INTRODUCTION:

Exclusive breastfeeding for the first six months and continuous nursing along with complementary feed for at least two years is advised by the World Health Organisation (WHO)¹. It is known as breastfeeding termination when breastfeeding (or exclusive breastfeeding) is stopped before the recommended time. For a baby's best development and growth, Breast milk is viewed as the most nutritious option. Every level of the health care systems, from the hospital to the community level, has started implementation of breastfeeding policies and recommendations in an effort to encourage breastfeeding and improve the proportion of women who primarily breastfeed.

Nevertheless, despite of widely accepted advices for continuation of lactation, working mothers still confront obstacles. Low rates of exclusive breastfeeding among working women were observed by a number of studies conducted around the globe. Study findings showed that the exclusive breastfeeding prevalence among study subjects was sixty one percent. About forty three percent of the mothers reported breastfeeding problems and thirty eight percent had started early weaning during exclusive breastfeeding³⁸. Numerous maternal factors may influence a mother's decision or ability to continue nursing., including her literacy level, the style of birth, psychological stress during the postpartum period, and nursing challenges brought on by an engorged breast or one that is tender or cracked. Breastfeeding a newborn requires a number of contributing elements related to the workplace, as well as individual and societal influences, in addition to the biological changes of the mother. (Fig 1)

Fig 1. Challenges impeding to success of exclusive breast feeding among employed mothers

Relation of Maternal Factors with Cessation of Exclusive Breastfeeding:

1. Literacy Level of Mothers:

Maintaining exclusive breastfeeding for six months requires mothers to have a in depth knowledge of breastfeeding techniques. While knowledge regarding the advantages of breastfeeding motivates mothers to continue breastfeeding practices, research indicates a correlation between the increased rates of early breastfeeding initiation among working mothers and a decreased likelihood of maintaining exclusive breastfeeding². The results of the study demonstrated that although three-fourths of working mother's understand about EBF and its advantages, still one-third practices EBF³. Another study revealed that very few nursing mothers had adequate knowledge and practices breastfeeding. It emphasized that mothers lack knowledge on proper technique and length of breastfeeding⁴.Furthermore, a study suggested that, while mothers were aware of the benefits of breastfeeding, certain workplace support variables contributed to breastfeeding abandonment among employed mothers.⁵Additionally, according to a different survey that evaluated mothers' breastfeeding expertise, the majority of women (71.4%) believed that breast milk was the greatest option for newborns, particularly those under the age of twenty.⁶ In another study , level of knowledge was significantly associated with education of mother, fathers occupation and source from which knowledge is gained²⁹. Even one study quoted very poor knowledge of mothers regarding infant feeding practices.³²Further research depicted that conducting health exhibition and video show for postnatal mothers had improved the knowledge level of postnatal mothers for breastfeeding³³. Similarly, another research concluded video teaching programme had changed the attitude and knowledge level of mothers regarding breastfeeding techniques³⁷. The aforementioned results showed that both mother knowledge and practice to lactate baby needs to be strengthen so to develop adequate pattern of exclusive breastfeeding.

2. Mode of Delivery:

Caesarean deliveries and maternal smoking have been considered as a major determinants for cessation of breastfeeding prematurely.⁷ According to reports, primiparity, Caesarean birth, and unexpected pregnancies were linked to delayed breastfeeding initiation.⁸ Similar to this, a study showed that low EBF rate (10.3%) despite 91% of mothers began to breast feed newborn early.⁹ Moreover, findings of another study reported that mothers who had delivered baby by caesarean section had high rate of discontinuation of breastfeeding.¹⁰Thus type of delivery and first time experience of mother influences the decision of cessation of breastfeeding.

3. Breast Complication And Difficulties In Feeding:

The mother faces challenges not only after the birth of the child but also during the postpartum period. Discomfort in breast and bulkiness of breast was the most often reported problem in lactating mothers³¹ .According to a study, a number of mothers regularly deal with issues including cracked nipples, the feeling that there isn't enough milk, soreness, and exhaustion, which makes it difficult for them to breastfeed exclusively and encourages them to switch to complementary feeding.¹¹ Interestingly, younger maternal age, Breast Feeding issues related to fatigue or inconvenience, engorged breasts ,flat or inverted nipples that were excessively painful, perceived less milk production, lacking Breast feeding skills, maternal decision were all significant factors indicated for stopping exclusive breastfeeding.¹² Considering the above studies, it is concluded that difficulties faced by mother demotivates mother to terminate the breastfeeding.

