{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:57:41Z","timestamp":1786121861951,"version":"build-2736575974"},"reference-count":64,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Breastfeed J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exclusive breastfeeding (EBF) is recommended for the first six months of life, yet only 48% of infants under six months are exclusively breastfed worldwide. Breastfeeding rates vary significantly across regions, countries, and even within cities. Brazil reports national rates of EBF of approximately 50%; however, there are notable in-country socioeconomic disparities, where EBF prevalence is lower in low-income communities compared to the wealthier communities. This study aims to: 1) investigate barriers to breastfeeding by exploring perceptions and experiences of breastfeeding in low-income communities in S\u00e3o Paulo, Brazil, and 2) evaluate the perceptions of a targeted social transfer program to improve EBF prevalence at six months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a semi-structured, exploratory, qualitative study in low-income communities in S\u00e3o Paulo, Brazil using focus group discussions (FGD) and key informant interviews (KII). Three FGDs were conducted, two with mothers and one with fathers (n = 14), alongside five KIIs with key stakeholders, including a nurse, neonatologist, social worker, and representatives from the Brazilian Ministries of Health and Social Development (n = 5), with a total sample of 19 participants. An inductive thematic analysis approach was used to develop the codebook and identify recurrent themes across transcripts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite the overall positive outlook on breastfeeding, FGDs and KIIs revealed several challenges, including economic, health system, and sociocultural barriers that hinder both initiation and continuation of breastfeeding. A targeted social transfer program was identified as a potential mechanism to address these barriers and support breastfeeding outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The identified barriers highlight the complexity of breastfeeding in low-income settings. Strengthening the existing breastfeeding social transfer program, Aux\u00edlio Nutriz, may serve as a supportive mechanism to address identified barriers and support breastfeeding practices. Understanding these challenges is a critical step toward developing coordinated, cross-sectoral interventions that support sustained breastfeeding practices. These findings have important implications for public health policy and program design, providing an evidence base for targeted interventions aimed at reducing inequities in breastfeeding outcomes among vulnerable populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      The RCT was registered on ClinicalTrial.gov on December 6, 2023 (NCT06157697);\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06157697?term=STEBB%26rank=1\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT06157697?term=STEBB%26rank=1<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13006-026-00865-2","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:03:28Z","timestamp":1781841808000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to breastfeeding and targeted breastfeeding social transfer programs in S\u00e3o Paulo, Brazil: a qualitative study"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8888-276X","authenticated-orcid":false,"given":"Stephanie","family":"Khoury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Carolina","family":"Onofre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Sartorio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Coca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maira Luchini","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najmeh","family":"Karimian-Marnani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Merten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Brentani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordyn","family":"Wallenborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"865_CR1","unstructured":"Organization WH. Global breastfeeding scorecard 2023: rates of breastfeeding increase around the world through improved protection and support. Global breastfeeding scorecard 2023: rates of breastfeeding increase around the world through improved protection and support. 