Factors Associated with Exclusive Breastfeeding Discontinuation in the First Six Months: A Prospective Cohort Study in Ogun State, South West Nigeria

Despite global evidence supporting exclusive breastfeeding (EBF) for the first six months of life, premature discontinuation remains common in Nigeria. Prospective longitudinal data on the timing and determinants of EBF cessation from South West Nigeria are limited. This prospective cohort study follows 320 mother-infant dyads recruited at delivery from two general hospitals in Abeokuta and Ijebu Ode, Ogun State, with monthly follow-up assessments through six months postpartum. EBF status was verified at each visit using a 24-hour recall method. Kaplan-Meier survival analysis estimated median time to EBF discontinuation, and Cox proportional hazards regression identified independent predictors. Median time to EBF discontinuation was 3.4 months, with only 44.1% of mothers exclusively breastfeeding at six months. The hazard of EBF discontinuation was significantly elevated in mothers who returned to formal employment before four months (HR 2.8), those who experienced perceived milk insufficiency (HR 3.2), and those without antenatal lactation counselling (HR 2.1). Primiparous mothers had a 60% higher discontinuation hazard compared to multiparous mothers. Support from the spouse was significantly protective against early cessation (HR 0.57). The study contributes prospective evidence to the EBF literature from South West Nigeria and highlights the importance of systemic factors including maternity leave duration, workplace policy, and spousal support in sustaining EBF. Keywords: exclusive breastfeeding, discontinuation, prospective cohort, Ogun State, South West Nigeria.