Factors associated with exclusive breastfeeding among infants of working mothers in Ghana: a secondary analysis of the 2022 demographic and health survey

Abstract

Background

Exclusive breastfeeding (EBF) plays a crucial role in reducing infant morbidity and mortality, contributing significantly to optimal infant growth and development. The World Health Organisation (WHO) recommends EBF for the first six months of life to ensure infants receive essential nutrients and immunity, particularly in developing countries.

Objective

This study aims to examine the determinants of exclusive breastfeeding among infants 0–6 months of working mothers in Ghana.

Methods

This study employed a cross-sectional analytical design using nationally representative data. After data cleaning and application of sampling weights, the final sample comprised 347 infants aged 0–6 months born to working mothers. An adjusted logistic regression model was used to identify factors associated with exclusive breastfeeding, accounting for stratification and the complex survey design.

Results

The prevalence of exclusive breastfeeding among infants of working mothers in the study was 86.31%. The majority of mothers were aged 25–34 years, with over half having attained secondary education. Antenatal care attendance, maternal education, maternal age, size of child, sex of child, parity, sex of household head, marital status, ethnicity and religion were found to be significant predictors of EBF. However, media exposure, mode of delivery and maternal breast cancer screening history showed no significant association with EBF practices.

Conclusion

Exclusive breastfeeding prevalence among working mothers in Ghana was relatively high. Strengthening antenatal care services, promoting maternal education and targeting key socio-demographic groups may further sustain and improve exclusive breastfeeding practices to enhance child health outcomes.

Introduction

Exclusive breastfeeding is deemed important because of its role in reducing infant morbidity and mortality [1]. Breastfeeding is an unparalleled way of providing ideal nutrition for the healthy growth and development of infants [2]. The global public health recommendation is that infants should be exclusively breastfed for the first six months to achieve optimal growth, development and health [3–6]. Exclusive breastfeeding (EBF) in the first six months of life stimulates babies’ immune systems. It protects them from diarrhoea and acute respiratory infections, two of the major causes of infant mortality in the developing world and improves their responses to vaccination [7–9]. Exclusive breastfeeding is defined as an infant’s consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for vitamins, minerals and medications until six months. According to [2], exclusive breastfeeding for 6 months confers many benefits to the infant and the mother. It has a protective effect against gastrointestinal infections, which is observed not only in developing but also in industrialised countries [10]. The risk of mortality due to diarrhoea and other infections can increase many-fold in infants who are either partially breastfed or not breastfed at all [4]. Studies revealed that, during the first two months of life, infants who are not breastfed are nearly 6 times more likely to die from infectious diseases than infants who are breastfed; between 2 and 3 months, non-breastfed infants are 4 times more likely to die compared to breastfed infants [11, 12]. Breastfeeding and exclusive breastfeeding in particular are one of the major strategies which help improve infants’ nutritional status and survival, for at least half of the almost 10 million deaths of children younger than 5 years old every year are a direct or indirect consequence of malnutrition [13].

In developed countries, around 2005, less than 25% were exclusively breastfed up to six months after their birth [5]. In Norway, Sweden and the United States of America, for example, the rate of exclusive breastfeeding ranged from 7% to 13.8% only [5]. This is the reason why WHO and UNICEF have formulated global recommendations for optimal infant feeding: exclusive breastfeeding for six months (180 days) and breastfeeding up to two years of age or beyond [14]. Unfortunately, only 35% of infants younger than 6 months, approximately one-third of the newborns, are exclusively breastfed worldwide [15].

Sub-Saharan Africa has been the worst affected, with the highest proportion of disease burden associated with sub-optimal breastfeeding [16]. Over 2/3 of these deaths are often associated with inappropriate feeding practices and occur in the first year of life [17–19]. Early initiation and exclusive breastfeeding, often referred to as optimal breastfeeding, have the potential to prevent over 800,000 child deaths each year [8, 20, 21]. Among children under five, stunting is 40 to 60% due to delayed initiation and non-exclusive breastfeeding in sub-Saharan Africa [16, 22]. Despite the substantial advantages breastfeeding offers to both mothers and babies, breastfeeding rates are still below ideal. According to [23], only 23 countries across the globe have achieved the UNICEF and WHO recommendation of EBF for 60% of infants six [6] months and younger. In practice, many countries report much lower rates, often ranging between 40 and 65% [15].

