Breastfeeding experience, barriers, and facilitators among mothers of vulnerable low birth weight infants in Amhara region, Ethiopia: a qualitative exploratory study.

Background: Globally, 15 - 20% of all live births are low birthweight (LBW) newborns, and many mothers with LBW newborns experience feeding difficulties. Efforts to understand and mitigate the barriers to breastfeeding among this vulnerable group are urgently needed.

Methods: Mother-newborn pairs were recruited from eight facilities from the government's Saving Little Lives initiative in Amhara Region, Ethiopia. We conducted a qualitative study using in-depth interviews among 30 mothers of LBW newborns (10 with very low birthweight [VLBW, < 1500 gm]; eight with LBW [< 2000 gm] who experienced breastfeeding difficulties, and 12 without difficulties). Data was collected from June to July 2022. The interviews were thematically analyzed to describe the breastfeeding experience, barriers, and facilitators for mothers with and without feeding difficulties.

Results: Despite strong plans to exclusively breastfeed during pregnancy, many mothers of LBW newborns had difficulties initiating and continuing breastfeeding after delivery. Self-reported insufficient milk, suboptimal breastfeeding support in hospitals, prolonged mother-newborn separation in Neonatal Intensive Care Units (NICUs), and limited knowledge of effective feeding techniques were the most common barriers. Further, mothers with multiple births reported greater feeding difficulties; they were more likely to adopt formula feeding compared to those with single births. The primary facilitators of LBW breastfeeding were the synergy between health workers and mothers, mothers' peer counseling, and family support. However, health worker support varied widely across facilities.

Conclusion: The findings from this study provide contextual insights into maternal LBW breastfeeding barriers and facilitators of successful and sustained breastfeeding. For example, creating NICU expectations to minimize maternal-newborn separation, targeting newborns' feeding support for mothers with VLBW newborns and/or multiple births, and designing a standardized protocol for LBW nutritional support to guide health worker support are critically needed.