Key Social Norms Take-aways Social norms—particularly those related to infant feeding practices, gender roles, and caregiving responsibilities—play a central role in shaping exclusive breastfeeding (EBF) behaviors. Norms around infant thirst, beliefs that breastmilk alone is insufficient, and expectations that grandmothers and other relatives should guide infant feeding often lead to early introduction of water or breastmilk substitutes. At the same time, positive norms around caregiving, such as shared responsibility within families and community expectations of maternal care, can support EBF. The discussion highlights that these norms operate across multiple levels (interpersonal, community, societal) and are reinforced through social networks, making it essential for interventions to target not only mothers but also fathers, grandmothers, and broader community influencers to effectively shift practices.

Objectives The study aimed to understand how relational influences from fathers, grandmothers, and other family members affect mothers’ adherence to recommended exclusive breastfeeding practices, and to document broader community and societal influences on EBF in Ghana.

Methods A qualitative study design was used, drawing on semi-structured in-depth interviews with 52 participants, including mothers (teen and adult), fathers, and caregivers of infants under one year of age in Ghana’s Central Region. The analysis followed a grounded theory approach and was guided by the social-ecological model to examine influences across individual, interpersonal, community, and societal levels. Social norms were assessed through participants’ narratives about beliefs, expectations, and practices related to infant feeding, including descriptive norms (common practices), injunctive norms (perceived expectations), and culturally embedded beliefs.

Results While participants generally understood and valued EBF, actual practices often diverged due to relational and normative influences. Fathers’ involvement was largely protective, providing financial, emotional, and informational support that promoted adherence to EBF. Grandmothers played a dual role, offering essential caregiving support but sometimes undermining EBF by introducing water or other foods based on cultural beliefs and prior experiences. Community actors, particularly nurses, were key sources of accurate information and influenced fathers more strongly, while community and church peers reinforced norms that shaped grandmothers’ beliefs. Societal norms—such as beliefs about infant thirst, breastmilk insufficiency, and traditional caregiving roles—further influenced behaviors. These multilevel interactions created both supportive and interfering dynamics affecting EBF adherence.

Conclusions The study concludes that exclusive breastfeeding practices are shaped by complex, multi-level social norms and relational dynamics. Effective interventions must adopt a family- and community-centered approach, addressing normative beliefs and engaging key influencers—especially fathers and grandmothers—while strengthening supportive environments through health systems and community-based strategies.