breastfeeding rates.

conclusionsTraining alone is insufficient to improve practices in Malaysian CCs. As CCs gain popularity, strategies that go beyond staff training, including regulatory oversight, public education, and integration of CCs into national maternal–child health systems are needed.