Experiences of breastfeeding support providers with breastfeeding counselling and support training and its application in practice in peri-urban Karachi, Pakistan: a qualitative study

Abstract

Breastfeeding counselling and peer support are effective strategies for promoting optimal breastfeeding practices and improving mothers’ breastfeeding experiences, particularly in low- and middle-income countries. However, limited evidence exists on how breastfeeding support providers experience structured breastfeeding counselling and support training and apply acquired knowledge and skills in underserved communities. This study explored the experiences of breastfeeding support providers regarding breastfeeding counselling and support training and its application in peri-urban Karachi, Pakistan. This exploratory qualitative study was conducted as a nested sub-study of the BRANCH (BReAstfeediNg Counselling and Management of GrowtH) multicentre trial. Data were collected in February 2025 through focus group discussions with breastfeeding counsellors and peer counsellors and in-depth interviews with a lactation consultant and a pediatrician involved in programme implementation. Purposive maximum-variation sampling was used to recruit participants with diverse roles and experiences. Thirty-seven female participants were included. Interviews and discussions were audio-recorded, transcribed verbatim, translated into English where necessary, and analysed using Braun and Clarke’s reflexive thematic analysis. Three overarching themes and eight subthemes were generated. Participants described the training as a valuable capacity-building opportunity that enhanced breastfeeding knowledge, counselling competencies, communication skills, and professional confidence. Demonstrations, role plays, supervised practice, and clinical exposure were viewed as particularly useful in preparing participants to support mothers experiencing breastfeeding difficulties. Participants reported applying acquired skills through individualized counselling, breastfeeding assessments, practical demonstrations, problem-solving support, and engagement with family members. They perceived improvements in mothers’ awareness, confidence, and acceptance of recommended breastfeeding practices following repeated counselling interactions. Barriers included breastfeeding misconceptions, sociocultural and family influences, maternal emotional distress, health system constraints, lack of privacy, and limited preparation for managing complex breastfeeding situations. Breastfeeding support providers perceived structured breastfeeding counselling and support training as beneficial for strengthening knowledge, counselling competencies, communication skills, and confidence in providing community-based support. Practical skills-based training, ongoing mentorship, culturally responsive counselling, and family engagement may strengthen breastfeeding support programmes in underserved peri-urban communities.