Background: Optimal breastfeeding and complementary feeding practices are critical for infant survival, nutrition, and development. Despite clear World Health Organization (WHO) guidelines, significant knowledge gaps and misconceptions persist among mothers, particularly in diverse socio-cultural settings like rural India. The present study aimed to assess the knowledge of breastfeeding and complementary feeding practices among pregnant women in the Solan district of Himachal Pradesh, identify knowledge gaps, and explore the influence of socio-demographic factors. Materials and Methods: A descriptive, cross-sectional, online survey was conducted from January to March 2025 among 400 pregnant women residing in Solan district. Participants were recruited using purposive and snowball sampling via online antenatal forums and healthcare platforms. A pre-validated bilingual questionnaire assessed socio-demographic information, knowledge regarding breastfeeding and complementary feeding, and sources of information. Knowledge scores were categorized into very good (≥80%), good (60-79%), fair (41-59%), and poor (<40%) levels. Data were analyzed using SPSS version 26.0 with descriptive statistics to summarize findings. Results: Of the 400 respondents, the majority (41.0%) were aged 26-30 years, with 65.0% residing in rural areas. Most were in their second (38.0%) or third (38.0%) trimester, and 47.0% were primiparous. Regarding knowledge, 82.0% knew breastfeeding should start within one hour of birth, and 79.0% recognized six months as the exclusive breastfeeding period. Awareness about colostrum benefits (77.3%) and breastfeeding’s role in infection prevention (81.0%) was strong; however, fewer participants demonstrated correct knowledge regarding iron-rich complementary foods (67.0%) and the maternal health benefits of breastfeeding (63.3%). Overall, 31.0% of participants had very good knowledge, 43.0% had good knowledge, 19.0% had fair knowledge, and 7.0% had poor knowledge, indicating the need for intensified antenatal educational efforts. Conclusion: While baseline knowledge regarding breastfeeding and complementary feeding among pregnant women in Solan is encouraging, significant gaps persist, especially in nuanced areas such as complementary feeding timing, nutrient adequacy, and breastfeeding during maternal illness. Strengthening antenatal counseling, addressing cultural misconceptions, and promoting structured community-based education initiatives are essential to improving infant feeding practices and maternal-child health outcomes in the region.
Optimal infant and young child feeding practices, particularly breastfeeding and complementary feeding, are fundamental to ensuring child survival, growth, and development. Breastfeeding is universally recognized as a cornerstone of child nutrition and health, providing essential nutrients, strengthening the immune system, and fostering a vital bond between mother and infant [1,2]. The World Health Organization (WHO) recommends exclusive breastfeeding for
the first six months of life, followed by the introduction of nutritionally adequate and safe complementary foods while continuing breastfeeding up to two years of age or beyond [3,4]. Despite clear global and national guidelines emphasizing these practices, substantial gaps in maternal knowledge and feeding behaviors persist, particularly in diverse socio-cultural settings.
In India, where maternal and child health remains a public health priority, breastfeeding rates have shown improvement over recent decades. However, early initiation of breastfeeding, exclusivity for six months, and timely, appropriate complementary feeding still face significant challenges, particularly in rural and semi-urban populations. Myths, misconceptions, inadequate family support, cultural beliefs, lack of access to accurate information, and poor counseling by healthcare providers often contribute to suboptimal feeding practices. These practices can have serious implications, including increased risk of malnutrition, infections, developmental delays, and infant mortality [5-7].
The district of Solan in Himachal Pradesh, characterized by its blend of rural and urban communities, evolving healthcare infrastructure, and socio-cultural diversity, presents a unique context for exploring maternal knowledge related to breastfeeding and complementary feeding. Although healthcare services have improved in the district, particularly with the strengthening of maternal and child health programs, localized data regarding pregnant women's understanding of recommended feeding practices remains limited. Considering that pregnancy is a critical period for shaping maternal intentions and behaviors, assessing knowledge at this stage can provide crucial insights for early intervention and behavior change strategies.
This study aims to evaluate the knowledge of pregnant women in Solan district regarding breastfeeding and complementary feeding practices, identify gaps and misconceptions, and explore socio-demographic factors influencing knowledge levels. The findings are intended to inform the design of culturally appropriate educational interventions and healthcare provider training programs to promote optimal infant feeding practices, ultimately contributing to better maternal and child health outcomes in the region.
This research utilized a descriptive, cross-sectional survey design aimed at evaluating the knowledge of pregnant women regarding breastfeeding and complementary feeding practices. The cross-sectional nature of the study allowed for the collection of real-time, self-reported data through an online platform, providing an immediate overview of knowledge levels among the target population.
