If the continuation of EBF was changed by providing complementary foods or products before six months, it was considered as cessation of EBF before six months. Even if the mother interrupted practicing EBF for a short while and then continued the EBF, this was also considered as cessation of EBF. The mean and median of the EBF duration were calculated.

The selected mothers (n = 338; two mothers did not agree to participate [response rate, 99.4%]) had 167 male children (49.4%), and the mean age of the total selected children was 24.2 (± 6.9) months. Low birth weight (LBW) (< 2500 g) babies were delivered by 16.3% (55 / 338) of the mothers. In this study, 88% gave birth vaginally. The majority of the mothers were Hindus (85.2%) (Table 1).

The highest percentage of mothers had three children (36.1%), while 14.8% of mothers had only one child (Table 1). This study found that 8.0%, 85.5% and 5.9% of the mothers, respectively, had education up to primary, secondary and tertiary levels, while two mothers (0.6%) had never attended schools (Table 1).

The total family income included the total income of all family members. The median and mean monthly income were LKR (Sri Lankan Rupee) 20,000.00 [interquartile range (IQR) = 15,000.00] and LKR 24,351.04 (± 15,022.36), respectively.

Household assets were considered to construct wealth status based on the principal component analysis [19, 20] and classified as poor, second, middle, and fourth classes. The majority of the mothers (47.3%) were from the middle class and equal numbers were from the poor and fourth classes (11.5%) (Table 2).

Of the total of 338 mothers, only 208 mothers who had children between six and 23 months of age were selected for the assessment of EBF, as the other 130 mothers had children older than 24 months and found it difficult to recall the information on EBF (Fig. 1). EBF as recommended by the WHO was practiced by 71.2% of the mothers (180 days).

EBF was higher for female babies (53.4%) than for male babies (46.6%) (p ≥ 0.05) (Table 3). In this present study, 67.6% of male and 74.5% of female babies were exclusively breastfed (p ≥ 0.05). The mean birth weight of the EBF babies was 2947.48 (± 467.46) g, and 9.5% of the mothers had LBW babies (< 2500 g) (Table 3).

Exclusive breastfeeding was practiced by 89.2% of mothers who had a vaginal delivery, while 10.8% of the mothers had a Caesarean section. Only 51.6% of the mothers who had Cesarean section exclusively breastfed.

Exclusive breastfeeding was practiced by 43.2% and 56.8% of mothers from extended and nuclear families, respectively (p ≥ 0.05) (Table 3). Of these mothers from 12.5% and 9.5%, respectively, had caesarean deliveries res.

In the selected population, 85.1% of mothers were Hindus. Exclusive breastfeeding was practiced by almost an equal percentage of Hindu (70.4%) and Christian (75.9%) mothers. However, among the exclusively breastfeeding group, were more Hindus (85.1%) than Christian mothers (14.9%) (Table 3).

Exclusive breastfeeding was practiced by more mothers who had one child (52%) than those with two or more children (Table 3). However, among the EBF mothers, those with three children were more in numbers (Table 3).

More of the mothers who had an education up to the senior secondary or higher level practiced EBF (50.3%) (Table 3). However, the mothers who had an educational level up to the junior secondary level were the highest among those who practiced EBF (44.6%), whereas 35% was the highest among those who had not EBF (p < 0.05).

Only 68.2% of the mothers who were aware of the WHO recommendation for the duration of EBF as six months practiced EBF (Table 3).

Among mothers, 47.1% of those who were unemployed and 50.0% who had professional jobs practiced EBF (Table 3). Of the employed and unemployed mothers who practiced EBF, 82.4% and 66.4%, respectively, had knowledge on EBF. The present study observed that 76.5% and 23.5% of the employed Hindus and Christian mothers, respectively and 86.3% and 13.7% of the unemployed Hindus and Christian mothers, respectively practiced EBF.

The majority of the 338 mothers were from families (47.0%) which had a monthly income of LKR < 19,999. Of the mothers who practiced EBF (n = 148), 37.2%, 52.7% and 10.1% were from families that had a monthly income of LKR 19,999.99, 20,000.00–39,999.99, and > 40,0000.00, respectively (Table 3).

