Abstract
Background
Prelacteal feeding, which deprives newborns of colostrum, remains a major public health concern, particularly in low- and middle-income countries. This study aimed to determine the prevalence and predictors of prelacteal feeding among mothers in eastern Turkey.
Methods
A cross-sectional study was conducted between January and August 2023, including 335 mothers with infants aged 0–24 months. Participants were recruited from volunteer mothers who met the inclusion criteria and attended the paediatrics and gynaecology clinics of a university hospital during the data collection period. Data were collected through face-to-face interviews conducted by the researchers using the Prelacteal Feeding Practices and Associated Factors Questionnaire (PFP-AFQ).
Results
Prevalence of prelacteal feeding was 17.9%. Common prelacteal substances administered include formula (51.7%), sugar water (28.3%), cow’s milk (3.3%), and plain water (16.7%). Maternal education level, place of residence, employment status, family type, household income level, receipt of regular antenatal care, birth weight, breastfeeding education status, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were found to be significantly associated with prelacteal feeding (p<0.05).
Furthermore, according to the multiple logistic regression analysis, income level, breastfeeding education, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were identified as significant predictors of prelacteal feeding (p<.05).
Conclusions
In conclusion, prelacteal feeding remains a preventable but persistent practice influenced by maternal education, antenatal care, breastfeeding knowledge, and early initiation of breastfeeding. Integrating targeted educational interventions into prenatal and postnatal care may help reduce the prevalence of prelacteal feeding and improve breastfeeding outcomes.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28052-2.
Keywords: Prelacteal, Prelacteal Feeding, Breastfeeding, Newborn
Background
Breastfeeding is the most physiological, safe, and cost-effective method of infant feeding and constitutes a fundamental public health priority due to its protective effects against infections, its role in optimal growth and development, and its long-term health benefits [1, 2]. UNICEF and the World Health Organization recommend initiating breastfeeding within the first hour after birth, exclusive breastfeeding for the first six months, and continued breastfeeding with appropriate complementary foods up to two years of age and beyond [2, 3]. Evidence shows that infants who are not breastfed within the first hour face a significantly higher risk of mortality and morbidity, whereas early initiation markedly increases survival [1, 3]. Despite these strong recommendations, prelacteal feeding-defined as the administration of any food or liquid other than breast milk before breastfeeding is initiated or within the first three days after birth-remains a major barrier to early breastfeeding in many [4, 5]. Substances such as honey, sugar water, cow’s or goat’s milk, herbal mixtures, ghee, or sacred fluids are often given based on cultural, traditional, or religious beliefs that they are “cleansing,” “strengthening,” or “protective.” However, these practices delay or prevent colostrum intake and deprive the newborn of critical immunological and nutritional benefits [6, 7]. Prelacteal feeding has been associated with delayed breastfeeding initiation, premature introduction of formula, disruption of lactation, reduced exclusivity of breastfeeding, and increased risks of infection, malnutrition, and growth faltering [8, 9]. In low- and middle-income countries (LMICs), prelacteal feeding remains a widespread traditional practice. Multinational surveys report that a substantial proportion of newborns are given water-based or milk-based prelacteals during the first days of life [10, 11]. Key determinants identified in the literature include low maternal education, rural residence, inadequate antenatal care, cesarean birth, perceived insufficient milk, the influence of elder family members, and low birth weight [12, 13]. Collectively, this evidence underscores that prelacteal feeding is not merely an individual behavior but a complex public health issue shaped by socio-cultural and structural factors.
In the Turkish context, despite national policies and programs promoting breastfeeding, the 2018 Turkey Demographic and Health Survey (TDHS) reported that 42% of breastfed infants received prelacteals before breastfeeding was initiated [14]. However, data on the regional distribution and determinants of prelacteal feeding remain limited. Notably, there is a lack of studies examining this practice in Eastern Anatolia, a region characterized by socioeconomic disadvantage, extended family structures, entrenched cultural norms, and disparities in access to healthcare services. This gap indicates that although national prevalence estimates exist, region-specific risk profiles and context-driven determinants remain insufficiently explored.
This study aims to determine the prevalence of prelacteal feeding and to identify associated sociodemographic, obstetric, and breastfeeding-related factors among mothers of children aged 0–24 months in Van, a province located in Eastern Turkey. By elucidating region-specific risk factors, the study seeks to provide evidence that can inform targeted breastfeeding counseling, antenatal care content, and community-based educational interventions aimed at reducing prelacteal feeding. In this respect, the study contributes novel data regarding Eastern Anatolia and offers insights that may support the strengthening of national breastfeeding policies through regionally tailored approaches.
Methods
Design
A cross-sectional study design was used.
