Breastfeeding mothers' perceptions of the adequacy of their milk supply and the methods they use to increase milk production

Introduction and Objective: Breast milk is a unique source that meets all nutritional and fluid requirements of infants during the first six months of life, strengthens the immune system, and provides lifelong health benefits. However, many mothers discontinue breastfeeding early due to the perception of insufficient milk supply. This situation is influenced not only by biological but also by psychosocial and environmental factors. The aim of this study was to determine breastfeeding mothers' perceptions regarding the adequacy of their milk, the methods they use to increase milk production, and the factors affecting this process. In addition, the impact of mothers' attitudes toward breastfeeding on breastfeeding success was evaluated using the Breastfeeding Attitude and Behavior Assessment Scale (ETDÖ). Materials and Methods: This descriptive and cross-sectional study was conducted between June 1 and October 1, 2025, at Ankara Bilkent City Hospital. The study population consisted of mothers with infants aged 0–6 months who applied to the Pediatrics and Family Medicine outpatient clinics. A total of 375 literate, volunteer mothers without contraindications to breastfeeding were included. The sample size was calculated as 341 at a 95% confidence level, and with a 10% anticipated loss, 375 participants were targeted. The power of the study was found to be 98.7% using G*Power analysis. Data were collected through a Descriptive Information Form and the Breastfeeding Attitude and Behavior Assessment Scale (ETDÖ), a 46-item, 5-point Likert-type scale (Cronbach's alpha=0.747). Ethical approval and informed consent were obtained. Data were analyzed using IBM SPSS v30.0. Descriptive statistics, chi-square, t-test, Mann-Whitney U, ANOVA, and Kruskal-Wallis tests were used. Logistic regression was applied to identify factors affecting breastfeeding success, and multiple linear regression was used to determine factors influencing ETDÖ scores. Statistical significance was accepted at p<0.05. Results: A total of 375 mother–infant pairs participated in the study. The mean age of mothers was 29.7±4.6 years; 69.1% were university graduates, and 56% were housewives. Two-thirds were unemployed, and 10% were smokers. Cesarean delivery rate was 68.8%. Among infants, 59.5% were exclusively breastfed, with a mean exclusive breastfeeding duration of 2.56±1.93 months. The rate of initiating breastfeeding within the first hour was 63.4%. While 54.9% of mothers perceived their milk as sufficient, 52.5% had received breastfeeding education. The mean ETDÖ score was 108.2±12.3, and higher attitude scores were associated with greater breastfeeding success. Formula use was reported in 38.9% of mothers, most frequently due to "insufficient milk" (63%) and "infant not being full" (45%). The most common methods used to increase milk were water intake (92%), fennel consumption (46.9%), and frequent breastfeeding (66.4%). Nipple cracks were observed in 27.5% of mothers, and lanolin cream (71.8%) was the most frequently used remedy. Statistical analyses revealed that smoking increased the risk of breastfeeding failure approximately fourfold (OR=3.94; p=0.005), whereas longer exclusive breastfeeding duration and higher breastfeeding frequency were protective (p<0.001). Mothers who perceived their milk as sufficient had a significantly lower risk of breastfeeding failure (OR=0.21; p<0.001). Increasing ETDÖ scores were associated with a reduced risk of failure (p=0.003). Moreover, mothers with regular sleep patterns, frequent breastfeeding, and confidence in their milk supply had significantly higher ETDÖ scores, while those experiencing nipple cracks, perceived milk insufficiency, or infant sucking difficulties had lower scores. The model showed strong explanatory power (Nagelkerke R²=0.50; AUC=0.863). These findings demonstrate that breastfeeding success is closely related not only to biological factors but also to mothers' perceptions, attitudes, and lifestyles. Conclusion: This study comprehensively evaluated breastfeeding mothers' perceptions of milk adequacy, breastfeeding attitudes, and the factors affecting breastfeeding success. The findings indicate that breastfeeding is influenced not only by biological but also by sociodemographic, psychosocial, and behavioral factors. Among infants aged 0–6 months, 59.5% were exclusively breastfed; the cesarean rate was 68.8%, and formula use was 38.9%. Smoking was identified as the strongest risk factor, increasing breastfeeding failure approximately fourfold, while perception of adequate milk, frequent breastfeeding, and longer exclusive breastfeeding duration were protective factors. Although breastfeeding success appeared lower among mothers who received breastfeeding education, this variable was not found to be an independent predictor. This finding suggests that the content and implementation of breastfeeding education should be revised to better meet mothers' needs. The associations between high ETDÖ scores and factors such as regular sleep, absence of nipple cracks, and confidence in milk sufficiency indicate that mothers' subjective perceptions play a decisive role in breastfeeding attitudes. Overall, breastfeeding success was found to be closely related to mothers' lifestyles, psychological states, and support systems. These findings emphasize the need to strengthen smoking cessation counseling, breastfeeding education, and psychosocial support programs at the family medicine level to enhance the sustainability of breastfeeding practices. Keywords: Breastfeeding, Maternal perception, ETDÖ, Family medicine, Psychosocial factors