Barriers to exclusive breastfeeding among young mothers at selected health care centers in Thembisile Hani local municipality, Mpumalanga Province, South Africa: A descriptive phenomenological study

Barriers to exclusive breastfeeding among young mothers at selected health care centers in Thembisile Hani local municipality, Mpumalanga Province, South Africa: A descriptive phenomenological study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Barriers to exclusive breastfeeding among young mothers at selected health care centers in Thembisile Hani local municipality, Mpumalanga Province, South Africa: A descriptive phenomenological study Gugu Charlaine Mahlalela, Mpho Gift Tau, Pamela Mafenngwe Mamogobo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7118730/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Exclusive breastfeeding is defined as giving an infant milk from its mother's breast or from a wet nurse in the first 6 months of life, as recommended by the World Health Organization (WHO). Younger mothers are less likely than older mothers are to exclusively breastfeed or to exclusively breastfeed for 6 months. Therefore, this research aims to assess knowledge and explore and describe barriers to exclusive breastfeeding among young mothers at the selected healthcare centers. Methods A descriptive phenomenological design was used as a method of inquiry. Two hundred and fifty young mothers who breastfed babies from 6 weeks to 6 months and attended a well-baby clinic at selected community healthcare centers were recruited via convenience sampling. One-on-one semi-structured interviews were conducted with 15 young mothers to assess their knowledge and explore and describe the barriers to exclusive breastfeeding. Interpretive thematic analysis revealed that although young mothers have adequate knowledge regarding exclusive breastfeeding, they do not practice it. Results Two themes emerged from the data: the knowledge of young mothers on exclusive breastfeeding and the barriers influencing the practice of exclusive breastfeeding. These findings indicate that most young mothers have a good understanding of the significance, duration, and advantages associated with exclusive breastfeeding. However, the practice of exclusive breastfeeding remains a challenge for several reasons. Conclusions Young mothers are well informed regarding exclusive breastfeeding, and its practice can reduce infant morbidity and mortality. Since knowledge is not a problem, to improve the practice of exclusive breastfeeding, the focus should be on the following aspects: developing strategies to bridge the gap between knowledge and practice, enhancing peer support groups for mothers to encourage one another and addressing barriers to the practice of exclusive breastfeeding. Furthermore, research on exclusive breastfeeding support by partners, families, communities and health care providers can improve the practice of exclusive breastfeeding among young mothers. Nursing Exclusive breastfeeding young mothers strategies knowledge practices barriers community health centers Background Exclusive breastfeeding occurs when an infant receives only breast milk from her mother's breasts or a wet nurse for the first 6 months of birth and no other solids or liquids except drops or syrups consisting of vitamins, minerals, supplements or medicines [ 1 ]. Most health organizations, such as the World Health Organization (WHO) and the United Nations Children’s Funds (UNICEF), have updated their recommendations that exclusive breastfeeding should be administered until the baby is 6 months old, before other additional food is offered, and that partial breastfeeding should continue with complimentary feeding for at least 2 years of age [ 2 ]. Several studies have been conducted to improve the practice of exclusive breastfeeding among young mothers. [ 3 ]; [ 4 ]; [ 5 ]. In the United States, several studies have been conducted in support of interventions to improve the practice of exclusive breastfeeding. The interventions included peer counseling, which was performed by a nonprofessional person during the postnatal period via telephone, letters and in person at the women, infants and children’s offices. Telephone support was provided by a nurse in the first 4 weeks after delivery; prenatal interventions, which were delivered by a trained peer counselor; and other interventions, which included massages, gift packs, and financial incentives [ 6 ]. All interventions in those studies were aimed at improving exclusive breastfeeding practices; however, studies that combined peer counseling, telephone support, and community health nurses revealed a positive effect on exclusive breastfeeding practices among young mothers [ 6 ]. In African countries, most pregnant women wish to breastfeed their babies; however, owing to certain barriers, such as cultural beliefs and misconceptions, exclusive breastfeeding rates among young mothers are low. [ 7 ] Furthermore, in Ghana, grandmothers misconception that health workers do not practice exclusive breastfeeding themselves, and young mothers say that grandmothers never practice exclusive breastfeeding but that their babies turn up fine and that their breast milk is watery by nature and does not satisfy the infant [ 8 ]. Therefore, it is very important to assess the knowledge and explore barriers to exclusive breastfeeding among young mothers to overcome such misconceptions. The global prevalence of exclusive breastfeeding among babies 0–6 months old is 38% [ 2 ]. The policy of breastfeeding published in 2014 by the World Health Organization covers the fifth target to increase the exclusive breastfeeding rate by 50% worldwide by 2025. Other strategies mentioned in the policy include providing health care facility-based capacity to support exclusive breastfeeding, including reenergizing, expanding and institutionalizing baby-friendly hospital initiatives. In addition, community-based approaches to support exclusive breastfeeding, including the implementation of communication operations tailored to local areas, should be provided. Importantly, the hostile and improper marketing of breast milk substitutes should be limited by strengthening monitoring, enforcement, and legislation related to the international code of marketing of breast milk substitutes. Women should be encouraged to exclusively breastfeed by enacting six months of mandatory paid maternity leave, as well as policies that encourage women to exclusively breastfeed in workplaces. Investment in training and capacity building is needed for exclusive breastfeeding protection, promotion, and support [ 2 ]. Therefore, this study will also play an important role in the fifth target of the World Health Organization to increase the exclusive breastfeeding rate by 50% by 2025. Methods This study used a descriptive phenomenological design to assess the knowledge regarding exclusive breastfeeding and to explore and describe the barriers to breastfeeding among young mothers in community health center (CHC) facilities in Thembisile Hani local municipality in Mpumalanga Province, South Africa. The study was carried out in the selected community health centers in Mpumalanga Province. The three facilities are all located in rural areas in Thembisile Hani local municipality, Mpumalanga Province, South Africa, where the majority of isiNdebele-speaking people live. The population of the study included all young mothers aged 18–35 years who were breastfeeding babies between 6 weeks and 6 months and who were attending well-baby clinics at the three selected CHCs in Thembisile Hani local municipality, Mpumalanga Province, South Africa. They were included in the study if their babies were not exclusively breastfed. Babies were considered not exclusively breastfed if they were given any other liquid or solid other than breast milk except for medication. Informed consent was obtained from all young mothers who participated in the study. Convenience sampling was used to select the sample whereby the researcher chose participants because they were accessible and were easy to recruit. Fifteen young mothers, 5 from each selected facility, were interviewed until data saturation was reached. Data collection was conducted from March 2023 to May 2023. Data were collected from all three selected facilities. Ethical clearance was sought by the Turfloop Research Ethics Committee (TREC/384/2022:PG) before the study was conducted [ 9 ]. Further permission was sought from the Mpumalanga Department of Health (DoH), district and operational managers of the selected facilities. The interview guide was developed in English and translated to isiNdebele. Furthermore, the interview guide, which consisted of three sections (A & B), assisted in data collection. Section A included questions on the sociodemographic characteristics of the participants. Section B included questions on knowledge of exclusive breastfeeding and questions related to barriers to exclusive breastfeeding for at least six months after birth. Biases were minimized by including the open-ended questions, bracketing and avoiding leading questions that would lead to particular answers. The central question is ‘ What is your knowledge of exclusive breastfeeding’? Further questions regarding barriers to exclusive breastfeeding were asked. The interviews took approximately 30–45 minutes in the rooms with privacy at the CHCs. Field notes were captured during each interview. The interviews were audio recorded with the permission of the participant and transcribed verbatim from audio to text [10;11]. Data collected in the local language (IsiNdebele) were translated into English before transcription. Results Sociodemographic characteristics of the young mothers Among the 15 participants, 10 mothers were breastfeeding babies aged between 6 and 14 weeks, and 5 mothers were breastfeeding babies aged 4 to 5 months. The age range of the participants was between 18 and 35 years. Nine participants had formal education ranging from secondary school to tertiary. Approximately 3 participants were still attending high school (grade 10), whereas the other 3 dropped out at Grade 11. Themes and subthemes Two major themes and eight subthemes emerged from the data after analysis. The first is young mothers’ knowledge of exclusive breastfeeding, and the second is barriers to exclusive breastfeeding practices. The results are presented in terms of themes, subthemes and quotations, which represent the knowledge of and barriers to exclusive breastfeeding among young mothers. THEME 1: Young mothers’ knowledge of exclusive breastfeeding Young mothers shared different levels of knowledge about exclusive breastfeeding. Two (2) subthemes emerged from this theme, namely, the definition