2023."},{"key":"865_CR2","unstructured":"Nations U. UN News Centre [Internet]. United Nations Sustainable Development Goals. 2017. Available from: https:\/\/www.un.org\/sustainabledevelopment\/blog\/2017\/08\/breastfeeding-is-smartest-investment-families-communities-and-countries-can-make-un\/."},{"issue":"10017","key":"865_CR3","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","volume":"387","author":"CG Victora","year":"2016","unstructured":"Victora CG, Bahl R, Barros AJD, Fran\u00e7a GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475\u201390. https:\/\/doi.org\/10.1016\/S0140-6736(15)01024-7.","journal-title":"Lancet"},{"key":"865_CR4","unstructured":"Organization WH. The optimal duration of exclusive breastfeeding. A systematic review Geneva WHO. 2001."},{"key":"865_CR5","doi-asserted-by":"publisher","unstructured":"Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;2012(8). https:\/\/doi.org\/10.1002\/14651858.CD003517.pub2.","DOI":"10.1002\/14651858.CD003517.pub2"},{"key":"865_CR6","unstructured":"20 countries with the biggest inequality in income distribution worldwide in 2023, based on the Gini index [Internet]. World Bank; 2024."},{"issue":"S1","key":"865_CR7","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/0020-7292(90)90082-V","volume":"Suppl 31","author":"MF Rea","year":"1990","unstructured":"Rea MF. The Brazilian National Breastfeeding Program: a success story. Int J Gynecol Obstet. 1990;Suppl 31(S1):79\u201382; discussion 3-4.https:\/\/doi.org\/10.1016\/0020-7292(90)90082-V.","journal-title":"Int J Gynecol Obstet"},{"key":"865_CR8","doi-asserted-by":"publisher","first-page":"108","DOI":"10.11606\/S1518-8787.2017051000029","volume":"51","author":"CS Boccolini","year":"2017","unstructured":"Boccolini CS, Boccolini P, Monteiro FR, Ven\u00e2ncio SI, Giugliani ERJ. Breastfeeding indicators trends in Brazil for three decades. Rev Saude Publica. 2017;51:108. https:\/\/doi.org\/10.11606\/S1518-8787.2017051000029.","journal-title":"Rev Saude Publica"},{"key":"865_CR9","doi-asserted-by":"publisher","unstructured":"Venancio SI, Melo DS, Relvas GRB, de Bortoli MC, de Ara\u00fajo BC, Oliveira C, et al. Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of primary health care. Rev Paul Pediatr. 2023;41:e2021362. https:\/\/doi.org\/10.1590\/1984-0462\/2023\/41\/2021362.","DOI":"10.1590\/1984-0462\/2023\/41\/2021362"},{"issue":"6","key":"865_CR10","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1590\/S0034-89102013000901141","volume":"47","author":"A Passanha","year":"2013","unstructured":"Passanha A, Ben\u00edcio MHDA, Ven\u00e2ncio SI, Reis M. Implementation of the Brazilian Breastfeeding Network and prevalence of exclusive breastfeeding. Rev Saude Publica. 2013;47(6):1141\u201348. https:\/\/doi.org\/10.1590\/S0034-89102013000901141.","journal-title":"Rev Saude Publica"},{"key":"865_CR11","doi-asserted-by":"publisher","unstructured":"Rea MF. A review of breastfeeding in Brazil and how the country has reached ten months\u2019 breastfeeding duration. Cad Saude Publica. 2003;19(suppl 1):S37\u201345. https:\/\/doi.org\/10.1590\/S0102-311X2003000700005.","DOI":"10.1590\/S0102-311X2003000700005"},{"issue":"4","key":"865_CR12","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1590\/1984-0462\/;2019;37;4;00004","volume":"37","author":"JA Lamounier","year":"2019","unstructured":"Lamounier JA, Chaves RG, Rego MAS, Bouzada MCF. Baby friendly hospital initiative: 25 years of experience in Brazil. Rev Paul Pediatr. 