Prevalence, determinants, and reasons for formula feeding among Palestinian mothers in the West Bank: a cross-sectional study.

BACKGROUND: Exclusive breastfeeding rates in Palestine remain below WHO targets, and formula use is prevalent among infants in the first two years of life. Evidence on the specific factors associated with formula introduction in the Palestinian context is limited. OBJECTIVES: To assess the prevalence of formula feeding among Palestinian mothers of infants aged 0-24 months, identify the primary reasons for formula introduction, and determine the independent sociodemographic, maternal, infant, and perinatal predictors of formula use. METHODS: A community-based cross-sectional study was conducted between October 2024 and January 2025 in three primary healthcare centers across the northern, central, and southern West Bank (Nablus, Ramallah, and Hebron governorates). A total of 506 mothers meeting eligibility criteria were enrolled using consecutive sampling. Data were collected via a structured, investigator-developed Arabic questionnaire covering maternal sociodemographic characteristics, chronic disease history, infant feeding practices, and perinatal variables. Bivariable analyses (chi-square and Fisher's exact tests) and multivariable binary logistic regression were used to identify factors independently associated with formula feeding. RESULTS: Mixed feeding was the most common feeding practice (62.3%), followed by exclusive breastfeeding (29.1%) and exclusive formula feeding (8.7%). Overall, 70.9% of mothers introduced formula within the first 24 months, primarily due to perceived low milk supply (32.3%) and time constraints (25.9%). Independent predictors of formula feeding included antenatal care attendance (aOR = 5.34, 95% CI: 1.45-19.70) and having ≥3 children (aOR = 1.88, 95% CI: 1.04-3.42), while breastfeeding education (aOR = 0.59, 95% CI: 0.35-0.98) and breastfeeding initiation within 24 h of birth (aOR = 0.27, 95% CI: 0.09-0.85) were protective factors. CONCLUSION: Formula feeding is highly prevalent among Palestinian mothers, with mixed feeding being the dominant practice. Antenatal breastfeeding education and targeted postnatal support for multiparous mothers are priority areas for intervention within Palestinian maternal health services. The counterintuitive positive association between antenatal care attendance and formula feeding underscores the need to audit and strengthen breastfeeding-promotional content within antenatal consultations.