A mixed methods study on the perception regarding breastfeeding practices among tribal mothers in Odisha

Breastfeeding is a cornerstone of infant health, ensuring optimal growth, immunity, and development. Despite strong evidence of its benefits, breastfeeding practices are influenced by cultural, social, and economic factors, especially in tribal communities where traditional beliefs and practices play a major role. Understanding these dynamics is crucial for designing effective public health interventions. This study aimed to assess the knowledge, attitudes, and practices (KAP) of tribal women regarding breastfeeding and to explore the facilitators and barriers influencing breastfeeding practices in the tribal areas of Koraput district, Odisha. An explanatory sequential mixed-methods design was adopted over twelve months (May 2023–April 2024). Quantitative data were collected from tribal women using a structured questionnaire to assess knowledge, attitudes, and practices. The findings were analyzed for associations with socio-demographic factors. Qualitative data were gathered through in-depth interviews and focus group discussions to explore underlying perceptions, cultural influences, and barriers. Thematic analysis was performed, generating code clouds and themes to complement quantitative findings. A total of 500 tribal women participated, with the majority (393, 78.6%) aged 21–30 years. Most belonged to lower (263, 52.6%) and lower-middle (231, 46.2%) socioeconomic strata. While 350 (70%) mothers were aware that breastfeeding should be initiated soon after birth, only 210 (42%) did so within the first hour of delivery. Awareness of colostrum's immunological benefits was low (190, 38%), and exclusive breastfeeding for 6 months was practiced by 275 (55%) participants. Prolonged breastfeeding beyond 1 year was prevalent (75%), reflecting deeply rooted cultural norms. Maternal age (p = 0.019), literacy (p = 0.0017), and socioeconomic status (p = 0.012) were significantly associated with breastfeeding practices. On qualitative analysis, elder family influence, cultural myths, maternal workload, and inconsistent postnatal counselling were key barriers, while spousal support, maternal education, and timely health worker guidance emerged as facilitators. The integrated analysis revealed a significant knowledge–practice gap, mediated by socio-cultural norms and systemic constraints rather than awareness alone. Breastfeeding practices among tribal mothers in Koraput appeared to be influenced by cultural beliefs, family dynamics, maternal workload, and healthcare support. While awareness of recommended practices was relatively common, adherence remained suboptimal. The findings highlight potential barriers and facilitators and suggest the need for further research to evaluate culturally appropriate strategies for improving breastfeeding outcomes.