Supporting breastfeeding in contexts of social disadvantage: insights from the qualitative component of the ECAIL trial
Breastfeeding is widely recognized for its nutritional, immunological, and relational benefits for both infants and birthing parents. However, in France and other high-income countries, persistent social inequalities affect breastfeeding initiation and duration. Women experiencing socio-economic disadvantage are less likely to initiate breastfeeding and tend to discontinue earlier, in contexts shaped by financial hardship, precarious employment, and limited social support.
The prEgnanCy and eArly Childhood nutrItion triaL (ECAIL), launched in 2017 in northern France, is a randomized controlled trial evaluating the effectiveness of the Malin program, a multilevel intervention supporting socially disadvantaged families from pregnancy until the child’s second birthday. The article published in the International Breastfeeding Journal reports findings from the qualitative component of the trial, focusing specifically on breastfeeding intentions, practices, and social representations among participating mothers
Forty-seven mothers were interviewed in their homes when their children were between 16 and 26 months old. Semi-structured interviews were analysed using thematic coding informed by the COM-B model (Capability, Opportunity, Motivation – Behaviour). Four key stages emerged along the breastfeeding trajectory: intention, initiation, continuation, and cessation.
Most participants reported intending to breastfeed during pregnancy. Motivations included perceived health and immune benefits for the infant, emotional bonding, convenience, financial savings, religious beliefs, family norms, and previous positive experiences. These findings indicate strong motivation and substantial knowledge about the breastfeeding benefits.
Nevertheless, many women described challenges during initiation and continuation, including pain, nipple cracks, latching difficulties, perceived low milk supply, exhaustion, and insufficient support after returning home. Some reported feeling pressured or judged in maternity wards. These experiences sometimes led to frustration, guilt, and premature cessation.
Returning to work was frequently identified as a major barrier, particularly in workplaces lacking appropriate facilities for milk expression. Breastfeeding in public spaces was also described as socially sensitive, exposing mothers to comments and disapproval. These structural and environmental factors primarily relate to the “Opportunity” dimension of the COM-B model.
The findings highlight the importance of strengthening early postpartum home visits and peer support in socially vulnerable contexts to enhance maternal confidence and prevent early discontinuation. They also call for public policies that promote breastfeeding-friendly environments in both public and professional settings, thereby contributing to more equitable health outcomes.
- Poquet D, de Lauzon-Guillain B, Ley D, Charles MA, Sauvegrain P, Lioret S. Intentions, practices, and social representations regarding breastfeeding among women experiencing social disadvantage: findings from the qualitative component of the ECAIL trial. Int Breastfeed J. 2026; 21(1):22. doi: 10.1186/s13006-026-00812-1
- https://doi.org/10.1186/s13006-026-00812-1
By Sandrine Lioret