While several studies in Ghana and similar contexts have explored exclusive breastfeeding (EBF) among all mothers, there is limited evidence specifically on working mothers using nationally representative data [24–29]. Working mothers face unique challenges, such as workplace policies, maternity leave duration, commuting time and job demands that may affect their ability to initiate and sustain EBF. This study addresses this gap by examining a range of predictors across multiple levels of influence. By situating these factors within the socio-ecological model, the study demonstrates how individual, relational, community and broader societal influences interact to shape EBF practices among working mothers. This approach provides a comprehensive framework for understanding barriers and facilitators, offering valuable guidance for designing effective public health interventions to promote exclusive breastfeeding among working mothers in Ghana.

Methods

Sampling design and sampling

This study utilised secondary data from the 2022 Ghana Demographic and Health Survey (GDHS), which employed a stratified two-stage sampling design to produce nationally representative data disaggregated by region and urban–rural residence. In the original survey, 618 clusters were selected from the 2021 Population and Housing Census using a probability proportional to size sampling method in the first stage. In the second stage, 30 households were systematically chosen from each cluster, yielding a total of 17,933 households. During the primary data collection, all women aged 15–49 and men aged 15–59 in selected households were eligible for interview, resulting in a final sample of 15,317 women and 7,263 men, with response rates of 98% and 97%, respectively [30]. The GDHS unweighted sample included 9,353 children under age five, which corresponded to 8,581 children in the weighted KR (Kids Recode). For the present analysis, the unit of analysis is infants aged 0–6 months of working mothers. A subset of this dataset was extracted, consisting of 347 infants aged 0–6 months of working mothers, identified after data cleaning and the application of sample weights.

Eligibility criteria

The study population consisted of infants aged 0–6 months who lived with their mothers, were currently being breastfed and whose mothers were working. These infants were identified from the GDHS Children’s Recode (KR) file and linked to the current status of working mothers. After applying these criteria, cleaning the data and excluding missing cases, the final weighted analytic sample included 347 infants.

Measures of the study

Dependent variable

The World Health Organisation (WHO) defines exclusive breastfeeding (EBF) as feeding infants only breast milk, either directly or expressed, without the addition of any other liquids or solids, except for oral rehydration solutions, or drops/syrups of vitamins, minerals, or medicines [31, 32]. The study’s outcome variable was exclusive breastfeeding (not exclusive, exclusive), which is defined as a child’s exclusive breastfeeding intake between the ages of 0 and 6 months [33].

Independent variables.

Independent variables were categorized into four levels: individual (maternal age, education, wealth index, child’s size and sex at birth, parity, EIBF, breast examination), interpersonal (marital status, sex of household head, parents living together), organizational (antenatal visits, access to healthcare, place and mode of delivery) and community (media exposure, water source, religion, ethnicity, residence). Some variables were recoded: maternal age (15–49 years) into four groups [15–49], marital status into “never” or “ever married,” and education into four levels (no formal education, primary, secondary, higher). Antenatal visits were grouped as 0, 1–3, or 4 + and “currently living with partner” was recoded to “parents living together” (yes/no). Place of delivery was grouped as home or health facility, mode of delivery as vaginal or caesarean and child’s size as small, average, or large.

The independent variables and their categorisation were guided by evidence from previous EBF studies and established maternal-child health frameworks [34–37]. Determinants such as maternal age, education, wealth, residence, parity, media exposure and work-related factors selected due to the study’s focus on working mothers were included for their documented influence on breastfeeding, with classifications aligned to DHS standards for comparability.

Ethical statement

Ethical approval for the 2022 GDHS was obtained from both national and international bodies. The Ghana Statistical Service (GSS) submitted the survey protocol to the Ethical Review Committee (ERC) of the Ghana Health Service, which approved it following national ethical standards. Additionally, ICF submitted the protocol to the ICF Institutional Review Board (IRB), which reviewed and approved it in compliance with U.S. and international ethical guidelines [38].

Data management and analysis 

Data from the 2022 Ghana Demographic and Health Survey (GDHS) were cleaned, recoded and analysed using STATA/SE 14.0 (StataCorp, College Station, TX, USA). The complex survey design, characterised by stratification, clustering and unequal sampling probabilities, was accounted for using the svyset command with Taylor series linearization to ensure valid estimates of p-values and confidence intervals.

