Introduction: Globally, the majority of infants are not exclusively breastfed for the recommended six months; Samoa is an exception to the trend with almost universal initiation and greater than average duration of exclusive breastfeeding.
Aim: We aimed to examine Samoan women’s attitudes and beliefs about infant feeding to identify factors contributing to Samoa’s positive deviance.
Methods: Semi-structured interviews with n=97 mothers of 2-month old infants focused on beliefs about the healthfulness of breast- and formula-feeding. A thematic analysis was used to identify salient themes related to three levels of the social-ecological model: individual, societal, and environmental/structural.
Findings: We identified seven major themes, six were organised under the levels of the social-ecological model that best represented their role in breastfeeding promotion: perceived benefits to mother and infant (individual); family and public support and child-led weaning (societal); infant infection and chronic disease, natural disasters, and economic benefits (environmental/structural). The seventh theme described barriers to breastfeeding. Unanimously Samoan women believed breastfeeding was healthy, and all themes supported a culture of breastfeeding protection and promotion in Samoa. Where barriers to breastfeeding were described they related to maternal ill health, insufficient milk supply, return to work, or becoming pregnant again.
Discussion: Samoan health institutions (hospitals, traditional healers, and the Ministry of Health) should focus on sustaining the high rates of adherence to exclusive breastfeeding guidelines. To maintain a culture that promotes breastfeeding, it is important to protect policies that prohibit formula marketing and strengthen those that support breastfeeding in the work place.