Barriers to breastfeeding and targeted breastfeeding social transfer programs in São Paulo, Brazil: a qualitative...

Exclusive breastfeeding (EBF) is recommended for the first six months of life, yet only 48% of infants under six months are exclusively breastfed worldwide. Breastfeeding rates vary significantly across regions, countries, and even within cities. Brazil reports national rates of EBF of approximately 50%; however, there are notable in-country socioeconomic disparities, where EBF prevalence is lower in low-income communities compared to the wealthier communities. This study aims to: 1) investigate barriers to breastfeeding by exploring perceptions and experiences of breastfeeding in low-income communities in São Paulo, Brazil, and 2) evaluate the perceptions of a targeted social transfer program to improve EBF prevalence at six months.

We conducted a semi-structured, exploratory, qualitative study in low-income communities in São Paulo, Brazil using focus group discussions (FGD) and key informant interviews (KII). Three FGDs were conducted, two with mothers and one with fathers (n = 14), alongside five KIIs with key stakeholders, including a nurse, neonatologist, social worker, and representatives from the Brazilian Ministries of Health and Social Development (n = 5), with a total sample of 19 participants. An inductive thematic analysis approach was used to develop the codebook and identify recurrent themes across transcripts.

Despite the overall positive outlook on breastfeeding, FGDs and KIIs revealed several challenges, including economic, health system, and sociocultural barriers that hinder both initiation and continuation of breastfeeding. A targeted social transfer program was identified as a potential mechanism to address these barriers and support breastfeeding outcomes.

The identified barriers highlight the complexity of breastfeeding in low-income settings. Strengthening the existing breastfeeding social transfer program, Auxílio Nutriz, may serve as a supportive mechanism to address identified barriers and support breastfeeding practices. Understanding these challenges is a critical step toward developing coordinated, cross-sectoral interventions that support sustained breastfeeding practices. These findings have important implications for public health policy and program design, providing an evidence base for targeted interventions aimed at reducing inequities in breastfeeding outcomes among vulnerable populations.

The RCT was registered on ClinicalTrial.gov on December 6, 2023 (NCT06157697); https://clinicaltrials.gov/study/NCT06157697?term=STEBB%26rank=1 .