A qualitative exploration of mothers' perspectives on infant formula use in Uruguay

The transformation of the first-food systems and the widespread availability and marketing of breastmilk substitutes undermine efforts to promote adequate breastfeeding practices. The objective of the present research was to explore mothers' perspectives on infant formula use in Montevideo, the capital of Uruguay. A generic qualitative design was used to explore mothers' perspectives on the factors that act as enablers or barriers for infant formula use. Semi-structured interviews with thirty-four mothers of 0-23 months old children, aged between 25- and 40-years old, were conducted. The interview transcripts were analyzed using content analysis based on inductive-deductive coding considering the framework of the Capability, Opportunity, Motivation, and Behavior (COM-B) model. The discourse of the interviewees enabled the identification of a wide range of barriers and enablers for the use of infant formula, which were related to the three components of the model: capabilities, opportunity, and motivation. The health system emerged as the key determinant of infant formula use. Most of the participants who used infant formula referred to medical indication when explaining the reasons underlying their infant feeding decisions. The working status of the mother and emotional aspects of the child feeding experience were also identified as key enablers of infant formula use, whereas knowledge about health benefits and breastfeeding techniques, support from families and health-professionals, and motivation to breastfeed were key barriers. Taken together, these results suggest that strategies to reduce the use of infant formula in Uruguay should mainly focus on providing opportunities to breastfeed by improving the quality of the support and guidance provided to families in the health system and facilitating greater balance between breastfeeding and work.