Descriptive statistics (frequencies and percentages) summarised the data and bivariate analyses explored associations between independent variables and exclusive breastfeeding. To account for between-cluster effects and hierarchical structure, a multilevel logistic regression model was used. Statistical significance was set at p < 0.05, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported.

Results

The analysis was based on a weighted sample of 347 infants, 0–6 months, of working mothers from the 2022 GDHS. A cross-tabulation of exclusive breastfeeding by working status revealed that 86.31% of working mothers’ infants were exclusively breastfed.

Most of the infants’ mothers were aged 25–34 years (53.82%) with a mean maternal age of 29.7 years. Ethnically, the majority of the infants’ mothers were Mole-Dagbani (45.07%) and Akan (34.87%) and most identified as Christians (67.34%). About 65.86% of the mothers were ever married, 55.22% resided in rural areas and 65.76% of households were male-headed. The average age of the infants’ fathers was 37.2 years. In terms of education, 52.21% of the mothers had secondary education, while 21.39% had no formal education. Based on the household wealth index, 41.46% of infants lived in poor households, while 37.82% lived in rich households. Media exposure was evenly distributed among the infants’ mothers and 81.41% reported access to healthcare, with 76.07% using improved drinking water sources (see Tables 1 and 2).

Table 1.

Weighted characteristics of individual-level variables of children 0–6 months of working mothers (N = 347)

	Frequency	Percent
Maternal age
15–24	78	22.55
25–34	187	53.82
35–44	74	21.32
45–49	8	2.32
Maternal education
No formal education	74	21.39
Primary	54	15.40
Secondary	181	52.21
Tertiary	38	10.99
Wealth index
Poor	144	41.46
Middle	72	20.72
Rich	131	37.82
Birth weight
Large	160	45.97
Average	141	40.76
Small	46	37.82
Sex of child
Male	204	58.90
Female	143	41.10
Parity
Primiparous	74	21.27
Multiparous	185	53.28
Grandparous	88	25.46
EIBF
Yes	209	60.20
No	138	39.80
Breast examined for cancer
No	263	75.88
Yes	84	24.12

Table 2.

Weighted characteristics of community variables of children 0–6 months of working mothers (N = 347)

	Frequency	Percent
Media exposure
Low	174	50.27
High	173	49.73
Source of drinking water
Unimproved	83	23.93
Improved	264	76.07
Religion
No religion/traditionalist	17	4.88
Islam	96	27.78
Christian	234	67.34
Ethnicity
Akan	121	34.87
Ga/Dangme	32	9.08
Ewe	38	10.98
Mole-Dagbani	156	45.07
Place of residence
Urban	155	44.78
Rural	192	55.22

Concerning maternal and infant health, 53.28% of infants were born to multiparous mothers and 42.38% of births were of order four or higher. Most of the infants were delivered via natural birth (86.72%) and took place in health facilities (87.17%). Antenatal care coverage was high, with 87.08% of mothers attending four or more visits. However, only 24.12% of the mothers had ever undergone breast cancer screening and 60.20% of the infants were given breastmilk within an hour of birth. Male infants accounted for 58.90% of the sample and 45.97% of the infants were perceived as large at birth. 65.86% of the mothers were ever-married and 71.65% lived with their partners (see Tables 1, 3 and 4).

Table 3.

Weighted characteristics of interpersonal variables of children 0–6 months of working mothers (N = 347)

	Frequency	Percent
Marital status
Never married	118	34.14
Ever married	229	65.86
Sex of household head
Male	228	65.76
Female	119	34.24
Parents living together
Yes	144	75.00
No	72	25.00

Note: Weight was not applied to parents living together

Table 4.

Weighted characteristics of organisational variables of children 0–6 months of working mothers (N = 347)

	Frequency	Percent
ANC visits
No visit	10	2.78
1–3	35	10.94
4 or more	302	87.08
Access to healthcare
No	64	18.59
Yes	283	81.41
Place of delivery
Home	45	12.83
Health facility	302	87.17
Mode of delivery
Natural	301	86.72
Caesarean	46	13.28