and duration of exclusive breastfeeding and the perceived benefits of exclusive breastfeeding. Definition and duration of exclusive breastfeeding Practicing exclusive breastfeeding among young mothers remains difficult, regardless of their sufficient knowledge about the phenomenon. The results revealed that young mothers have sufficient knowledge about the importance and recommended duration of exclusive breastfeeding. P#3 maintained, “ I know that exclusive breastfeeding is giving baby breast milk only for 6 months without giving water or soft porridge; I myself breastfeed all my babies for 6 months without giving them any food”. Most young mothers reported that exclusive breastfeeding involves providing infant milk for only 6 months. P#5 said, ” Yes, exclusive breastfeeding is giving baby breast milk only from birth to 6 months without giving any food or soft porridge.” Some participants had little knowledge regarding exclusive breastfeeding and duration. P#7: “I know that exclusive breastfeeding is when you give your baby breastmilk only for a certain recommended time”. Other participants stated that exclusive breastfeeding involves providing infant milk for only 3 months. P#3 indicated, “I know that you can give breast milk first from birth until 3 months; I mean, from 3 months, you can start giving soft porridge” . Therefore, this implies that knowledge about exclusive breastfeeding is not a challenge for most of the participants; however, the difficult aspect is the practice thereof. Perceived benefits of exclusive breastfeeding The participants were aware of the benefits of exclusive breastfeeding, but they could not practice it. The results revealed benefits such as bonding, cost effectiveness, belief in the nutritional benefits of breast milk, and the ready availability of breast milk. Most young mothers emphasized that breastfeeding mothers tend to have good relationships with their infants (bonding). P#1 indicated, “Yoh, I view it as a good thing, because I believe that a mother who is breastfeeding exclusively has enough time to bond with her baby”. P#4 indicated, “I am breastfeeding, my baby is healthy, my baby enjoys, and I have more contact or bonds with my baby. Furthermore, breastfeeding enhances the bond between me and the baby”. P#5 said, “Breastfeeding has given me the joy of being a mother; my baby knows me more than anyone does, he even knows my voice, and how breastfeeding has influenced my bond with my baby.” Breast milk is always available at the right temperature and does not require preparation, making it convenient. Additionally, it is cost-free compared with formula feeding. The participants recognized that, for only safe money to breastfeed, they do not have to buy expensive formula milk for their babies (cost effectiveness). P#2 showed, “I tell myself that I cannot afford formula and pampers, I know that when I am breastfeeding, I save money and that I become stress free with cost problems, and I know that breast milk does not finish, as long as I drink rooibos tea to improve breast milk production, I am fine” . P#3 maintained: My baby daddy told me to breastfeed because he doesn’t have money to buy formula milk, and he said that because I also do not have money, then I should breastfeed. All the participants expressed concern about the financial burden of purchasing formula milk. They perceive formula milk as expensive and are aware of the costs associated with it. Breastfeeding is considered a more economical option because breast milk is free and readily available. Exclusive breastfeeding is highlighted as a way to reduce stress related to the cost of formula milk. The participants mentioned that by breastfeeding, they avoid the financial burden of purchasing formula, which alleviates worries about paying for essential supplies for their babies. Some participants mentioned external factors that influence their decision to breastfeed. One participant emphasized the high cost of buying formula milk and diapers, leading them to prioritize breastfeeding to reduce costs. This shows how financial considerations regarding different baby care items play a role in their decision-making process. Young mothers believe that breast milk prevents their babies from becoming sick from diseases such as diarrhea, which can be caused by unsafe preparation of formula milk. Furthermore, the easy access of baby feeds from their own breast allows them to practice exclusive breastfeeding. P#2 indicated, “The baby that receives breast milk does not get sick faster, but the baby who receives bottle feeding or formula feed becomes sick easily; because it is difficult to maintain sterility when the mother is feeding in the bottle, the baby tends to feed on gems that cause diarrhea. Breast milk is better for the baby than formula milk from the store. ” P#6 maintained : “My mother's opinion is very influential, she told me that formula milk is not healthy and does not meet the correct number of feeds needed for the baby it may cause overfeeding or underfeeding; she also told me that bottles easily attract gems, so I remained encouraged to practice exclusive breastfeeding.” The participants emphasized the health benefits of breastfeeding over formula feeding. These findings suggest that compared with formula-fed babies, breastfed babies are less prone to illnesses. They attributed this to the difficulty in maintaining sterility with bottles, which can expose formula-fed babies to germs and increase the risk of diarrhea or infections. Participant 6 mentioned concerns about the nutritional adequacy of formula milk compared with that of breast milk. The idea that formula might lead to overfeeding or underfeeding suggests that breast milk is naturally tailored to meet a baby's needs more precisely. Theme 2: Barriers to exclusive breastfeeding practices Most young mothers were willing to practice exclusive breastfeeding, but they were having difficulty practicing exclusive breastfeeding due to a wide range of challenges, such as minor breast and nipple problems, family pressures, time constraints, crying of the baby and contradictory information. Most young mothers were able to deal with these challenges and continued with exclusive breastfeeding, but some were unable to deal with the challenges and therefore could not exclusively breastfeed their babies for 6 months. Pain when breastfeeding These results reflect the common challenges that some mothers face during the initial stages of breastfeeding, such as soreness, tenderness, or pain in the breasts. Despite these difficulties, the participants demonstrated resilience and determination to overcome discomfort and continue breastfeeding for the benefit of their babies. This resilience is a test of their commitment to providing their infants with the nutritional benefits of breast milk, even in the face of physical discomfort. P#4 said: “Yes, at first when I started breastfeeding, my breast was painful”. P#3 concluded, “Yoh, I almost stopped when I started, because my breast was painful and my baby was breastfeeding too much, but I continued breastfeeding”. P#4 said, “Oh, I moisturized my breast with Vaseline to relieve pain and prevent the breast from cracking”. Regardless of the degree of pain experienced while breastfeeding, participants were willing to continue exclusively breastfeeding, indicating that participants understood the importance of exclusive breastfeeding for their babies. The participants also reported how to address pain, rather than minor breast and nipple problems. One participant highlighted a common practice among breastfeeding mothers to alleviate pain and prevent their breasts from cracking. Young mothers understood the importance of practicing breastfeeding because even with their painful breasts, they still continued with exclusive breastfeeding, and they also used nonpharmacological techniques to relieve pain, such as the use of Vaseline. Breastfeeding can cause soreness or discomfort, and Vaseline application might provide a soothing effect, reducing pain. Vaseline, a brand of petroleum jelly, is used by some mothers to moisturize their breasts. Continuous breastfeeding can sometimes cause the nipples or surrounding skin to dry out or crack. Moisturizing with Vaseline forms a protective barrier that can help prevent this cracking and keep the skin hydrated. Family pressure Family opinions, especially those of experienced elders, such as mothers or grandmothers, often hold considerable weight and can heavily influence an individual's decision-making process. Most young mothers find it difficult to practice exclusive breastfeeding under the pressure of family members. Thus, most participants stated that old family members told them to give soft porridge to the baby because the baby is hungry and will not grow properly with milk from the breast only. The comments from older family members that forced young mothers to provide soft porridge hindered the practice of exclusive breastfeeding, as recommended. P#5 stated, “ My grandmother told me that the baby is hungry, she cannot be full of breast milk alone, and she will continue to try or she will not grow well”. P#3 expressed, “ Yes , nurses in the clinic tell us to give breast milk only for 6 months; at home, the alders once the baby is 3 months, they tell us to give soft porridge because they believe that they have been doing that for a long time ago”. P#7 said , “I could not resist the pressure of my family members, so I started to give my baby soft porridge at 3 months”. The above quotations show that older family members do not have sufficient knowledge of exclusive breastfeeding and do not know that breast milk is sufficient for the infant from birth to 6 months. Poor knowledge among family members hinders the practice of exclusive breastfeeding among young mothers. Crying of the baby When the baby is crying, it is always associated with hunger; therefore, most of the participants shared that they were always told that they should give their babies soft or complimentary feeds before 6 months because the baby is crying because he is hungry. The misinterpretation of a crying baby negatively impacts the practice of exclusive breastfeeding because it leads to the early introduction of meals. P#5 explained, “ I think it is in the person's choice to do the right thing, because here at the clinic, they always tell us that, according to the books and research, breast milk is enough for the baby from birth until six months, but we insist that if the baby is crying, she needs food”. P#6 indicated, “You know what other people do when the baby cries, they will say the baby is crying, they will say that the baby is hungry, so a young mother with less knowledge will introduce feeds early”. Regardless of the information