4. Psycological Stress:

Additionally, "maternal preference" is another reason why nursing mothers stop using EBF, which may be brought on by the mothers' psychological stress¹³.One physiological theory proposed is that psychological anxiety hinders the oxytocin production which is essential for the ejection of milk during breastfeeding. Furthermore, maternal distress may lead to elevated serum cortisol levels and impaired insulin sensitivity, both of which are associated with decreased milk production.¹⁴According to another study, maternal characteristics including responsiveness, stress, and hydration have a direct impact on the composition and ejection of milk. In addition to improving mother-infant attachment, oxytocin-mediated emotional bonding during feeding may lower the incidence of postpartum depression³⁴. Therefore, the role of stress and anxiety during postnatal period is crucial in framing maternal decision in continuing exclusive breastfeed to infant.

Contributory Challenges Leading to Termination of Pregnancy Among Working Mothers:

1. Workplace-Related Challenges:

Working mothers' decision to stop exclusively nursing is influenced by a variety of variables, with workplace-related challenges being particularly influential. A qualitative study conducted in Ghana identified several challenges related to workplace such as the short maternity leave, lack of maternity guidelines, lack of organisational backing, inflexible working hours ,challenges in balancing work and family responsibilities considered as significant determinants in mothers' decisions to discontinue exclusive breastfeeding^.15 Similarly, a research revealed, an early return to work especially before four months postpartum, as well as employment characteristics such as manual labour or self-employment were major predictors of low exclusive breastfeeding rates among working mothers.¹⁶ Another study conducted among employed mothers showed a high prevalence around (75.7%) termination of breastfeeding with contributory barriers like short maternity leave, full-time position, private sector job, absence of flex times, absent pumping time, no lactation breaks, and remote workplaceor distant job places from their infant.¹⁷.However, study conducted with a sample of doctors and nurses suggested thatinsufficient milk production, inconvenience and lactation weariness, and required job resumption were identified as major factors contributing to breastfeeding cessation.¹⁸ Workplace adaptability for breastfeeding mothers is essential to promote exclusive breastfeeding, especially in such environment where employee needs are prioritized.¹⁹ Furthermore, according to another study, the majority of working moms cease breastfeeding as soon as they return to their jobs. Breastfeeding behaviours were greatly impacted by strong employer support at work.²⁰ Findings of research in Karnataka revealed that approximately half the women employees did not get benefits related to postnatal leave. Only few mothers were given feeding time during work time, and no crèches available at employment place. The commonest cause of discontinuing Exclusive Breast Feeding was the early return to work following childbirth.³ These findings emphasize the essential role of the workspace policies and layout in supporting the continuation of breastfeeding.

2 . Individual and Social Determinants:

One of the study revealed that 72.5% of physicians and 27.5% of nursing staff reported ineffective breastfeeding skills as a notable concern.¹⁸ Additionally, the influence of sociocultural factors, such as the familial endorsement particularly from husbands and elder female guidance shapes maternal feeding decisions.²¹ Another study's results indicated that several factors are closely linked to the early discontinuation of breastfeeding. These factors include residing in cities, uneducated mother, working professionally, deficient parenting awareness, delayed lactation onset, and primiparous woman.²² Other sociodemographic factors associated with Exclusive Breast Feeding practice were the working mother's literacy status, occupation of spouse, birth place, sex of baby, feeding rate per day, pumping and storing breastmilk before leaving for work.³ In another study results depicted the level of practice on infant feeding among working mothers was statistically associated with age of the mother and sex of the child and among non-working mothers was statistically associated with age³⁰ .Furthermore, a study assessed self-efficacy in providing breast feeding among postnatal mothers reported nearly half of mothers had high confidence, one third moderate and one fourth had low confidence³⁵. Additionally, it has been noted that nursing mothers' knowledge of breastfeeding was significantly influenced by household income³⁶. Thus, these results suggested that early breastfeeding cessation among working women is significantly influenced by several demographic factors.

Relation of Fetal Factors with Cessation of Exclusive Breastfeeding:

Fetal factors linked to cessation of exclusive breastfeeding among employed mothers include the infant's age, feeding habits, birth weight, and overall health.

