Objective: This study aimed to evaluate the degree of knowledge regarding exclusive breastfeeding (EBF) and to explore the determining factors related to the initiation and maintenance of EBF.

Methods: A cross-sectional observational study was carried out in the primary health care centers (PHCCs)  in the Second Health Cluster, Riyadh, from December 2022 to June 2023. A total of 360 mothers visiting the Well Baby Clinic and whose babies were less than 2 years old were included in the study. A validated interview questionnaire was used for data collection.

Results: Around 48.9% of participants were aged 20-30 years. Almost 32.5% reported pain as a barrier to breastfeeding and 18.3% reported fear of deformation of the shape of the breast due to breastfeeding. Furthermore, 31.9% had poor moral support for the mother before and after childbirth. 34.4% perceived insufficient breast milk production while 21.1% reported that the baby’s father does not encourage breast feeding. Additionally, 38.6% felt shame and embarrassment about breastfeeding in public places and 36.4% reported being too busy to breastfeed. Only 1.4% had a positive attitude towards absolute breastfeeding.

Conclusion: The study showed a very poor attitude of mothers towards absolute breastfeeding. There was no significant association between any of the sociodemographic characteristics of participants and attitude scores towards absolute breastfeeding. Mothers should receive information and encouragement to practice EBF, with a focus on those who had never done it before because they were more likely to wean their children too young.