Socio-Ecological Factors Influencing Exclusive Breastfeeding and the Lived Experiences of Mothers in Kroonstad, Free State, South Africa

Abstract

South Africa has an exclusive breastfeeding (EBF) rate of 32% and current national efforts to increase this rate are not showing any improvement. This study examined the socio-ecological factors influencing EBF and the lived experiences of mothers in Kroonstad, Free State, South Africa. The explanatory sequential mixed-methods study collected data from a cross-sectional survey from a convenience sample of 100 mothers and 10 key informant interviews (KIIs). Descriptive statistics were used for the quantitative data guided by the Socio-Ecological Model (SEM), and the Maternal Role Attainment (MRA) theory for qualitative data. The results showed that most of the mothers were 18–35 years old (86%); Africans (88%); single or never married (83%); had a secondary school qualification or college diploma (86%); and were unemployed (80%). The factors that influenced mothers to practise EBF were: individual – correct knowledge of breastfeeding (88%); interpersonal – not living with their husbands (49%); policy – having a policy on breastfeeding at work (23%); and organisational – healthcare providers explaining the importance of EBF during antenatal visits (91%) and after delivery (92%). Qualitative MRA analysis identified the lived experiences of the mothers to practise EBF to be the nurses or their mothers (anticipatory stage); the health care workers, baby and family (formal stage); previous experience of mothering (informal stage); and becoming increasingly acquainted and comfortable with their infants (personal stage). Thus, the study concluded that a combination of social and ecological factors colluded to support mothers in practising EBF for their infants during the first six months of life.