1. Infant Age and Birth Weight:

An infant's age has a big impact on whether or not breastfeeding is continued. Premature breastfeeding cessation is associated with factors like lower birth weight, earlier gestational age, and slower weight increase.²³ Conversely, Higher birth weights increase the likelihood of long-term breastfeeding, probably due to better health and feeding abilities.²⁴Furthermore, studies have demonstrated that low birth weight and the nuclear family structure both significantly influence the decision to stop exclusive breastfeeding.²⁵

2. Infant Feeding Practices and Infant Health Issues:

Reduced rates of exclusive breastfeeding are associated with prelacteal feeding, a method in which babies are given nutrients other than breast milk shortly after delivery. Breastfeeding may be disrupted by this technique, which could lead to an early cessation of the practice.²⁶ Furthermore, an exploratory study found a strong correlation between the age at which bottle feeding begins and the age at which breastfeeding ends. The results showed that 65 days after the introduction of bottle feeding, breastfeeding was discontinued which further concluded that while bottles may initially complement breastfeeding, they can eventually replace it entirely.²⁷ Similarly, stopping exclusive breastfeeding was associated with health problems for the newborn, including treatment for jaundice and hospitalisation to a neonatal critical care unit.²⁸

CONCLUSION:

In conclusion, challenges impeding to success of exclusive breast feeding among employed mothers are multifaceted. Key contributors identified were inadequate postpartum leaves, high pressure shifts, lack of workplace breastfeeding support (such as lactation breaks and facilities), workplace and the infant gap, early return to work, poor feeding self -belief, societal norms resistance, infant age, infant weight, Infant feeding practices and their health issues, maternal stress, breast complications and maternal knowledge deficits regarding breastfeeding.

CONFLICT OF INTEREST:

None

REFERENCES:

1. Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services. Geneva: World Health Organization; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK487814/

2. Zainab Taha, Ahmed Ali Hassan, Ludmilla Wikkeling-Scott, Dimitrios Papandreou. Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi. International Journal of Women’s Health. 2021. Available from: https://doi.org/10.2147/IJWH.S303041

3. Swastika Chhetria, Arathi P. Rao, Vasudeva Gudd.Factors affecting exclusive breastfeeding among working mothers. Clinical Epidemiology and Global Health. 2018: 216–219. Available from: https://doi.org/10.1016/j.cegh.2018.06.008

4. Ravichandran M, Parida SP, Singh AK, Mishra AK, Gopi K. Knowledge and practice of breastfeeding among lactating mothers in AIIMS, Bhubaneswar - A hospital-based cross-sectional study. J Educ Health Promot. 2024; 13: 141.

5. Amandeep K, Gagandeep K. Assessment of factors leading to termination of breast feeding among working mothers. IJARESM. 2024:12(6).

6. Sultania, P., Agrawal, N.R., Rani, A., Dharel, D., Charles, R. and Dudani, R. Breastfeeding. Knowledge and Behavior Among Women Visiting a Tertiary Care Center in India: A Cross-Sectional Survey. Annals of Global Health; 2019; 85(1): 64, 1–9. Available from: https://doi.org/10.5334/aogh.2093

7. Patil, D. S., Pundir, P., Dhyani, V. S., Krishnan, J. B., Parsekar, S. S., D’Souza, S. M., Ravishankar, N., and Renjith, V. A mixed-methods systematic review on barriers to exclusive breastfeeding. Nutrition and Health. 2020; 26(4), 323–346. Available from: https://doi.org/10.1177/0260106020942967

8. Gedefaw G, Goedert MH, Abebe E, Demis A. Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey. PLOS One. 2020; 15(12): e0244229. Available from: https://doi.org/10.1371/journal.pone.0244229

9. Dun-Dery EJ, Laar AK. Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. Int Breastfeed J; 2016; 11 (1): 23.

10. Elmugabil A, Rayis DA, Hassan AA, Ali AA, Adam I. Epidemiology of cesarean delivery in Kassala, Eastern Sudan: a community-based study. Sud J Med Sci. 2016; 11(2): 49–54.

11. Karthigesu K, Balakumar S, Arasaratnam V. Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka. Int Breastfeed J. 2023; 18(1): 42.

12. Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, Cavallaro G, Raffaeli G, Crippa BL, Colombo L, Morniroli D, Liotto N, Roggero P, Villamor E, Marchisio P, Mosca F. Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation. Nutrients. 2019; 11(10): 2266.

