Psychosocial Factors and Resilience of Disaster-Survivor Mothers during Exclusive Breastfeeding Phase: A Mixed-Methods Study in Palu, Indonesia

Background : Exclusive breastfeeding (EBF) reduces infant morbidity and mortality, but is difficult to sustain after disasters because of trauma, disrupted services, and psychosocial stress. This study examined psychosocial factors associated with EBF during the first six months of life and explored resilience among disaster-survivor mothers in Palu, Central Sulawesi, Indonesia. Methods : An explanatory sequential mixed-methods design was employed. In the quantitative phase, 111 disaster-survivor mothers of infants aged 6–24 months were interviewed to retrospectively assess exclusive breastfeeding during the first six months postpartum using WHO IYCF indicators. Multivariate logistic regression was used to identify independent determinants of exclusive breastfeeding. The qualitative phase involved in-depth interviews with 10 mothers, and thematic analysis was conducted to explain and contextualize the quantitative findings. Results: The point prevalence of exclusive breastfeeding (EBF) was 42.3% (n = 47) at 0–2 months, 49.5% (n = 55) at 3–4 months, and 47.7% (n = 53) at 5–6 months. In multivariate analysis, EBF was independently associated with higher husband support (AOR 3.61; 95% CI 1.30–10.00), better maternal breastfeeding knowledge (AOR 2.88; 95% CI 1.07–7.73), higher mother-in-law support (AOR 3.16; 95% CI 1.13–8.85), lower perceived milk insufficiency/positive milk adequacy (PIM) (AOR 2.83; 95% CI 1.08–7.37), and higher health-cadre support (AOR 2.95; 95% CI 1.11–7.84) (all p<0.05). Three levels of maternal resilience were identified: high (n = 2), moderate (n = 4), and low (n = 4). Highly resilient mothers maintained EBF despite trauma, supported by spiritual coping, strong motivation, and family encouragement. Moderate resilience was characterized by mixed feeding under fatigue and limited support, while low resilience involved early cessation driven by exhaustion, poor confidence, and perceived milk insufficiency. These findings highlight that maternal resilience is a dynamic, context-dependent process, evolving through interaction between individual strength, family involvement, and community support in post-disaster setting. Conclusions: Maternal resilience in exclusive breastfeeding is shaped by individual, family, and community factors. Strengthening faith-based coping, emotional regulation, and social support can enhance resilience and sustain breastfeeding in post-disaster contexts.