Tape, Pepper, and Perseverance: Understanding Weaning Decisions in Iranian Mothers Through a Social-Ecological Lens – A Mixed Methods Study

Background: Weaning is a significant developmental milestone with lasting effects on maternal and child health. Although the World Health Organization recommends initiating complementary feeding gradually around six months, culturally specific practices remain underexplored in many settings. This study examined maternal weaning decisions in Tehran, Iran, using a social-ecological approach. Methods: A convergent parallel mixed methods design was applied, combining quantitative and qualitative data from a descriptive cross-sectional survey. In 2021, 420 mothers of healthy, singleton children aged 6 months to under 4 years were recruited from 28 public health centers in Tehran. An expert-validated, 42-item online questionnaire collected data on demographics, weaning methods, perceived outcomes, and maternal experiences. Quantitative data were analyzed using IBM SPSS Statistics software for descriptive and inferential statistics, while qualitative responses were thematically analyzed. Findings were interpreted using the Social Ecological Model. Results: Most mothers (69.3%) were aged 25–34, had average financial status (79.8%), and a university degree (45.5%). Children were primarily aged 42–48 months. Weaning was predominantly mother-led (86.4%). Over half (56.2%) ceased breastfeeding between 18 and 24 months. Use of bitter or adhesive substances (41.2%) and unprescribed remedies (32.9%) was widespread. Only 34.8% consulted healthcare providers, mainly for emotional reassurance. Family advice influenced some decisions (22.3%), though overt pressure was rare. Emotional and physical discomfort, including guilt and breast pain, were frequently reported. Child outcomes varied: 58% of mothers noted increased independence, but over 80% described behavioral challenges such as irritability and clinginess. Maternal education and part-time employment were associated with weaning method choices. Conclusions: Weaning among Iranian mothers involves a complex interplay of personal agency, sociocultural norms, and limited institutional support. Despite strong maternal autonomy, reliance on traditional practices persists in the absence of professional guidance. Multi-level, culturally informed interventions should engage families and healthcare providers to promote safe, supportive weaning. National guidelines are urgently needed to align practices with WHO recommendations and address maternal and child well-being more effectively.