13. Aldalili AYA, El MahalliAA. Research Title: Factors Associated with Cessation of Exclusive Breastfeeding. J Multidiscip Health. 2021; 14: 239-246.

14. Rozga MR, Kerver JM, Olson BH. Self-reported reasons for breastfeeding cessation among low-income women enrolled in a peer counseling breastfeeding support program. J Hum Lact. 2015; 31(1): 129–137.

15. Nagel EM, Howland MA, Pando C, Stang J, Mason SM, Fields DA, Demerath EW. Maternal Psychological Distress and Lactation and Breastfeeding Outcomes: a Narrative Review. Clin Ther. 2022; 44(2): 215-227.

16. Abekah-Nkrumah, G., Antwi, M. Y., Nkrumah, J., Gbagbo, F. Y. Examining working mothers experience of exclusive breastfeeding in Ghana. International Breastfeeding Journal. 2020; 15(1). Available from: https://doi.org/10.1186/s13006-020-00300-0

17. Abou-Elwafa, H. S., El-Gilany, A.-H. Maternal work and exclusive breastfeeding in Mansoura, Egypt. Family Practice. 2018; 36(5): 568–572. Available from: https://doi.org/10.1093/fampra/cmy120

18. Kebede, T., Woldemichael, K., Jarso, H., Bekele, B. B. Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia. International Breastfeeding Journal. 2020; 15(1). Available from: https://doi.org/10.1186/s13006-019-0250-9

19. Zahra, M., Shama Izhar, Samra Ali, Samina Anwar, and Faiza Boota. Factors Affecting in Termination of Breastfeeding, among Nurses and Doctors as Working Mothers. Journal of Health and Rehabilitation Research. 2024; 4(2): 1687–91. Available from: https://doi.org/10.61919/jhrr.v4i2.1084

20. Kadale PG, Pandey AN, Raje SS. Challenges of working mothers: balancing motherhood and profession. Int J Community Med Public Health. 2018; 5: 2905-10.

21. Muda, Siti Mariam, Aung, Khin, Ibrahim, Amirah, Ismail. Breast Feeding Issue: A Study on Factors Affecting Termination of Breast feeding among Working Mothers. International Journal of Health Sciences and Research. 2016; 6: 257-63.

22. Joseph, F. I., Earland, J. A qualitative exploration of the sociocultural determinants of exclusive breastfeeding practices among rural mothers, North West Nigeria. International Breastfeeding Journal. 2019; 14(1). Available from: https://doi.org/10.1186/s13006-019-0231-z

23. Emagneneh T, Mulugeta C, Alamrew A, Ejigu B and Abebe W. Early cessation of exclusive breastfeeding and associated factors in Ethiopia: a systematic review and meta-analysis. Front. Nutr. 2025; 12: 1500077. Available from: http;//doi: 10.3389/fnut.2025.150007

24. Yasuda, S., Fukuda, T., Toba, N. et al. Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan. Int Breastfeed J. 2022; 17: 20 . Available from: https://doi.org/10.1186/s13006-022-00449

25. Brani, P., Iliadou, M., Andersson, E., Daskalakis, G., Drakakis, P., Dagla, M. Factors Influence Breastfeeding Duration after High Risk and Low Risk Pregnancies. Healthcare. 2024; 12(18): 1896. Available from: https://doi.org/10.3390/healthcare12181896

26. Mohite RV, Kshirsagar VY, Mohite VR. Prevalence and determinants of cessation of exclusive breastfeeding among primi-para rural Indian mothers. Int J Community Med Public Health. 2019; 6: 314-9.

27. Mekuria, G., Edris, M. Exclusive breastfeeding and associated factors among mothers in DebreMarkos, Northwest Ethiopia: a cross-sectional study. International Breastfeeding Journal. 2015; 10(1). Available from: https://doi.org/10.1186/s13006-014-0027-0

28. Kearns, Annie, Castro, Marcia, Lourenço, Bárbara, Augusto, Rosangela, Cardoso, Marly. Factors Associated with Age at Breastfeeding Cessation in Amazonian Infants: Applying a Proximal–Distal Framework. Maternal and Child Health Journal. 2016; Available from: htttps://doi.org/20. 10.1007/s10995-016-1953-9.

