Prevalence of exclusive breastfeeding practices and associated factors among employed and unemployed mothers: a community-based, comparative cross-sectional study in the Arada sub city, Addis Ababa, Ethiopia, 2024

Abstract Background Exclusive breastfeeding is defined as feeding infants only breast milk for the first six months of life, with no additional liquids or solids except prescribed medicines, vitamins, or mineral supplements. This study aimed to compare the prevalence of exclusive breastfeeding and identify factors associated with its practice among employed and unemployed mothers in Arada Subcity, Addis Ababa, Ethiopia, in 2024. Methods A community-based comparative cross-sectional study was conducted from July–August 2024 in four randomly selected woredas of Arada Subcity, Addis Ababa. Using proportional stratified sampling, 808 mother–infant dyads (404 employed, 404 unemployed) with infants aged 0–6 months were enrolled. Exclusive breastfeeding status was determined using a 24-hour recall method, using a pretested interviewer-administered questionnaire adapted from the WHO Infant and Young Child Feeding indicators and the 2016 Ethiopian Demographic and Health Survey. multilevel logistic regression identified factors associated with EBF, reported as adjusted odds ratios (AORs) with 95% CIs. Results Exclusive breastfeeding during the first six months was reported by 440 mothers (54.7%): 69.0% (95% CI 64.3, 73.4) of nonemployed mothers and 40.3% (95% CI 35.6, 45.1) of employed mothers. Nonemployed mothers had 3.3 times greater odds of practicing EBF (AOR 3.3, 95% CI 2.47, 4.4). Among unemployed mothers, EBF was positively associated with being married, having ≥ 3 years of birth spacing, lacking religious barriers, being comfortable discussing breastfeeding, and receiving counseling. Among employed mothers, higher odds of EBF were linked to working < 20 h/week, being married, having a lower income, the absence of religious barriers, perceived workplace support, and high confidence in breastfeeding while employed. Conclusions The prevalence of exclusive breastfeeding in Arada was low and more common among nonemployed mothers. EBF practices are significantly influenced by multiple factors. Strengthening workplace support; enhancing family and social support; addressing religious barriers; improving maternal confidence; ensuring effective counseling; and creating supportive environments at home, workplaces, and health facilities are recommended to improve EBF practices in cities. Clinical trial number Not applicable.