Sample and power analyze
To determine the statistical power of the study, a post-hoc power analysis was conducted using the G*Power software based on the existing sample size (N = 335) [15]. The analysis was performed considering the main predictors that showed a statistically significant effect on the dependent variable in the multiple logistic regression model. Since logistic regression estimates coefficients based on the z distribution, the “z tests” family and the “Logistic Regression” option were selected. The adjusted odds ratio of the strongest predictor in the model, “postpartum colostrum feeding” (OR = 9.412), was used as the basis for the analysis [16]. The proportion of the dependent variable among those not engaging in prelacteal feeding was entered as 0.96. The R² other X value was calculated from the variance inflation factor (VIF = 1.866) and entered as 0.464. As the dependent variable was categorical, a binomial distribution was selected, and the prevalence of prelacteal feeding in the sample was defined as 0.179 (60/335). As a result of the post-hoc analysis, the statistical power of the study was calculated as 1 − β = 0.999 at a significance level of α = 0.05 with a sample size of 335. This value is substantially higher than the 80% (0.80) power threshold recommended by Cohen (1988), indicating that the risk of Type II error is minimal and that the statistically significant findings obtained in this study are highly reliable [17].
Place and time
The study was conducted in the Tuşba district of Van Province, located in the Eastern Anatolia Region of Türkiye, between January and August 2023. Data were collected through face-to-face interviews conducted by the researchers with volunteer mothers aged over 19 years who had children aged 0–24 months, met the research criteria, and attended the Paediatrics and Gynaecology outpatient clinics of a university hospital.
Inclusion criteria
Having a child aged 0–24 months, being able to speak and understand Turkish, having initiated breastfeeding at least once after birth (to assess prelacteal feeding behavior), and being willing to participate in the study.
Exclusion criteria
The baby had a chronic, congenital, metabolic, or hereditary disease or a condition that could affect feeding (e.g., cleft palate/lip, gastrointestinal malformations, etc.); the mother had a medical condition that contraindicated breastfeeding (e.g., HIV infection, untreated active tuberculosis, medication use incompatible with breastfeeding, etc.); and multiple pregnancies (twins, triplets, etc.) were excluded from the study because breastfeeding dynamics and the likelihood of using complementary foods/formulas differ in these cases compared to singleton pregnancies. The mother had a diagnosed psychiatric or cognitive disorder; and mothers who had never breastfed after birth.
Data collection
Data were collected using the Prelacteal Feeding Practices and Associated Factors Questionnaire (PFP-AFQ) (Additional File-1), which was developed by the researchers based on the literature [9, 18].
The questionnaire items were not developed to measure a single latent construct; rather, they were designed to describe various conditions and characteristics related to the research topic. Therefore, the items in the data collection instrument were evaluated as formative rather than reflective in nature.
Since the questions were structured in a dichotomous (yes/no) format and did not represent a single latent construct, no total score was calculated. After establishing content and scope validity, the data collection instrument was analyzed at a descriptive level [19].
In the literature, it is emphasized that internal consistency coefficients (e.g., Cronbach’s α, McDonald’s ω) are meaningful only for reflective measurement models and are not appropriate for formative constructs [20, 21].
The survey form was collected in a quiet room of the hospital. The administration of the questionnaire took approximately 15–20 min.
Prelacteal feeding practices and associated factors questionnaire (PFP-AFQ)
Data were collected using a structured questionnaire comprising 24 items. The first Sect. (6 items) assessed the socio-demographic characteristics of the mothers. The second Sect. (18 items) evaluated the mothers’ obstetric history, breastfeeding knowledge, and specific infant feeding practices, including colostrum administration and prelacteal feeding. Of the items, 21 were structured as multiple-choice (closed-ended), while 3 were designed as open-ended questions to provide deeper insight into the reasons for prelacteal feeding.
Study variables
Prelacteal feeding practices were analyzed in relation to various independent variables, which were grouped into different categories. The independent variables included socio-demographic factors (age, educational status, place of residence, employment status, family type, income level), factors related to the mother (number of pregnancies, number of living children, regular prenatal care, mode of delivery, birth week, birth weight of the baby, breastfeeding education, source of information about breastfeeding), and factors related to breastfeeding practices (the first time of breastfeeding the baby, the importance of colostrum, the necessity of giving colostrum immediately after birth, the status of giving colostrum, the reason for not giving colostrum, the status of prelacteal feeding, the level of knowledge about the harm of prelacteal feeding, the substance given before breastfeeding, the reason for prelacteal feeding, the perceived benefit of prelacteal feeding for the baby).