29. Froń, A., Orczyk-Pawiłowicz, M. Breastfeeding Beyond Six Months: Evidence of Child Health Benefits. Nutrients. 2024; 16(22): 3891. Available from: https://doi.org/10.3390/nu16223891

30. Maheshwari L, Swapna Mary A., Laishram Dabashini Devi. A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Attitude regarding Breastfeeding and Weaning Practices among Post-natal Mothers in Channasandra Urban, Bangalore City. Asian Journal of Nursing Education and Research. 2023; 13(2): 130-4. doi: 10.52711/2349 2996.2023.00028 Available on: https://ajner.com/AbstractView.aspx?PID=2023-13-2-11

31. Mabal Abisha. A Comparative Study to Assess the level of Knowledge and Practice on Infant Feeding Practices among Working and Non-Working Mothers at selected areas in Puducherry. Asian J. Nursing Education and Research. 2019; 9(2): 185-187. doi: 10.5958/2349-2996.2019.00038.7 Available on: https://ajner.com/AbstractView.aspx?PID=2019-9-2-6

32. Amira Gado, Ahmed El-Minawi, Naaglaa Abdel Razek, Mariam Raafat Louis, Omneya M. Osman. Guidelines and Protocol of Managing Patients with Breast Problems during Pregnancy and Lactation. Research Journal of Pharmacy and Technology. 2023; 16(4): 1679-4. doi: 10.52711/0974-360X.2023.00275

33. Priyanaka Devi. Assessment of Mother’s Knowledge on Malnutrition among Under-Five Children in selected Rural Areas: A Descriptive Survey. Asian Journal of Nursing Education and Research. 2024; 14(4): 281-7. doi: 10.52711/2349-2996.2024.00055 Available on: https://ajner.com/AbstractView.aspx?PID=2024-14-4-6

34. Sheela Willaims, Ambika K, Chandrashekar M, Prasannakumar D R, Muralimohan. A Study to Assess the Effectiveness of Health Exhibition and Video Show on Knowledge regarding the exclusive Breastfeeding among Nursing mothers at Immunization Clinic, Makkala Koota, Mysore. Asian J. Nur. Edu. and Research. 2016; 6(1): 105-108. doi: 10.5958/2349-2996.2016.00022.7 Available on: https://ajner.com/AbstractView.aspx?PID=2016-6-1-22

35. Muneeswari J.. Mutual Interdependency during Breastfeeding: A Harmonious Exchange of Nourishment and Connection. Asian Journal of Nursing Education and Research. 2025; 15(3): 175-6. doi: 10.52711/2349-2996.2025.00036 Available on: https://ajner.com/AbstractView.aspx?PID=2025-15-3-11

36. Kambham Jahnavi, S. Gomathi. A Study to Assess the Breastfeeding practices and Breastfeeding Self-Efficacy among Postnatal mothers at NRI General Hospital Guntur District, Andhra Pradesh in A view to prepare Information Booklet. International Journal of Advances in Nursing Management. 2022; 10(3): 211-0. doi: 10.52711/2454-2652.2022.00051 Available on: https://www.ijanm.com/AbstractView.aspx?PID=2022-10-3-10

37. Kaur Harleen, Sohi Darshan, Parveen Sultan. Quasi Experimental Study to assess the Knowledge regarding Breastfeeding among the Lactating Mothers. Int. J. Nur. Edu. and Research. 2017; 5(3): 331-334.DOI: 10.5958/2454-2660.2017.00068.

38. Lavanya Suku, Santhi Appavu. Breastfeeding: Outcome on attitude among Postnatal primi Mothers. Int. J. Nur. Edu. and Research. 2021; 9(1): 24-26. doi: 10.5958/2454-2660.2021.00006.5 Available on: https://ijneronline.com/AbstractView.aspx?PID=2021-9-1-6

39. Rinu Abraham, Ann Mary Sabu, Manu Philip, Laya Elsa Jacob. Breastfeeding Problems during Exclusive Breastfeeding Period and Factors Leading to Early Weaning Among Mothers of Infants. A and V Pub Journal of Nursing and Medical Research. 2025; 4(4): 130-2. doi: 10.52711/jnmr.2025.29 Available on: https://jnmronline.com/AbstractView.aspx?PID=2025-4-4-5.

Received on 03.03.2026 Revised on 20.04.2026

Accepted on 23.05.2026 Published on 27.07.2026

Available online from August 01, 2026

Asian J. Nursing Education and Research. 2026;16(3):229-233.

DOI: 10.52711/2349-2996.2026.00046

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.