Influence of traditionality and modernity on public breastfeeding behaviors: a theory of planned behavior approach

Background: Breast milk is widely recognized as the optimal source of infant nutrition, with the World Health Organization recommending exclusive breastfeeding for the first six months. However, breastfeeding rates remain suboptimal worldwide and in Taiwan. The six-month exclusive breastfeeding rate in Taiwan, defined as the percentage of infants aged six months who received only breast milk and no other foods or liquids in the previous 24 h, declined from 46.2% in 2018 to 37.9% in 2020. One barrier to continued breastfeeding is the discomfort or hesitation some mothers feel when breastfeeding in public. While qualitative research has indicated that conservative values may inhibit public breastfeeding, few quantitative studies have examined the simultaneous influence of traditionality and modernity. This study investigates how traditionality and modernity affect public breastfeeding behavior in Taiwan, using the Theory of Planned Behavior (TPB) as a framework. Methods: A cross-sectional online survey was conducted from 4 to 15 March 2024, recruiting 358 Taiwanese mothers with prior breastfeeding experience via social media. Validated instruments measured traditionality, modernity, TPB constructs (attitudes, subjective norms, perceived behavioral control, and intention), and frequency of public breastfeeding. Data were analyzed using descriptive statistics, bivariate correlations, and structural equation modeling. Results: Traditionality was negatively associated with attitudes (β = -0.30), perceived control (β = -0.11), intention (β = -0.14), and public breastfeeding behavior (β = -0.14). Modernity indirectly promoted public breastfeeding through positive links with attitudes (β = 0.12), subjective norms (β = 0.23), and perceived control (β = 0.26). Intention strongly predicted behavior (β = 0.60). The model explained 42% of the variance (CFI = 0.99, SRMR = 0.05). Conclusions: The study confirms that traditionality may hinder public breastfeeding, while modernity enhances it by shaping attitudes, norms, and control beliefs. These findings have important implications for public health policy and practice. Since traditionality and modernity influence behavior through distinct psychological pathways, interventions should be culturally tailored. For mothers with high traditionality, mobilizing family and community support may reinforce positive norms. For those with strong modern values, strategies should focus on autonomy, self-efficacy, and informed decision-making to support breastfeeding in public spaces.