The highest number of the mothers belonged to the middle class (n = 160), while a higher number of poor-classed mothers practiced EBF (53.8%). However, among those who practiced EBF, were more middle-classed mothers who practiced EBF followed by those from the second class. EBF was practiced by 70.0%, 73.8%, 77.3% and 44.0% of mothers from poor, second, middle, and fourth classes of wealth status, respectively (Table 3).

Results for mothers (n = 60) who did not abide by the WHO recommendation, to practice EBF for six months (28.8%) are shown in Tables 4 and 5. Table 4 gives information on the early cessation of EBF by 1st, 2nd, 3rd, 4th and 5th months. About 10% of the mothers ceased EBF by the 1st month, while 28.3% of the mothers ceased EBF by the 3rd month.

More mothers with male babies ceased EBF before the 4th month, but during the 4th month, the majority of the mothers with female babies ceased EBF (Table 4). Among the 60 mothers, more mothers with male babies (55%) ceased EBF before the completion of six months than those who had female babies (45%).

The mean birth weight of the babies who were not EBF for six months was 2779.48 (± 475.81) g. Among these babies, 30% had LBW babies (< 2500 g) (Table 4). EBF up to six months was more for normal birth weight babies than for the LBW babies (Table 4).

The early cessation of EBF was by 75% of the mothers who had normal vaginal deliveries. Almost the same number of mothers ceased EBF by the 2nd, 3rd, 4th and 5th months, while a higher number of mothers who had vaginal delivery ceased EBF by the 3rd, 4th and 5th months (Table 4).

A higher number of mothers from nuclear families ceased EBF (63.3%) than those from the extended families (36.7%) (p ≥ 0.05). The cessation of EBF by the mothers from nuclear families increased from the 1st to the 5th months, while the numbers fluctuated among the mothers from extended families (Table 4).

Among the 60 mothers who ceased EBF, only one Christian mother ceased EBF at the increased with time by the Hindu mothers. Among the mothers who ceased EBF early, 88.3% and 11.7% were Hindu or Christian, respectively (p ≥ 0.05). The Hindu and Christian mothers who had a Cesarean section and ceased EBF early were 26.4% and 14.3%, respectively, from extended families and 64.2% and 57.1%, respectively, were from nuclear families.

More mothers who had two (38.3%) or three (33.3%) children ceased EBF earlier than those with only one child (11.7%) (Table 4). The mothers with four or more children or fewer than four children and who ceased EBF early had 30.0% and 30.0% LBW children, respectively. In this study, more mothers with senior secondary level education (53.3%), ceased EBF than mothers with other levels of education (Table 5).

Among the mothers who had ceased EBF early, 76.7% were aware of the WHO recommended duration of EBF for six months and, among them, 23.9% had LBW babies, 19.6% had a Cesarean section, and 60.9% were from nuclear families (Table 5).

Among the mothers who ceased EBF early, 75.0% were unemployed (Table 5). More employed mothers (80.0%) who ceased EBF early had knowledge of EBF than unemployed mothers (75.6%). Further, 86.7% and 13.3% of the employed Hindu and Christian mothers, respectively, and 88.9% and 11.1% of the unemployed Hindu and Christian mothers, respectively, ceased EBF early. Among these mothers, 13.3%, 40.0%, and 46.7% of the employed mothers, respectively, had > 3, 3, and 2 children and among the unemployed mothers, and 17.8%, 31.1% and 35.6%, and 15.6%, respectively, had > 3, 3, and 2 children and one child (Table 5).

Of the mothers who ceased EBF early, the majority (58.3%) had a monthly family income of LKR 19,999.99 (Table 5). The majority of mothers who had a LBW baby (34.3%) who ceased EBF had a total monthly income of LKR < 19,999.00 followed by those who had LKR 19,999.00–39,999.99 (31.3%). Mothers who had a vaginal delivery (75.0%) and ceased EBF early had a total monthly income of LKR < 19,999.99 and had 22.2% of LBW babies.

Early cessation of EBF was highest (33.3%) among those who were from middle-class wealth status (Table 5). The mothers from the poor class who ceased EBF early had 55.6% LBW babies, followed by those from the fourth (42.9%) and second classes (35.6%).