Prevalence and bivariate description of exclusive breastfeeding

Individual-level factors

Infants born to mothers aged 25–34 years had the highest rates of exclusive breastfeeding (45.93%), followed by those whose mothers were aged 35–44 years (19.41%) and 15–24 years (18.92%). Infants whose mothers had secondary education recorded the highest exclusive breastfeeding rate (44.10%), with those whose mothers had no education following (19.27%). Exclusive breastfeeding was more common among infants from poor households (37.46%) than those from rich (30.36%) and middle-income households (18.49%). Infants reported as large at birth were more likely to be exclusively breastfed (40.90%) compared to those of average size (35.25%) and small size (10.16%). Male infants had a higher rate of exclusive breastfeeding (52.02%) than females (34.29%). Infants of multiparous mothers had the highest exclusive breastfeeding (46.43%), compared to those of primiparous (16.02%) and grand-multiparous mothers (23.85%). Early initiation of breastfeeding within one hour after birth was associated with higher exclusive breastfeeding rates (53.78%) compared to delayed initiation (32.53%). Finally, infants whose mothers had never undergone breast examination made up a larger proportion of exclusive breastfeeding (65.05%) compared to those whose mothers had been examined (21.26%).

Interpersonal factors

Exclusive breastfeeding was more common among infants born to ever-married mothers (58.48%) compared to those of never-married mothers (27.83%). Infants living in male-headed households had a higher exclusive breastfeeding rate (56.96%) than those in female-headed households (29.35%). Infants whose mothers were living with their husbands or partners recorded a higher exclusive breastfeeding rate (65.52%) compared to infants whose mothers’ partners were staying elsewhere (22.13%).

Organisational factors

Exclusive breastfeeding was more prevalent among infants whose mothers had four or more antenatal care (ANC) visits (74.11%), compared to those whose mothers had fewer visits. Infants whose mothers had access to healthcare services exhibited higher exclusive breastfeeding rates (70.88%) than those without access (15.43%). Moreover, infants born in health facilities had a greater likelihood of exclusive breastfeeding (74.41%) compared to those born at home (11.90%). Finally, infants delivered through vaginal birth showed a higher exclusive breastfeeding rate (76.22%) than those delivered by caesarean Sect. (10.09%).

Community factors

Exclusive breastfeeding was more common among infants whose mothers had lower media exposure (45.20%) compared to those with higher media exposure (41.11%). Infants living in households with improved sources of drinking water were more likely to be exclusively breastfed (64.43%) than those with unimproved water sources (21.88%). Regarding maternal religion, exclusive breastfeeding was highest among infants of Christian mothers (58.07%), followed by Muslim mothers (24.46%) and least among those with no religion/traditional religion (3.78%). Ethnic differences were also observed: infants from Mole-Dagbani ethnic groups had the highest exclusive breastfeeding rates (40.42%), followed by Akan (26.85%), Ewe (10.60%) and Ga/Dangme (8.44%). Additionally, exclusive breastfeeding was slightly more prevalent among infants residing in rural areas (48.56%) compared to those in urban areas (37.75%).

Discussion

The adjusted regression analysis shown in Table 5 revealed that ANC visits (antenatal care visits) significantly predicted exclusive breastfeeding. Infants born to working mothers who attended 1–3 ANC visits were significantly more likely to be exclusively breastfed compared to infants born to mothers who had no ANC visits. This finding is consistent with a study [39] conducted in the Amhara region of Ethiopia, which also identified antenatal care (ANC) as a significant predictor of exclusive breastfeeding, as well as with evidence from Worebabo, Ethiopia [40]. In Ghana, this may reflect structural and social barriers, as the quality of infant feeding counselling during ANC is inconsistent and working mothers often face short maternity leave, limited workplace support and competing work demands that hinder exclusive breastfeeding despite repeated ANC exposure. However, there was no significant effect for mothers attending four or more ANC visits.

Table 5.

Adjusted Logistic Regression Model of Factors Associated with Exclusive Breastfeeding (EBF)

