Barriers to exclusive breastfeeding in first 6 months of life in infants born in a tertiary care center in Hyderabad


  • Syed Adnan Ali Deccan College of Medical Sciences, Hyderabad, India
  • C. V. S. Lakshmi Deccan College of Medical Sciences, Hyderabad, India
  • Numeera A. Mirza Deccan College of Medical Sciences, Hyderabad, India
  • Shariq Siddiqui Deccan College of Medical Sciences, Hyderabad, India
  • Heeba Anis Deccan College of Medical Sciences, Hyderabad, India
  • Hunaina Manfusa Deccan College of Medical Sciences, Hyderabad, India



Exclusive breast feeding, Neonatology, Newborns, Breastmilk


Background: Exclusive breast feeding during first 6-months has been proven to ensure growth and development of children. The habit of Exclusive breast feeding is often overlooked by mothers due to various factors. Therefore, this study aims to identify the barriers to Exclusive Breast Feeding.

Methods: This is a prospective study conducted from August 2018 to October 2020 in a tertiary care hospital in Hyderabad among 155 mothers with neonate to 6 months old infants. Data was collected through face-to-face interview using premade questionnaire and a predetermined sample size of 155 was considered.

Results: The prevalence of exclusive breast feeding was 20%. The barriers to exclusive breastfeeding practice were identified as lower socio-economic status (59.4%), Lack of formal education (52.9%), lack of counselling about breast feeding (10.3%), early return to work (32.2%), poor family support (49.03%), 22-25years mean age group (36.7%) , use of bottle feeding (16.3%) and pacifiers (12.2%). It was also observed that mothers experienced difficulties such as cracks (2.58%) and suction problems (2.58%) currently, and breast pain (2.58%) previously.

Conclusions: Promoting education of women especially in lower socio-economic sector and emphasizing need of avoiding complementary feeding rather counselling women regarding importance of exclusive breastfeeding during first 6-months and negative impact of early return to work, and providing health care for the difficulties faced during breastfeeding and encouraging family support are recommendations to improve exclusive breastfeeding practice.


Fujita M, Roth E, Lo YJ, Hurst C, Vollner J, Kendell A. In poor families, mothers' milk is richer for daughters than sons: a test of Trivers-Willard hypothesis in agropastoral settlements in Northern Kenya. Am J Phys Anthropol. 2012;149(1):52-9.

Michaelsen KF, Skafte L, Badsberg JH, Jorgensen M. Variation in macronutrients in human bank milk: influencing factors and implications for human milk banking. J Pediatr Gastroenterol Nutr. 1990;11(2):229-39.

The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Surgeon General Publishers; 2011.

Hanson LA, Korotkova M. The role of breastfeeding in prevention of neonatal infection. Semin Neonatol. 2002;7(4):275-81.

Bezirtzoglou E, Tsiotsias A, Welling GW. Microbiota profile in feces of breast- and formula-fed newborns by using fluorescence in situ hybridization (FISH). Anaerobe. 2011;17(6):478-82.

Donovan SM, Wang M, Monaco MH, Martin CR, Davidson LA, Ivanov I, et al. Noninvasive molecular fingerprinting of host-microbiome interactions in neonates. FEBS Lett. 2014;588(22):4112-9.

Dieterich CM, Felice JP, O'Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am. 2013; 60(1):31-48.

Frank NM, Lynch KF, Uusitalo U, Yang J, Lönnrot M, Virtanen SM, et al. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr. 2019;19(1):339.

Dadhich JP, Agarwal RK. Mainstreaming early and exclusive breastfeeding for improving child survival. Indian Pediatr. 2009;46(1):11-7.

Chandhiok N, Singh KhJ, Sahu D, Singh L, Pandey A. Changes in exclusive breastfeeding practices and its determinants in India, 1992-2006: analysis of national survey data. Int Breast feed J. 2015;10:34.

American Academy of Pediatrics. Policy statement: Prevention of pediatric overweight and obesity. Pediatrics. 2005;112(2):424-30.

Global strategy for infant and young child feeding. Available at: Accessed on 20 February 2023.

Bai Y. K, Wunderlich S, & Fly A. Predicting intentions to continue exclusive breastfeeding for 6 months: A comparison among racial/ethnic groups. Maternal Child Health J. 2011;15(8):1257-64.

Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas MK, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390:1345.

Chandhiok N, Singh KJ, Sahu D, Singh L, Pandey A. Changes in exclusive breastfeeding practices and its determinants in India, 1992-2006: analysis of national survey data. Int Breastfeed J. 2015;10:34.

Bai YK, Middlestadt SE. Psychosocial factors underlying the mother’s decision to continue exclusive breastfeeding for 6 months: An elicitation study. J Human Nutr Diet. 2002;22(2):134-40.

Scott J, Landers M. Factors associated with breastfeeding at discharge and duration of breastfeeding. J Paediatr Child Health. 2001;37(3): 254-61.

Breastfeeding report card 2014. Available at: Accessed on 20 February 2023.

Sustainable development goals: United Nations 2018. Available at: development/sustainable-development-goals/. Accessed on 20 February 2023.

Racial and ethnic differences in breastfeeding initiation and duration, by state, National Immunization Survey, United States, 2004-2008. Available at: http://www. Accessed on 20 february 2023.

Crenshaw JT. Healthy birth practice 6: Keep mother and baby together it’s best for mother, baby, and breastfeeding. J Perinat Edu. 2014;23(4):211-7.

Declercq E, Labbok M, Sakala C, O’Hara M. Hospital practices and women’s likelihood of fulfilling their intention to exclusively breastfeed. Am J Public Health. 2009;99(5):929-935.

Rojjanasrirat W, Sousa V. Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010;19(13):2014-22.

Kent JC, Ashton E. Nipple pain in breastfeeding mothers: Incidence, causes and treatments. Int J Environ Res Public Health. 2015;12(10):12247-63.

Stewart-Knox B, Gardiner K, Wright M. What is the problem with breastfeeding? A qualitative analysis of infant feeding perceptions. J Human Nutr Diet. 2003; 16(4):265-73.

Brand E, Kothari C, Stark M. Factors related to breastfeeding discontinuation between hospital discharge and 2 weeks postpartum. J Perinat Edu. 2011;20(1):36-44.

Mitra A, KhouryA et al. Evaluation of a comprehensive loving support program among state women, infants, and children (WIC) program breast-feeding coordinators. Southern Med J. 2002;96(2): 168-71.

Ajzen I. The theory of planned behavior. Org Behav Human Decision J. 1991;50(2):179.

District planning tool for maternal and newborn health strategy. Available at: child_adolescent/ documents. Accessed on 20 February 2023.

McMillan B, Conner M. Predicting breastfeeding in women living in areas of economic hardship: Explanatory role of the theory of planned behaviour. Psychol Health. 2008;23(7):767-88.

Cross-Barnet C, Augustyn M. Long-term breastfeeding support: Failing mothers in need. Mat Child Health J. 2012;16(9):1926-193.

Xu F, Binns C, Zheng S. Determinants of exclusive breastfeeding duration in Xinjiang, PR China. Asia Pac J Clin Nutr. 2007;16 (2):316-21.

Laugen CM, Islam N, Janssen PA. Social Support and Exclusive Breast feeding among Canadian Women. Paediatr Perinat Epidemiol. 2016;30(5):430‐8.

Matare CR, Craig HC, Martin SL. Barriers and opportunities for improved exclusive breast-feeding practices in tanzania: household trials with mothers and fathers. Food Nutr Bull. 2019;40(3):308‐25.






Original Research Articles