Introduction: Despite evidence from various studies on exclusive breastfeeding (EBF) being best for infants, many women do not or are unable to practise EBF. This study aimed to examine perceptions on EBF and its influencing factors among a sample of Malay women in rural and urban areas in Kelantan, Malaysia. Methods: A qualitative study using in-depth interviews was conducted to examine respondents’ views about EBF including their beliefs, experiences and feelings. The interviews were audio-recorded and transcribed verbatim, followed by discussion and identification of emergent concepts. Results: Data saturation was achieved after interviewing a total of 30 women. The mean age of the women was about 30 years with most having at least secondary level schooling; the majority were working women. Thirteen of the 30 women practised EBF. They believed breastfeeding allowed them to fulfill their reproductive role and regarded it as a gift from God. The practice required sacrifice, and was therefore associated with a combination of positive and negative feelings. Differing opinions surfaced with regard to belief in the superiority of breastfeeding and feasibility of practice. Many women accepted breastfeeding practice but found it challenging to practise EBF especially when confronted with low milk production, perceived low nutritional quality breast milk, and work commitments. Conclusion: Women should be educated on the importance of EBF with regard to the nutritional adequacy of breast milk and long term benefits for mother and children.