Ethical approval
For this study, ethical approval numbered 2022/07–13 was obtained from the Van Yüzüncü Yıl University Non-Interventional Clinical Research Ethics Committee, and study permission was obtained from the hospital where the study was conducted. Mothers were informed about the study, fulfilling the principle of “Informed Consent,” stating that they were free to choose whether or not to participate, and the principle of “Respect for Autonomy,” stating that the information they provided would remain confidential. Written and verbal consent was obtained. Pregnant women who agreed to participate were informed that they had the right to withdraw from the study at any time. Because personal rights must be protected in the study, the Helsinki Declaration of Human Rights was adhered to throughout the study.
Statistical analysis
Statistical analysis were performed using SPSS version 27. Descriptive statistics in the study were expressed as mean, standard deviation, and minimum and maximum values for continuous variables, and as frequency and percentage for categorical variables. The Chi-Square test was performed to examine the relationship between categorical variables related to mothers and infants and prelacteal feeding, with Pearson Chi-Square values considered. Variables found to be statistically significant in the Chi-Square test were included in the binary logistic regression analysis. Postpartum prelacteal feeding was treated as the dependent variable, and the effects of demographic and socio-economic characteristics, as well as obstetric history and infant feeding practices, were evaluated using logistic regression analysis. Prior to the analysis, the assumptions required for logistic regression (multicollinearity, outliers, and model fit) were assessed [22]. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test. A significance level of 5% was used in the calculations.
Results
The findings of the study are presented in Tables 1, 2 and 3.
Table 1.
Socio-demographic and obstetric factors associated with the prelacteal feeding
| Prelacteal feeding | |||||
|---|---|---|---|---|---|
| Yes (n = 60, %17.9) |
No (n = 275, %82.1) |
Total (n = 335, %100.0) |
Statistics |
p. (V) |
|
| Mother’s age | |||||
|
M ± SD: (Min-Max): |
31.5 ± 6,6 (20–50) |
29.9 ± 5.62 (19–47) |
30.2 ± 5.8 (19–50) |
t:1.912 | 0.057 |
| n (%) | n (%) | n (%) | χ 2 | p. | |
|---|---|---|---|---|---|
| Mother’s Education | |||||
| Illiterate | 13 (26.0) a | 37 (74.0) a | 50 (14.9) | 7.322 |
0.026* (0.148) |
| Up to high school | 21 (23.9) a | 67 (76.1) a | 88 (26.3) | ||
| High school or above | 26 (13.2) a | 171 (86.8) b | 197 (58.8) | ||
| Place of residence | |||||
| Urban | 41 (15.2) a | 229 (84.8) b | 270 (80.6) | 7.029 |
0.008* (0.145) |
| Rural | 19 (29.2) a | 46 (70.8) b | 65 (19.4) | ||
| Mother’s employment status | |||||
| Employed | 5 (8.2) a | 56 (91.8) b | 61 (18.2) | 4.786 |
0.029* (0.120) |
| Unemployed | 55 (20.1) a | 219 (79.9) b | 274 (81.8) | ||
| Family type | Yes | No | |||
| Nuclear family | 28 (13.5) a | 180 (86.5) b | 208 (62.1) | 7.386 |
0.007* (0.148) |
| Extended family | 32 (25.2) a | 95 (74.8) b | 127 (37.9) | ||
| Family income | Yes | No | |||
| Income less than expenditure | 26 (11.8) a | 194 (88.2) b | 220 (65.7) | 17.361# |
0.001* (0.236) |
| Income matches expenditure | 31 (32.0) a | 66 (68.0) b | 97 (29.0) | ||
| Income more than expenditure | 3 (16.7) a | 15 (83.3) a | 18 (5.4) | ||
| Number of pregnancies | |||||
| 1 | 6 (10.0) | 54 (90.0) | 60 (17.9) | 6.907 | 0.075 |
| 2 | 13 (13.5) | 83 (86.5) | 96 (28.7) | ||
| 3 | 22 (22.2) | 77 (77.8) | 99 (29.6) | ||
| 4 + | 19 (23.8) | 61 (76.3) | 80 (23.9) | ||
| Number of Living Children | |||||
| 1 | 12 (14.8) | 69 (85.2) | 81 (24.2) | 4.836 | 0.184 |
| 2 | 22 (21.2) | 82 (78.8) | 104 (31.0) | ||
| 3 | 10 (12.0) | 73 (88.0) | 83 (24.8) | ||
| 4 + | 16 (23.9) | 51 (76.1) | 67 (20.0) | ||
| Did you receive regular antenatal care? | |||||
