Myths lead to insufficient milk secretion perception and a sense of failure in mothers and are among the most common reasons for cessation of breastfeeding. Previous studies have revealed that women's beliefs in breastfeeding myths are quite common and that some traditional practices are known by all mothers and applied at low rates. The objective of the present study was to determine the effects of pregnant women’s breastfeeding myths on their breastfeeding self-efficacy.

This cross-sectional study was conducted on 483 nulliparous pregnant women in the gynecology and obstetrics outpatient clinics of a hospital in the east of Türkiye between March 29, 2024, and September 30, 2024. The research data were collected using the Information Form, Breastfeeding Myths Scale, and Prenatal Breastfeeding Self-Efficacy Scale. The independent samples t-test, variance, Pearson’s and Spearman’s correlation analysis, and single regression analysis were used to analyze the data.

Pregnant women scored 68.01 ± 17.72 on average on the BMS, and 98.6% had breastfeeding myths at a low level. Pregnant women scored 75.01 ± 14.89 on average on the PBSES. The analysis detected a negative and low-level correlation between the BMS and PBSES scores (p < 0.001).

The study found that pregnant women’s breastfeeding self-efficacy decreases with an increase in their breastfeeding myths. Breastfeeding myths explain 23% of the change in breastfeeding self-efficacy.

Nowadays, evidence-based studies have proven the physical, mental, and social impacts of breast milk and breastfeeding on maternal, infant, and community health [1,2,3,4,5,6,7,8,9]. Although breastfeeding has been supported by national and international organizations, breastfeeding rates are still not at the desired level [10, 11]. The rate of exclusive breastfeeding of infants in the first six months of life is 44% globally, but this rate is 41% in Türkiye [12, 13]. The World Health Organization aims to increase the rate of exclusive breastfeeding of infants in the first six months of life to 50% by 2025 [12].

Numerous factors positively or negatively affect the effective and regular initiation and continuation of breastfeeding [14, 15]. Many factors such as the mother's knowledge and experience in breastfeeding, awareness of the subject, social support, presence in the same environment with the infant, and the existence of any health problems in the infant or herself may also determine the fate of breastfeeding [2, 5, 16,17,18,19,20,21,22,23,24]. In this respect, it is known that traditional practices, false beliefs, and myths are also among the most important factors impacting breastfeeding [10].

Myths lead to insufficient milk secretion perception and a sense of failure in mothers and are among the most common reasons for cessation of breastfeeding [10]. There may be similarities or differences regarding myths among countries [25, 26]. Some of the most common beliefs and practices that are known to be wrong in Türkiye are giving sugar water to the infant immediately after birth, applying dates to the infant's mouth, dropping Zamzam water, initiating supplementary food early with the belief that breast milk is insufficient [27], and not giving colostrum to the infant thinking that it is harmful or dirty [28]. Practices similar to those in Türkiye are generally observed in Muslim societies [25, 26, 29].

The mother's breastfeeding self-efficacy is another most important factor affecting breastfeeding [30]. The mother’s breastfeeding self-efficacy affects initiating and continuing breastfeeding, in other words, achieving successful breastfeeding. Mothers with high breastfeeding self-efficacy have higher rates of exclusive breastfeeding [31], breastfeeding intentions, and breastfeeding success [14, 23, 30, 32].

The present research was conducted to determine the effects of pregnant women’s breastfeeding myths on their breastfeeding self-efficacy.

This descriptive cross-sectional study was carried out according to STROBE guidelines. It was conducted in a city hospital in a province in eastern Türkiye between March 29, 2024, and September 30, 2024. The province where the study was conducted has been in the “Golden Baby-Friendly Province” category as of 2017. The hospital where the research was carried out was chosen because of its patient density and the service it provides to individuals with different socioeconomic statuses, and the institution also has the title of mother and baby-friendly hospital [33,34,35,36].

Nulliparous women aged 18–35 in the prenatal period constituted the study’s population. A priori power analysis was performed to calculate the sample size of the study. The power analysis was based on Cohen's standard effect sizes. In this study, it was computed that data should be collected from approximately 342 pregnant women to reach a significance level of 0.05, an effect size of 0.5, a confidence interval of 95%, and a power of 90% for Pearson’s correlation analysis to compare the effects of pregnant women's breastfeeding myths on their breastfeeding self-efficacy. The study was completed with 483 pregnant women.

The “Women Information Form” prepared by the researcher, the “Breastfeeding Myths Scale,” and the “Prenatal Breastfeeding Self-Efficacy Scale” were utilized as the data collection tools.

The above-mentioned form was prepared with the objective of determining women’s descriptive characteristics and consists of a total of 10 questions [10, 14, 37].

The Breastfeeding Myths Scale (BMS), developed by Yılmaz Sezer et al. (2024), was developed in order to assess breastfeeding myths in Turkish society. The scale in question can be used on all women and men who are older than 18 years and can read and understand Turkish. The BMS comprises 30 items and one dimension. The scale is graded in 5-point Likert type (Strongly Agree = 5, Agree = 4, Moderately Agree = 3, Disagree = 2, Strongly Disagree = 1). All items are coded reversely. The total scale score is obtained by summing the scores from all items. The total score that can be received on the scale ranges from 30 to 150, and the cut-off score of the scale was found to be 119.5. The prevalence of breastfeeding myths increases with an increase in the total score obtained from the scale. Cronbach's alpha value in the original form of the scale is 0.90 [38]. The present study calculated Cronbach's alpha value to be 0.91.

The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) was developed by Wells et al. (2006) to determine the breastfeeding self-efficacy perceptions of pregnant women in the prenatal period, and its Turkish validity and reliability were made by Aydın and Pasinlioğlu (2018) [15, 39]. The said scale comprises a total of 20 items and is rated as a 5-point Likert scale (1 = Not sure at all, 5 = Absolutely sure). The total scale score is obtained by summing the scores from all items. The total score that can be received on the scale varies between 20 and 100, and a higher score indicates increased breastfeeding self-efficacy perception [15]. Cronbach's alpha value in the original form of the scale is 0.86 [15]. This study computed Cronbach's alpha value to be 0.90.

Data were collected using the face-to-face interview method while pregnant women who came to the hospital for a prenatal check-up were waiting in line for polyclinic examination. The researcher read the questions to pregnant women, and they were asked to answer them. After the survey, pregnant women's questions about breastfeeding, if any, were answered, and the interview was terminated. Before the study, ethics committee approval (Date: 29.03.2024, Number: B.30.2.ATA.0.01.00/214) from the Ethics Committee of Atatürk University, Faculty of Medicine, and written permission from the institution where the research would be conducted were obtained. Pregnant women who met the research criteria were informed about the study, and then the data were collected after obtaining their consent. The ethical principles and the Declaration of Helsinki were followed during the study.

The data were analyzed using the SPSS 22 package program. Number, percentage, minimum–maximum scores, mean, standard deviation, independent samples t-test, variance, Pearson’s and Spearman’s correlation analysis, Cronbach’s α coefficient, and single regression analysis were used to analyze the data. The data’s conformity to the normality assumption was calculated with the"Kurtosis"and"Skewness"coefficients (± 2).

The mean age of the pregnant women was 25.80 ± 3.84, the mean age of their husbands was 28.95 ± 4.04, and they were married for an average of 1.68 ± 1.07 years (data are not shown). Of the pregnant women, 49.5% were university graduates, and 74.7% were unemployed. Of the pregnant women, 57.3% had a middle economic status, 82% lived in a nuclear family, and 61.7% were in the 3rd trimester of their pregnancy.

Pregnant women scored an average of 68.01 ± 17.72 on the total BMS and an average of 75.01 ± 14.89 on the total PBSES (Table 1). According to the scale cut-off point, 98.6% of the pregnant women were found to have a low level of breastfeeding myths. The difference in the BMS total mean scores according to the pregnant women's education level, employment status, husband's education level, husband's occupation, and family type was statistically significant (p < 0.05, Table 2). Furthermore, the difference in the PBSES total mean scores according to education level, employment status, husband's education level, husband's occupation, economic status, presence of health insurance, and family type was statistically significant (p < 0.001, Table 2).

Among some descriptive variables, there was a negative and low-level correlation between age, husband's age, marriage duration, and the BMS score, and a significant, positive, and low-level correlation between age, husband's age, and the PBSES score (p < 0.05 Table 3). The study found a negative and low-level correlation between breastfeeding myths and breastfeeding self-efficacy (p < 0.001, Table 3).

The regression analysis performed to reveal to what extent having breastfeeding myths predicted breastfeeding self-efficacy determined that having breastfeeding myths explained 23% of the change in breastfeeding self-efficacy (p < 0.001, Table 4).

