Background: Exclusive breastfeeding (EBF) for the first six months after birth has been recommended by the WHO as the best infant feeding strategy. Despite this, studies carried out in Ghana among singletons indicate low EBF rates. Data on EBF rates among twin infants in Ghana remain limited and the EBF rate among twins is hypothesized to be low.

Objectives: The study sought to identify factors associated with EBF among Ghanaian infants particularly, twins. The duration of EBF among both twins and singletons were estimated. The mean daily breast milk volume produced by mothers with singletons and mothers with twins were estimated.

Methods: A cross-sectional survey involving 50 mother-singleton and 50 mother-twin pairs recruited from three health facilities in the Tema metropolis and Ashaiman municipality was done. Infants were between 2 to 6 months. Data on the sociodemographic, biomedical and biocultural characteristics of participants were collected. Information on foods or liquids fed to the infants in the previous 24 hours and past month were used to estimate EBF among the infants. The deuterium oxide stable isotope dilution method was used in estimating the mean daily volume of breast milk produced by a subsample of mothers with singletons (n = 11) and mothers with twins (n = 13). Multivariate binary logistic regression analysis was used to identify the predictors of EBF at six months.

Results: Only 14% of twin infants were exclusively breastfed for six months compared to 44% of singletons (p < 0.01). EBF for six months was significantly associated with mother’s perceived breast milk production ability (p < 0.01) and television (TV) ownership (p = 0.048). The median EBF duration for singleton and twin infants was 4 months and 1 month respectively (p < 0.01). Mean daily volume of breast milk produced by mothers with singletons was significantly higher than that produced by mothers with twins (900.18 ± 363.68 ml/day vs. 608.65 ± 270.21 ml/day, p = 0.02). The predictors of EBF at six months were perceived breast milk production ability (AOR = 4.340; 95% CI, 1.011 – 18.622) and prenatal EBF intention (AOR = 16.075; 95% CI, 1.077 – 239.951).

Conclusions: Encouraging expectant mothers particularly those with twin gestations to decide prenatally to exclusively breastfeed upon delivery could increase EBF rates among Ghanaian women. Mothers must be encouraged and supported to believe in their abilities to produce enough milk to meet the nutritional needs of their infants.