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Background  Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals.    Methods  Mixed methods were conducted between May and July 2017, including surveys ( n  = 543) and semi-structured interviews ( n  = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15–49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico.    Results  Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%;  p  < 0.05) and those who received information during pregnancy (OR 1.07;  p  = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05;  p  < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13;  p  = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46;  p  = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists.    Conclusions  Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach