Midwives' Perspectives on Exclusive Breastfeeding Support in Umuahia North, Nigeria: A Qualitative Study

Background: Exclusive breastfeeding for the first six months of life lowers infant illness and death, yet uptake in Nigeria remains below global targets. Midwives are the health workers most consistently placed to counsel and support mothers on this practice, but their own perceptions and experiences of providing this support are rarely examined on their own terms, particularly across different tiers of care. This study explored how midwives working in primary and tertiary health facilities in Umuahia North Local Government Area, Abia State, perceive and experience their role in supporting exclusive breastfeeding.A qualitative descriptive design was used. Eight midwives working in antenatal, postnatal, immunisation and maternity units across two primary health centres and one tertiary hospital were purposively selected and interviewed using a semi-structured guide until no new information emerged. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Two broad themes emerged, comprising five barrier subthemes and four facilitator subthemes. Under barriers, midwives described pressure from family members and cultural custom, the pull of paid work on new mothers, the emotional strain mothers carry after delivery, maternal misconceptions about the adequacy of breast milk, and thin staffing with heavy caseloads. Under facilitators, midwives pointed to their own continuous reassurance and follow-up, stronger maternity-leave and workplace policies, structured antenatal and postnatal counselling, and encouragement from husbands and relatives. Midwives in this setting see themselves as central to exclusive breastfeeding promotion but describe their effectiveness as bounded by staffing levels, time, and the social pressures mothers face outside the clinic. Strengthening staffing, in-service training and family-inclusive counselling could improve breastfeeding support at both levels of care.