Factors associated with successful exclusive breastfeeding among mothers in the formal sector. A mixed method study of Kampala Capital 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, family, communities, nation, and the whole world. 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 in Uganda. This study aims to identify and explain the factors that enable EBF success among employed mothers in the formal sector. Method The study employed mixed-methods, utilizing questionnaires and key-informant interviews to collect data. Multivariable logistic regression analysis of quantitative data established associated factors with EBF. The qualitative data analysis involved a systematic coding process (using ATLAS Ti v.5.21.2; themes were then used to further describe and understand how and why some employed mothers succeeded in EBF and others failed. Results Participants mean age was 27 years (± SD = 3.87). EBF prevalence was 31.7%. Significant factors were: Financial support (AOR: 6.62. 95% CI.2.27–19.31. P = 0.001***), domestic support (AOR: 5.23. 95% CI.1.88–14.52. P = 0.002**), psychological support (AOR: 5.45. 95% CI.1.47–20.20. P = 0.011*), and workmate support (AOR: 2.95. 95% CI. 1.54–5.67. P = 0.001***). Pre-lacteal feeding reduced likelihood of EBF success by 84% (AOR: 0.16. 95% CI. 0.06–0.45. P = 0.001***). Emerged themes from the qualitative component were: context, social support system, breastfeeding-friendly hospitals and workplace, and maternal EBF mind-set. The analysis of the quantitative and qualitative data yielded four theory relevant concepts: social cognition, individual cognition, EBF behavior, and institutional factors. These concepts align well with Social Cognitive theory. Conclusion EBF prevalence was at 31.7%. Close family support in forms of: financial, domestic, psychological, and workmate support predicted EBF success. Strong social support systems (at family, workplace, and healthcare), positive EBF mindset, and breastfeeding-friendly policies strengthened EBF success. Pre-lacteal feeds harmed EBF success. Thus, concurrent interventions directed at providing: basic-financial package for breastfeeding mothers, domestic, and psychological support coupled with strong social support systems, positive EBF mind-set, and implementation of breastfeeding-friendly policies would increase EBF in the formal sector.