| Yes | 34 (14.2) a | 205 (85.8) b | 239 (71.3) | 7.701 |
0.006* (0.152) |
| No | 26 (27.1) a | 70 (72.9) b | 96 (28.7) | ||
| Number of prenatal follow-ups | |||||
| 1–3 times | 28 (25.7) a | 81 (74.3) b | 109 (32.5) | 6.648 |
0.010* (0.141) |
| 4 and more | 32 (14.2) a | 194 (85.8) b | 226 (67.5) | ||
| Mode of Birth | |||||
| Normal | 28 (14.8) | 161 (85.2) | 189 (56.4) | 2.827 | 0.093 |
| Caesarean section | 32 (21.9) | 114 (78.1) | 146 (43.6) | ||
| Baby’s birth week | |||||
| 37th week or below | 14 (18.2) | 63 (81.8) | 77 (23.0) | 0.005 | 0.944 |
| 38 weeks or above | 46 (17.8) | 212 (82.2) | 258 (77.0) | ||
| Baby’s birth weight | |||||
| Under 2500 g | 13 (40.6) | 19 (59.4) a | 32 (9.6) b | 12.416 |
0.001* (0.193) |
| Above 2500 g | 47 (15.5) | 256 (84.5) a | 303 (90.4) b | ||
Bold values: p < 0.05
*: p<.05, V: Cramer V effect size, χ2: Chi-Square Tests Value, Analysis method: Pearson Chi-square test. (#: Some cells completed with Fisher-Freeman-Halton Exact Test where expected count <5), a-b: Post hoc adjust p-values (Benferroni method)
Table 2.
Relationship between breastfeeding/colostrum-related variables and prelacteal feeding
| Prelacteal feeding | |||||
|---|---|---|---|---|---|
| Yes (n = 60, %17.9) |
No (n = 275, %82.1) |
Total (n = 335, %100.0) |
Statistics |
p. (V) |
|
| Receiving information and training on breastfeeding | |||||
| Yes | 31 (11.3) a | 244 (88.7) b | 275 (82.1) | 46.012 |
0.001* (0.371) |
| No | 29 (48.3) a | 31 (51.7) b | 60 (17.9) | ||
| Source of information about breastfeeding | |||||
| Healthcare Worker | 25 (11.7) | 189 (88.3) | 214 (77.0) | 1.724# | 0.438 |
| Press and Broadcast Media | 1 (5.6) | 17 (94.4) | 18 (6.5) | ||
| Family elders | 8 (17.4) | 38 (82.6) | 46 (16.5) | ||
| Baby’s first breastfeeding time | |||||
| Immediately after birth | 25 (11.5) a | 193 (88.5) b | 218 (65.1) | 34.329 |
0.001* (0.320) |
| first hour | 14 (19.4) a | 58 (80.6) a | 72 (21.5) | ||
| 1–4 h | 13 (40.6) a | 19 (59.4) b | 32 (9.6) | ||
| After 4 h | 8 (61.5) a | 5 (38.5) b | 13 (3.9) | ||
| Do you know the importance of colostrum for your baby? | |||||
| Yes | 31 (12.0) a | 227 (88.0) b | 258 (77.0) | 26.530 |
0.001* (0.281) |
| No | 29 (37.7) a | 48 (62.3) b | 77 (23.0) | ||
| Should colostrum be given to the baby immediately after birth? | |||||
| Yes | 34 (11.5) a | 261 (88.5) b | 295 (88.1) | 68.507 |
0.001* (0.452) |
| No | 26 (65.0) a | 14 (35.0) b | 40 (11.9) | ||
| Did you give your baby colostrum after birth? | |||||
| Yes | 33 (11.1) a | 264 (88.9) b | 297 (88.7) | 82.330 |
0.001* (0.496) |
| No | 27 (71.1) a | 11 (28.9) b | 38 (11.3) | ||
| Why didn’t you give colostrum after birth? | |||||
| Family elders said it was harmful | 16 (84.2) | 3 (15.8) | 19 (50.0) | 3.445# | 0.204 |
| My milk’s not coming in. | 6 (54.5) | 5 (45.5) | 11 (28.9) | ||
| Because it’s dirty milk. | 5 (62.5) | 3 (37.5) | 8 (21.1) | ||
| Do you have any information about the harm of nutrition given other than colostrum? | |||||
| Yes | 16 (7.2) a | 207 (92.8) b | 223 (66.6) | 52.286 |
0.001* (0.395) |
| No | 44 (39.3) a | 68 (60.7) b | 112 (33.4) | ||
| What was the first nutrition you gave to the baby other than breast milk? | |||||
| Formula | 31 (51.7) | ||||
| Sugar water | 17 (28.3) | ||||
| Cow’s milk | 2 (3.3) | ||||
| Water | 10 (16.7) | ||||
| Why did you give nutrition other than breast milk? | |||||
| Perceived milk insufficiency | 27 (45.0) | ||||
| Advice of family elders | 13 (21.7) | ||||
| NICU hospitalization | 6 (10.0) | ||||
| Perceived infant thirst | 9(15.0) | ||||
| Blood sugar regulation. | 5 (8.3) | ||||
| Is the nutrition you give other than breast milk beneficial for the baby? | |||||
| Yes | 48 (80.0) | ||||
| No | 12 (20.0) | ||||
Bold values: p < 0.05
*: p<0.05, V: Cramer V effect size, χ2: Chi-Square Tests Value, Analysis method: Pearson Chi-square test. (#: Some cells completed with Fisher-Freeman-Halton Exact Test where expected count < 5), a−b: Post hoc adjust p-values (Benferroni method)
Table 3.
