Breastfeeding perceptions and exclusive breastfeeding practices: A qualitative comparative study in rural and urban Central Java']Java, Indonesia

Breastfeeding has been associated with improved growth, development, and health outcomes for infants and children. However, the exclusive breastfeeding rate in Indonesia is suboptimal (37%). There is limited contextualised understanding of mothers' perceptions of breastfeeding and the factors behind exclusive breastfeeding practices. The aim of this qualitative study was to compare breastfeeding perceptions and exclusive breastfeeding practices between rural and urban mothers. We conducted a qualitative comparative study through in-depth interviews with 46 caregivers of children aged 6-23 months, two health professionals, and ten kader (frontline female health workers at the village level) in Central Java, Indonesia. We analysed the data using thematic analysis. Urban mothers had better knowledge and perceptions of breastfeeding and more access to breastfeeding information sources. However, exclusive breastfeeding practice was more frequent among rural mothers. Family and healthcare workers acted as both facilitators and barriers to exclusive breastfeeding practice in both settings. Perceptions of insufficient breast milk supply, infant illness, and breast problems prevented rural and urban mothers to breastfeed exclusively. Mother-infant separation after birth, breast rejection, latching difficulty, and maternal employment were among the factors that caused urban mothers to discontinue breastfeeding exclusively. Breastfeeding promotion strategies should focus on enhancing maternal breastfeeding knowledge and problem-solving skills by considering the individual and social context, particularly in urban areas where exclusive breastfeeding obstacles are more nuanced.