The study was conducted among pregnant women residing in the Solan district of Himachal Pradesh. Participants included women from a range of rural, semi-urban, and urban areas within the district, ensuring representation of diverse socio-economic and educational backgrounds. The target population comprised pregnant women of any gestational age, regardless of parity, with the capacity to understand and respond to an online survey.
The data collection was carried out over a three-month period, from January to March 2025. This timeframe allowed sufficient opportunity to engage pregnant women attending antenatal check-ups and those reachable through online community groups and healthcare networks.
Based on a 95% confidence interval, 5% margin of error, and an assumed 50% prevalence of adequate knowledge regarding infant feeding practices, a minimum sample size of 400 participants was determined. A purposive and snowball sampling technique was employed, whereby initial participants were identified through online antenatal groups, healthcare WhatsApp communities, social media pages, and hospital-linked platforms. Participants were encouraged to share the survey link with other eligible pregnant women within their networks to broaden the reach.
Inclusion Criteria
Pregnant women aged 18 years and above residing in Solan district
Ability to understand and complete the survey in Hindi or English
Access to an internet-enabled device (smartphone, tablet, or computer)
Willingness to provide informed consent before participation
Exclusion Criteria
Women undergoing high-risk pregnancies requiring immediate hospitalization at the time of survey participation
Healthcare professionals (doctors, nurses, dietitians) and medical students
Incomplete or partially submitted survey responses
A structured, pre-validated, bilingual (Hindi and English) questionnaire was developed in consultation with experts in maternal and child health, public health, and nutrition. The survey was hosted online using Google Forms, ensuring easy accessibility and user-friendliness for participants. The questionnaire was divided into four main sections:
Demographic Information: Including age, education level, occupation, gestational age, parity, and residence (urban or rural)
Knowledge of Breastfeeding: Covering early initiation, exclusivity duration, benefits, challenges, and breastfeeding techniques
Knowledge of Complementary Feeding: Covering timing of initiation, appropriate food choices, frequency, and continuation of breastfeeding alongside complementary foods
Sources of Information: Exploring where participants had received breastfeeding and complementary feeding guidance (e.g., healthcare providers, family, media).
Each correct response was awarded one point, while incorrect or “don’t know” answers received zero points. Based on total scores, participants’ knowledge was classified into the following categories:
Very Good Knowledge: ≥80% correct responses
Good Knowledge: 60%-79% correct responses
Fair Knowledge: 41%-59% correct responses
Poor Knowledge: <40% correct responses
Participants accessed the online survey link, which was shared through antenatal care support groups, community forums, and healthcare outreach initiatives. The link included an information sheet detailing the study’s objectives, voluntary nature, confidentiality assurances, and an informed consent declaration. Only participants who agreed to the consent statement could proceed to complete the questionnaire. All responses were anonymous, and submission of the completed form implied consent to participate.
Participation was entirely voluntary, and confidentiality of all responses was maintained throughout the study. No personal identifiers were collected, and all procedures complied with the ethical standards of the Declaration of Helsinki for research involving human participants.
Table 1 presents the socio-demographic profile of the 400 pregnant women surveyed in the Solan district. The majority of participants (41.0%) were aged between 26-30 years, followed by 28.0% in the 18-25 years age group, indicating a predominantly young maternal population. Most women were in their second (38.0%) or third trimester (38.0%) of pregnancy, with a fairly even distribution between primiparous (47.0%) and multiparous (53.0%) participants. In terms of education, 37.0% had completed secondary schooling, 30.0% held undergraduate degrees, and 9.0% had postgraduate qualifications, suggesting a moderately educated cohort, although 6.0% had no formal education. Homemakers constituted the largest occupational group (39.0%), followed by self-employed women (20.0%) and the unemployed (20.0%), reflecting a socio-economic diversity. Notably, 65.0% of the participants resided in rural areas, emphasizing the need for targeted maternal health education initiatives in less urbanized settings.
Table 2 highlights the awareness and knowledge levels of the participants regarding breastfeeding and complementary feeding practices. A strong majority (82.0%) knew that breastfeeding should be initiated within one hour of birth, and 79.0% correctly identified that exclusive breastfeeding should continue for six months. Awareness about the benefits of colostrum (77.3%), breastfeeding's role in infection prevention (81.0%), and the importance of complementary feeding initiation at six months (74.3%) was encouraging. However, knowledge about the necessity of iron-rich complementary foods (67.0%), the risks of inadequate complementary feeding (78.0%), and breastfeeding's potential to reduce maternal breast cancer risk (63.3%) revealed areas needing improvement. Positively, 84.0% recognized that healthcare providers should guide breastfeeding practices. Overall, while basic knowledge was strong across many domains, gaps remained in specific technical aspects such as the continuation of breastfeeding during maternal illness (70.8%) and understanding the need for nutrient-dense complementary foods (73.3%).
