Somalian mothers' perspectives on breast milk while their infants are cared for in the neonatal intensive care unit: a qualitative study

Abstract

Breastfeeding is essential for neonatal survival and development, yet it is often disrupted when infants are hospitalized in neonatal intensive care units (NICU). In low-resource settings, structural barriers such as limited access to lactation support, equipment, and storage facilities further complicate the maintenance of breastfeeding. Despite its importance, evidence on mothers' experiences and challenges in sustaining breast milk provision in these contexts remains limited. The aim of this study was to explore the lived experiences of Somali mothers regarding breast milk while their infants were hospitalized in the NICU. METHOD: A descriptive phenomenological design was used. Data were collected through individual, semi-structured, in-depth interviews with 12 mothers whose infants were receiving care in the NICU of a tertiary hospital in Mogadishu, Somalia. Participants were selected using purposive sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis following Thomas and Harden's approach. The study was conducted in accordance with the COREQ reporting guidelines. RESULTS: Four main themes were identified: (1) Breast Milk as an Absolute Good, but a Vague Knowledge Domain; (2) Milk Production Shaped More by Living Conditions Than by the Maternal Body; (3) Breastfeeding Knowledge Learned Through Trial and Error Rather Than Intergenerational Transfer; and (4) Motherhood as a Well-Intentioned but Poorly Supported Effort. Mothers viewed breast milk as beneficial but had limited biomedical knowledge and low risk perception. Breastfeeding practices were shaped by socioeconomic barriers, with pumping mainly during hospital visits and knowledge largely acquired through trial and error despite limited support. CONCLUSION: Breastfeeding during NICU hospitalization in Somalia is shaped more by structural and health-system constraints than by maternal motivation or physiological capacity. Positive attitudes toward breast milk alone are insufficient to sustain lactation without consistent professional guidance and basic infrastructure support. NICU nurses should deliver structured, skills-based lactation counseling on pumping, milk handling, and transport, and ensure access to practical resources to minimize milk loss and support breastfeeding continuity in low-resource settings.