	(95% CI)
	Adjusted OR	Lower	Higher	P-Value
Maternal age
15–24 (RC)	1.000	1.000	1.000	1.000
25–34	0.131	0.035	0.497	0.003
35–44	0.600	0.110	3.267	0.553
45–49	0.047	0.002	1.085	0.056
Maternal education
No formal education (RC)	1.000	1.000	1.000	1.000
Primary	1.090	0.237	5.010	0.912
Secondary	1.335	0.337	5.281	0.679
Tertiary	16.700	1.278	218.229	0.032
Wealth index
Poor (RC)	1.000	1.000	1.000	1.000
Middle	0.585	0.149	2.294	0.441
Rich	0.318	0.076	1.335	0.117
Birth weight
Large (RC)	1.000	1.000	1.000	1.000
Average	1.120	0.355	3.533	0.846
Small	0.183	0.049	0.692	0.013
Sex of child
Male (RC)	1.000	1.000	1.000	1.000
Female	0.290	0.110	0.764	0.012
Parity
Primiparous (RC)	1.000	1.000	1.000	1.000
Multiparous	2.169	0.832	5.653	0.113
Grandparous	5.100	1.213	21.449	0.026
EIBF
Yes (RC)	1.000	1.000	1.000	1.000
No	0.902	0.315	2.582	0.846
Breast examined for cancer
No (RC)	1.000	1.000	1.000	1.000
Yes	2.631	0.634	10.912	0.182
Marital Status
Never Married (RC)	1.000	1.000	1.000	1.000
Ever Married	3.880	1.412	11.992	0.019
Sex of household head
Male (RC)	1.000	1.000	1.000	1.000
Female	5.067	1.078	16.398	0.029
Partner living together
Yes (RC)	1.000	1.000	1.000	1.000
No	0.789	0.234	2.658	0.702
Antenatal visits
No visit (RC)	1.000	1.000	1.000	1.000
1–3	10.849	2.324	205.562	0.010
4 or more	5.225	0.494	55.314	0.169
Access to healthcare
No (RC)	1.000	1.000	1.000	1.000
Yes	2.756	0.850	8.937	0.091
Place of delivery
Home (RC)	1.000	1.000	1.000	1.000
Health facility	0.501	0.073	3.459	0.482
Mode of delivery
Natural (RC)	1.000	1.000	1.000	1.000
Caesarean	0.522	0.143	1.903	0.323
Media exposure
Low (RC)	1.000	1.000	1.000	1.000
High	0.902	0.269	3.023	0.866
Source of drinking water
Unimproved (RC)	1.000	1.000	1.000	1.000
Improved	0.987	0.300	3.249	0.987
Religion of Women
No religion/Traditionalist (RC)	1.000	1.000	1.000	1.000
Islam	4.839	7.658	30.585	0.093
Christian	11.010	1.843	65.580	0.009
Ethnicity
Akan (RC)	1.000	1.000	1.000	1.000
Ga/Dangme	8.972	1.278	63.012	0.028
Ewe	11.357	2.249	57.358	0.003
Mole-Dagbani	4.204	1.078	16.398	0.039
Place of residence
Urban (RC)	1.000	1.000	1.000	1.000
Rural	0.661	0.214	2.044	0.471

Reference category: Non-exclusive breastfeeding

The wealth index was not a significant predictor. Compared to infants whose mothers were from poor homes, those from middle and rich homes were less likely to be exclusively breastfed. This is similar to a study conducted in Ecuador [41]. This may be linked to the greater likelihood of wealthier mothers engaging in formal employment with limited maternity leave, alongside easier access to formula and early complementary feeding, which can undermine exclusive breastfeeding despite improved economic resources.

The sex of the child was a significant predictor. Compared to male infants, female infants were less likely to be exclusively breastfed. This finding is consistent with previous studies conducted in Iran, Saudi Arabia and Ghana [42–44]. This may be attributed to gendered caregiving practices in which male infants are often viewed as more fragile or in greater need of nutritional support, prompting mothers to place greater emphasis on exclusive breastfeeding for boys than for girls.

The mode of delivery was not a significant predictor of exclusive breastfeeding. Infants born via caesarean section were less likely to be exclusively breastfed compared to those who had vaginal deliveries, though the association was not significant. This finding contradicts evidence from Southern India but aligns with results from China [45, 46]. This may be due to the shorter hospital stays and limited postnatal lactation support often associated with caesarean deliveries; however, strong cultural norms that encourage breastfeeding in Ghana may counterbalance these challenges, minimising any significant differences.

Similarly, high media exposure did not significantly predict exclusive breastfeeding. Infants whose mothers had high media exposure were not significantly more likely to be exclusively breastfed compared to those with low media exposure. This may echo the limited emphasis of Ghanaian media on exclusive breastfeeding, with messaging often focusing on general maternal and child health rather than practical breastfeeding guidance.

Breast examination for cancer was also not a significant predictor of exclusive breastfeeding. Infants whose mothers had undergone breast examination are more likely to be exclusively breastfed compared to those whose mothers had not. This is because mothers who get breast exams for cancer may be more likely to breastfeed exclusively, not because the exam itself helps, but because these women are often more connected to healthcare. They might receive better breastfeeding advice, feel more confident about their breast health, or simply be more proactive about following medical recommendations.

