Mothers' breastfeeding experiences and practices: An explorative mixed methods study in the sub-district of Tlokwe, North West Province, South Africa

PhD (Nutrition), North-West University, Potchefstroom CampusBackground: The World Health Organization has set a target for exclusive breastfeeding (EBF) of 50% at country level by 2025. Despite national efforts, without accelerated efforts at scale, South Africa will not meet the 2025 target for EBF. The aim of this mixed methods study was to examine the rate of EBF discontinuation after birth, explore the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, and 4-8, 10-14 and 20-24 weeks and to identify home, family and community-based interventions to promote EBF and overall breastfeeding rates for infants aged 6-24 weeks in low- and middle-income settings (LMICs). Methods: This community-based mixed-methods study collected data within a prospective cohort study on socio-demographics characteritics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics were used for the quantitative data and thematic analysis for qualitative data. A systematic review of reviews was also conducted. Results: In the cohort of 178 breastfeeding mothers, EBF decreased from 34% at 4-8 weeks (n = 159) to 9.7% at 20-24 weeks (n = 72) (p