Predictors of prelacteal feeding practices: A multiple logistic regression model
| Depended variable: Prelacteal feeding (R: No, 1:Yes) |
95% C.I.for EXP(B) | |||||||
|---|---|---|---|---|---|---|---|---|
| B | S.E. | Wald | df | Sig. | Exp(B) | Lower | Upper | |
| Mother’s Education (Ordinal) | 0,103 | 0,314 | 0,107 | 1 | 0,743 | 1,108 | 0,599 | 2,052 |
| Place of residence (R: Urban, 1: Rural) | -0,66 | 0,62 | 1,132 | 1 | 0,287 | 0,517 | 0,153 | 1,743 |
|
Mother’s employment status (R: Unemployed, 1: Employed) |
-0,864 | 0,639 | 1,828 | 1 | 0,176 | 0,421 | 0,12 | 1,475 |
|
Family type (R: Nuclear, 1: Exctended) |
0,437 | 0,488 | 0,801 | 1 | 0,371 | 1,548 | 0,595 | 4,027 |
| Income | 1,001 | 0,334 | 8,962 | 1 | 0,003* | 2,72 | 1,413 | 5,238 |
|
Did you receive regular antenatal care? (R: Yes, 1:No) |
0,338 | 0,502 | 0,454 | 1 | 0,500 | 1,403 | 0,524 | 3,751 |
|
Number of prenatal follow-ups (R: 4 and more, 1:0–3 times) |
-0,397 | 0,481 | 0,68 | 1 | 0,410 | 0,672 | 0,262 | 1,727 |
|
Baby’s birth weight (R: Above 2500 g, 1:Under 2500 g) |
0,384 | 0,522 | 0,541 | 1 | 0,462 | 1,467 | 0,528 | 4,078 |
| Receiving information and training on breastfeeding (R: Yes, 1:No) | 1,497 | 0,455 | 10,838 | 1 | 0,001* | 4,467 | 1,832 | 10,891 |
| Baby’s first breastfeeding time (Ordinal) | 0,737 | 0,217 | 11,559 | 1 | 0,001* | 2,09 | 1,366 | 3,196 |
| Do you know the importance of colostrum for your baby? (R: Yes, 1:No) | -1,009 | 0,715 | 1,992 | 1 | 0,158 | 0,364 | 0,09 | 1,481 |
| Should colostrum be given to the baby immediately after birth? (R: Yes, 1:No) | 1,636 | 0,748 | 4,787 | 1 | 0,029* | 5,134 | 1,186 | 22,226 |
| Did you give your baby colostrum after birth? (R: Yes:1:No) | 2,242 | 0,609 | 13,57 | 1 | p < 0,001 | 9,412 | 2,855 | 31,025 |
| Do you have any information about the harm of nutrition given other than colostrum? (R: Yes, 1:No) | 1,008 | 0,461 | 4,771 | 1 | 0,029* | 2,74 | 1,109 | 6,769 |
| Constant | -5,825 | 1,147 | 25,795 | 1 | p < 0,001 | 0,003 | ||
Omnibus test χ²=130.728, df = 14, p < 0.001
Nagelkerke R² = 0.530
Hosmer-Lemeshow goodness-of-fit test: χ²=6.7, df = 8, p = 0.570 (p > 0.05 indicates acceptable model calibration)
Durbin-Watson: 1,884, VIF:1,167-2,963 (< 10)
*p<.05, # Marginally significant
R Reference category, Exp(B) Adjusted odds ratio, CI Confidence interval
Analysis method: Enter (simultaneous) binary logistic regression
Bold values: p < 0.05
Table 1 showed among the mothers surveyed, 17.9% reported feeding their babies prelacteals. Mothers with a bachelor’s degree or higher (86.8%) did not engage in prelacteal feeding (χ²(2) = 7.32, p = 0.026, V=0.148). The rate of not practicing prelacteal feeding was higher among those living in urban areas (84.8%) (χ²(1) = 7.03, p = 0.008, V=0.145). Non-working mothers (20.1%) were more likely to practice prelacteal feeding (χ²(1) = 4.79, p = 0.029, V=0.120).
