INTRODUCTION
Breastfeeding (BF) is a feeding method human beings initiate when coming to the world, but it is also a public health strategy which prioritizes infant development and maternal health throughout both mother and infant’s lives1. There are multiple benefits from BF, including immunity, nutrition, emotional and psychological well-being and public health2.
Recent studies have emphasized that the decision to initiate and sustain exclusive breastfeeding is strongly influenced by structural, social, and interpersonal factors, beyond mere intention1-3. Elements such as work-related constraints, previous breastfeeding difficulties, emotional vulnerability during the postpartum period, and the presence or absence of social support – particularly from close family members – have been shown to play a central role4-6. These findings support the need for in-depth, contextualized analyses that highlight the lived experiences of mothers.
Over the last decade, the prevalence of exclusive breastfeeding (EBF) has increased. It is estimated that it has reached 48% of infants and young children7. Even though many countries – rich and poor alike – have not made much progress towards reaching the global target of 70%, in high-income countries, the prevalence of mothers who have ever breastfed is much lower than in low-income countries. BF is one of the few positive health behaviors whose prevalence in poorer countries is higher than in richer ones; also, poor women breastfeed for longer than wealthier women in low- and middle-income countries. On the contrary, infant feeding modalities with breast milk substitutes act oppositely in richer countries, with rates being higher among wealthier and more educated women8,9.
Low EBF rates are of concern to states. In poorer countries, the main challenge is delayed breastfeeding initiation; just one in two neonates is put to the breast within the first hour of birth. In contrast, in middle- and high-income countries, where less than one in five infants is breastfed for the first 12 months, the challenges are different. Simultaneously, the data surrounding BF are limited, which hinders trend and progress monitoring10.
In the case of Argentina, these issues take place differently. Argentina is one of the main Latin American economies. The World Bank’s income classification sets Argentina as a middle-high-income country, even though its productivity matrix is centered on activities of low and medium-low technological complexity, in a productive structure that presents high levels of concentration and foreign capital11. Also, poverty and indigence rates affect 66% and 27% of children aged 0–14 years, respectively12. According to the National Survey on Breastfeeding (EnaLac)13, breastfeeding trends have remained stable since 2017. With 91.7% of infants initiating their feeding with breast milk, it is possible to say that, in Argentina, there is a high practice of BF. Nevertheless, EBF decreases as the age of infants increases: 53.5% of 2-month-old infants have EBF, but this number decreases to 44.6% when they are 6-month-old babies13. Moreover, data show that as EBF decreases – namely, from the second month – mixed feeding (alternating human milk with other milk) increases. This clearly shows that the initiation of breastfeeding is not the central problem, but rather its maintenance is what entails a significant challenge that needs to be focused on.
Argentina holds a wide range of legislation promoting BF. The National Constitution (in its Article 75, subsection 23) protects women who breastfeed, while also Act No. 26061, in its Article 18, extends the comprehensive protection measures to ‘the mother and the father during pregnancy, labor and the lactation period’. Act No. 27611 on ‘Comprehensive Health Care and Assistance during Pregnancy and Early Childhood’ aims to ‘protect, strengthen and support comprehensive care to protect the life and health of pregnant persons and children up to 3 years of age’14. Moreover, labor legislation establishes the right to have breastfeeding breaks (Law No. 20744, Article 179) and suitable spaces for the extraction and conservation of human milk (Law No. 26873 ‘Breastfeeding Promotion and Public Awareness’).
As it is known, breastfeeding is conditioned by multiple barriers (including physical and emotional challenges, among others) during its initiation and maintenance. With regard to the antecedents, there is diverse research on the actions conducted worldwide in order for women to choose and maintain breastfeeding1, as well as on the benefits and difficulties that arise in BF based on economic and socio-individual nuances15-18.
There are also a number of studies advocating paid maternity leave and discussing its effect on the initiation and maintenance of breastfeeding16,19. However, there is a heterogeneity of reasons for breastfeeding suspension, among them, the most mentioned are: the presence of pain and discomfort when breastfeeding, the lack of practical knowledge to get the baby to latch on, self-reported insufficient milk, the availability of qualified support, bonding to carry out breastfeeding, the training of maternal and child health personnel, the cultural acceptance of breastfeeding, and the development or not of donated human milk banks, among others20-23. Apart from the reasons related to maternal health and the return to work, there are few studies that address the processes of breastfeeding from the perspective of mothers.