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18-25 | 112 | 28.0 |
26-30 | 164 | 41.0 | |
31-35 | 92 | 23.0 | |
36 and above | 32 | 8.0 | |
Gestational age | First trimester | 96 | 24.0 |
Second trimester | 152 | 38.0 | |
Third trimester | 152 | 38.0 | |
Parity | Primiparous | 188 | 47.0 |
Multiparous | 212 | 53.0 | |
Education level | No formal education | 24 | 6.0 |
Primary school | 72 | 18.0 | |
Secondary school | 148 | 37.0 | |
Undergraduate degree | 120 | 30.0 | |
Postgraduate degree | 36 | 9.0 | |
Occupation | Homemaker | 156 | 39.0 |
Self-employed | 80 | 20.0 | |
Government employee | 44 | 11.0 | |
Private sector | 40 | 10.0 | |
Unemployed | 80 | 20.0 | |
Residential setting | Urban | 140 | 35.0 |
Rural | 260 | 65.0 |
Table 2: Awareness and knowledge of breastfeeding and complementary feeding among participants
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | When should breastfeeding be initiated? | a) After 24 hours, b) Within 1 hour of birth, c) After 6 hours, d) After 12 hours | 328 | 82.0 |
2 | How long should exclusive breastfeeding continue? | a) 3 months, b) 6 months, c) 9 months, d) 12 months | 316 | 79.0 |
3 | Does colostrum benefit the newborn? | a) Yes, b) No, c) Only for preterm babies, d) Only if mother is healthy | 309 | 77.3 |
4 | Can breastfeeding reduce infant infections? | a) Yes, b) No, c) Only in first month, d) Only in rural areas | 324 | 81.0 |
5 | When should complementary feeding begin? | a) 3 months, b) 6 months, c) 9 months, d) 12 months | 297 | 74.3 |
6 | Should breastfeeding continue after introducing complementary foods? | a) Yes, b) No, c) Only for 1 year, d) Only if infant demands | 302 | 75.5 |
7 | Is breast milk sufficient alone for the first 6 months? | a) Yes, b) No, c) Only for preterm babies, d) Only with water | 288 | 72.0 |
8 | Can improper breastfeeding technique cause nipple pain? | a) Yes, b) No, c) Only in first-time mothers, d) Only with infection | 314 | 78.5 |
9 | Are mashed fruits suitable as early complementary foods? | a) Yes, b) No, c) Only after 1 year, d) Only with cereals | 279 | 69.8 |
10 | Does breastfeeding promote mother-infant bonding? | a) Yes, b) No, c) Only in early months, d) Only in rural areas | 334 | 83.5 |
11 | Can complementary foods include iron-rich options? | a) Yes, b) No, c) Only after 1 year, d) Only for anemic infants | 268 | 67.0 |
12 | Is frequent breastfeeding important for milk production? | a) Yes, b) No, c) Only in first month, d) Only if infant is hungry | 321 | 80.3 |
13 | Can breastfeeding reduce maternal breast cancer risk? | a) Yes, b) No, c) Only in young mothers, d) Only with long duration | 253 | 63.3 |
14 | Should complementary foods be homemade initially? | a) Yes, b) No, c) Only in urban areas, d) Only with packaged foods | 286 | 71.5 |
15 | Can inadequate complementary feeding cause malnutrition? | a) Yes, b) No, c) Only in rural areas, d) Only in preterm infants | 312 | 78.0 |
16 | Is water necessary during exclusive breastfeeding? | a) Yes, b) No, c) Only in summer, d) Only for formula-fed babies | 274 | 68.5 |
17 | Should complementary foods be nutrient-dense? | a) Yes, b) No, c) Only after 1 year, d) Only for vegetarians | 293 | 73.3 |
18 | Which is NOT a benefit of breastfeeding? | a) Immune support, b) Growth promotion, c) Bonding, d) Vision correction | 259 | 64.8 |
19 | Can breastfeeding be continued during maternal illness? | a) Yes, b) No, c) Only with doctor’s advice, d) Only in mild illness | 283 | 70.8 |
20 | Who should guide breastfeeding practices? | a) Family, b) Healthcare provider, c) Friends, d) Self | 336 | 84.0 |
Table 3: Knowledge score classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 124 | 31.0 |
Good | 60%-79% | 172 | 43.0 |
Fair | 41%-59% | 76 | 19.0 |
Poor | <40% | 28 | 7.0 |
Table 3 categorizes participants based on their total knowledge scores regarding breastfeeding and complementary feeding. About 31.0% of the pregnant women demonstrated "Very Good" knowledge (≥80% correct answers), while the largest proportion (43.0%) achieved "Good" knowledge (60%-79% correct answers), indicating that a majority had an appreciable understanding of recommended infant feeding practices. Nevertheless, 19.0% were classified under "Fair" knowledge (41%-59%), and 7.0% fell into the "Poor" knowledge category (<40%), highlighting that approximately one-quarter of the participants possessed only moderate or insufficient knowledge. These results emphasize the need for strengthened antenatal counseling and community-based education programs to bridge these knowledge gaps and promote optimal breastfeeding and complementary feeding practices among expectant mothers in Solan district.