Prelacteal feeding was more common among mothers living in extended families (25.2%) (χ²(1) = 7.39, p = 0.007, V=0.148). Mothers whose income was lower than their expenses (88.2%) had a higher rate of prelacteal feeding compared to those whose income equaled their expenses (68.0%) (χ²(2) = 17.36, p = 0.001, V=0.236).
Mothers who received regular antenatal care (85.8%) did not practice prelacteal feeding (χ²(1) = 7.70, p = 0.006, V=0.152), and similarly, those with four or more antenatal visits (85.8%) did not engage in prelacteal feeding (χ²(1) = 6.65, p = 0.010, V=0.141). Additionally, mothers of infants with a birth weight above 2500 g (84.5%) were less likely to practice prelacteal feeding (χ²(1) = 12.42, p < 0.001, V=0.193).
Mothers who received breastfeeding education (χ²(1) = 46.01, p < 0.001, V=0.371), initiated breastfeeding immediately after birth (χ²(3) = 34.33, p < 0.001, V=0.320), considered colostrum important (χ²(1) = 26.53, p < 0.001, V=0.281), were aware of the necessity of colostrum administration immediately after birth (χ²(1) = 68.51, p < 0.001, V=0.452), provided colostrum postpartum (χ²(1) = 82.33, p < 0.001, V=0.496), and had knowledge about the harms of foods other than breast milk (χ²(1) = 52.29, p < 0.001, V=0.395) were found not to practice prelacteal feeding. Among those who practiced prelacteal feeding, 51.7% used infant formula, 45.0% reported perceived insufficient milk supply as the reason, and 80.0% believed that foods other than breast milk were beneficial.
Multiple logistic regression analysis was conducted using the variables that showed statistically significant differences/associations (Tables 1 and 2) (Table 3).
The Omnibus test of the logistic regression model was statistically significant (χ²(18) = 139.936; p < 0.001), and the model demonstrated good fit as confirmed by the Hosmer–Lemeshow test (p = 0.396). The Nagelkerke R² value indicated that 56% of the variance in the dependent variable was explained by the model. In addition, the assumptions of autocorrelation (Durbin–Watson = 1.884) and multicollinearity (VIF < 10) were satisfied (Table 3).
Income level was identified as a significant predictor (OR = 2.720, 95% CI: 1.413–5.238, p = 0.003). However, examination of the raw distribution suggested that the relationship between groups did not follow a linear pattern (Table 1). Mothers who had not received breastfeeding education/information were approximately 4.5 times more likely to practice prelacteal feeding compared to those who had received education (OR = 0.224, 95% CI: 0.092–0.546, p = 0.001).
Time of first breastfeeding was also a significant predictor (OR = 2.090, 95% CI: 1.366–3.196, p = 0.001). This finding indicates an ordinal relationship, suggesting that the likelihood of prelacteal feeding increases as the initiation of breastfeeding is delayed. Mothers who were unaware that colostrum should be given immediately after birth had a significantly higher likelihood of practicing prelacteal feeding (OR = 0.195, 95% CI: 0.045–0.843, p = 0.029). This likelihood was markedly higher among mothers who did not provide colostrum to their infants (OR = 0.106, 95% CI: 0.032–0.350, p < 0.001).
Similarly, mothers who lacked knowledge about the harms of prelacteal feeding were significantly more likely to engage in this practice (OR = 0.365, 95% CI: 0.148–0.902, p = 0.029). In the regression analysis, maternal education level, place of residence, employment status, family type, receipt of regular antenatal care, number of prenatal visits, infant birth weight, and knowledge regarding the importance of colostrum were not identified as statistically significant predictors (p > 0.05).
Discussion
Prelacteal feeding is a harmful practice that deprives newborns of the vital benefits of colostrum and continues to be sustained in many countries as a culturally embedded norm. Consequently, it is regarded as a significant public health concern at both national and global levels. This practice deprives newborns of essential nutrients and colostrum, increasing their susceptibility to preventable illnesses and mortality [18, 23, 24]. In our study, 17.9% of mothers reported practicing prelacteal feeding. In contrast, according to the 2018 Turkey Demographic and Health Survey (TNSA), the rate was much higher at 41.7% [14]. The lower rate observed in our study (which included a predominantly urban sample of 81% mothers) likely reflects urbanization trends.