In this framework, the main objective of this study is to explore and analyze the factors that facilitate or hinder exclusive breastfeeding from the perspective of mothers, considering their socio-educational background and maternity experience.
METHODS
This study employed a qualitative, exploratory, and descriptive design based on the use of focus group discussions, aimed at understanding the fundamental challenges and strengths of exclusive breastfeeding and its sustainability over time from the perspective of mothers of infants aged 3 to 15 months.
The sample consisted of 32 focus groups. The segmentation criteria were: 1) Maternal experience – primiparous mothers (with a single child aged 3–15 months) and multiparous mothers (with more than one child, and with an infant in that age range at the time of the study); 2) The highest education level achieved – mothers with incomplete secondary education or lower, and mothers with complete secondary education or higher; and 3) Experience of exclusive breastfeeding continuity – exclusive breastfeeding (EBF) until at least the first six months and non-exclusive breastfeeding (Non-EBF) prior to the first six months.
The groups were conducted in different cities in Argentina with the objective of obtaining a sample with a broader range of social segments for analysis. The geographical selection criterion was the EBF level registered in the last National Survey on Breastfeeding13. The selected urban areas were Greater Buenos Aires Metropolitan Area (56.3% of EBF); Resistencia, Chaco (65.8% of EBF); San Fernando del Valle de Catamarca, Catamarca (30.4% of EBF), and Gran Córdoba, Córdoba (40% of EBF).
Sample selection and recruitment were conducted by the survey team based on predefined eligibility criteria, including parity (primiparous and multiparous mothers), education level, and EBF continuity.
In each of the four selected Argentine cities – with varying EBF prevalence – key informants from neighborhoods with diverse socioeconomic backgrounds were identified. These informants included community leaders such as coordinators of neighborhood clubs, cultural centers, schools, and religious institutions. They were tasked with identifying and contacting eligible mothers. Snowball sampling was then applied, as initial participants referred additional mothers from their networks.
A total of 32 focus groups were conducted, each including 6 to 10 mothers, resulting in the participation of 234 women. The recruitment and discussion sessions were not held in hospitals or healthcare centers, but rather in neutral, socially oriented spaces – such as coworking venues and communal meeting rooms – specifically arranged to ensure a comfortable, non-clinical environment. This setting was intended to foster openness and trust among participants.
Each session, lasting between 50 and 85 minutes, was facilitated by one of the trained authors using a semi-structured discussion guide. To foster connection among participants, sessions began with short personal introductions (name, age, occupation, and age of the child). Discussions evolved from general reflections on breastfeeding to detailed accounts of factors that facilitated or hindered EBF.
Prior to participation, all mothers provided written informed consent. The sessions were audio-recorded using a mobile app and a voice recorder, with strict anonymity protocols in place. Recordings were then transcribed verbatim for analysis.
Data analysis was conducted through a combination of deductive and inductive coding, grounded in the study objectives and the transcribed content. The initial coding was performed using MAXQDA, followed by further analysis in Atlas.ti. This process resulted in the identification of approximately 79 codes, which were later organized into a set of core analytical categories.
RESULTS
In the analysis, 31 face-to-face groups were valid (one focus group was conducted virtually), resulting in the inclusion of 231 participants. The participating mothers were aged 16–44 years, with a mean age of 29.5 years (Table 1).
Table 1
Demographic and social characteristics of mother participants in the focus groups (N=231)
The aspects that facilitate and hinder the exclusive breastfeeding (EBF) process are multiple and often interrelated. For the purpose of analysis and presentation, these elements are organized into a set of categories considered relevant to the study (Table 2). Some of these categories were predefined in the guiding instrument used during the focus group discussions, while others emerged inductively from the participants’ accounts. Although facilitators and barriers are not addressed under separate headings, both are clearly identified within each thematic category, allowing for an integrated understanding of the experiences described. The following section provides a category-by-category analysis of these findings (Tables 3 and 4).