given by the nurses in the clinics, the participants stated that when the baby cries, they insist that the baby needs to obtain complimentary food (mixed food). The ignorance of other participants that exclusive breastfeeding is not enough for the newborn affects the practice of exclusive breastfeeding. Misconceptions Contradicting information about exclusive breastfeeding leads to poor practices of exclusive breastfeeding, in which young mothers attempt to start feeding babies complimentary feeds before 6 months. The participants believed that infants are always hungry and cannot be fed breast milk alone; therefore, if this is the case, they would recommend EBF for only 3 months. Some participants said that they were told that they are killing their babies with hunger because they have a small breast. Most young mothers stated a misconception about breastfeeding that could or caused them to start mixing feeding before 6 months. P#1 said, “I was once told my breast is small; they cannot produce breast milk, and I kill my baby with hunger because my breast is small”. P#2 explained , “ My friends told me if I breastfeed, I will lose a lot of weight, and when I breastfeed, I will not get a job because I will have to stay 24/7 with my baby; in other words, I will lose employment opportunities when I breastfeed”. P#7 indicated , “Babies are always hungry shame; if it were me, I would have recommended that we exclusively breastfeed for 3 months only, myself even if I breastfeed my baby, he is always crying”. Time constraints Exclusive breastfeeding practices among young mothers in this study were hindered or negatively impacted by less time for breastfeeding mothers with their babies. Most young working mothers are expected to return to work after 4 months, whereas they are expected to exclusively breastfeed for 6 months. Some young mothers cannot exclusively breastfeed for 6 months because they need to return to school as soon as they have delivered their babies. P#8 stated, “When I go to school, my baby will be getting the fine porridge; she will get breast milk when I come back”. P#6 said , “ I know that I should breastfeed for 6 months as I said that I breastfeed my 2 children for 6 months, but for this one because I have to go back to work, I will only breastfeed exclusively for 4 months; at 4 months, I will give them food solids”. The young mothers in this study knew about breast pumping but did not see a reason to pump breast milk for their babies when they went to school because they knew that even if they could return to school, their babies would still have something to eat. P#8 maintained, “ I know that I can breast pump, but I don’t see a reason to do that because my baby will be getting soft porridge when I go to school.” The results revealed that exclusive breastfeeding caused young mothers to lose weight, so alternative methods of feeding were recommended by friends and relatives, which affected their practices. Furthermore, they noted that breastfeeding allows them to stay home and that they can lose job opportunities. All the misconceptions about breastfeeding hinder the practice of exclusive breastfeeding. Partner’s conflict Young mothers believe that a mother with stress should not continue breastfeeding her baby because stressed mothers transfer their stress to their babies. Furthermore, depressed mothers believe that babies will not grow and will always become sick. Therefore, some participants reported that they could not continue with exclusive breastfeeding because the fight they had with their baby daddy led to depression. The participant stated that she was always crying and that the baby was not growing well. P#2 said, “When I was breastfeeding my first baby, I was stressed, always crying due to baby daddy, and when I continued breastfeeding, my baby was losing weight, so I stopped breastfeeding before 6 months”. P#4 explained: “We introduce meals early owing to stress, because I believe that when you are stressed as a breastfeeding mother you tend to produce less milk and the baby cries too much, in that case you will think about introducing meals”. This implies that the conflict between a breastfeeding mother and a baby daddy has a negative effect on the practice of exclusive breastfeeding. In addition, stressed mothers find it difficult to practice exclusive breastfeeding. Discussions Exclusive breastfeeding is recommended by the World Health Organization to be practiced by all mothers as long as there are no medical contraindications [ 2 ]. However, the study revealed that most of the young mothers practiced mixed-feeding before their babies reached 6 months. The purpose of this study was to assess the barriers to exclusive breastfeeding among young mothers in community health center (CHC) facilities in Thembisile Hani local municipality in Mpumalanga Province, South Africa. The majority of participants were mothers between the ages of 18 and 25 years. Most of this age group is still at school and working, which could pose a potential challenge in the expected practice of exclusive breastfeeding for their babies. Young mothers in this age group have less time with their babies after delivery because of the need to return to school or work [12;13]. This situation could cause an enormous burden on the health system because poor nutrition could result in over/undernutrition, leading to increased child mortality and morbidity rates and new infections by HIV and AIDS in infants. HIV-positive mothers who do not practice exclusive breastfeeding have increased chances of vertical transmission of HIV infection to their babies [ 14 ]. In addition, malnutrition in young infants is caused by poor breast milk intake and therefore also places a burden on the health system [ 15 ]. The study revealed that most young mothers are aware of the meaning, duration and benefits of exclusive breastfeeding; however, this practice remains a challenge. Furthermore, the study revealed that young mothers had a positive attitude toward the practice of exclusive breastfeeding, as indicated by the participant, who stated that they ignored any negative opinion about them practicing exclusive breastfeeding to maintain their practice [ 16 ]. This finding indicates that the knowledge of young mothers about exclusive breastfeeding resulted in their willingness to practice it. This aligns with the findings of a study conducted in Ghana, which revealed that the knowledge of teenage mothers about the benefits of exclusive breastfeeding 'make them certain that they will breastfeed their babies, and thus also indicated the conviction of teenage mothers about the nutritional value of breast milk for their babies. A separate study reported that young mothers’ knowledge of exclusive breastfeeding allows them to practice exclusive breastfeeding [1; 16;17; 18;19]. The study findings further revealed barriers that influenced young mothers not to exclusively breastfeed for 6 months, which included pain when breastfeeding, family pressure, baby crying, contradicting information/misconception, time constraints, and partner conflict. The presence of pain during breastfeeding is related to factors that hinder the practice of exclusive breastfeeding among young mothers, as indicated by the findings of previous studies, which revealed that young mothers who experienced pain when breastfeeding almost stopped breastfeeding; however, the nonpharmacological techniques they used to relieve breast pain assisted them in continuing breastfeeding [20;21;22]. The nonpharmacological technique used by young mothers in this study involved the application of Vaseline to their nipples to relieve pain. Similar studies have indicated that mothers with extreme breast pain quickly lose interest in breastfeeding and feel pressured to introduce solid food and other fluids prematurely [ 23 ]. The findings of this study indicated that family pressure during infant feeding contributed to the poor practice of exclusive breastfeeding. The participants were not able to exclusively breastfeed their infant for 6 months as recommended because they were told by older family members to give their babies soft porridge because breast milk or milk alone is not enough for the infant. A separate study [ 24 ] also indicated that few mothers breastfed exclusively, but many introduced complementary food before the recommended age of 6 months, due to the strong influence of family members on the decision around infant feeding, as has been done by many communities in South Africa. Another study [ 25 ] reported that family members influenced young mothers positively to exclusively breastfeed their babies. The study results revealed that owing to an unbearable cry of the babies, it was difficult for young mothers to continue with exclusive breastfeeding, as expected by health care workers, who always tech them. Consistent with the findings of a study conducted in the municipality of Tswelepele, mothers stated that their infants' inexplicable crying concerned them so much that they were forced to stop EBF before 6 months of age [ 26 ]. Misconceptions about the practice of exclusive breastfeeding hinder the practice of exclusive breastfeeding among young mothers, as revealed in a previous study in which small breasts produced less milk, lost weight because babies ate from the mother, lost jobs and hungry infants characterized by crying [ 27 ]. Other studies revealed that mothers did not breastfeed under the assumption that they did not have enough breast milk for their babies; the other assumption was to give infants butter, furegreek, and cow milk to soften the stomach [ 8 ]. Some mothers give solid and other fluids because they believe that the use of breast milk alone is not enough for their babies [26;27;28]. Young mothers who have less time with their child after delivery due to the need to return to work often have difficulty maintaining the practice of exclusive breastfeeding, as indicated by the current study results [ 27 ]. A separate study conducted in Rustenburg district indicated that mothers who needed to return to work soon after the birth of the baby realized that exclusive breastfeeding was not easy. Furthermore, mothers also felt that maternity leave of less than six months was not conducive to exclusive breastfeeding [ 29 ]. Conflicts between partners contribute to the poor practice of exclusive breastfeeding among young mothers, whereby most young mothers in this study said that they stopped breastfeeding their infants because of the fight they had with their partners. There is a strong belief that breastfeeding while depressed affects a baby’s health and growth. A separate study showed that mothers with support and love from their partners tend to exclusively breastfeed their