The study revealed that 98.6% of the pregnant women had a low level of breastfeeding myths. All communities in the world have various beliefs around their own geography, religion, and lifestyle [40]. Women's beliefs in breastfeeding myths are quite common [41], and it has been reported that 99.2% of mothers perform a traditional practice related to breastfeeding and increasing breast [42]. In particular, it has been determined that some traditional practices are known by all mothers and applied at low rates [43]. It has been reported that more than half of mothers also consider traditional practices related to breast milk and breastfeeding “important” [44].

Traditional practices and beliefs related to cultures can be used in all societies at different stages of life, from birth to death [45, 46]. In fact, myths are the beliefs that an individual assumes to be true but are actually false or have not yet been proven true [47]. These beliefs have been observed since the existence of humanity [48]. Cultural values, practices, and beliefs determine individuals’ attitudes and affect their health conditions and lifestyle [45]. Table 3 shows that some descriptive characteristics affect the level of having breastfeeding myths (p < 0.05, Table 3). Our feelings and behaviors and our cultural beliefs shape breastfeeding. Myths are considered inheritance depending on the mother's culture and are more common in societies where tradition prevails over science [49]. In the current study, pregnant women who had a high education level, were employed, had civil servant husbands, had good economic conditions, and lived in a nuclear family had lower levels of breastfeeding myths than other groups. Traditional beliefs and practices decrease with the increased socio-economic level [5, 37, 45, 50,51,52,53]. Depending on the socio-economic level, mothers are more prone to guidance from the family and individuals in their environment [54] and can change their attitudes and behaviors accordingly [42, 45, 55].

The mother's breastfeeding self-efficacy is among the factors impacting breastfeeding. Breastfeeding self-efficacy is considered an essential factor in the initiation and continuation of breastfeeding that affects breastfeeding [56]. The breastfeeding self-efficacy levels of the pregnant women in the study group were above the average level, which is parallel to the study by Konukoğlu and Pasinlioğlu (2021) [57]. The present study revealed that pregnant women who had a university education, were employed, had civil servant husbands, had a high economic status, had social security, and lived in a nuclear family had higher levels of breastfeeding self-efficacy (Table 3) (p < 0.05). Self-efficacy beliefs determine how individuals think, feel, behave, and motivate themselves [58]. Individuals'understanding of self-efficacy impacts their reactions to events, problem-solving skills, ideas, and thoughts. Individual achievements are the most effective source of information in increasing self-efficacy [58]. In particular, it is thought that individuals with a higher level of education have higher decision-making and task-accomplishment capacities and that the above result originates from this [57, 59].

As seen in Table 4, there was a statistically significant, negative, and low-level correlation between breastfeeding myths and prenatal breastfeeding self-efficacy (p < 0.05). Myths have varied since the past, in different social classes, in different countries and societies, and even in different regions within countries [48]. Taboos, myths, namely, wrong practices due to false beliefs about breastfeeding in society adversely impact the initiation and continuation of breastfeeding, early cessation of breastfeeding by starting supplementary food early, and ultimately the success of breastfeeding [47, 52]. The mother's low breastfeeding self-efficacy is one of the most important reasons for low breastfeeding rates and receiving formula support [31]. The literature has highlighted a positive correlation between breastfeeding self-efficacy and breastfeeding success [23]. Beliefs in myths are generally high in societies where traditional practices are common. Although many traditional practices have arrived to the present day, it is remarkable that they have decreased compared to the past. The most important factor here is considered to be the increased level of education in society and the ease of access to information. The level of education also affects the problem-solving success of individuals and causes them to approach events more constructively. It is considered that the fact that most women in the study group had higher education contributed to this result.

The fact that the research was performed on nulliparous pregnant women constitutes the study’s limitation. Since the study was conducted in a single region, the results can only be generalized to this region.

The study revealed that the majority of pregnant women had low levels of breastfeeding myths and that breastfeeding self-efficacy decreased with an increase in breastfeeding myths.

In line with the study results, it is recommended that:

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AJY: Conceptualization, Methodology, Data curation, Writing- Original draft preparation, ZDÜT: Visualization, Investigation, Supervision, Software, Validation, Writing- Reviewing and Editing.

Correspondence to Zehra Demet Üst Taşğın.

Ethical approval for the study was obtained from the Ethics Committee of Atatürk University, Faculty of Medicine (Date: 29.03.2024, Number: B.30.2.ATA.0.01.00/214). Pregnant women who met the research criteria were informed about the study, and then the data were collected after obtaining their consent. The ethical principles and the Declaration of Helsinki were followed during the study.

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The authors declare no competing interests.

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