<![CDATA[Background: Formula milk is often blamed as the primary cause of exclusive breastfeeding substitution. However, breastfeeding substitution occurs within the broader context of social systems with various dimensions. These variations are complex, and each social system has its unique construction, necessitating a qualitative approach. Objectives: This study aims to uncover the social dimensions, especially the relationship between daughter-in-law and mother-in-law, as an underlying breastfeeding substitution in the rural areas of the Nias Islands. Methods: The study used in-depth interviews and Focus Group Discussions (FGDs). Informants included mothers with children under two years of age, mothers-in-law, midwives, and community leaders. The analysis was conducted thematically. Results: The study revealed that the pressure to work and contribute to the family economy is a gateway to breastfeeding substitution. However, the key factor is the prevailing norms in the local community. The societal expectation that women must work hard and be responsible for the family's needs leaves no choice for mothers but to leave their children. Mothers-in-law play a significant role in this social system. Conclusions: This study highlights that women choose to conform to the ideal image of a praiseworthy daughter-in-law devoted to the family, thereby neglecting the need to breastfeed their children exclusively. Localized intervention designs must consider such social situations.]]>
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