Early initiation of breastfeeding was not a significant predictor of exclusive breastfeeding. However, infants who were breastfed immediately after birth were significantly likely to be exclusively breastfed. This is consistent with previous findings from a study conducted in China, which found that mothers who breastfed their infants immediately after birth were likely to practice exclusive breastfeeding [46]. This may indicate the role of delivery practices and immediate postnatal counselling, where early skin-to-skin contact and breastfeeding initiation are encouraged but inconsistently implemented, influencing mothers’ ability to sustain EBF.

Religion is a significant predictor of exclusive breastfeeding, infants of Christian mothers were significantly more likely to be exclusively breastfed compared to those from no religion/traditional religions. The current findings support previous research that shows that Christian mothers are likely to practice exclusive breastfeeding [47]. This might be explained by the impact of religiously affiliated medical institutions and health education initiatives run by churches, which frequently highlight breastfeeding and other mother and child health practices.

However, Marital status was a significant predictor. Infants of mothers who were ever married had higher odds of being exclusively breastfed compared to those whose mothers were never married. This finding is consistent with studies by [48, 49], which found that married women were likely to exclusively breastfeed their infants compared to single mothers. This could be accounted for by the social and financial support that comes with marriage, which can help people follow suggested feeding guidelines.

Access to healthcare is not a significant predictor of EBF. Infants whose mothers had access to healthcare are likely to be exclusively breastfed compared to those whose mothers didn’t have access. While healthcare access theoretically supports exclusive breastfeeding (EBF) through education and resources, its lack of significance as a predictor suggests that other factors, like maternal motivation, cultural norms, or socioeconomic constraints, play a stronger role. Mothers with healthcare access may still choose formula due to work demands, social pressures, or misconceptions, while those without access might rely on EBF out of necessity (e.g., inability to afford formula) or traditional practice.

Although not statistically significant, women who delivered at health facilities were less likely to be exclusively breastfeeding their infants compared to those who delivered at home. This is consistent and dissimilar to previous findings, which found that the odds of exclusive breastfeeding were higher among infants who were delivered outside a health facility and delivery at a health facility was a significant predictor of exclusive breastfeeding [50, 51]. The discrepancy can result from variations in postnatal care and counselling among medical facilities. Some encourage early beginning, while others encounter obstacles, including cultural norms, a lack of staff, or inadequate direction. On the other hand, home births frequently facilitate early breastfeeding by enabling faster mother-child interaction and family influence.

Ethnicity also showed mixed results. Ewe ethnicity was significantly associated with higher odds of exclusive breastfeeding, while Ga/Dangme ethnicity was not significant. Moreover, Mole-Dagbani was not a significant predictor. These differences may be linked to cultural norms and community breastfeeding practices. For instance, some ethnic groups promote early initiation and prolonged breastfeeding as part of traditional child-care practices, while others incorporate prelacteal feeding or early supplementation, which can discourage exclusive breastfeeding.

Maternal age was a significant predictor of exclusive breastfeeding. Infants whose mothers were aged 25–34 (p = 0.013) were less likely to be breastfed exclusively compared to those whose mothers were aged 15–24. Other age groups did not show significant associations. These current findings support those of [49, 52], where it was reported that aged mothers are likely to do exclusive breastfeeding, suggesting that younger mothers may adhere more closely to recommended breastfeeding practices, potentially due to greater exposure to recent health education campaigns and antenatal counselling.

Maternal education level was not significantly associated with exclusive breastfeeding; however, higher education showed increased odds of exclusive breastfeeding. Infants whose mothers had a tertiary education are likely to be exclusively breastfed compared to those whose mothers had no formal education, which opposes findings from earlier studies in Southern India [45]. Higher education in Ghana may improve mothers’ awareness of the advantages of EBF and suggested feeding methods, as well as their openness to messages promoting health. However, the capacity of educated mothers to continue exclusive breastfeeding for six months may be limited by work-related limitations, such as short maternity leave and rigid employment schedules, as well as cultural and familial expectations.

Birth weight was a significant predictor. Working women who reported their child was small at birth were less likely to be exclusively breastfed compared to those whose infants were average in size (p = 0.017). This is consistent with studies in Zimbabwe and South Africa, where the latter stated that infant weights prompt mothers to add complementary diets to infants’ feeding before 6 months [53, 54]. Concerns about insufficient growth, susceptibility to disease, or perceived nutritional deficiencies may lead working moms to give supplemental foods earlier for babies who are thought to be small at birth.

