Objective  To explore the impact and influence mechanisms of infant formula recommendation and trial use on breastfeeding practice among mothers of infants aged 0 – 6 months in poverty-stricken rural areas of China.

  Methods  We randomly selected 447 households with 0 – 6 months old infants in 123 villages in two national-level poverty-stricken counties locating at Qinba mountainous region and conducted a survey among mothers of the infants of the households selected in March – April 2019. Information about breastfeeding of the infants, maternal exposure to infant formula sales promotion, maternal nutrition health knowledge, maternal attitude towards breastfeeding and breastfeeding self-efficacy were collected with a self-designed questionnaire, Iowa Infant Feeding Attitude Scale (IIFAS), and The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Logit regression and multivariate linear regression were used in analyses.

  Results  The logit regression analysis demonstrated that receiving infant formula samples for sales promotion (odds ratio OR = 0.60, 95% confidence interval 95% CI: 0.38 – 0.93; P = 0.02) was a hindering factor for basic breastfeeding and feeding a newborn first time with infant formula (OR = 0.54, 95% CI: 0.31 – 0.95, P = 0.03) was a hindering factor for breastfeeding; the analysis did not indicate significant correlation between exposed to infant formula sales promotion (advertisements or advices for infant formula use from others) and breastfeeding practice (both P > 0.1). Exposure to infant formula advertisements was related with higher score for nutrition health knowledge (β = 0.33, P = 0.01) and higher score for breastfeeding attitude (β = 1.04, P = 0.04); while exposure to advices for infant formula use and receiving infant formula samples for sales promotion were not associated with scores for nutrition health knowledge and breastfeeding attitude (both P > 0.1), but receiving infant formula samples for sales promotion was correlated with significantly reduced breastfeeding self-efficacy (β = – 3.22, P = 0.03).

  Conclusion  In poverty-stricken rural areas in Qinba mountainous region, the mothers of infants aged 0 – 6 months have no sufficient feeding skills; the usage of infant formula for sales promotion could increase maternal dependence on infant formula but reduce breastfeeding self-efficacy and thus decrease breastfeeding rate among the mothers.