Breastfeeding experience, barriers, and facilitators among mothers of vulnerable low birth weight infants in Amhara Region, Ethiopia: a qualitative exploratory study

Abstract Introduction: Globally, 15% - 20% of all live births are low birthweight (LBW) newborns, and many mothers with LBW newborns experience feeding difficulties. Concrete efforts to understand and mitigate the barriers to breastfeeding among this vulnerable group are urgently needed. Methods: Mother-newborn pairs were recruited from 8 facilities from the government’s Saving Little Lives initiative in Amhara Region, Ethiopia. We conducted a qualitative study using in-depth interviews among 30 mothers of LBW newborns (10 with very low birthweight [VLBW, <1500 gm]; 8 with LBW [<2000 gm] who experience breastfeeding difficulties, and 12 without difficulties). The interviews were analyzed using thematic analysis to describe the breastfeeding barriers and facilitators for mothers with and without feeding difficulties. Results: Despite strong intentions to exclusively breastfeed during pregnancy and knowledge of breastfeeding benefits, many mothers of LBW newborns had difficulties initiating and continuing breastfeeding while in-patient. Self-reported insufficient milk (SRIM), suboptimal breastfeeding support in hospitals, prolonged mother-newborn separation in Neonatal Intensive Care Units (NICUs), and limited knowledge of effective feeding techniques (limited antenatal and postnatal care education) were the most common barriers. Further, mothers with multiple births reported greater feeding difficulties; they were more likely to adopt formula feeding compared to those with single births. The primary facilitators of LBW breastfeeding were the synergy between health workers (mainly women health workers) and mothers, mothers’ peer counseling, and family support. However, health worker support varied widely across facilities. Conclusion: The findings from this study provide contextual insights into maternal LBW breastfeeding barriers and facilitators of successful and sustained breastfeeding. For example, creating NICU expectations to minimize maternal-newborn separation, targeting neonates’ feeding support for mothers with VLBW newborns and/or multiple births, and designing a standardized protocol for LBW nutritional support to guide health worker support are critically needed.