The birth order of a child was also significant; second-born infants had higher odds of exclusive breastfeeding than firstborns (p = 0.003). Other birth order categories were not significant. It is obvious that mothers with prior breastfeeding experience may be more confident and skilled in managing infant feeding, leading to higher adherence to exclusive breastfeeding for subsequent children.

Place of residence was not a significant predictor. Infants whose mothers reside in rural areas are less likely to be exclusively breastfed compared to those in urban areas. This finding is consistent with a previous study [55]. However, this does not support a finding by [56] which found that there is an increasing likelihood of exclusive breastfeeding among mothers from rural residences. Most rural mothers engage in physically demanding work, such as subsistence farming, trading, or other informal labour, which can limit the time and energy available for frequent breastfeeding. Cultural practices and family pressures in rural communities may also encourage the early introduction of complementary foods.

The source of drinking water was not a statistically significant predictor of the outcome. Women who relied on improved sources of drinking water were less likely to experience the outcome than those using unimproved sources, though this relationship was not significant. While limited access to water may encourage continued breastfeeding as the safest option for infants, mothers with improved access to water may feel more comfortable introducing formula or other liquids earlier, which may influence decisions about complementary feeding rather than exclusive breastfeeding.

Furthermore, the parents living together did not significantly predict exclusive breastfeeding. Infants whose mothers are not living with their partners are less likely to be exclusively breastfed. Exclusive breastfeeding can be facilitated by the various sorts of support that cohabiting partners can offer. While financial help might make it possible to buy wholesome foods that promote lactation, emotional support from a spouse can lessen maternal stress and boost confidence in breastfeeding. Help with practical tasks, like childcare or housework, enables moms to spend more time breastfeeding.

Conclusion

To improve and sustain exclusive breastfeeding (EBF) among working mothers in Ghana, multiple strategies are needed. Maternal education and comprehensive antenatal counselling should be prioritised to enhance awareness of the benefits of EBF and equip mothers with practical skills to overcome breastfeeding challenges. Workplace policies, including extended maternity leave, flexible work arrangements and dedicated breastfeeding spaces, must be implemented to support mothers in balancing employment and infant care. Community and family support systems should be strengthened, with particular attention to cultural, ethnic and religious practices that influence breastfeeding behaviours. Targeted interventions are also necessary for subgroups with lower EBF rates, such as mothers of female infants, certain ethnic groups, or those in higher-wealth households, to promote equity in infant nutrition outcomes.

However, this study is limited by its use of cross-sectional secondary data, which captures only the current EBF status rather than the completed six-month EBF and therefore cannot establish causality. Despite this, the findings have important theoretical and practical implications: they highlight how socio-demographic, cultural and work-related factors interact to influence breastfeeding practices, supporting frameworks in maternal and child health that emphasise multi-level determinants of infant feeding behaviours. Policymakers, healthcare providers and community leaders can leverage these insights to design evidence-based, context-specific interventions aimed at improving EBF rates and ultimately enhancing child health and development outcomes in Ghana.

What is new?

• This study reports a higher prevalence of exclusive breastfeeding (86.31%) compared to earlier findings, providing an updated and more optimistic estimate for Ghana.

• Expands the range of factors influencing EBF, including access to healthcare, parents living together, sex of household, source of drinking and media exposure, offering new insights.

• This is the first study in Ghana to examine exclusive breastfeeding practices specifically among infants of working mothers, addressing an under-explored demographic in the context of maternal employment

Authors’ contributions

C.L. conceptualised the study, drafted the manuscript and oversight the study. J.S. was responsible for formal analysis and data curation. F.L. reviewed and proofread the manuscript, ensuring that it met academic standards and enhancing its clarity. C.M. contributed to the language editing, refining the manuscript’s grammar and overall readability. All authors reviewed and approved the final manuscript.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets analysed during the current study are publicly available in the DHS Program repository (https://dhsprogram.com/data) upon reasonable request and approval.

Ethics approval and consent to participate

The data used in this study were obtained from the Ghana Demographic and Health Survey (GDHS), which received ethical approval from the Ghana Health Service Ethical Review Committee and the ICF Institutional Review Board. Informed consent was obtained from all participants before data collection. For this secondary data analysis, no additional ethical approval was required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.