International literature reports varying rates of prelacteal feeding, with some studies reporting rates similar to ours [25–30], while others report higher [13, 31–33] or lower rates [14]. These discrepancies are attributed to variations in sample sizes, cultural factors, and geographic locations across studies. Common prelacteal substances administered include formula (51.7%), sugar water (28.3%), cow’s milk (3.3%), and plain water (16.7%). The prelectors used in another study conducted in Turkey were similar to those used in our study [34]. Other studies has noted a wide array of prelacteals administered, such as butter, honey, tea, fruit juice, and rice water [26, 29, 32].
Our findings indicate that the likelihood of prelacteal feeding is 3.6-fold higher in mothers who initiate breastfeeding within 1–4 h of birth compared to mothers who breastfeed immediately after birth. This risk increases dramatically, reaching 14.35-fold, for mothers who delay breastfeeding for more than 4 h. This strong association clearly demonstrates the critical role of early breastfeeding in preventing prelacteal feeding.
Our results are largely consistent with the literature; numerous studies report that delayed breastfeeding increases the perception of milk insufficiency, delays access to support from healthcare professionals, and leads to greater exposure to culturally ingrained prelacteal recommendations from elders [18, 26, 35–37]. These mechanisms explain why delayed breastfeeding is such a strong risk factor for prelacteal feeding.
Early breastfeeding facilitates the physiological initiation of lactation by ensuring the timely intake of colostrum and reduces the newborn’s perceived need for external feeding.
Therefore, the practice of “initiating breastfeeding within the first hour,” one of the most critical components of postpartum care, stands out as a fundamental intervention not only for successful lactation but also for preventing harmful traditional practices.
Another important finding of our study is that prelacteal feeding practices are significantly higher in mothers who have not received breastfeeding education. This result demonstrates that breastfeeding education not only increases knowledge but also directly impacts prelacteal feeding behavior by correcting misconceptions, reducing the perception of milk insufficiency, and strengthening support from healthcare professionals. Studies in the literature similarly report that mothers who receive breastfeeding education are less likely to use prelacteal feeding practices, strongly supporting the protective role of educational interventions [12, 26, 29, 35–37]. Taken together, these findings suggest that breastfeeding education is a critical public health intervention that not only transfers information but also facilitates cultural and behavioral transformation.
The protective effect of regular and adequate antenatal care on prelacteal feeding was also clearly evident in our study. The significantly lower prelacteal feeding rates in mothers who received four or more prenatal visits demonstrates that regular prenatal contact with a healthcare professional is crucial for preventing misconduct. Prenatal checkups facilitate mothers’ access to accurate information about breastfeeding, support early breastfeeding behavior, and enable healthcare professionals to identify at-risk groups early and provide the necessary counseling. This finding is consistent with studies in the literature highlighting the positive impact of antenatal care on breastfeeding outcomes [12, 13, 25, 26, 36].
Another striking finding of the study is that mothers living in rural areas are more likely to practice prelacteal feeding than those living in urban areas. This may be explained by the stronger continuation of traditional practices in rural areas, limited access to modern healthcare services, less frequent contact with healthcare professionals, and the greater influence of family elders on decision-making processes. International literature also reports that prelacteal feeding is more common in rural areas, supporting our findings [25, 32, 36].
The literature has long emphasized that mothers of low-birth-weight infants use prelacteal feeding more frequently than mothers of normal-birth-weight infants [13, 32, 36, 38–42]. Our study also found that prelacteal feeding was significantly more common among mothers of infants born weighing less than 2500 g. This finding may be related to factors such as low birth weight making it more difficult for healthcare professionals to monitor the baby, the perception of the baby as vulnerable, and a greater willingness of family members to intervene, and is strongly consistent with existing literature. Furthermore, higher maternal education levels have been consistently associated with lower rates of prelacteal feeding, further confirming the critical impact of education level on the adoption of appropriate breastfeeding practices [12, 13, 29, 36, 43].
In our study, prelacteal feeding practices showed significant differences according to both family structure and income level. Prelacteal feeding was more common among mothers living in extended families compared to those living in nuclear families; additionally, mothers whose income was equal to their expenses exhibited higher rates of prelacteal feeding than those in both lower and higher income groups.
Previous studies have demonstrated that mothers often initiate prelacteal feeding under the influence of family elders and that socioeconomic conditions play a determining role in this behavior [29, 30, 42, 43]. In this context, mothers living in extended family settings and belonging to relatively more vulnerable or middle-income groups may be more susceptible to the influence of family elders, while also experiencing limitations in access to accurate information and healthcare services, thereby contributing to the higher prevalence of prelacteal feeding. In particular, the strong adherence of grandparents to traditional practices, combined with socioeconomic constraints, may shape maternal behaviors despite modern health recommendations. These findings highlight the importance of jointly considering cultural structure and economic conditions in understanding breastfeeding practices.
