Factors associated with successful exclusive breastfeeding among mothers in the formal sector. A mixed method study of kampala city

Background Globally, evidence show that exclusive breastfeeding (EBF) for the first six months of an infant’s life has several health benefits for the mother–infant pair. However, many employed women discontinue EBF before six months, while others succeed. However, limited research on the factors that enable some employed mothers succeed in EBF exists. This study aims to identify and explain the factors that enable EBF success among employed mothers in the formal sector. Method The study employed a mixed-methods, utilizing questionnaires and key-informant interviews to collect data. Multivariable logistic regression analysis established associated factors with EBF. The grounded theory technique was used to code findings, which were then triangulated to understand how and why some employed mothers succeeded in EBF and others failed. Results Participants mean age was 27years (± SD = 3.87). EBF prevalence was 30.1%. Significant factors were: education (AOR: 3.04. 95% CI: 1.04–8.86. P = 0.042*), family support (AOR: 0.45. 95% CI: 0.24–0.85. p = 0.02), financial support (AOR: 6.99. 95% CI: 2.46–19.88. P˂0.001), domestic support (AOR: 4.87. 95% CI: 1.80–13.14. p = 0.002), psychological support (AOR: 3.83. 95% CI: 1.16–12.65. p = 0.028), workmate support (AOR: 2.00. 95% CI: 1.10–3.64. p = 0.042), attending more than four antenatal care visits increased EBF success by 18%. Prelacteal feeding decreased EBF success by 23%. Themes: context, social support system, breastfeeding-friendly hospitals and workplace, and maternal EBF mind-set. Four theory were abstracted: social and individual cognition, EBF behavior, and institutional factors, that fit social cognitive theory. Conclusion The study revealed that associated factors for successful EBF were: Bachelor’s education level, financial support, social support systems (at family, workplace, and healthcare), strong maternal EBF mindset, and breastfeeding-friendly policies in hospitals and workplaces. Thus, concurrent interventions directed at promoting: women’s further education, basic-financial package for breastfeeding mothers, strong social support systems (at family, workplace, and healthcare), building maternal EBF mind-set, and implementation of breastfeeding-friendly (hospitals and workplaces) polices would increase EBF in the formal sector.