Table 2
Categories used in the analysis of exclusive breastfeeding (EBF)
| Aspects facilitating EBF | Aspects hindering EBF |
|---|---|
Table 3
Key quotes from the breastfeeding analysis, organized by analytical category
Table 4
Summary of main findings according to analytical categories
Biopsychosocial aspects
Barriers
Participant mothers frequently identified biopsychosocial factors that hinder the maintenance of EBF. These include physical discomforts, such as pain, dermatitis, and nipple damage, which often lead to early abandonment of breastfeeding. Additionally, many mothers reported experiencing postpartum depression, psychological distress, and a sense of isolation, especially during the first month after birth. Feelings of insecurity when caring for the baby also emerged as common obstacles, particularly among first-time mothers. These challenges were often exacerbated by the lack of practical knowledge and emotional support, making it harder to persist with breastfeeding.
Facilitators
Despite the difficulties, mothers also described certain internal resources and attitudes that helped them maintain EBF. Several participants emphasized that breastfeeding is a demanding process that requires patience, calmness, and the ability to enjoy the bond with the baby. Recognizing breastfeeding as a learned skill – rather than something automatic – empowered some women to seek knowledge and support, which in turn fostered greater confidence and perseverance in continuing EBF.
Characteristics of delivery and newborn health
Facilitators
Delivery conditions were identified by mothers as an important factor influencing the initiation of breastfeeding. According to their accounts, vaginal delivery often facilitated the early latching of the infant onto the breast, especially when the first hour of mother–infant contact was respected. Mothers emphasized that immediate contact with the baby contributed significantly to the successful initiation of breastfeeding.
Barriers
In contrast, mothers who underwent cesarean sections commonly reported that their babies were initially fed with formula milk and experienced difficulties latching onto the breast. This was attributed to delayed physical contact due to the medical attention the mothers required post-surgery.
Additional barriers arose when the newborn required neonatal intensive care, which similarly delayed mother–infant contact and led to early formula feeding. Comparable challenges were mentioned when the baby was underweight or exhibited behaviors such as excessive sleepiness, refusal to latch, or breast rejection during the first hours of life.
From the mothers’ perspective, these factors often interacted with the lack of immediate contact, resulting in the early introduction of alternative milk. Furthermore, infant weight loss during the first days after birth was considered a relevant issue, frequently leading to ‘mixed feedings’ – the combination of formula and breast milk – as a perceived solution.
Family environment
Barriers
In primipara mothers and in households with a low level of education, lack of family support, or the presence of ‘weak’ support ties (i.e. the absence of a helpful and supportive environment), combined with physical problems and psychological distress, can negatively affect the maintenance of EBF. Mothers also expressed that, due to their insecurity in caring for the baby and the challenges in feeding and satisfying the baby’s appetite, the intervention of family members – typically other women such as their own mothers or mothers-in-law – was often invasive and counterproductive. These interventions sometimes generated psychological distress, feelings of guilt, and a sense of failure, hindering the process of learning to breastfeed.
Some mothers reported that in such environments, decisions about infant care were made by others, reducing the mother’s autonomy. This was particularly noted among mothers with a low level of education, but also appeared among multipara mothers who were burdened with additional care and domestic responsibilities, and therefore relied heavily on the help of other women in the household.
Facilitators
In these contexts, having learned how to express and safely store breast milk was considered an advantage, as it allowed other household members to participate in the care of the baby, and the baby could still be fed with breast milk.
Prenatal breastfeeding education
Facilitators
The information women could obtain before labor became pivotal for the development of self-confidence and the skills necessary for maintaining breastfeeding. Expectant mothers who participated in maternity support programs reported acquiring valuable competencies, such as nipple preparation prior to labor, finding suitable breastfeeding positions, expressing and handling milk, and even building a breast milk bank. In addition, the knowledge of breastfeeding benefits for both baby and mother was a source of motivation. Although most participants had access to group activities, longer duration programs were considered especially influential.
Support during the post-partum period also played a critical role, particularly for primipara mothers, who described this time as full of anxiety, fear, and uncertainty. In this context, the presence of trained professionals (e.g. obstetricians, midwives, childcare specialists, liaison nurses, pediatricians) and access to maternity care structures facilitated EBF initiation and continuation. Open consultation spaces, WhatsApp chats, and postpartum activities offered mothers real-time guidance and emotional support.