2019;37(4):486\u201393. https:\/\/doi.org\/10.1590\/1984-0462\/;2019;37;4;00004.","journal-title":"Rev. Paul. Pediatr"},{"key":"865_CR13","doi-asserted-by":"publisher","unstructured":"Boccolini CS, de Aquino Lacerda EMDA, Bertoni N, Oliveira N, Alves-Santos NH, Farias DR, et al. Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO\/UNICEF 2030 targets. BMJ Glob Health. 2023;8(9):e012529. https:\/\/doi.org\/10.1136\/bmjgh-2023-012529.","DOI":"10.1136\/bmjgh-2023-012529"},{"key":"865_CR14","volume-title":"Aleitamento materno: Preval\u00eancia e pr\u00e1ticas de aleitamento materno em crian\u00e7as brasileiras menores de 2 anos 4: ENANI 2019","author":"U Janeiro","year":"2021","unstructured":"Janeiro U. Aleitamento materno: Preval\u00eancia e pr\u00e1ticas de aleitamento materno em crian\u00e7as brasileiras menores de 2 anos 4: ENANI 2019. UFRJ Rio de Janeiro; 2021."},{"issue":"2","key":"865_CR15","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1590\/S0102-311X2013000600026","volume":"29","author":"L Sadeck","year":"2013","unstructured":"Sadeck L, Leone CR. Avalia\u00e7\u00e3o da situa\u00e7\u00e3o do aleitamento materno em menores de um ano de idade no Munic\u00edpio de S\u00e3o Paulo, Brasil, em 2008. Cad Saude Publica. 2013;29(2):397\u2013402. https:\/\/doi.org\/10.1590\/S0102-311X2013000600026.","journal-title":"Cad Saude Publica"},{"key":"865_CR16","doi-asserted-by":"publisher","unstructured":"Pega F, Pabayo R, Benny C, Lee E-Y, Lhachimi SK, Liu SY. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev. 2022;2022(3). https:\/\/doi.org\/10.1002\/14651858.CD011135.pub3.","DOI":"10.1002\/14651858.CD011135.pub3"},{"issue":"16","key":"865_CR17","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1001\/jama.298.16.1900","volume":"298","author":"M Lagarde","year":"2007","unstructured":"Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA. 2007;298(16):1900\u201310. https:\/\/doi.org\/10.1001\/jama.298.16.1900.","journal-title":"JAMA"},{"key":"865_CR18","first-page":"124","volume":"40","author":"S Segura-P\u00e9rez","year":"2016","unstructured":"Segura-P\u00e9rez S, Grajeda R, P\u00e9rez-Escamilla R. Conditional cash transfer programs and the health and nutrition of Latin American children. Rev Panam Salud Publica. 2016;40:124\u201337.","journal-title":"Rev Panam Salud Publica"},{"issue":"1","key":"865_CR19","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1080\/17441692.2020.1850828","volume":"17","author":"JA Neves","year":"2022","unstructured":"Neves JA, Vasconcelos F, Machado ML, Recine E, Garcia GS, Medeiros M. The Brazilian cash transfer program (Bolsa Fam\u00edlia): a tool for reducing inequalities and achieving social rights in Brazil. Global Public Health. 2022;17(1):26\u201342. https:\/\/doi.org\/10.1080\/17441692.2020.1850828.","journal-title":"Global Public Health"},{"key":"865_CR20","volume-title":"Reaching the hard to reach: a case study of Brazil\u2019s Bolsa Fam\u00edlia program: Munk School of Global Affairs","author":"J Wong","year":"2016","unstructured":"Wong J, Sim A, Dos Santos N, Waud A, Garcia NDN, Ray S. Reaching the hard to reach: a case study of Brazil\u2019s Bolsa Fam\u00edlia program: Munk School of Global Affairs. University of Toronto; 2016."},{"issue":"1","key":"865_CR21","doi-asserted-by":"publisher","first-page":"2818","DOI":"10.1186\/s12889-024-20046-2","volume":"24","author":"J Magalh\u00e3es","year":"2024","unstructured":"Magalh\u00e3es J, Ziebold C, Evans-Lacko S, Matijasevich A, Paula CS. Health, economic and social impacts of the Brazilian cash transfer program on the lives of its beneficiaries: a scoping review. BMC Public Health. 