Gendered Predictors of Exclusive Breastfeeding Among Employed Mothers: An Ecological Multicenter Study

Aim To examine the factors affecting employed mothers' exclusive breastfeeding by testing Bronfenbrenner's Ecological Systems Theory. Design A cross‐sectional study was conducted. Method A random sample of 201 employed mothers who had given birth 6 months ago was recruited from two hospitals and two primary healthcare centres in Saudi Arabia. Data were collected using self‐reported questionnaires that included background characteristics and valid and reliable Arabic measures. Hierarchical logistic regression was used to analyse the data across ecological levels. Results More than a third (36.8%) of employed mothers did not practice exclusive breastfeeding. The logistic regression with four ecological levels (individual characteristics, microsystem, exosystem, and macrosystem) explained 42.9% of the variance in employed mothers' exclusive breastfeeding. In the final model, the significant gendered predictors of exclusive breastfeeding were perception of milk supply (OR = 1.029), mental health status (OR = 0.931), workplace support (OR = 1.024), and social norms (OR = 2.009). Conclusion Breastfeeding among employed mothers is predicted by gender‐based factors, including perceived milk insufficiency, maternal mental health burden, workplace conditions, and social norms. This underscores the importance of developing multi‐level programmes that empower women to follow the recommended breastfeeding practices. Implications for the Profession and/or Patient Care During routine care, healthcare providers should assess the perception of milk supply and maternal mental health. They should advocate for flexible workplace policies that enable women to breastfeed and develop community campaigns targeting social norms. Impact The findings show the effect of key gendered factors on exclusive breastfeeding among employed mothers. These findings can inform maternal healthcare practices, gender‐sensitive workplace policies, and social norm transformation. Reporting Guidelines The study follows STROBE reporting guidelines. Patient or Public Contribution No patient or public contribution.