Breastfeeding Practices, Sociocultural Influences, and Health-System Factors Among Mothers in Rural Etawah, Uttar Pradesh: A Cross-Sectional Study

Abstract

Background: Breastfeeding is a critical determinant of child survival and maternal health. Despite global and national policy commitments, suboptimal breastfeeding practices persist in rural India, driven by a complex interplay of sociocultural norms, health-system gaps, and knowledge deficits. Uttar Pradesh (UP) consistently records among the lowest exclusive breastfeeding (EBF) rates nationally, making community-level evidence urgently required.
Objectives: To assess breastfeeding initiation, exclusive breastfeeding rates, and reported sociocultural and health-system factors among mothers residing in rural Etawah district, Uttar Pradesh.
Methods: A cross-sectional study was conducted among 99 eligible mothers with children aged 0 to 24 months attending the Rural Health Training Centre (RHTC), Department of Community Medicine, UPUMS, Saifai. Eligible mothers attending the RHTC outpatient department were consecutively recruited using purposive sampling during the study period. Data were collected using a pre-tested, structured interviewer-administered questionnaire on breastfeeding practices, reasons for delayed initiation or non-exclusive breastfeeding, supplementary feeding patterns, traditional beliefs, family support, and healthcare provider interactions. Descriptive statistics were used to summarize the data, and frequencies and proportions were reported.
Results: Antenatal care (ANC) coverage was 85.9%, and institutional delivery was reported in 92.9% of cases. Early initiation of breastfeeding within one hour of birth was observed among 65.7% of mothers, while 34.3% experienced delayed initiation, primarily due to maternal health issues (44.7%) and post-delivery fatigue (42.1%). Exclusive breastfeeding for six months was practiced by 70.4% of mothers (69/98). Among mothers who did not practice exclusive breastfeeding (n=29), perceived insufficient milk supply was the most commonly reported reason (51.9%). Traditional beliefs influenced breastfeeding practices in 12.4% of cases, with honey and gutti administration reported for religious and cultural reasons. Family support for breastfeeding was high (92.9%), and the mother-in-law emerged as the principal influencer of infant feeding decisions (68.5%). Healthcare providers discussed the benefits of breastfeeding with 79.6% of mothers, while 54.1% received breastfeeding-related educational materials.
Conclusion: While EBF rates and early initiation in this cohort appeared higher than state estimates, these findings should be interpreted cautiously because of the descriptive study design and purposive sampling. Perceived milk insufficiency, maternal fatigue, and traditional practices were commonly reported barriers. Strengthening frontline worker counselling, community-based demand generation, and family-inclusive lactation support may improve breastfeeding practices.