2024;24(1):2818. https:\/\/doi.org\/10.1186\/s12889-024-20046-2.","journal-title":"BMC Public Health"},{"issue":"5\u20136","key":"865_CR22","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1080\/03670244.2023.2247332","volume":"62","author":"MM Mendes Normande","year":"2023","unstructured":"Mendes Normande MM, de Montemor Mar\u00e7al G, Madalena Rinaldi AE, de Menezes Toledo Flor\u00eancio TM, Bezerra Bueno N, Grotti Clemente AP. Factors associated with continued breastfeeding practice in children under 2 years of age assisted by the Brazilian conditional cash transfer program, Bolsa Fam\u00edlia. Ecol Food Nutr. 2023;62(5\u20136):210\u201322. https:\/\/doi.org\/10.1080\/03670244.2023.2247332.","journal-title":"Ecol Food Nutr"},{"key":"865_CR23","unstructured":"Minist\u00e9rio do Desenvolvimento e Assist\u00eancia Social FeC\u00e0FGdM. PORTARIA MDS N\u00ba 897, DE 07 DE JULHO DE 2023. 2023."},{"key":"865_CR24","doi-asserted-by":"publisher","unstructured":"Becker GE, Zambrano P, Ching C, Cashin J, Burns A, Policarpo E, et al. Global evidence of persistent violations of the international code of marketing of breast-milk substitutes: a systematic scoping review. Matern Child Nutr. 2022;18(S3):e13335. https:\/\/doi.org\/10.1111\/mcn.13335.","DOI":"10.1111\/mcn.13335"},{"key":"865_CR25","doi-asserted-by":"publisher","unstructured":"Boccolini C, Boccolini P, Mezzavilla R. National system to monitor the international code of breast milk substitutes in Brazil: SisNBCAL. Curr Dev Nutr. 2020;4:nzaa051_02. https:\/\/doi.org\/10.1093\/cdn\/nzaa051_002.","DOI":"10.1093\/cdn\/nzaa051_002"},{"key":"865_CR26","doi-asserted-by":"publisher","unstructured":"Barreto AA, Lopes IMD. Aleitamento materno exclusivo e fatores determinantes do desmame precoce: uma revis\u00e3o integrativa da literatura. Res Soc Devel. 2023;12(5):e0712541358\u2013e. https:\/\/doi.org\/10.33448\/rsd-v12i5.41358.","DOI":"10.33448\/rsd-v12i5.41358"},{"key":"865_CR27","doi-asserted-by":"publisher","unstructured":"Ribeiro JP, Cirqueira MAS, Lima MEM, da Trindade Vieira MPDT. Fatores que dificultam a ades\u00e3o ao aleitamento materno exclusivo nos primeiros seis meses na Aten\u00e7\u00e3o Prim\u00e1ria \u00e0 Sa\u00fade em um munic\u00edpio do estado do Par\u00e1. Rev Eletron Acervo Cient. 2023;45:e13643\u2013e. https:\/\/doi.org\/10.25248\/reac.e13643.2023.","DOI":"10.25248\/reac.e13643.2023"},{"key":"865_CR28","doi-asserted-by":"publisher","unstructured":"Unfried AGC, Paix\u00e3o G, Fraga C, Oliveira JD, Cavalcante Neto JL. Fatores neonatais associados ao desmame precoce em um munic\u00edpio da Bahia: um estudo transversal. Rev Esc Enferm Usp. 2024;58:e20240091. https:\/\/doi.org\/10.1590\/1980-220x-reeusp-2024-0091pt.","DOI":"10.1590\/1980-220x-reeusp-2024-0091pt"},{"key":"865_CR29","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1590\/S0034-8910.2015049005971","volume":"49","author":"CS Boccolini","year":"2015","unstructured":"Boccolini CS, Carvalho M, Oliveira M. Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review. Rev Saude Publica. 2015;4991. https:\/\/doi.org\/10.1590\/S0034-8910.2015049005971.","journal-title":"Rev Saude Publica"},{"key":"865_CR30","doi-asserted-by":"publisher","unstructured":"Primo CC, Ferreira CI, Soares J, Muri LAC, Lima Ed EDFA, Brand\u00e3o MAG. Body image of women during breastfeeding: analysis supported by nursing theory. Rev Gaucha Enferm. 2023;44:e20220051. https:\/\/doi.org\/10.1590\/1983-1447.2023.20220051.pt.","DOI":"10.1590\/1983-1447.2023.20220051.pt"},{"issue":"17","key":"865_CR31","doi-asserted-by":"publisher","first-page":"3120","DOI":"10.1017\/S1368980017002531","volume":"20","author":"JA Kavle","year":"2017","unstructured":"Kavle JA, LaCroix E, Dau H, Engmann C. Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr. 2017;20(17):3120\u201334. https:\/\/doi.org\/10.1017\/S1368980017002531.","journal-title":"Public Health Nutr"},{"issue":"1","key":"865_CR32","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12939-024-02147-x","volume":"23","author":"JM Goodman","year":"2024","unstructured":"Goodman JM, Lara-Mej\u00eda V, Hern\u00e1ndez-Cordero S, Vilar-Compte M. Breastfeeding among women employed in Mexico\u2019s informal sector: strategies to overcome key barriers. Int J Equity Health. 