This study provides valuable insights into the knowledge levels regarding breastfeeding and complementary feeding among pregnant women residing in the Solan district of Himachal Pradesh. The findings emphasize both strengths and gaps in maternal understanding at a critical time when proper knowledge could directly influence future infant feeding practices and, consequently, child health outcomes. The predominantly young age distribution, with over two-thirds of participants aged below 30 years, highlights a population segment that stands to greatly benefit from early, targeted educational interventions during antenatal care.
Encouragingly, a substantial proportion of respondents demonstrated good awareness regarding essential breastfeeding practices. A strong majority (82.0%) knew the importance of initiating breastfeeding within the first hour of birth, a crucial practice for improving neonatal outcomes and promoting early mother-infant bonding. Similarly, 79.0% were aware that exclusive breastfeeding should continue for the first six months of life, aligning with WHO and national recommendations. Awareness about the immunological and nutritional benefits of colostrum (77.3%) and breastfeeding’s role in infection prevention (81.0%) was also commendable. These findings suggest that basic messages on breastfeeding promotion are being disseminated relatively effectively through antenatal care visits, healthcare workers, and community outreach programs in Solan.
Despite these positive trends, several critical knowledge gaps were identified. Only 74.3% correctly recognized six months as the appropriate time to introduce complementary foods, and even fewer (67.0%) acknowledged the need for iron-rich complementary foods. These findings highlight potential risks of early or delayed complementary feeding, which can predispose infants to malnutrition, anemia, and growth faltering. Furthermore, only 63.3% of women were aware of the protective effect of breastfeeding against maternal breast cancer, indicating a missed opportunity for reinforcing breastfeeding as a maternal health-promoting behavior. Knowledge about breastfeeding during maternal illness (70.8%) and the need for nutrient-dense complementary foods (73.3%) also revealed room for improvement.
Another area of concern was the misperception surrounding water supplementation during exclusive breastfeeding. Although 68.5% correctly identified that water is unnecessary during the first six months, a significant proportion still harbored misconceptions, especially common in summer months when cultural practices sometimes recommend early water introduction. Additionally, while 84.0% of participants trusted healthcare providers for breastfeeding advice, reliance on family members and traditional practices still plays a strong role in rural settings, as suggested by responses in knowledge-related questions.
The knowledge score distribution further illustrates the diversity of understanding among the study participants. While it is reassuring that 74% of respondents fell into the "Very Good" and "Good" knowledge categories, the fact that approximately one-quarter of pregnant women had only "Fair" or "Poor" knowledge signals an urgent need for intensified educational strategies. These vulnerable groups may be at a higher risk of adopting suboptimal infant feeding practices, thus perpetuating the cycle of child undernutrition and morbidity.
Socio-demographic factors likely influenced knowledge levels. Higher educational attainment, urban residence, and engagement with antenatal care services have been previously shown to correlate with better awareness and feeding practices, a trend that appears consistent in this study where rural participants constituted a majority (65.0%), pointing to a potential target group for enhanced outreach. Furthermore, given that 47.0% of participants were primiparous, the antenatal period represents a particularly critical "window of opportunity" for shaping positive breastfeeding intentions and behaviors among first-time mothers.
The online method of data collection, while beneficial for wide reach and rapid response, may have introduced selection bias favoring women with better access to technology and higher literacy levels, potentially inflating knowledge scores. Nevertheless, the findings reflect a significant need for reinforcing breastfeeding and complementary feeding education not only at individual and family levels but also through structured community interventions.
From a public health perspective, these findings underscore the importance of integrating comprehensive, evidence-based infant feeding education into routine antenatal care services. Strategies should include structured breastfeeding counseling sessions, myth-busting workshops, peer support groups, and widespread dissemination of culturally appropriate educational materials in both rural and urban settings. Engaging family members, especially mothers-in-law and husbands, in breastfeeding promotion programs could also be instrumental in fostering an enabling environment for optimal infant feeding practices [8,10].
In conclusion, while basic knowledge about breastfeeding and complementary feeding among pregnant women in Solan is reasonably encouraging, significant knowledge gaps persist, especially regarding the nuances of complementary feeding, maternal benefits of breastfeeding, and practices during maternal illness. Addressing these gaps through targeted, culturally sensitive interventions during antenatal care has the potential to substantially improve breastfeeding practices, child nutrition, and maternal health outcomes in the district.
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