Evaluating a DOHaD-informed breastfeeding education programme for adolescents in rural South African schools

Abstract

Background: Breastfeeding is essential for infant survival and health, yet South Africa’s exclusive breastfeeding rates remain below global targets, with adolescents, future parents, and influencers seldom engaged in breastfeeding education.
Methods: A quasi-experimental design study was conducted with 119 Grade 11 and 12 learners in two rural South African public schools. A standardised 40-minute education session, based on WHO guidelines and the Developmental Origins of Health and Disease (DOHaD) framework, was delivered in English and Tshivenda during regular school hours. Breastfeeding knowledge was assessed using a 10-item questionnaire administered before and after the intervention. Preferences for breastfeeding benefits were ranked post-intervention. Statistical analyses involved paired t-tests, McNemar’s test, chi-square tests, and logistic regression.
Results: Breastfeeding knowledge scores improved significantly, rising from a mean score of 6.45 ± 1.3–7.53 ± 1.2 (p < 0.001), with a large effect size (Cohen’s d = 0.83). Notable changes were observed in awareness of fathers’ roles in breastfeeding (54% to 83%, p < 0.001) and in awareness of the benefits for fathers (17% to 66%, p < 0.001). Adolescents found maternal (38.7%) and paternal (30.3%) benefits most interesting. Female sex was identified as a significant predictor of high engagement, defined as rating two or more breastfeeding benefit categories as most interesting (OR = 1.80, 95% CI: 1.05–3.20, p = 0.04).
Conclusion: A brief classroom intervention improved adolescents’ understanding and involvement in breastfeeding, emphasising parental roles. Integrating DOHaD-informed education in secondary schools may strengthen family and community support for breastfeeding in rural South Africa.

Keywords: adolescents, breastfeeding education, DOHaD, health promotion, parental roles, rural schools, South Africa