A Qualitative Analysis of Multilevel Barriers and Facilitators to Breastfeeding for Mothers Receiving Medication for Opioid Use Disorder

Background: As national rates of opioid use disorder (OUD) continue to persist, the resulting impact on the affected mother-infant dyad is immense. While there is concrete evidence in support of breastfeeding in women receiving medication for OUD, gaps in widespread support for breastfeeding in this population remain, leading to continued breastfeeding disparities. Purpose: Explore the multilevel barriers and facilitators to breastfeeding for mothers receiving medication for OUD. Methods: Semi-structured interviews were completed with a total of 29 participants (N = 14 mothers, N = 3 family members, and N = 12 providers). We used three levels of the socio-ecological model, including the individual, microsystem, and macrosystem, to guide our multiple case study analysis. Qualitative, latent content analysis was used to focus on identifying and understanding barriers and facilitators to breastfeeding across these various levels. Results: Participants across groups identified barriers to breastfeeding at all three socio-ecological model levels, while facilitators were only identified at the individual and microsystem levels. Across the different levels of the socio-ecological model, six subthemes emerged: (1) breastfeeding knowledge and readiness; (2) infant factors; (3) support; (4) daily routines; (5) organizational environment; and (6) policies. Implications for Practice and Research: Application of the socio-ecological model to identify barriers and facilitators to breastfeeding may inform approaches that are sustainable and more likely to improve rates of breastfeeding over time for mothers receiving medication for OUDs.