babies for 6 months [ 1 ];[ 30 ]; [ 31 ]. Conclusions Young mothers possess sufficient knowledge concerning exclusive breastfeeding; however, its practice remains a challenge. This suggests a significant gap between what mothers know and what they are able to implement. Despite largely positive attitudes toward breastfeeding, various challenges prevent mothers from exclusively breastfeeding their infants. Therefore, since knowledge is not the primary barrier, this study recommends developing strategies to bridge the gap between knowledge and practice regarding exclusive breastfeeding. Abbreviations CHC: Community Healthcare Centre EBF: Exclusive Breastfeeding EFF: Exclusive Formula Feeding MPDoH: Mpumalanga Department of Health PMTCT: Prevention of Mother to Child Transmission WHO: World Health Organization HIV: Human immunodeficiency virus Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by Turfloop Research Ethics Committee (TREC/384/2022:PG) University of Limpopo, South Africa. Written informed consent was obtained for all the participants. Dara were collected anonymously. Consent for publication is not applicable. Availability of data and materials The data are available from the authors upon reasonable request. Competing interests The authors declare that they have no competing interests. Acknowledgment We are grateful to the mothers who shared their valuable experiences and knowledge on exclusive breastfeeding. All authors were involved in the analysis and data interpretation. Funding This research was funded by the HWSETA Authors’ contributions GC, MG and PM designed the study, GC collected the data and transcribed the data. GC, MG and PM analyzed and interpreted the data, and drafted the manuscript.PM verified the data, all the authors proofread and approved the manuscript. References Hunegnaw, M.T., Gezie, L. D. & Teferra, A. S.,2017. Exclusive breastfeeding and associated factors among mothers in Gozamin district, northwest Ethiopia:a community based. 12(30),pp 1-19. https://www.springernature.com/gp/open-research/about/the-fundamentals-of-open-access-and-open-research World Health Organization (WHO). 2014. Global Nutrition Targets 2025. Breastfeeding Policy Brief. http://www.who.int/nutrition/trackingtool Buckland, C., Hector, D., Kolt, G.S. et al. Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis. 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"The kind of support that matters to exclusive breastfeeding" a qualitative study. BMC Pregnancy and Children, 21(1), pp.1-8. South Africa. 2023. Integrated Management of Childhood Illness. Department of Health. https://www.Health.gov.za South Africa. 2023. Guidelines for Vertical Transmission Prevention of Communicable Infection. Department of health. https://www.Health.gov.za Senghore, T., Omotosho, T. A., Ceesay, O. & Williams, D. C., 2018. Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: A cross sectional study. International Breastfeeding Journal, 1(13), pp.1-8. Asare, B. Y. A., Preko, J. V., Baafi, D., & Dwumfour-Asare, B. (2018). Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana. International breastfeeding journal, 13, 1-9. Nukpezah, R. N., Nuvor, S. V., & Ninnoni, J. 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T., O’Keefe-McCarthy, S., & Mantler, T. (2018). Moving toward a better understanding of the experience and measurement of breastfeeding-related pain. Journal of Psychosomatic Obstetrics & Gynecology, 40(4), 318–325. https://doi.org/10.1080/0167482X.2018.1518421 Motadi, S. A., Malaise, S. A. & Mushaphi, L. S. (2019). Breastfeeding knowledge and practices among mothers of children younger than 2 years from rural area in the Limpopo province, South Africa. S Afr J Child Health, 13(3), pp.115-119. Charlick, S. J., Fielder, A., Pincombe, J., & McKellar, L. (2017). ‘Determined to breastfeed’: A case study of exclusive breastfeeding using interpretative phenomenological analysis. Women and Birth, 30(4), 325-331. Thet, M. M., Khaing, E. E., Diamond-Smith, N., Sudhinaraset, M., Oo, S., & Aung, T. (2016). Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands. Appetite, 96, 62-69. Sultana, M., Dhar, S., Hasan, T., Shill, L. C., Purba, N. H., Chowdhury, A. I., & Shuvo, S. D. (2022). Knowledge, attitudes, and predictors of exclusive breastfeeding practice among lactating mothers in Noakhali, Bangladesh. Heliyon, 8(10). Paramashanti, B. A., Dibley, M. J., Huda, T. M., & Alam, A. (2022). Breastfeeding perceptions and exclusive breastfeeding practices: A qualitative comparative study in rural and urban Central Java, Indonesia. Appetite, 170, 105907. Maponya, N., Van Rensburg, Z. J. & Plessis Furrie, A. D. (2021). Understanding South Africa mothers' challenges to adhere to exclusive breastfeeding at workplace: A qualitative study. International Journal of Nursing sciences, 1(8), pp. 339-346. Senghore, T., Omotosho, T. A., Ceesay, O. & Williams, D. C. (2018). Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: A cross sectional study. International Breastfeeding Journal, 1(13), pp.1-8. Jebena, D. D., Tenagashaw, M. W. (2022). Breastfeeding practice and factors associated with exclusive breastfeeding among mothers in Horro District, Ethiopia: A community based cross- sectional study. PLOS ONE, 17(4), pp. 1-16. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7118730","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484986645,"identity":"f0d59099-1004-4c32-9ecd-b4df1e546b41","order_by":0,"name":"Gugu Charlaine Mahlalela","email":"","orcid":"https://orcid.org/0009-0002-8537-7191","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Gugu","middleName":"Charlaine","lastName":"Mahlalela","suffix":""},{"id":484994473,"identity":"e2c9f083-2b27-48e7-b96c-098e310543da","order_by":1,"name":"Mpho Gift Tau","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYFACHgjFz8DcQIqWBAYGyQZGUrUYHCBWi+7s3oMPGH/YJW6+kdjA8KOGwZ6fkE6zO+eSDRgSkhO3AbUw9hxjYJY4QEjLjRwzCYYEZrAWBt4GBjYGIrXUJ26eAbTlbwMDjzyRWg4nbpBIbGAG2iJhQFDLnTPGBglpx41nnHnYcFjmmISBIUEtt3sMH3ywqZbtb08++PBNjY29HCEtDBIM4GgBgwMQLjFaRsEoGAWjYBTgBQBqtT9EyPIV4AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-6640-5172","institution":"University of Limpopo","correspondingAuthor":true,"prefix":"","firstName":"Mpho","middleName":"Gift","lastName":"Tau","suffix":""},{"id":484994474,"identity":"9110afc4-82ab-45a4-98a4-8d3e707341fd","order_by":2,"name":"Pamela Mafenngwe Mamogobo","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Pamela","middleName":"Mafenngwe","lastName":"Mamogobo","suffix":""}],"badges":[],"createdAt":"2025-07-14 08:26:16","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7118730/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7118730/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86746477,"identity":"712abfbb-2f51-4d63-b647-1d3663dd24ae","added_by":"auto","created_at":"2025-07-15 07:49:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":650582,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7118730/v1/a316d5d4-460e-423d-b487-4f46d5df1624.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBarriers to exclusive breastfeeding among young mothers at selected health care centers in Thembisile Hani local municipality, Mpumalanga Province, South Africa: A descriptive phenomenological study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eExclusive breastfeeding occurs when an infant receives only breast milk from her mother's breasts or a wet nurse for the first 6 months of birth and no other solids or liquids except drops or syrups consisting of vitamins, minerals, supplements or medicines [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Most health organizations, such as the World Health Organization (WHO) and the United Nations Children’s Funds (UNICEF), have updated their recommendations that exclusive breastfeeding should be administered until the baby is 6 months old, before other additional food is offered, and that partial breastfeeding should continue with complimentary feeding for at least 2 years of age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies have been conducted to improve the practice of exclusive breastfeeding among young mothers. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]; [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the United States, several studies have been conducted in support of interventions to improve the practice of exclusive breastfeeding. The interventions included peer counseling, which was performed by a nonprofessional person during the postnatal period via telephone, letters and in person at the women, infants and children’s offices. Telephone support was provided by a nurse in the first 4 weeks after delivery; prenatal interventions, which were delivered by a trained peer counselor; and other interventions, which included massages, gift packs, and financial incentives [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. All interventions in those studies were aimed at improving exclusive breastfeeding practices; however, studies that combined peer counseling, telephone support, and community health nurses revealed a positive effect on exclusive breastfeeding practices among young mothers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn African countries, most pregnant women wish to breastfeed their babies; however, owing to certain barriers, such as cultural beliefs and misconceptions, exclusive breastfeeding rates among young mothers are low. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Furthermore, in Ghana, grandmothers misconception that health workers do not practice exclusive breastfeeding themselves, and young mothers say that grandmothers never practice exclusive breastfeeding but that their babies turn up fine and that their breast milk is watery by nature and does not satisfy the infant [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, it is very important to assess the knowledge and explore barriers to exclusive breastfeeding among young mothers to overcome such misconceptions.\u003c/p\u003e\u003cp\u003eThe global prevalence of exclusive breastfeeding among babies 0–6 months old is 38% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The policy of breastfeeding published in 2014 by the World Health Organization covers the fifth target to increase the exclusive breastfeeding rate by 50% worldwide by 2025. Other strategies mentioned in the policy include providing health care facility-based capacity to support exclusive breastfeeding, including reenergizing, expanding and institutionalizing baby-friendly hospital initiatives. In addition, community-based approaches to support exclusive breastfeeding, including the implementation of communication operations tailored to local areas, should be provided. Importantly, the hostile and improper marketing of breast milk substitutes should be limited by strengthening monitoring, enforcement, and legislation related to the international code of marketing of breast milk substitutes. Women should be encouraged to exclusively breastfeed by enacting six months of mandatory paid maternity leave, as well as policies that encourage women to exclusively breastfeed in workplaces. Investment in training and capacity building is needed for exclusive breastfeeding protection, promotion, and support [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, this study will also play an important role in the fifth target of the World Health Organization to increase the exclusive breastfeeding rate by 50% by 2025.