“Everybody breastfeeds if they have milk”: factors that shape exclusive breastfeeding practices in informal settlements of Mumbai, India

The study investigates factors influencing exclusive breastfeeding (EBF) in Mumbai's informal settlements, using a "positive deviance" approach to focus on mothers who successfully practiced EBF for six months. The findings reveal that while breastfeeding is culturally ingrained, the understanding of EBF often diverges from its strict definition. For many mothers, EBF meant avoiding major supplements like formula or animal milk, although minor supplements such as water or traditional medicines were not considered violations.

Key enablers of EBF include the mother's belief in the adequacy of her milk, strong family support, and the presence of breastfeeding role models. Mothers often linked their dietary practices to milk production and relied heavily on cues from their babies, such as contentment and sleep patterns, to assess sufficiency. Family dynamics played a pivotal role, with supportive family members easing household burdens and encouraging EBF.

The study also highlights challenges such as inconsistent breastfeeding practices, economic pressures, and the limited influence of healthcare advice compared to familial norms. While poverty sometimes necessitated EBF as a cost-saving measure, it also led to suboptimal practices, including infrequent feeding due to time constraints or inadequate maternal nutrition.

Recommendations emphasize the need for clear, community-specific education on EBF and its benefits, addressing misconceptions, and involving entire families in counseling. Programs should also promote consistent and demand-based breastfeeding practices while supporting mothers in overcoming environmental and systemic barriers.