2024;23(1):144. https:\/\/doi.org\/10.1186\/s12939-024-02147-x.","journal-title":"Int J Equity Health"},{"issue":"2","key":"865_CR33","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1177\/101053950201400206","volume":"14","author":"A Lakati","year":"2002","unstructured":"Lakati A, Binns C, Stevenson M. The effect of work status on exclusive breastfeeding in Nairobi. Asia Pac J Public Health. 2002;14(2):85\u201390. https:\/\/doi.org\/10.1177\/101053950201400206.","journal-title":"Asia Pac J Public Health"},{"issue":"1","key":"865_CR34","doi-asserted-by":"publisher","first-page":"13","DOI":"10.25159\/2520-5293\/1484","volume":"16","author":"C Goosen","year":"2016","unstructured":"Goosen C, McLachlan M, Schubl C. Factors impeding exclusive breastfeeding in a low-income area of the Western Cape province of South Africa. Afr J Nurs Midwifery. 2016;16(1):13\u201331. https:\/\/doi.org\/10.25159\/2520-5293\/1484.","journal-title":"Afr J Nurs Midwifery"},{"issue":"5","key":"865_CR35","first-page":"1687","volume":"4","author":"Z Heidari","year":"2016","unstructured":"Heidari Z, Keshvari M, Kohan S. Breastfeeding promotion, challenges and barriers: a qualitative research. Int J Pediatrics. 2016;4(5):1687\u201395.","journal-title":"Int J Pediatrics"},{"issue":"1","key":"865_CR36","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s13006-020-00327-3","volume":"15","author":"S Hern\u00e1ndez-Cordero","year":"2020","unstructured":"Hern\u00e1ndez-Cordero S, Lozada-Tequeanes AL, Fern\u00e1ndez-Gaxiola AC, Shamah-Levy T, Sachse M, Veliz P, et al. Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach. Int Breastfeed J. 2020;15(1):87. https:\/\/doi.org\/10.1186\/s13006-020-00327-3.","journal-title":"Int Breastfeed J"},{"issue":"3","key":"865_CR37","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/NMC.0000000000000909","volume":"48","author":"J Mahurin-Smith","year":"2023","unstructured":"Mahurin-Smith J. Challenges with breastfeeding: pain, nipple trauma, and perceived insufficient milk supply. MCN Am J Matern Child Nurs. 2023;48(3):161\u201367. https:\/\/doi.org\/10.1097\/NMC.0000000000000909.","journal-title":"MCN Am J Matern Child Nurs"},{"issue":"10","key":"865_CR38","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.3390\/nu11102266","volume":"11","author":"ML Gianni","year":"2019","unstructured":"Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, et al. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients. 2019;11(10):2266. https:\/\/doi.org\/10.3390\/nu11102266.","journal-title":"Nutrients"},{"issue":"1","key":"865_CR39","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12992-024-01088-y","volume":"20","author":"C Horwood","year":"2024","unstructured":"Horwood C, Mapumulo S, Haskins L, Doherty T, Kingston G, Rollins N, et al. Women\u2019s exposure to commercial milk formula marketing: a WHO multi-country market research study. Globalizat Health. 2024;20(1):85. https:\/\/doi.org\/10.1186\/s12992-024-01088-y.","journal-title":"Globalizat Health"},{"issue":"12","key":"865_CR40","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1136\/archdischild-2023-325767","volume":"108","author":"R Conway","year":"2023","unstructured":"Conway R, Ritchie I, Esser S, Steptoe A, Smith AD, Llewellyn C. Perceived influence of commercial milk formula labelling on mothers\u2019 feeding choices in Great Britain: a qualitative study. Arch Dis Child. 2023;108(12):1008\u201313. https:\/\/doi.org\/10.1136\/archdischild-2023-325767.","journal-title":"Arch Dis Child"},{"issue":"1","key":"865_CR41","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/0890334420978405","volume":"37","author":"MIC de Oliveira","year":"2021","unstructured":"de Oliveira MIC, Boccolini CS, Fonseca Sally E. Breastmilk substitutes marketing violations and associated factors in Rio de Janeiro, Brazil. J Hum Lact. 2021;37(1):158\u201368. https:\/\/doi.org\/10.1177\/0890334420978405.","journal-title":"J Hum Lact"},{"key":"865_CR42","doi-asserted-by":"publisher","first-page":"1181229","DOI":"10.3389\/fpubh.2023.1181229","volume":"11","author":"KD Gribble","year":"2023","unstructured":"Gribble KD, Smith JP, Gammeltoft T, Ulep V, Van Esterik P, Craig L, et al. Breastfeeding and infant care as \u2018sexed\u2019care work: reconsideration of the three Rs to enable women\u2019s rights, economic empowerment, nutrition and health. Front Public Health. 