Experiences and beliefs related to exclusive breastfeeding (EBF) and early supplementation in urban slums of Karachi, Pakistan-A qualitative study

Exclusive breastfeeding (EBF) until six months of age is recommended as it contributes to childhood growth and development as well as protects against infections. Establishing EBF in certain settings can be difficult especially when women do not have access to basic antenatal or postnatal care-a critical window for education about breastfeeding. Myths and beliefs prevail, and socioeconomic practices influence and vary across cultures. In settings of infant growth failure or maternal undernutrition, early supplementation is preferred. Understanding local experiences regarding is crucial, as well as understanding community practices for early supplementation. A qualitative study was conducted in four urban slums of Karachi, Pakistan. Focus group discussions were conducted with mothers, fathers, and grandmothers of infants as well as community health workers. Minor mothers and those who refused consent were excluded. Eighty-four participants were recruited and 9 FGDs were conducted. Although overall knowledge about the benefits of breastfeeding was sufficient, many mothers were not aware of proper breastfeeding techniques. Mothers’ health and inadequate milk production were considered key drivers influencing EBF. A lack of psychosocial support, as well as extended family members being the key decision makers, also interfered with mothers' ability to EBF. Few mothers did not practice early supplementation or pre-lacteal feeding. In situations where breastfeeding was not possible, early complementary feeding was a preferred option, compared with breast milk expression or formula feeding. Caregivers know the recommended feeding practices, yet adherence remains a challenge. A nuanced approach is required to explore these barriers so policymakers and awareness campaigns can target specific reasons hindering EBF. There is a need to strengthen evidence related to whether to provide early supplementation in conditions where challenges arise owing to the availability or ability to breastfeed. Lastly, maternal counseling and guidance regarding breastfeeding techniques should be inculcated at regular antenatal and postnatal checkups.