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study used a descriptive phenomenological design to assess the knowledge regarding exclusive breastfeeding and to explore and describe the barriers to breastfeeding among young mothers in community health center (CHC) facilities in Thembisile Hani local municipality in Mpumalanga Province, South Africa. The study was carried out in the selected community health centers in Mpumalanga Province. The three facilities are all located in rural areas in Thembisile Hani local municipality, Mpumalanga Province, South Africa, where the majority of isiNdebele-speaking people live. The population of the study included all young mothers aged 18–35 years who were breastfeeding babies between 6 weeks and 6 months and who were attending well-baby clinics at the three selected CHCs in Thembisile Hani local municipality, Mpumalanga Province, South Africa. They were included in the study if their babies were not exclusively breastfed. Babies were considered not exclusively breastfed if they were given any other liquid or solid other than breast milk except for medication. Informed consent was obtained from all young mothers who participated in the study. Convenience sampling was used to select the sample whereby the researcher chose participants because they were accessible and were easy to recruit. Fifteen young mothers, 5 from each selected facility, were interviewed until data saturation was reached.\u003c/p\u003e\u003cp\u003eData collection was conducted from March 2023 to May 2023. Data were collected from all three selected facilities. Ethical clearance was sought by the Turfloop Research Ethics Committee (TREC/384/2022:PG) before the study was conducted [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Further permission was sought from the Mpumalanga Department of Health (DoH), district and operational managers of the selected facilities. The interview guide was developed in English and translated to isiNdebele. Furthermore, the interview guide, which consisted of three sections (A \u0026amp; B), assisted in data collection. Section A included questions on the sociodemographic characteristics of the participants. Section B included questions on knowledge of exclusive breastfeeding and questions related to barriers to exclusive breastfeeding for at least six months after birth. Biases were minimized by including the open-ended questions, bracketing and avoiding leading questions that would lead to particular answers.\u003c/p\u003e\u003cp\u003eThe central question is ‘\u003cem\u003eWhat is\u003c/em\u003e your \u003cem\u003eknowledge of exclusive breastfeeding’?\u003c/em\u003e Further questions regarding barriers to exclusive breastfeeding were asked. The interviews took approximately 30–45 minutes in the rooms with privacy at the CHCs. Field notes were captured during each interview. The interviews were audio recorded with the permission of the participant and transcribed verbatim from audio to text [10;11]. Data collected in the local language (IsiNdebele) were translated into English before transcription.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSociodemographic characteristics of the young mothers\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 15 participants, 10 mothers were breastfeeding babies aged between 6 and 14 weeks, and 5 mothers were breastfeeding babies aged 4 to 5 months. The age range of the participants was between 18 and 35 years. Nine participants had formal education ranging from secondary school to tertiary. Approximately 3 participants were still attending high school (grade 10), whereas the other 3 dropped out at Grade 11.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThemes and subthemes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo major themes and eight subthemes emerged from the data after analysis. The first is young mothers\u0026rsquo; knowledge of exclusive breastfeeding, and the second is barriers to exclusive breastfeeding practices. The results are presented in terms of themes, subthemes and quotations, which represent the knowledge of and barriers to exclusive breastfeeding among young mothers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTHEME 1: Young mothers\u0026rsquo; knowledge of exclusive breastfeeding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eYoung mothers shared different levels of knowledge about exclusive breastfeeding. Two (2) subthemes emerged from this theme, namely, the definition and duration of exclusive breastfeeding and the perceived benefits of exclusive breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDefinition and duration of exclusive breastfeeding\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePracticing exclusive breastfeeding among young mothers remains difficult, regardless of their sufficient knowledge about the phenomenon. The results revealed that young mothers have sufficient knowledge about the importance and recommended duration of exclusive breastfeeding. P#3 maintained, \u0026ldquo;\u003cem\u003eI know that exclusive breastfeeding is giving baby breast milk only for 6 months without giving water or soft porridge; I myself breastfeed all my babies for 6 months without giving them any food\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMost young mothers reported that exclusive breastfeeding involves providing infant milk for only 6 months. P#5 said, \u0026rdquo;\u003cem\u003eYes, exclusive breastfeeding is giving baby breast milk only from birth to 6 months without giving any food or soft porridge.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSome participants had little knowledge regarding exclusive breastfeeding and duration. P#7: \u003cem\u003e\u0026ldquo;I know that exclusive breastfeeding is when you give your baby breastmilk only for a certain recommended time\u0026rdquo;.\u003c/em\u003e Other participants stated that exclusive breastfeeding involves providing infant milk for only 3 months. P#3 indicated, \u003cem\u003e\u0026ldquo;I know that you can give breast milk first from birth until 3 months; I mean, from 3 months, you can start giving soft porridge\u0026rdquo;\u003c/em\u003e. Therefore, this implies that knowledge about exclusive breastfeeding is not a challenge for most of the participants; however, the difficult aspect is the practice thereof.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceived benefits of exclusive breastfeeding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe participants were aware of the benefits of exclusive breastfeeding, but they could not practice it. The results revealed benefits such as bonding, cost effectiveness, belief in the nutritional benefits of breast milk, and the ready availability of breast milk. Most young mothers emphasized that breastfeeding mothers tend to have good relationships with their infants (bonding). P#1 indicated, \u0026ldquo;Yoh, \u003cem\u003eI view it as a good thing, because I believe that a mother who is breastfeeding exclusively has enough time to bond with her baby\u0026rdquo;.\u003c/em\u003e P#4 indicated, \u0026ldquo;I \u003cem\u003eam breastfeeding, my baby is healthy, my baby enjoys, and I have more contact or bonds with my baby. Furthermore, breastfeeding enhances the bond between me and the baby\u0026rdquo;.\u003c/em\u003e P#5 said, \u0026ldquo;Breastfeeding has \u003cem\u003egiven me the joy of being a mother; my baby knows me more than anyone does, he even knows my voice, and how breastfeeding has influenced my bond with my baby.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eBreast milk is always available at the right temperature and does not require preparation, making it convenient. Additionally, it is cost-free compared with formula feeding. The participants recognized that, for only safe money to breastfeed, they do not have to buy expensive formula milk for their babies (cost effectiveness). P#2 showed, \u0026ldquo;I \u003cem\u003etell myself that I cannot afford formula and pampers, I know that when I am breastfeeding, I save money and that I become stress free with cost problems, and I know that breast milk does not finish, as long as I drink rooibos tea to improve breast milk production, I am fine\u0026rdquo;\u003c/em\u003e. P#3 maintained: \u003cem\u003eMy baby daddy told me to breastfeed because he doesn\u0026rsquo;t have money to buy formula milk, and he said that because I also do not have money, then I should breastfeed.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAll the participants expressed concern about the financial burden of purchasing formula milk. They perceive formula milk as expensive and are aware of the costs associated with it. Breastfeeding is considered a more economical option because breast milk is free and readily available. Exclusive breastfeeding is highlighted as a way to reduce stress related to the cost of formula milk. The participants mentioned that by breastfeeding, they avoid the financial burden of purchasing formula, which alleviates worries about paying for essential supplies for their babies. Some participants mentioned external factors that influence their decision to breastfeed. One participant emphasized the high cost of buying formula milk and diapers, leading them to prioritize breastfeeding to reduce costs. This shows how financial considerations regarding different baby care items play a role in their decision-making process.\u003c/p\u003e\u003cp\u003eYoung mothers believe that breast milk prevents their babies from becoming sick from diseases such as diarrhea, which can be caused by unsafe preparation of formula milk. Furthermore, the easy access of baby feeds from their own breast allows them to practice exclusive breastfeeding. P#2 indicated, \u0026ldquo;The \u003cem\u003ebaby that receives breast milk does not get sick faster, but the baby who receives bottle feeding or formula feed becomes sick easily; because it is difficult to maintain sterility when the mother is feeding in the bottle, the baby tends to feed on gems that cause diarrhea. Breast milk is better for the baby than formula milk from the store. \u0026rdquo; P#6 maintained\u003c/em\u003e: \u0026ldquo;My mother's \u003cem\u003eopinion is very influential, she told me that formula milk is not healthy and does not meet the correct number of feeds needed for the baby it may cause overfeeding or underfeeding; she also told me that bottles easily attract gems, so I remained encouraged to practice exclusive breastfeeding.