Global and Indonesian guidelines suggest that breastfeeding should continue for at least the first two years of life. While many studies have focused on six-month exclusive breastfeeding practices, little is known about why mothers do not sustain breastfeeding beyond this period. This qualitative study aimed to explore factors influencing breastfeeding continuation and formula feeding beyond six months, regardless of any additional food consumed, focusing on Indonesia’s rural and urban areas. We collected the data through 46 in-depth interviews in Pati District and Surakarta City, Central Java, Indonesia. Participants were mothers, grandmothers, health care practitioners, and village kader (frontline female health workers). We used thematic analysis combining deductive and inductive techniques for analysing the data. Rural mothers practised breastfeeding and intended to breastfeed for a longer duration than urban mothers. Maternal attitude towards breastfeeding, breastfeeding knowledge, previous experiences, and other breastfeeding strategies (e.g., enhancing maternal dietary quality) positively influenced breastfeeding sustainability. In the urban setting, mothers encountered several breastfeeding barriers, such as perceived breast milk insufficiency and child hunger and satiety, child biting, and breastfeeding refusal, causing them to provide formula milk as a breast milk substitute or supplement. In addition, families, communities, health practitioners, and employment influenced maternal decisions in breastfeeding continuation and formula-feeding practices. Optimal breastfeeding practices up to two years of age are determined by the individual and setting (i.e., community, healthcare, employment) factors. Providing breastfeeding education covering practical breastfeeding guidance will encourage mothers to breastfeed for longer. Such interventions should involve families, communities, health workers, and the work environment as a breastfeeding support system. Policymakers should develop, enforce, and monitor the implementation of breastfeeding policies to protect, promote, and support breastfeeding in households, communities, health systems, and work settings.

中文翻译：

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影响印度尼西亚农村和城市家庭六个月以上继续母乳喂养和配方奶喂养的因素：定性调查

全球和印度尼西亚指南建议，母乳喂养至少应持续到生命的头两年。虽然许多研究都集中在六个月的纯母乳喂养实践上，但对于母亲在这段时间之后不再维持母乳喂养的原因知之甚少。这项定性研究旨在探讨影响六个月以上继续母乳喂养和配方奶喂养的因素，无论是否消耗任何额外食物，重点关注印度尼西亚的农村和城市地区。我们通过对印度尼西亚中爪哇省帕蒂区和梭罗市的 46 次深度访谈收集了数据。参与者包括母亲、祖母、医护人员和乡村卡德尔（一线女性卫生工作者）。我们使用主题分析结合演绎和归纳技术来分析数据。农村母亲实行母乳喂养，并且打算母乳喂养的时间比城市母亲更长。母亲对母乳喂养的态度、母乳喂养知识、以往的经验和其他母乳喂养策略（例如，提高母亲饮食质量）对母乳喂养的可持续性产生积极影响。在城市环境中，母亲们遇到了一些母乳喂养障碍，例如认为母乳不足、孩子饥饿和饱腹、孩子咬人、拒绝母乳喂养，导致她们提供配方奶作为母乳替代品或补充品。此外，家庭、社区、保健人员和就业也会影响母亲继续母乳喂养和配方奶喂养的决定。两岁以下的最佳母乳喂养方式取决于个人和环境（即社区、医疗保健、就业）因素。提供涵盖实用母乳喂养指导的母乳喂养教育将鼓励母亲延长母乳喂养时间。此类干预措施应涉及家庭、社区、卫生工作者和工作环境，作为母乳喂养支持系统。政策制定者应制定、执行和监督母乳喂养政策的实施，以保护、促进和支持家庭、社区、卫生系统和工作环境中的母乳喂养。