Mothers who lack knowledge about the importance of colostrum, believe that colostrum should not be given, do not give colostrum, perceive prelacteal feeding as beneficial, or have low awareness of the potential harms of prelacteals were found to resort to this practice at significantly higher rates. This suggests that breastfeeding behaviors are influenced not only by a lack of knowledge but also by cultural norms, misconceptions, and practices passed down through generations.
Studies indicate that a lack of awareness about the potential harms of prelacteals is one of the most significant risk factors that drives mothers to prelacteal feeding. Furthermore, it has been reported that mothers who do not initiate breastfeeding with colostrum are more likely to engage in prelacteal feeding, while mothers who do not understand the risks are more likely to engage in this behavior [28, 31]. The common thread among these findings is that a lack of knowledge, combined with cultural practices, strongly encourages prelacteal feeding.
In conclusion, our study demonstrates that prelacteal feeding is not solely a matter of individual knowledge; it is a complex behavior influenced by multilayered factors such as family structure, cultural norms, birth-related characteristics, and healthcare utilization. Therefore, strategies to reduce prelacteal feeding should not be limited to maternal education; they should be supported by culturally sensitive breastfeeding counseling and public awareness programs that include family elders.
Conclusion
Overall, the findings of this study underscore that prelacteal feeding is a deeply rooted, multidimensional public health problem that cannot be addressed through isolated or individual-level interventions alone. Although the practice is often perceived as a simple feeding choice made by the mother, our results clearly demonstrate that prelacteal feeding is shaped by a complex interplay of structural inequities, cultural norms, intergenerational beliefs, gaps in health literacy, and barriers to timely and effective perinatal care.
To eliminate this harmful practice, public health strategies must therefore extend beyond the mother-infant dyad and target the broader social ecology in which infant feeding decisions are made. This includes empowering mothers through comprehensive breastfeeding education, strengthening antenatal and postnatal care systems, ensuring immediate breastfeeding support after birth, and critically-engaging family elders who often act as key decision-makers in culturally embedded feeding practices.
Ultimately, reducing prelacteal feeding requires a coordinated, culturally informed, and evidence-based approach that integrates health system interventions with community-level behavioral change efforts. By addressing the sociocultural and structural determinants that perpetuate prelacteal feeding, policymakers and healthcare providers can create an enabling environment where every newborn can benefit from the irreplaceable protection of colostrum and optimal early breastfeeding practices. Such an integrated approach is essential not only for improving breastfeeding outcomes but also for strengthening neonatal survival and long-term child health-an achievement of profound public health significance. However, it should be acknowledged that the findings are limited to mothers who attended the healthcare institution where the study was conducted and who share similar sociodemographic characteristics; therefore, caution is warranted when generalizing the results to broader populations.
Limitations and generalizability
This study has several limitations. First, as the research was conducted using a cross-sectional design, relationships between variables can be identified; however, causal inferences cannot be established. Second, the data were based on mothers’ self-reports, and therefore the possibility of recall bias and social desirability bias-particularly regarding culturally sensitive practices such as prelacteal feeding-cannot be ruled out. Third, the study was carried out with mothers residing in the Tuşba district of Van Province in the Eastern Anatolia Region and who presented to a university hospital. This may limit the representativeness of mothers living in remote areas with restricted access to healthcare services or differing healthcare-seeking behaviors. Consequently, the sample may not fully reflect the broader population characteristics of the region.
Although the questionnaire used in the study was developed by the researchers based on the literature and its psychometric properties were evaluated, linguistic and cultural adaptation may be required when the instrument is applied in different regions or cultural contexts.
Nevertheless, the study was conducted with a relatively large sample size (n = 335) and included mothers from both urban and rural settings. The findings are interpretable primarily for mothers who attended the healthcare institution where the study was conducted and who share similar sociodemographic characteristics; their generalizability to broader or different populations is limited. However, larger-scale, multi-center, and longitudinal studies are needed to strengthen the validity of these findings and to provide clearer evidence regarding causal pathways.
Supplementary Information
Acknowledgements
We thank the mothers who participated in the study for their support.
Institutional Review Board Statement
For this study, ethical approval numbered 2022/07-13 was obtained from the Van Yüzüncü Yıl University Non-Interventional Clinical Research Ethics Committee, and study permission was obtained from the hospital where the study was conducted.
Authors’ contributions
Conceptualization, V.C. and MB; design & writing of MS, E.KC., Y.D., N.A. and R.K.; design & writing of MS, review, editing & coordination. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Data availability
Data are contained within the article.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
Data are contained within the article.