2023;11:1181229. https:\/\/doi.org\/10.3389\/fpubh.2023.1181229.","journal-title":"Front Public Health"},{"issue":"2","key":"865_CR43","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.clinthera.2021.11.007","volume":"44","author":"EM Nagel","year":"2022","unstructured":"Nagel EM, Howland MA, Pando C, Stang J, Mason SM, Fields DA, et al. Maternal psychological distress and lactation and breastfeeding outcomes: a narrative review. Clin Ther. 2022;44(2):215\u201327. https:\/\/doi.org\/10.1016\/j.clinthera.2021.11.007.","journal-title":"Clin Ther"},{"issue":"1","key":"865_CR44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2012\/902487","volume":"2012","author":"AM Dozier","year":"2012","unstructured":"Dozier AM, Nelson A, Brownell E. The relationship between life stress and breastfeeding outcomes among low-income mothers. Adv Prev Med. 2012;2012(1):1\u201310. https:\/\/doi.org\/10.1155\/2012\/902487.","journal-title":"Adv Prev Med"},{"key":"865_CR45","doi-asserted-by":"publisher","first-page":"1357965","DOI":"10.3389\/fpubh.2024.1357965","volume":"12","author":"RE Grattan","year":"2024","unstructured":"Grattan RE, London SM, Bueno GE. Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time. Front Public Health. 2024;12:1357965. https:\/\/doi.org\/10.3389\/fpubh.2024.1357965.","journal-title":"Front Public Health"},{"issue":"7","key":"865_CR46","doi-asserted-by":"publisher","first-page":"3819","DOI":"10.3390\/ijerph18073819","volume":"18","author":"S Llorente-Pulido","year":"2021","unstructured":"Llorente-Pulido S, Custodio E, L\u00f3pez-Gim\u00e9nez MR, Sanz-Barbero B, Otero-Garc\u00eda L. Barriers and facilitators for exclusive breastfeeding in women\u2019s biopsychosocial spheres according to primary care midwives in tenerife (Canary Islands, Spain). Int J Environ Res Public Health. 2021;18(7):3819. https:\/\/doi.org\/10.3390\/ijerph18073819.","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"865_CR47","doi-asserted-by":"publisher","first-page":"105833","DOI":"10.1016\/j.appet.2021.105833","volume":"169","author":"RF Rodgers","year":"2022","unstructured":"Rodgers RF, Fischer LE, Zimmerman E. Partner influences, breastfeeding, and body image and eating concerns: an expanded biopsychosocial model. Appetite. 2022;169:105833. https:\/\/doi.org\/10.1016\/j.appet.2021.105833.","journal-title":"Appetite"},{"issue":"1","key":"865_CR48","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.midw.2014.06.003","volume":"31","author":"A Brown","year":"2015","unstructured":"Brown A, Rance J, Warren L. Body image concerns during pregnancy are associated with a shorter breast feeding duration. Midwifery. 2015;31(1):80\u201389. https:\/\/doi.org\/10.1016\/j.midw.2014.06.003.","journal-title":"Midwifery"},{"key":"865_CR49","volume-title":"Utilizing the mother infant lactation questionnaire to assess lactation and breastfeeding success after benign breast surgery","author":"A Gordon","year":"2023","unstructured":"Gordon A. Utilizing the mother infant lactation questionnaire to assess lactation and breastfeeding success after benign breast surgery. Boston University; 2023."},{"issue":"35","key":"865_CR50","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/S0968-8080(10)35519-4","volume":"18","author":"D Dorneles de Andrade","year":"2010","unstructured":"Dorneles de Andrade D. On norms and bodies: findings from field research on cosmetic surgery in Rio de Janeiro, Brazil. Reprod Health Matters. 