Additionally, all mothers – both those who continued and those who discontinued EBF – mentioned that its practicality was a strong motivator. The absence of the need to heat water, sterilize bottles, or pack extra items when leaving the house simplified daily life, especially in households with more than one child.
A widely used and valued source of information was social media, particularly TikTok, where mothers accessed content from pediatricians, professionals, and peers, reinforcing and legitimizing breastfeeding practices.
Barriers
However, some participants described significant barriers. Limited access to health services was reported as a key factor that restricted their ability to gain sufficient knowledge and education to build confidence and sustain breastfeeding. This lack of access also made it harder for some mothers to legitimize EBF in family or social settings.
Another major barrier mentioned was physical pain and discomfort, especially at the beginning of the breastfeeding process. Many mothers stated that pain, in combination with insufficient information, left them without the tools or strategies to manage difficulties – ultimately leading to the early cessation of EBF.
Working conditions
Facilitators
Returning to paid work is one of the most compelling explanations for not continuing with EBF. However, mothers who had access to maternity leave and flexible work arrangements were generally able and willing to continue breastfeeding. Among mothers with a higher level of education, various strategies were employed to sustain EBF, including the use of paid or unpaid maternity leave, remote work, and reduced working hours. These conditions functioned as facilitating factors, enabling the continuation of breastfeeding alongside work responsibilities.
Barriers
Conversely, mothers with precarious jobs, where lactation rights were not respected or where minimum conditions were not met, reported feeling forced to abandon EBF. This was particularly true for women in the informal labor market or those without adequate job protections.
Mothers with a low level of education who worked before pregnancy, often chose to leave the workforce to focus on caring for their child, while those in more formal settings – especially with higher level of education – faced a dilemma upon returning to work.
There was widespread agreement on the difficulty of combining EBF with paid employment. Reported tensions included: delegation of feeding decisions to other caregivers, challenges with milk expression and storage, psychological distress from negotiating breastfeeding rights at work or within the family, and personal fatigue or unmet needs.
Sociocultural aspects
Barriers
In certain contexts, particularly among primipara mothers, participants reported experiencing social pressure rooted in the notion that breastfeeding is directly linked to being a ‘good mother’. This perception created emotional stress and heightened expectations around the breastfeeding experience.
In low education environments, persistent myths such as the belief that ‘breastfeeding does not feed the baby’, undermined mothers’ confidence in EBF and often led to encouragement to introduce other milk as a supplement.
Additionally, in some provincial cities, mothers reported stigmatization of breastfeeding in public spaces. While not a formal or structural barrier, this was widely described as an uncomfortable and inhibiting experience, which discouraged breastfeeding in public and contributed to feelings of exposure or shame.
Facilitators
No significant facilitators were reported in this category. However, the discomfort expressed by mothers highlights an opportunity for cultural and policy interventions aimed at normalizing breastfeeding in public and challenging harmful myths.
Based on the interviews, it is observed that there are concrete processes in the experiences of mothers that facilitate or hinder EBF initiation and, primarily, its maintenance. A summary of the results, which were systematized based on the central categories surrounding both EBF processes, is given in Table 4.
DISCUSSION
The main research findings are in line with previous BF research showing that what mostly conditions BF initiation and maintenance are not the biological and health-related aspects, but rather the cultural aspects, since BF not only depends on working conditions, but also, primarily, on BF public policies, the availability of support groups, social media use, and lobby groups1,22.
It is known and as this study confirmed, the prior decision made by the mother and her environment is fundamental for the initiation and continuity of exclusive breastfeeding (EBF) over time, but this decision is made before the baby is born2,24. Family and professional support also play a key role in the initiation of breastfeeding and in providing support for its continuation, issues that were also evidenced in the present study4,25. In the case of Argentina, this is further reinforced by the importance of peer group support and exchange.
Although family environment, both the role of the father and close family, offers opportunities for the mother to have post-partum peace and enjoy maternity3,24,26, in diverse cases, as shown by the present study, this environment can turn into a barrier, especially when it is invasive or the support ties are weak. The research data show that the family environment, especially that of the maternal grandmother and/or the primipara mother’s sister, focuses on the mother’s loss of autonomy, in the face of her inability to leave the baby in the care of others. This becomes a process hindering EBF, as it influences the introduction of formula milk as the concrete solution to the need of leaving the baby at the care of others, turning family into a lobby group24,27,28.
