Usually, an adolescent mother is considered less likely to continue EBF in comparison to older women due to the higher likelihood of young women being single [13], having low educational levels and lower income [12, 13] and due to the urgency of attending school [28]. Nevertheless, this study showed no strong relationship between those factors and the cessation of EBF before age of sixth months. Therefore, as proposed by Sipsma and collaborators, enhanced clinical support and promotion of EBF, may be more influential than interventions aimed at improving the above mentioned factors [29].

This study showed that about 62.9 % of adolescent mothers delivering at the Isidro Ayora’s hospital, exclusively breastfeed their infants within the first six months of life. This rate is higher than the one estimated for all mothers in Ecuador (43.8 %) [10] and higher than the EBF prevalence reported in other countries among adolescent mothers (which has been reported to range from 52 % in the United States of America to 13.8 % in Brazil) [13, 14, 18]. There are several possible explanations for these findings. First, adolescent mothers are less likely to be employed [19] and we found a high rate of mothers who left school after or during pregnancy, therefore, they have more opportunity to stay at home taking care of the infant, including EBF. Second, although adolescent mothers have lower education levels [12, 17], the majority of surveyed mothers knew the recommended time of EBF and agreed that breast milk is the best food source for their infants; as a result, those may be a motivation for them to EBF their infants [30]. Finally, HGOIA provides free maternity services [25, 26]; for this reason, mothers who attend to this center could be more likely to have lower incomes, so nourishing their babies with breast milk exclusively may be economically more convenient than buying infant formula.

Although the definition of EBF includes breastmilk from a wet nurse, there are different implications when the infant is not fed by their mothers. La Leche League discourages this practice for several reasons; the most important ones are the risk for the baby of acquiring an infection and being affected by chemical contaminants such as drugs that may be used by the wet nurse. Also, the milk from another mother, whose infant does not have the same age, may not provide the components the other baby needs according to his age [31]. Therefore, human milk provided by an adequately managed human milk bank is the best option if the mother is unable to express her own milk [32]. Our results show that approximately 14 % of all mothers used milk from a donor. Considering that it is a high percentage, we recommend that the risks, indications and precaution for using human milk from a donor should be part of the breastfeeding counseling.

On this study, the prevalence of EBF was higher in the group of mothers who knew the recommended length of time for EBF. Our results are in agreement with previous studies reporting the association between the awareness of the WHO recommendations with initiation and duration of EBF [33]. According to Renfrew and collaborators, the breastfeeding guidance provided personally by trained staff and given during an accessible schedule, increases the duration of EBF [34]. However, adolescent mothers who denied having received breastfeeding assistance did not present a higher rate of early discontinuation of EBF.

The results show that less than 5 % of all participants know that breastfeeding helps prevent breast cancer. The lack of awareness about the benefits of breastfeeding to the mother’s health has been previously reported [35]. Hence, there is a necessity to promote the mother’s knowledge about maternal benefits of breastfeeding in order to optimize breastfeeding initiation and maintenance.

One of the most important factors affecting the adolescent mother’s decision to breastfeed their babies is the family’s and partners’ support. On this study, 55 % of adolescent mothers were married or cohabiting and, some of them lived with multiple immediate or extended family members that could have influenced their EBF decision [36–38]. Unfortunately, there is no data that determine neither the family members’ role nor the partners’ role in the mother’s breastfeeding behaviors. Therefore, although there was no significant relationship between marital status and the mother’s breastfeeding behaviors, we consider this point as an avenue for future research.

Regarding the reasons given by mothers for early discontinuation of EBF, this study highlights the perception of low breast milk production. This result is similar to the one previously reported in Ecuador, establishing that this reason prevailed as an important consideration in the duration of breastfeeding [39]. However, only about 5 % of all mothers are not physiologically able to produce enough milk, so the real cause of insufficient milk intake is the inability of the infant to extract milk, due to inappropriate early feeding routines [40]. This means that the perception of low milk production can be generally avoided by teaching the mothers about the correct way to feed their babies.

Our study is limited to mothers who were attended the maternity hospital in which a breastfeeding counseling program is freely available. In addition, all the participants involved in the study came from an urban area where the population has a higher education level, higher incomes and a lower fertility rate than the rural population [10]. Therefore, the EBF prevalence may be dissimilar from other samples of mothers in Ecuador. Furthermore, our study is based on self-reporting by the mothers, and the questions asked to them were posed in a specific order with the aim of obtaining sincere answers, particularly in the question about the baby’s age in which EBF was suspended. Despite this fact, mothers might have felt compelled to respond according to the information they received during counseling (whether or not they truly followed the guidelines), since the interviewers were always health personnel, wearing medical coats.