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe participants emphasized the health benefits of breastfeeding over formula feeding. These findings suggest that compared with formula-fed babies, breastfed babies are less prone to illnesses. They attributed this to the difficulty in maintaining sterility with bottles, which can expose formula-fed babies to germs and increase the risk of diarrhea or infections. Participant 6 mentioned concerns about the nutritional adequacy of formula milk compared with that of breast milk. The idea that formula might lead to overfeeding or underfeeding suggests that breast milk is naturally tailored to meet a baby's needs more precisely.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Barriers to exclusive breastfeeding practices\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost young mothers were willing to practice exclusive breastfeeding, but they were having difficulty practicing exclusive breastfeeding due to a wide range of challenges, such as minor breast and nipple problems, family pressures, time constraints, crying of the baby and contradictory information. Most young mothers were able to deal with these challenges and continued with exclusive breastfeeding, but some were unable to deal with the challenges and therefore could not exclusively breastfeed their babies for 6 months.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePain when breastfeeding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThese results reflect the common challenges that some mothers face during the initial stages of breastfeeding, such as soreness, tenderness, or pain in the breasts. Despite these difficulties, the participants demonstrated resilience and determination to overcome discomfort and continue breastfeeding for the benefit of their babies. This resilience is a test of their commitment to providing their infants with the nutritional benefits of breast milk, even in the face of physical discomfort. P#4 said: \u0026ldquo;Yes, \u003cem\u003eat first when I started breastfeeding, my breast was painful\u0026rdquo;.\u003c/em\u003e P#3 concluded, \u0026ldquo;Yoh, \u003cem\u003eI almost stopped when I started, because my breast was painful and my baby was breastfeeding too much, but I continued breastfeeding\u0026rdquo;.\u003c/em\u003e P#4 said, \u0026ldquo;Oh, \u003cem\u003eI moisturized my breast with Vaseline to relieve pain and prevent the breast from cracking\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eRegardless of the degree of pain experienced while breastfeeding, participants were willing to continue exclusively breastfeeding, indicating that participants understood the importance of exclusive breastfeeding for their babies. The participants also reported how to address pain, rather than minor breast and nipple problems. One participant highlighted a common practice among breastfeeding mothers to alleviate pain and prevent their breasts from cracking.\u003c/p\u003e\u003cp\u003eYoung mothers understood the importance of practicing breastfeeding because even with their painful breasts, they still continued with exclusive breastfeeding, and they also used nonpharmacological techniques to relieve pain, such as the use of Vaseline. Breastfeeding can cause soreness or discomfort, and Vaseline application might provide a soothing effect, reducing pain. Vaseline, a brand of petroleum jelly, is used by some mothers to moisturize their breasts. Continuous breastfeeding can sometimes cause the nipples or surrounding skin to dry out or crack. Moisturizing with Vaseline forms a protective barrier that can help prevent this cracking and keep the skin hydrated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFamily pressure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFamily opinions, especially those of experienced elders, such as mothers or grandmothers, often hold considerable weight and can heavily influence an individual's decision-making process. Most young mothers find it difficult to practice exclusive breastfeeding under the pressure of family members. Thus, most participants stated that old family members told them to give soft porridge to the baby because the baby is hungry and will not grow properly with milk from the breast only. The comments from older family members that forced young mothers to provide soft porridge hindered the practice of exclusive breastfeeding, as recommended. P#5 stated, \u003cb\u003e\u0026ldquo;\u003c/b\u003e\u003cem\u003eMy grandmother told me that the baby is hungry, she cannot be full of breast milk alone, and she will continue to try or she will not grow well\u0026rdquo;.\u003c/em\u003e P#3 expressed, \u0026ldquo;\u003cem\u003eYes\u003c/em\u003e, \u003cem\u003enurses in the clinic tell us to give breast milk only for 6 months; at home, the alders once the baby is 3 months, they tell us to give soft porridge because they believe that they have been doing that for a long time ago\u0026rdquo;. P#7 said\u003c/em\u003e, \u0026ldquo;I could not \u003cem\u003eresist the pressure of my family members, so I started to give my baby soft porridge at 3 months\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe above quotations show that older family members do not have sufficient knowledge of exclusive breastfeeding and do not know that breast milk is sufficient for the infant from birth to 6 months. Poor knowledge among family members hinders the practice of exclusive breastfeeding among young mothers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCrying of the baby\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhen the baby is crying, it is always associated with hunger; therefore, most of the participants shared that they were always told that they should give their babies soft or complimentary feeds before 6 months because the baby is crying because he is hungry. The misinterpretation of a crying baby negatively impacts the practice of exclusive breastfeeding because it leads to the early introduction of meals. P#5 explained, \u0026ldquo;\u003cem\u003eI think it is in the person's choice to do the right thing, because here at the clinic, they always tell us that, according to the books and research, breast milk is enough for the baby from birth until six months, but we insist that if the baby is crying, she needs food\u0026rdquo;.\u003c/em\u003e P#6 indicated, \u0026ldquo;You \u003cem\u003eknow what other people do when the baby cries, they will say the baby is crying, they will say that the baby is hungry, so a young mother with less knowledge will introduce feeds early\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eRegardless of the information given by the nurses in the clinics, the participants stated that when the baby cries, they insist that the baby needs to obtain complimentary food (mixed food). The ignorance of other participants that exclusive breastfeeding is not enough for the newborn affects the practice of exclusive breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMisconceptions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eContradicting information about exclusive breastfeeding leads to poor practices of exclusive breastfeeding, in which young mothers attempt to start feeding babies complimentary feeds before 6 months. The participants believed that infants are always hungry and cannot be fed breast milk alone; therefore, if this is the case, they would recommend EBF for only 3 months. Some participants said that they were told that they are killing their babies with hunger because they have a small breast. Most young mothers stated a misconception about breastfeeding that could or caused them to start mixing feeding before 6 months. P#1 said, \u003cem\u003e\u0026ldquo;I was once told my breast is small; they cannot produce breast milk, and I kill my baby with hunger because my breast is small\u0026rdquo;.\u003c/em\u003e P#2 \u003cem\u003eexplained\u003c/em\u003e, \u0026ldquo;\u003cem\u003eMy friends told me if I breastfeed, I will lose a lot of weight, and when I breastfeed, I will not get a job because I will have to stay 24/7 with my baby; in other words, I will lose employment opportunities when I breastfeed\u0026rdquo;.\u003c/em\u003e P#7 \u003cem\u003eindicated\u003c/em\u003e, \u0026ldquo;Babies \u003cem\u003eare always hungry shame; if it were me, I would have recommended that we exclusively breastfeed for 3 months only, myself even if I breastfeed my baby, he is always crying\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTime constraints\u003c/b\u003e\u003c/p\u003e\u003cp\u003eExclusive breastfeeding practices among young mothers in this study were hindered or negatively impacted by less time for breastfeeding mothers with their babies. Most young working mothers are expected to return to work after 4 months, whereas they are expected to exclusively breastfeed for 6 months. Some young mothers cannot exclusively breastfeed for 6 months because they need to return to school as soon as they have delivered their babies. P#8 stated, \u0026ldquo;When I go \u003cem\u003eto school, my baby will be getting the fine porridge; she will get breast milk when I come back\u0026rdquo;.\u003c/em\u003e P#6 \u003cem\u003esaid\u003c/em\u003e, \u0026ldquo;\u003cem\u003eI know that I should breastfeed for 6 months as I said that I breastfeed my 2 children for 6 months, but for this one because I have to go back to work, I will only breastfeed exclusively for 4 months; at 4 months, I will give them food solids\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe young mothers in this study knew about breast pumping but did not see a reason to pump breast milk for their babies when they went to school because they knew that even if they could return to school, their babies would still have something to eat. P#8 maintained, \u0026ldquo;\u003cem\u003eI know that I can breast pump, but I don\u0026rsquo;t see a reason to do that because my baby will be getting soft porridge when I go to school.