Moreover, as shown by international research, women expect breastfeeding to happen ‘naturally’ and easily, but they reported that once they were faced with the situation, they did not feel prepared for the challenges BF presented28. Those who attended classes and courses were provided with more tools to overcome the physical pain associated with the initiation of breastfeeding and the characteristics of infant feeding, which is consistent with the findings of other studies21-23. As a finding, it can be claimed that those who attended long-term courses and had professional post-partum support were provided with tools that enabled them to meet these needs and overcome the first instances that usually hinder BF.
Returning to paid work is one of the key factors for EBF cessation10,24. This study reveals a paradox: while informal and precarious work is generally associated with vulnerability and limited rights, in the context of early motherhood, it may provide certain conditions such as flexibility and the ability to pause employment that unintentionally support the continuation of exclusive breastfeeding. For some women, especially primiparas, the low opportunity cost of leaving poorly paid informal jobs makes continued breastfeeding a more viable and even preferable option.
Another key finding of this study is that EBF maintenance is different for multipara mothers and primipara mothers. As multipara mothers have other children to take care of, the domestic workload is multiplied, and because they have previous experience, they present greater flexibility in their decision-making regarding EBF. For multipara mothers, formula milk opens the possibility of having time and leaving children in the care of others, and their greater individual experience shows them that children grow up, either way, healthy. Hence, it was observed that one of the differences in EBF maintenance or not, among primipara and multipara mothers, is not evoked by having previous breastfeeding experience, but rather by watching children grow.
As shown by the latest research, it was also observed that social media is a space not only for socializing with other mothers sharing the same experience, but also for searching for updated information3,6,29,30. Social media, primarily TikTok and Instagram, offer the opportunity for breastfeeding support from peers, mother-to-mother, including the incorporation of informal interactions which create ‘momentary ties’ of support. By offering the opportunity for immediacy and anonymity, social media allow greater communication about personal choices related to infant feeding methods and breastfeeding complications, as well as the sharing of values and concrete experiences, and a space to ask questions to peer groups5,30-32. Although in this study, as in others, primipara mothers are the ones who use social media the most33, it is important to stress that searching for information prior to infant birth is valued by all mothers as a process facilitating breastfeeding. The present study shows that multipara mothers, though experienced, also seek updated information, since their children were born years ago, and this new information entails a different view of breastfeeding, and also, because of the difference in ‘how babies are nowadays’ compared to before. Mothers’ comprehension of maternity norms is shaped by digital interactions. Therefore, online relationships are a key source of support for all mothers. As it was observed, information and support are two key aspects of breastfeeding; hence, social media spaces become a great option to promote breastfeeding through information sharing and the creation of positive social connections. Social media can be effective in providing a type of support that counteracts the processes hindering EBF and can also be incorporated into family groups.
The mothers’ assessment of the practicality of EBF is also deemed a finding of this study. The totality of mothers, both those who exclusively breastfeed and those who do not, emphasizes the practical advantages of BF for everyday life (especially during the first months and at night), since it is not necessary to consider or organize extra equipment to feed the baby. This aspect can be a great advantage for future work on actions to promote EBF.
Limitations
Among the main limitations of the study are its qualitative design and focus on urban areas, which restrict the generalizability of the findings to other populations, particularly those in rural settings. Additionally, the study relies solely on the perspectives of mothers, without incorporating those of healthcare professionals, employers, or other key stakeholders. There may also be participation bias, as the women who agreed to take part in the focus groups might have been more engaged or sensitized to the issue of breastfeeding.
CONCLUSIONS
This study highlights that exclusive breastfeeding (EBF) is facilitated by access to information through participatory formats such as interactions with health professionals and peer support groups, which empower mothers in both social and work environments. In contrast, barriers such as insufficient postnatal support, physical and emotional discomfort, family pressures, and work-related challenges hinder EBF continuation. The findings underscore the need to raise social awareness and promote shared responsibility among families, employers, and society.
