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Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices in\u00a0maternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community\/society factors associated with maternal report of exclusive breastfeeding at the time of discharge.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (<jats:italic>n<\/jats:italic>\u2009=\u200919,350) exclusively breastfed and 27.6% (<jats:italic>n<\/jats:italic>\u2009=\u20097,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (<jats:italic>p<\/jats:italic>\u2009=\u20090.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration number<\/jats:title>\n                <jats:p>Clinical Trials NCT04847336.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13006-022-00517-1","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T08:34:11Z","timestamp":1669970051000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries"],"prefix":"10.1186","volume":"17","author":[{"given":"Ilana Azulay","family":"Chertok","sequence":"first","affiliation":[]},{"given":"Rada","family":"Artzi-Medvedik","sequence":"additional","affiliation":[]},{"given":"Maryse","family":"Arendt","sequence":"additional","affiliation":[]},{"given":"Emma","family":"Sacks","sequence":"additional","affiliation":[]},{"given":"Marina Ruxandra","family":"Otelea","sequence":"additional","affiliation":[]},{"given":"Carina","family":"Rodrigues","sequence":"additional","affiliation":[]},{"given":"Raquel","family":"Costa","sequence":"additional","affiliation":[]},{"given":"Karolina","family":"Linden","sequence":"additional","affiliation":[]},{"given":"Mehreen","family":"Zaigham","sequence":"additional","affiliation":[]},{"given":"Helen","family":"Elden","sequence":"additional","affiliation":[]},{"given":"Daniela","family":"Drandic","sequence":"additional","affiliation":[]},{"given":"Susanne","family":"Grylka-Baeschlin","sequence":"additional","affiliation":[]},{"given":"C\u00e9line","family":"Miani","sequence":"additional","affiliation":[]},{"given":"Emanuelle Pessa","family":"Valente","sequence":"additional","affiliation":[]},{"given":"Benedetta","family":"Covi","sequence":"additional","affiliation":[]},{"given":"Marzia","family":"Lazzerini","sequence":"additional","affiliation":[]},{"given":"Ilaria","family":"Mariani","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"517_CR1","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1186\/s12887-019-1693-2","volume":"19","author":"NM Frank","year":"2019","unstructured":"Frank NM, Lynch KF, Uusitalo U, Yang J, Lonnrot M, Virtanen SM, et al. 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Cochrane Database Syst Rev. 2016;CD006641. https:\/\/doi.org\/10.1002\/14651858.CD006641.pub3.","DOI":"10.1002\/14651858.CD006641.pub3"}],"container-title":["International Breastfeeding Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-022-00517-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13006-022-00517-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-022-00517-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T08:36:25Z","timestamp":1669970185000},"score":1,"resource":{"primary":{"URL":"https:\/\/internationalbreastfeedingjournal.biomedcentral.com\/articles\/10.1186\/s13006-022-00517-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["517"],"URL":"https:\/\/doi.org\/10.1186\/s13006-022-00517-1","relation":{},"ISSN":["1746-4358"],"issn-type":[{"value":"1746-4358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,2]]},"assertion":[{"value":"29 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the General Data Protection Regulation (GDPR) and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. The study protocol was approved by the Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d coordinating center\u2019s institutional review board and then reviewed and approved or deemed exempt by the ethics committees of other participating researchers\u2019 countries.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"There is no identifying data in the manuscript as the study used an anonymous survey and the authors consent to publication of the manuscript.The datasets generated and analyzed for the current study are not publicly available as the study is ongoing; however, data may be available from the principal investigator, Dr. Marzia Lazzerini, upon reasonable request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"83"}}