2010;18(35):74\u201383. https:\/\/doi.org\/10.1016\/S0968-8080(10)35519-4.","journal-title":"Reprod Health Matters"},{"issue":"20","key":"865_CR51","doi-asserted-by":"publisher","first-page":"4217","DOI":"10.1007\/s00266-024-04260-2","volume":"48","author":"L Triana","year":"2024","unstructured":"Triana L, Palacios Huatuco RM, Campilgio G, Liscano E. Trends in surgical and nonsurgical aesthetic procedures: a 14-year analysis of the International Society of Aesthetic Plastic Surgery-ISAPS. Aesth Plast Surg. 2024;48(20):4217\u201327. https:\/\/doi.org\/10.1007\/s00266-024-04260-2.","journal-title":"Aesth Plast Surg"},{"issue":"5","key":"865_CR52","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.asj.2008.07.004","volume":"28","author":"B Rinker","year":"2008","unstructured":"Rinker B, Veneracion M, Walsh CP. The effect of breastfeeding on breast aesthetics. Aesthet Surg J. 2008;28(5):534\u201337. https:\/\/doi.org\/10.1016\/j.asj.2008.07.004.","journal-title":"Aesthet Surg J"},{"issue":"3","key":"865_CR53","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1097\/CEJ.0b013e328359cb81","volume":"22","author":"C Rauh","year":"2013","unstructured":"Rauh C, Faschingbauer F, Haeberle L, Jud SM, Heusinger K, Fasching PA, et al. Factors influencing breast changes after pregnancy. Eur J Cancer Prev. 2013;22(3):259\u201361. https:\/\/doi.org\/10.1097\/CEJ.0b013e328359cb81.","journal-title":"Eur J Cancer Prev"},{"issue":"1","key":"865_CR54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/8651010","volume":"2019","author":"M Mgongo","year":"2019","unstructured":"Mgongo M, Hussein TH, Stray-Pedersen B, Vangen S, Msuya SE, Wandel M. Facilitators and barriers to breastfeeding and exclusive breastfeeding in Kilimanjaro region, Tanzania: a qualitative study. Int J Pediatrics. 2019;2019(1):1\u20137. https:\/\/doi.org\/10.1155\/2019\/8651010.","journal-title":"Int J Pediatrics"},{"issue":"1","key":"865_CR55","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13006-018-0161-1","volume":"13","author":"JB Coomson","year":"2018","unstructured":"Coomson JB, Aryeetey R. Perception and practice of breastfeeding in public in an urban community in Accra, Ghana. Int Breastfeed J. 2018;13(1):18. https:\/\/doi.org\/10.1186\/s13006-018-0161-1.","journal-title":"Int Breastfeed J"},{"issue":"7","key":"865_CR56","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1136\/jech-2018-211148","volume":"73","author":"C Farkas","year":"2019","unstructured":"Farkas C, Girard L-C. Breastfeeding initiation and duration in Chile: understanding the social and health determinants. J Epidemiol Community Health. 2019;73(7):637\u201344. https:\/\/doi.org\/10.1136\/jech-2018-211148.","journal-title":"J Epidemiol Community Health"},{"issue":"1","key":"865_CR57","doi-asserted-by":"publisher","first-page":"33","DOI":"10.4025\/actascihealthsci.v38i1.28514","volume":"38","author":"MA Frota","year":"2016","unstructured":"Frota MA, Lopes MF, Lima KF, Sales C, da Silva CAB. Interfaces of the discontinuation of breastfeeding. Acta Sci Health Sci. 2016;38(1):33\u201338. https:\/\/doi.org\/10.4025\/actascihealthsci.v38i1.28514.","journal-title":"Acta Sci Health Sci"},{"issue":"1","key":"865_CR58","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13006-017-0104-2","volume":"12","author":"AK-A Diji","year":"2016","unstructured":"Diji AK-A, Bam V, Asante E, Lomotey AY, Yeboah S, Owusu HA. Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: a descriptive cross-sectional study. Int Breastfeed J. 2016;12(1):1\u20137. https:\/\/doi.org\/10.1186\/s13006-017-0104-2.","journal-title":"Int Breastfeed J"},{"issue":"1","key":"865_CR59","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1472-698X-14-10","volume":"14","author":"A Shei","year":"2014","unstructured":"Shei A, Costa F, Reis MG, Ko AI. The impact of Brazil\u2019s Bolsa Fam\u00edlia conditional cash transfer program on children\u2019s health care utilization and health outcomes. BMC Int Health Hum Rights. 