**Background:** Breastfeeding is the optimal source of nutrition for neonates, reducing mortality and morbidity from diarrhea, otitis media, necrotizing enterocolitis, and sudden infant death syndrome. Despite global recommendations for exclusive breastfeeding (EBF) for the first six months and initiation within one hour of birth, rates remain suboptimal worldwide. India accounts for 20% of global child fatalities, with malnutrition contributing to nearly 50% of under-five deaths. In rural Bankura, West Bengal, female literacy (60.44%) is below the national average (65.46%), potentially impacting breastfeeding practices. This study aimed to assess breastfeeding knowledge and practices among mothers attending a tertiary care facility in this underserved region.
**Methods:** A hospital-based cross-sectional study was conducted from January 1 to June 30, 2022, at Bankura Sammilani Medical College and Hospital's pediatric outpatient department. Inclusion criteria were mothers with at least one living child aged 6 months to 2 years who consented to participate. Exclusion criteria included non-consent, medical contraindications to breastfeeding, or adoption. Using a formula (n=Zα²×P×(1-P)/d²) with 95% confidence interval, 65% expected EBF prevalence, and 5% precision, the calculated sample size was 350, increased to 400 to account for 15% non-response. A pretested 30-item interviewer-administered questionnaire covered demographics (11 questions), breastfeeding knowledge (11 questions), and practices (8 questions). Knowledge was scored as good (7-11), fair (4-6), or poor (0-3); practice as good (4-8), fair (2-3), or poor (0-1). Data were analyzed using Epi Info version 3.5.1 with chi-square tests; p<0.05 was considered significant.
**Key Results:** Among 400 mothers, 78% were ≤25 years old, 93% resided in rural areas, 67% had education up to grade 10 or less, and 87% were homemakers. Only 68% had heard of EBF, with 62% learning from healthcare professionals and 29% from family members. Only 23% knew breastfeeding should start within one hour of birth. Regarding EBF duration, 45% correctly identified six months, while 28% did not know. Alarmingly, 67% had not heard of colostrum, and 39% believed colostrum should be discarded. Prelacteal feeds were known to 20% of mothers, with honey being the most common (16%). Only 29% recognized that breastfeeding benefits both mother and baby, and only 9% knew breastfeeding should continue for two years. Overall, 49% had good knowledge, 36% fair, and 15% poor. In practice, only 36% initiated breastfeeding within one hour, 57% gave colostrum, 67% gave breast milk as first feed, and 33% administered prelacteal feeds. EBF for six months was practiced by 53%, and 61% introduced solid foods at six months. Breastfeeding continued beyond six months in 81% of cases. Statistically significant associations with better EBF knowledge were found for maternal age >25 years (p=0.001), education beyond grade 10 (p=0.000), working mothers (p=0.000), and multiparity (p=0.000), but not family income (p=0.766). Similarly, EBF practice was significantly associated with age >25 (p=0.002), education >grade 10 (p=0.000), being a homemaker (p=0.000), and multiparity (p=0.000), but not income (p=0.509).
**Clinical Implications:** The EBF rate of 53% in this rural population falls below India's NFHS-5 national average of 63.7%, though it slightly exceeds the WHO 2025 target of 50%. Critical knowledge deficits—particularly regarding early initiation (only 23% aware), colostrum (67% unaware), and maternal-child benefits of breastfeeding (only 29% aware)—highlight urgent targets for intervention. The finding that 39% of mothers believed colostrum should be discarded, yet 57% actually gave it, suggests that traditional practices may sometimes override harmful beliefs, but also indicates substantial room for improvement through education. The significant associations of higher education and multiparity with better outcomes suggest that antenatal counseling and peer education programs targeting younger, less educated, and primiparous mothers could be effective. The lack of association with family income implies that knowledge deficits are not purely economic but relate to information access and health literacy. The authors recommend integrating breastfeeding education into school curricula, enhancing media promotion, and strengthening healthcare system counseling to address these gaps and reduce under-five mortality.