Breastfeeding and care trade-offs in Eastern Ethiopia: social factors shaping maternal decision-making

Introduction The World Health Organization recommends breastfeeding as essential for infant feeding for up to two years and beyond. In Ethiopia, the focus is on ‘optimal’ breastfeeding, but little is known about how women themselves make breastfeeding decisions.Theory The feminist political economy of health theory is used to understand why breastfeeding decisions are not a matter of strictly individual choice, but made under structural constraints of gendered divisions of labour and the societal undervaluation of reproductive labour.Method Data were collected from April to June 2023, through 29 qualitative interviews with mothers, healthcare workers, traditional birth attendants, and religious leaders; six focus group discussions with 44 participants; and participant observation in six health centres. Mothers were selected through purposive sampling with being pregnant or having children <2 years as the inclusion criteria. Data analysis used a thematic analysis approach.Results Mothers were unable to breastfeed under optimal conditions, because of an unequal division of productive and reproductive tasks in the households. A cross-cutting theme concerns care trade-offs: the temporal and moral calculations women make when deciding whether to breastfeed during pregnancy. Together, the accounts of women illustrate how gendered hierarchies and food scarcity in Kersa were literally embodied in women’s own nutritional depletion and in their perceived inability to produce ‘enough’ milk.Discussion The narratives reveal temporal care trade-offs, where women weigh the imagined future of the foetus against the visible present of the breastfed child, under conditions of limited reproductive autonomy. Drawing on this care trade-offs framework, women’s decisions about breastfeeding emerged as temporal negotiations of care under constraint, rather than individual failures. Future research should consider husbands’ perspectives on their roles in breastfeeding.