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Factors associated with exclusive breastfeeding at 6 months postpartum: a prospective mixed-method cohort study

Pediatric Research (2026)Cite this article

Abstract

Background

Exclusive breastfeeding (EBF) rates at 6 months postpartum remain low globally and in Hong Kong. This prospective mixed-method study examined the barriers to and facilitators of sustaining EBF until 6 months postpartum.

Methods

Nine hundred forty-two pregnant women completed baseline and at least one of the five follow-up surveys: immediate (<7 days) (T1), 1 month (T2), 2 months (T3), 4 months (T4), and 6 months postpartum (T5). The response rates were 81.0% (T1), 69.9% (T2), 67.3% (T3), 65.8% (T4) and 81.4% (T5). Eighteen participants and 6 partners participated in either individual or focus group interviews at 6 months postpartum.

Results

The quantitative study found that mothers who worked full-time, had attained lower levels of education, lacked breastfeeding experience, and had caesarean sections were less likely to practise EBF at 6 months postpartum. In contrast, mother-in-law’s breastfeeding experience, higher breastfeeding intention and better breastfeeding knowledge were positively associated with EBF at 6 months postpartum. Qualitative data identified perceived insufficient breast milk and returning to work as the main barriers, while support from family was the key facilitator.

Conclusions

In addition to education and support for mothers, in order to sustain EBF, it is crucial to engage with family members and for workplaces to create more conducive environments.

Impact

  • This large-scale mixed methods cohort study describes mothers’ feeding practices and perspectives from the immediate postpartum period until 6 months.

  • Factors associated with EBF at 6 months included (1) mother and infant attributes, (2) workplace and employment, (3) family and community, and (4) health systems and services.

  • Policies and strategies extending to family members, workplace and health system will create a more conducive environment for sustaining EBF.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

We would like to express our gratitude to Ms Carrie Cheung, Ling Chow and Angela Mak for their help with data collection, and to Dr Kai Chow Choi and Mr Jeffy Fung for their support in statistical analysis. We also express our sincere gratitude to all the mothers for their participation in this study.

Funding

This study was part of the research project ‘Commissioned Study on Mothers Barriers to Sustain Exclusive Breastfeeding in the First Six Months’ which was supported by the Health and Medical Research Fund, Health Bureau, The Government of the HKSAR.

Author information

Authors and Affiliations

  1. The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Ka Ming Chow & Alice Wai Yi Leung

  2. Department of Food Science and Nutrition, Faculty of Science, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Lai Ling Hui

  3. Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Karene Hoi Ting Yeung & E. Anthony S. Nelson

  4. Department of Psychology, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong SAR, China

    Esther Yuet Ying Lau

  5. School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK

    Nigel C. Rollins

  6. School of Medicine, The Chinese University of Hong Kong Shenzhen, Shenzhen, Guangdong, China

    E. Anthony S. Nelson

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  1. Ka Ming Chow
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Contributions

Ka Ming Chow: conceptualisation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualisation, and writing—original draft. Alice Wai Yi Leung: data curation, formal analysis, and writing—original draft. Lai Ling Hui: conceptualisation, funding acquisition, methodology, and writing—review & editing. Karene Hoi Ting Yeung: conceptualisation, funding acquisition, methodology, and writing—review & editing. Esther Yuet Ying Lau: conceptualisation and writing—review & editing. Nigel C. Rollins: conceptualisation and writing—review & editing. E. Anthony S. Nelson: conceptualisation, funding acquisition, methodology, validation, and writing—review & editing.

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Correspondence to Ka Ming Chow, Lai Ling Hui, Karene Hoi Ting Yeung or E. Anthony S. Nelson.

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Chow, K.M., Leung, A.W.Y., Hui, L.L. et al. Factors associated with exclusive breastfeeding at 6 months postpartum: a prospective mixed-method cohort study. Pediatr Res (2026). https://doi.org/10.1038/s41390-025-04731-5

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