'Breastfeeding Is Not the Sole Responsibility of Women': A Qualitative Examination of the Supportive Environment for Breastfeeding in Nigeria Across Levels of the Socioecological Model.

Breastfeeding is the optimal method of infant and young child feeding. In Nigeria, breastfeeding rates have struggled to markedly improve over past decades. Prior efforts to understand the determinants of breastfeeding have heavily focused on women themselves, with lesser attention on the complex interplay of cultural, economic and health system factors affecting breastfeeding. Given the struggle to sustain improvements in optimal feeding practices, a deeper, updated understanding of the supportive environment for breastfeeding in Nigeria is needed. This subset analysis stems from a formative study that conducted semi-structured interviews and focus group discussions in urban and rural communities in Nigeria's six geo-political zones. The analysis explored barriers and facilitators to breastfeeding at different levels of a socioecological model (SEM). Discussions with pregnant women and mothers of young children focused on the supportive environment for breastfeeding beyond the individual level, exploring facilitators and barriers in women's nuclear and multi-generational families, their communities, and institutions that provide health and nutrition services. At the household level, participants highlighted the influence of family elders. In their communities, widespread traditional practices and beliefs helped and hindered breastfeeding, along with varying sources of community-level support and influence. At the service level, women elaborated on the effect of healthcare service access, service availability, and the quality of health and nutrition services. This formative analysis deepens understanding of factors crucial for developing multilevel and multicomponent interventions across the SEM in Nigeria that can simultaneously support mothers and improve infant health outcomes nationwide.