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe results revealed that exclusive breastfeeding caused young mothers to lose weight, so alternative methods of feeding were recommended by friends and relatives, which affected their practices. Furthermore, they noted that breastfeeding allows them to stay home and that they can lose job opportunities. All the misconceptions about breastfeeding hinder the practice of exclusive breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePartner\u0026rsquo;s conflict\u003c/b\u003e\u003c/p\u003e\u003cp\u003eYoung mothers believe that a mother with stress should not continue breastfeeding her baby because stressed mothers transfer their stress to their babies. Furthermore, depressed mothers believe that babies will not grow and will always become sick. Therefore, some participants reported that they could not continue with exclusive breastfeeding because the fight they had with their baby daddy led to depression. The participant stated that she was always crying and that the baby was not growing well. \u003cem\u003eP#2 said, \u0026ldquo;When I was breastfeeding my first baby, I was stressed, always crying due to baby daddy, and when I continued breastfeeding, my baby was losing weight, so I stopped breastfeeding before 6 months\u0026rdquo;. P#4 explained: \u0026ldquo;We introduce meals early owing to stress, because I believe that when you are stressed as a breastfeeding mother you tend to produce less milk and the baby cries too much, in that case you will think about introducing meals\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis implies that the conflict between a breastfeeding mother and a baby daddy has a negative effect on the practice of exclusive breastfeeding. In addition, stressed mothers find it difficult to practice exclusive breastfeeding.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eExclusive breastfeeding is recommended by the World Health Organization to be practiced by all mothers as long as there are no medical contraindications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the study revealed that most of the young mothers practiced mixed-feeding before their babies reached 6 months. The purpose of this study was to assess the barriers to exclusive breastfeeding among young mothers in community health center (CHC) facilities in Thembisile Hani local municipality in Mpumalanga Province, South Africa. The majority of participants were mothers between the ages of 18 and 25 years. Most of this age group is still at school and working, which could pose a potential challenge in the expected practice of exclusive breastfeeding for their babies. Young mothers in this age group have less time with their babies after delivery because of the need to return to school or work [12;13]. This situation could cause an enormous burden on the health system because poor nutrition could result in over/undernutrition, leading to increased child mortality and morbidity rates and new infections by HIV and AIDS in infants. HIV-positive mothers who do not practice exclusive breastfeeding have increased chances of vertical transmission of HIV infection to their babies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, malnutrition in young infants is caused by poor breast milk intake and therefore also places a burden on the health system [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study revealed that most young mothers are aware of the meaning, duration and benefits of exclusive breastfeeding; however, this practice remains a challenge. Furthermore, the study revealed that young mothers had a positive attitude toward the practice of exclusive breastfeeding, as indicated by the participant, who stated that they ignored any negative opinion about them practicing exclusive breastfeeding to maintain their practice [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This finding indicates that the knowledge of young mothers about exclusive breastfeeding resulted in their willingness to practice it. This aligns with the findings of a study conducted in Ghana, which revealed that the knowledge of teenage mothers about the benefits of exclusive breastfeeding 'make them certain that they will breastfeed their babies, and thus also indicated the conviction of teenage mothers about the nutritional value of breast milk for their babies. A separate study reported that young mothers\u0026rsquo; knowledge of exclusive breastfeeding allows them to practice exclusive breastfeeding [1; 16;17; 18;19].\u003c/p\u003e\u003cp\u003eThe study findings further revealed barriers that influenced young mothers not to exclusively breastfeed for 6 months, which included pain when breastfeeding, family pressure, baby crying, contradicting information/misconception, time constraints, and partner conflict. The presence of pain during breastfeeding is related to factors that hinder the practice of exclusive breastfeeding among young mothers, as indicated by the findings of previous studies, which revealed that young mothers who experienced pain when breastfeeding almost stopped breastfeeding; however, the nonpharmacological techniques they used to relieve breast pain assisted them in continuing breastfeeding [20;21;22]. The nonpharmacological technique used by young mothers in this study involved the application of Vaseline to their nipples to relieve pain. Similar studies have indicated that mothers with extreme breast pain quickly lose interest in breastfeeding and feel pressured to introduce solid food and other fluids prematurely [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings of this study indicated that family pressure during infant feeding contributed to the poor practice of exclusive breastfeeding. The participants were not able to exclusively breastfeed their infant for 6 months as recommended because they were told by older family members to give their babies soft porridge because breast milk or milk alone is not enough for the infant. A separate study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] also indicated that few mothers breastfed exclusively, but many introduced complementary food before the recommended age of 6 months, due to the strong influence of family members on the decision around infant feeding, as has been done by many communities in South Africa. Another study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] reported that family members influenced young mothers positively to exclusively breastfeed their babies.\u003c/p\u003e\u003cp\u003eThe study results revealed that owing to an unbearable cry of the babies, it was difficult for young mothers to continue with exclusive breastfeeding, as expected by health care workers, who always tech them. Consistent with the findings of a study conducted in the municipality of Tswelepele, mothers stated that their infants' inexplicable crying concerned them so much that they were forced to stop EBF before 6 months of age [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Misconceptions about the practice of exclusive breastfeeding hinder the practice of exclusive breastfeeding among young mothers, as revealed in a previous study in which small breasts produced less milk, lost weight because babies ate from the mother, lost jobs and hungry infants characterized by crying [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Other studies revealed that mothers did not breastfeed under the assumption that they did not have enough breast milk for their babies; the other assumption was to give infants butter, furegreek, and cow milk to soften the stomach [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some mothers give solid and other fluids because they believe that the use of breast milk alone is not enough for their babies [26;27;28].\u003c/p\u003e\u003cp\u003eYoung mothers who have less time with their child after delivery due to the need to return to work often have difficulty maintaining the practice of exclusive breastfeeding, as indicated by the current study results [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A separate study conducted in Rustenburg district indicated that mothers who needed to return to work soon after the birth of the baby realized that exclusive breastfeeding was not easy. Furthermore, mothers also felt that maternity leave of less than six months was not conducive to exclusive breastfeeding [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConflicts between partners contribute to the poor practice of exclusive breastfeeding among young mothers, whereby most young mothers in this study said that they stopped breastfeeding their infants because of the fight they had with their partners. There is a strong belief that breastfeeding while depressed affects a baby\u0026rsquo;s health and growth. A separate study showed that mothers with support and love from their partners tend to exclusively breastfeed their babies for 6 months [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e];[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]; [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eYoung mothers possess sufficient knowledge concerning exclusive breastfeeding; however, its practice remains a challenge. This suggests a significant gap between what mothers know and what they are able to implement. Despite largely positive attitudes toward breastfeeding, various challenges prevent mothers from exclusively breastfeeding their infants. Therefore, since knowledge is not the primary barrier, this study recommends developing strategies to bridge the gap between knowledge and practice regarding exclusive breastfeeding.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCHC:\u003c/strong\u003e Community Healthcare Centre\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBF:\u003c/strong\u003e Exclusive Breastfeeding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEFF:\u003c/strong\u003e Exclusive Formula Feeding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMPDoH:\u003c/strong\u003e Mpumalanga Department of Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePMTCT:\u003c/strong\u003e Prevention of Mother to Child Transmission\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO: \u003c/strong\u003e World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e HIV: \u003c/strong\u003e Human immunodeficiency virus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by Turfloop Research Ethics Committee (TREC/384/2022:PG) University of Limpopo, South Africa. Written informed consent was obtained for all the participants. Dara were collected anonymously. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the mothers who shared their valuable experiences and knowledge on exclusive breastfeeding. All authors were involved in the analysis and data interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the HWSETA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGC, MG and PM designed the study, GC collected the data and transcribed the data. GC, MG and PM analyzed and interpreted the data, and drafted the manuscript.PM verified the data, all the authors proofread \u0026nbsp;and approved the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHunegnaw, M.T., Gezie, L. D. \u0026amp; Teferra, A. S.,2017. Exclusive breastfeeding and associated factors among mothers in Gozamin district, northwest Ethiopia:a community based. 