Exclusive Breastfeeding Among Female Head Porters (kayayei) in Kumasi, Ghana: Social Welfare Barriers, Support Systems, and Policy Implications

Female head porters ( kayayei ) in urban Ghana face conditions of informal work, poverty, migration, and weak institutional support that can make exclusive breastfeeding difficult. Guided by the Social Ecological Model, this study examined the barriers and support systems shaping exclusive breastfeeding among kayayei in the Kumasi Metropolis, Ghana, across individual, interpersonal, community, and structural levels. A cross-sectional mixed-methods design was used. Quantitative data were collected from 398 mothers through structured questionnaires, while qualitative interviews were conducted with 30 mothers to explore lived experience and care practices. Descriptive and thematic analyses were used to integrate the findings. The study found that exclusive breastfeeding was constrained at the individual level by pain, latch difficulties, and maternal stress; at the interpersonal level by limited family and partner support; at the community level by demanding market work, mobility, and lack of privacy; and at the structural level by weak social protection and limited access to supportive services. Peer networks, informal childcare help, and health education offered partial but inconsistent support. The findings show that breastfeeding among kayayei is both a maternal health and social welfare issue. The study calls for multilevel interventions that combine counselling, community support, child-friendly market spaces, and welfare-responsive urban policy.