Background: Breastfeeding is crucial for optimal maternal and child health, yet disparities in breastfeeding practices persist, particularly among women of color. These disparities lead to lower breastfeeding rates, adversely affecting birth outcomes. Although previous research has examined these disparities, the interplay of social, cultural, and systemic factors influencing breastfeeding remains underexplored.

Objectives: Our study examines multilevel influences on breastfeeding decisions and practices among Black/African American mothers and assesses how these interactions shape their breastfeeding self-efficacy using the Socioecological Model.

Methods: Building on a previous phenomenological study of breastfeeding experiences among a diverse population, we conducted a secondary qualitative analysis to explore how individual, interpersonal, institutional, and community factors collectively influence breastfeeding among Black mothers. We analyzed interviews of 16 Black/African American mothers, aged 18 or older, recruited across community settings and clinics from nine counties in Ohio who gave birth between 2019 and 2021, irrespective of their breastfeeding status. Transcripts were analyzed using a deductive reflexive thematic approach in Dedoose.

Results: Breastfeeding practices and self-efficacy were shaped by a range of factors. Key motivators at the individual level included perceived health benefits and cost savings while barriers included physical difficulties such as mastitis, inadequate milk production and work-related stress. At the interpersonal level, strong support from social networks such as family members with prior breastfeeding experiences enhanced breastfeeding self-efficacy. Institutional factors that boosted breastfeeding efforts included hands-on support from lactation consultants and positive interactions with healthcare providers. Finally, community influences such as cultural norms, public stigma exacerbated by COVID-19, and limited resources significantly impacted breastfeeding efforts.

Conclusions: Our findings highlight key interrelated barriers to breastfeeding practices and self-efficacy among Black mothers. Targeted policy interventions and enhanced support systems that address these factors are critical for promoting breastfeeding and improving maternal and infant outcomes, particularly among populations affected by systemic inequities.