12(30),pp 1-19. https://www.springernature.com/gp/open-research/about/the-fundamentals-of-open-access-and-open-research\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (WHO). 2014. Global Nutrition Targets 2025. Breastfeeding Policy Brief. http://www.who.int/nutrition/trackingtool\u003c/li\u003e\n \u003cli\u003eBuckland, C., Hector, D., Kolt, G.S. et al. Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis. Int Breastfeed J 15, 102 (2020). https://rdcu.be/eocQA\u003c/li\u003e\n \u003cli\u003eHossain, M., Islam, A., Kamarul, T. and Hossain, G., 2018. Exclusive breastfeeding practice during first six months of an infant’s life in Bangladesh: a country based cross-sectional study. \u003cem\u003eBMC pediatrics\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e, pp.1-9.\u003c/li\u003e\n \u003cli\u003eRahman, M.A., Khan, M.N., Akter, S., Rahman, A., Alam, M.M., Khan, M.A. and Rahman, M.M., 2020. Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data. Plos one, 15(7), p.e0236080.\u003c/li\u003e\n \u003cli\u003eBuckland, C. et al., 2020. interventions to promote exclusive breastfeeding among mothers:a systematic review and meta-analysis. International breastfeeding journal, 1(15), pp. 1-14.\u003c/li\u003e\n \u003cli\u003eSosseh, S.A.L., Barrow, A. \u0026amp; Lu, Z.J. Cultural beliefs, attitudes and perceptions of lactating mothers on exclusive breastfeeding in The Gambia: an ethnographic study. BMC Women's Health 23, 18 (2023). https://doi.org/10.1186/s12905-023-02163-z\u003c/li\u003e\n \u003cli\u003eAsamoah, C. N., Doku, D. T. \u0026amp; Agblori, S., 2020. Mothers and Grandmothers misconceptions and sociocultural factors as barriers to exclusive breastfeeding: A qualitative study involving Health Workers in two rural districts. PloS one, 9(15), pp. 1-9.\u003c/li\u003e\n \u003cli\u003eAcheampong, A. K., 2020. Perceived eneblers of exclusive breastfeeding by teenage mothers in Ghana. South African Family Practice , 1(62), pp. 1-5. http://dx.doi.org/10.4102/safp.v62:1.5108\u003c/li\u003e\n \u003cli\u003eCreswell, J. W., \u0026amp; Creswell, J. D. (2022). Research Design: Qualitative, Quantitative, and Mixed Methods Approach. SAGE Publication.\u003c/li\u003e\n \u003cli\u003eBrink, H., Vander Walt, C. \u0026amp; Van Rensburg, G. (2013). Fundamentals of Research methodology for Health Professionals. 3rd edition ed. Cape Town: s.n.\u003c/li\u003e\n \u003cli\u003eQuebu, S. R., Murray, D., \u0026amp; Okafor, U. B. (2023). Barriers to Exclusive Breastfeeding for Mothers in Tswelopele Municipality, Free State Province, South Africa: A Qualitative Study. Children, 10(8), 1380. https://doi.org/10.3390/children10081380\u003c/li\u003e\n \u003cli\u003eTheodorah, D. Z. \u0026amp; Mc' Deline, R. N., 2021. \"The kind of support that matters to exclusive breastfeeding\" a qualitative study. BMC Pregnancy and Children, 21(1), pp.1-8.\u003c/li\u003e\n \u003cli\u003eSouth Africa. 2023. Integrated Management of Childhood Illness. Department of Health. https://www.Health.gov.za\u003c/li\u003e\n \u003cli\u003eSouth Africa. 2023. Guidelines for Vertical Transmission Prevention of Communicable Infection. Department of health. https://www.Health.gov.za\u003c/li\u003e\n \u003cli\u003eSenghore, T., Omotosho, T. A., Ceesay, O. \u0026amp; Williams, D. C., 2018. Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: A cross sectional study. International Breastfeeding Journal, 1(13), pp.1-8.\u003c/li\u003e\n \u003cli\u003eAsare, B. Y. A., Preko, J. V., Baafi, D., \u0026amp; Dwumfour-Asare, B. (2018). Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana. International breastfeeding journal, 13, 1-9.\u003c/li\u003e\n \u003cli\u003eNukpezah, R. N., Nuvor, S. V., \u0026amp; Ninnoni, J. (2018). Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana. Reproductive health, 15, 1-9.\u003c/li\u003e\n \u003cli\u003eTahiru, R., Amoako, M., \u0026amp; Apprey, C. (2024). Exclusive breastfeeding: an exploratory thematic analysis of the perspectives of breastfeeding mothers and significant others in the Tamale metropolis of Northern Ghana. BMC nutrition, 10(1), 161.\u003c/li\u003e\n \u003cli\u003eMahurin-Smith, J. (2023). Challenges with Breastfeeding: Pain, Nipple Trauma, and Perceived Insufficient Milk Supply. MCN, The American Journal of Maternal/Child Nursing 48(3):p 161-167. DOI: 10.1097/NMC.0000000000000909\u003c/li\u003e\n \u003cli\u003eShaheen, H. M., Hegazy, N. N., \u0026amp; Sakr, S. S. (2018). The barriers to breastfeeding among women: a single-center experience. Menoufia Medical Journal, 31(3), 855-861.\u003c/li\u003e\n \u003cli\u003eJackson, K.T., Mantler, T; O'Keefe-McCarthy, S. (2019). Women's Experiences of Breastfeeding-Related Pain. MCN, The American Journal of Maternal/Child Nursing 44(2):p 66-72. DOI: 10.1097/NMC.0000000000000508\u003c/li\u003e\n \u003cli\u003eJackson, K. T., O’Keefe-McCarthy, S., \u0026amp; Mantler, T. (2018). Moving toward a better understanding of the experience and measurement of breastfeeding-related pain. Journal of Psychosomatic Obstetrics \u0026amp; Gynecology, 40(4), 318–325. https://doi.org/10.1080/0167482X.2018.1518421\u003c/li\u003e\n \u003cli\u003eMotadi, S. A., Malaise, S. A. \u0026amp; Mushaphi, L. S. (2019). Breastfeeding knowledge and practices among mothers of children younger than 2 years from rural area in the Limpopo province, South Africa. S Afr J Child Health, 13(3), pp.115-119.\u003c/li\u003e\n \u003cli\u003eCharlick, S. J., Fielder, A., Pincombe, J., \u0026amp; McKellar, L. (2017). ‘Determined to breastfeed’: A case study of exclusive breastfeeding using interpretative phenomenological analysis. Women and Birth, 30(4), 325-331.\u003c/li\u003e\n \u003cli\u003eThet, M. M., Khaing, E. E., Diamond-Smith, N., Sudhinaraset, M., Oo, S., \u0026amp; Aung, T. (2016). Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands. Appetite, 96, 62-69.\u003c/li\u003e\n \u003cli\u003eSultana, M., Dhar, S., Hasan, T., Shill, L. C., Purba, N. H., Chowdhury, A. I., \u0026amp; Shuvo, S. D. (2022). Knowledge, attitudes, and predictors of exclusive breastfeeding practice among lactating mothers in Noakhali, Bangladesh. Heliyon, 8(10).\u003c/li\u003e\n \u003cli\u003eParamashanti, B. A., Dibley, M. J., Huda, T. M., \u0026amp; Alam, A. (2022). Breastfeeding perceptions and exclusive breastfeeding practices: A qualitative comparative study in rural and urban Central Java, Indonesia. Appetite, 170, 105907.\u003c/li\u003e\n \u003cli\u003eMaponya, N., Van Rensburg, Z. J. \u0026amp; Plessis Furrie, A. D. (2021). Understanding South Africa mothers' challenges to adhere to exclusive breastfeeding at workplace: A qualitative study. International Journal of Nursing sciences, 1(8), pp. 339-346.\u003c/li\u003e\n \u003cli\u003eSenghore, T., Omotosho, T. A., Ceesay, O. \u0026amp; Williams, D. C. (2018). Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: A cross sectional study. International Breastfeeding Journal, 1(13), pp.1-8.\u003c/li\u003e\n \u003cli\u003eJebena, D. D., Tenagashaw, M. W. (2022). Breastfeeding practice and factors associated with exclusive breastfeeding among mothers in Horro District, Ethiopia: A community based cross- sectional study. PLOS ONE, 17(4), pp. 1-16.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Limpopo","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Exclusive breastfeeding, young mothers, strategies, knowledge, practices, barriers, community health centers","lastPublishedDoi":"10.21203/rs.3.rs-7118730/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7118730/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eExclusive breastfeeding is defined as giving an infant milk from its mother's breast or from a wet nurse in the first 6 months of life, as recommended by the World Health Organization (WHO). Younger mothers are less likely than older mothers are to exclusively breastfeed or to exclusively breastfeed for 6 months. Therefore, this research aims to assess knowledge and explore and describe barriers to exclusive breastfeeding among young mothers at the selected healthcare centers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive phenomenological design was used as a method of inquiry. Two hundred and fifty young mothers who breastfed babies from 6 weeks to 6 months and attended a well-baby clinic at selected community healthcare centers were recruited via convenience sampling. One-on-one semi-structured interviews were conducted with 15 young mothers to assess their knowledge and explore and describe the barriers to exclusive breastfeeding. Interpretive thematic analysis revealed that although young mothers have adequate knowledge regarding exclusive breastfeeding, they do not practice it.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwo themes emerged from the data: the knowledge of young mothers on exclusive breastfeeding and the barriers influencing the practice of exclusive breastfeeding. These findings indicate that most young mothers have a good understanding of the significance, duration, and advantages associated with exclusive breastfeeding. However, the practice of exclusive breastfeeding remains a challenge for several reasons.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eYoung mothers are well informed regarding exclusive breastfeeding, and its practice can reduce infant morbidity and mortality. Since knowledge is not a problem, to improve the practice of exclusive breastfeeding, the focus should be on the following aspects: developing strategies to bridge the gap between knowledge and practice, enhancing peer support groups for mothers to encourage one another and addressing barriers to the practice of exclusive breastfeeding. Furthermore, research on exclusive breastfeeding support by partners, families, communities and health care providers can improve the practice of exclusive breastfeeding among young mothers.\u003c/p\u003e","manuscriptTitle":"Barriers to exclusive breastfeeding among young mothers at selected health care centers in Thembisile Hani local municipality, Mpumalanga Province, South Africa: A descriptive phenomenological study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 07:33:37","doi":"10.21203/rs.3.rs-7118730/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf3d3867-580d-4730-83fa-a66322eef321","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51480840,"name":"Nursing"}],"tags":[],"updatedAt":"2025-07-15T07:33:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 07:33:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7118730","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7118730","identity":"rs-7118730","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}