Intentions, practices, and social representations regarding breastfeeding among women experiencing social disadvantage: findings from the qualitative component of the ECAIL trial

The PrEgnanCy and eArly childhood nutrItion triaL (ECAIL) is a randomised controlled trial targeting socially disadvantaged families in northern France. It aims to evaluate the effectiveness of a multi-level, family-based intervention starting from pregnancy that combines nutritional support with improved access to healthy foods to promote healthy feeding practices and lifestyle behaviours in children. This qualitative study explored breastfeeding (or chest feeding) intentions, practices, and social representations among 47 birthing parents (mothers) participating in the trial. Semi-structured interviews were conducted in participants’ homes from April 2022 to May 2023 (Lille) and from February to June 2024 (Valenciennes). Interviews lasted an average of 61 min (SD 24; range 24–169) and were conducted when children were 16 to 26 months old. The interview guide drew on the three components of the COM-B model (Capability, Opportunity, Motivation). All interviews were manually transcribed verbatim and analysed in NVivo using thematic coding. An inter-coder reliability check was performed to ensure consistency. Four main themes emerged, broadly following the course of breastfeeding: intention, initiation, continuation, and cessation. Most mothers intended to breastfeed, motivated by perceived health benefits, emotional bonding, previous positive experiences, social support, family norms and religious beliefs. Women reported challenges during initiation and continuation, including pain, low milk supply, latching difficulties, fatigue, limited professional support after returning home, and social pressures, sometimes leading to frustration, guilt, or premature cessation. Participants highlighted advantages such as convenience, cost savings, and improved infant digestion and immunity. Workplace and logistical challenges were also reported, notably the lack of suitable spaces for milk expression. These findings highlight the need to address structural determinants—particularly social opportunity—to support breastfeeding in socially vulnerable contexts. Because of the difficulties encountered after postnatal discharge, early home visits combined with peer support may offer tailored guidance during a pivotal period and help strengthen maternal confidence. Improving the visibility and acceptability of breastfeeding in public and professional settings, and creating more welcoming environments, represents an important policy lever. In contexts where research on disadvantaged populations remains limited, these findings provide useful insight for developing targeted, context-sensitive lactation support strategies. Clinical Trials.gov: NCT03003117, registered on 21 December 2016.