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To examine the relationship between maternal perceptions of insufficient milk and breastfeeding confidence using the Breastfeeding Self-Efficacy Scale.Cross-sectional study.Two hundred and sixty-two in-hospital breastfeeding mothers in Japan.Breastfeeding self-efficacy was measured in-hospital and perception of insufficient milk was measured at 4 weeks postpartum.Although most mothers intended to exclusively breastfeed, less than 40% were doing so at 4 weeks postpartum. Among the mothers using formula, 73% cited perceived insufficient milk as the primary reason for supplementation or completely discontinuing breastfeeding. Mothers' perception of insufficient milk at 4 weeks postpartum were significantly related to breastfeeding self-efficacy in hospital in the immediate postpartum period (r=.45, p<.001). Hierarchical multiple regression revealed that breastfeeding self-efficacy explained 21% of the variance in maternal perceptions of insufficient milk, and the contribution was independent of sociodemographic variables.Enhancing breastfeeding self-efficacy in the immediate postpartum period may reduce maternal perceptions of insufficient milk and the premature discontinuation or supplementation of breastfeeding. Additional research is warranted.