2014;14(1):1\u20139. https:\/\/doi.org\/10.1186\/1472-698X-14-10.","journal-title":"BMC Int Health Hum Rights"},{"issue":"11\/12","key":"865_CR60","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1108\/IJSSP-03-2020-0093","volume":"40","author":"S Mariano","year":"2020","unstructured":"Mariano S. Conditional cash transfers, empowerment and female autonomy: care and paid work in the Bolsa Fam\u00edlia programme, Brazil. Int J Sociol Soc Policy. 2020;40(11\/12):1491\u2013507. https:\/\/doi.org\/10.1108\/IJSSP-03-2020-0093.","journal-title":"Int J Sociol Soc Policy"},{"issue":"2","key":"865_CR61","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1001\/jamapediatrics.2024.5079","volume":"179","author":"JT Wallenborn","year":"2025","unstructured":"Wallenborn JT, Sonephet S, Sayasone S, Siengsounthone L, Kounnavong S, Fink G. Conditional and unconditional social transfers, early-life nutrition, and child growth: a randomized clinical trial. JAMA Pediatrics. 2025;179(2):129\u201336. https:\/\/doi.org\/10.1001\/jamapediatrics.2024.5079.","journal-title":"JAMA Pediatrics"},{"issue":"2","key":"865_CR62","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1177\/0379572119836582","volume":"40","author":"M Vilar-Compte","year":"2019","unstructured":"Vilar-Compte M, Teruel G, Flores D, Carroll GJ, Buccini GS, P\u00e9rez-Escamilla R. Costing a maternity leave cash transfer to support breastfeeding among informally employed Mexican women. Food Nutr Bull. 2019;40(2):171\u201381. https:\/\/doi.org\/10.1177\/0379572119836582.","journal-title":"Food Nutr Bull"},{"key":"865_CR63","doi-asserted-by":"publisher","unstructured":"Venancio SI, Buccini G. Implementation of strategies and programs for breastfeeding, complementary feeding, and malnutrition of young children in Brazil: advances and challenges. Cad Saude Publica. 2023;39(suppl 2):e00053122. https:\/\/doi.org\/10.1590\/0102-311xen053122.","DOI":"10.1590\/0102-311xen053122"},{"key":"865_CR64","doi-asserted-by":"publisher","unstructured":"Khoury S, Brentani A, Brentani H, Fiamoncini J, Francisco R, Onofre AC, et al. Social transfers for exclusive breastfeeding in Brazil: protocol for a randomized controlled trial. JMIR Res Protoc. 2025;14(1):e75796. https:\/\/doi.org\/10.2196\/75796.","DOI":"10.2196\/75796"}],"container-title":["International Breastfeeding Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13006-026-00865-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-026-00865-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-026-00865-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:07:45Z","timestamp":1786086465000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13006-026-00865-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":64,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["865"],"URL":"https:\/\/doi.org\/10.1186\/s13006-026-00865-2","relation":{},"ISSN":["1746-4358"],"issn-type":[{"value":"1746-4358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"19 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Commission of Northwestern and Central Switzerland (EKNZ; reference number 2024-00015, April 9, 2024) and the Brazilian National Commission for Ethics in Research (CONEP; approval number 7.643.369, March 15, 2024). All participants provided written informed consent prior to participation. Participants were informed of their right to withdraw at any time without consequences, and all data were anonymized to ensure confidentiality. Full ethics approval can be provided upon request.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all subjects involved in the study.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests. KC is an Editorial Board member of the International Breastfeeding Journal but did not participate in the review of this manuscript. KC affirms that her views are her own and do not represent those of the International Board of Lactation Consultant Examiners, and that she does not have access to any International Board Certified Lactation Consultant examination materials or other non-public information related to that organization's credentials.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"75"}}