Challenges Of Exclusive Breastfeeding Among Working Class Women

Project and Seminar Material for Nursing (Science)

Challenges Of Exclusive Breastfeeding Among Working Class Women

Abstract

Background: In Nigeria, periodic national surveys report the practice of exclusive breastfeeding (EBF) in the general population to be over 50 %. However, little is known about EBF among professional working mothers, particularly its duration after maternity leave. Female workers are entitled to 12 weeks (84 days) of maternity leave with full pay in Nigeria, and this can be extended by two additional weeks in case of a caesarean or abnormal delivery. This study assessed the prevalence of EBF, as well as factors associated with the practice among professional working mothers in one of the ten regional capitals of Nigeria.

Methods: The study was descriptive cross-sectional in design and employed a multi-stage sampling technique to sample 369 professional working mothers. The study was planned and implemented between January to July 2015. Study-specific structured questionnaires were used in the data collection over a period of one month. Some factors including demographic characteristics, types of facilities available at workplace to support breastfeeding, challenges to exclusive breastfeeding at the workplace and mother’s knowledge base on EBF, were assessed. Exclusive breastfeeding is defined as feeding infants with only breast milk, without supplemental liquids or solids except for liquid medicine and vitamin or mineral supplements.

Results: There was a near universal awareness of exclusive breastfeeding among respondents (99 %). Even though most mothers initiated breastfeeding within an hour of delivery (91 %), the EBF rate at six months was low (10.3 %). The study identified three elements as determinants of EBF; Those who did not receive infant feeding recommendation from health workers were less likely to practice exclusive breastfeeding (Adjusted Odds Ratio [AOR] 0.45; 95 % Confidence Interval [CI] 0.27, 0.77), mothers who had shorter duration of maternity leave were less likely to practice exclusive breastfeeding (AOR 0.09; 95 % CI 0.02, 0.45), and those who had a normal delivery were almost 10 times as likely to practice exclusive breastfeeding (AOR 9.02; 95 % CI 2.85, 28.53).

Conclusion: Given the high breastfeeding initiation, but low EBF continuation rate among professional working mothers, improved policies around maternity leave and breastfeeding friendly work environments are needed.

Table of Contents

Preliminary Page(s)

  • Title page
  • Certification page
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of content

Chapter One:

Introduction

  • 1.1 Background to the study
  • 1.2 Statement of problem
  • 1.3 Objectives of the study
  • 1.4 Research questions
  • 1.5 Significance of the study
  • 1.6 Scope of study
  • 1.7 Definition of terms
  • 1.8 Organization of Study

Chapter Two:

Literature Review

  • 2.1 The historical context of breastfeeding
  • 2.2 Exclusive breastfeeding trends in the developing world
  • 2.3 Health benefits of exclusive breastfeeding
  • 2.4 Determinants of exclusive breastfeeding
  • 2.5 Pre-breastfeeding practices
  • 2.6 Influences on breastfeeding
  • 2.7 Weaning and the weanling’s dilemma
  • 2.8 Family knowledge of breastfeeding
  • 2.9 Family beliefs and practices
  • 2.10 Collective sense of responsibility
  • 2.11 Learning to breastfeed
  • 2.12 Implications for public health policy

Chapter Three:

Materials And Methods

  • 3.1 Research Design
  • 3.2 Area of study
  • 3.3 Study Population
  • 3.4 Sampling technique
  • 3.5 Sample size
  • 3.6 Data collection
  • 3.7 Data collection tools and procedures
  • 3.8 Data analysis
  • 3.9 Ethical approval and consent to participate

Chapter Four:

Results And Discussion

  • 4.1 Results
  • 4.2 Discussion

Chapter Five:

Conclusion And Recommendation

  • 5.1 Conclusions
  • 5.2 Recommendations
  • References
  • Appendix / Questionnaire

Chapter One

Introduction

1.1 Background to the study

Breast feeding which is the act of feeding babies with breast milk. This is a universal cultural practice among human species of all races. However, there are commonly observable variations in the frequency and exclusiveness of application of breast milk in the feeding of babies. This is noted by Berg and Brenms (1989) who asserted that the question about breastfeeding is not whether it is being practiced or not, but the degree of practice. There are, therefore types of breastfeeding of which three categories are discernible from literature: Exclusive, predominant and complementary breastfeeding.

Exclusive breastfeeding (EBF) is the application of breast milk alone in the feeding of a baby for at least four months and if possible six months of life, without the addition of water, food or drinks. The baby however receives vitamins, minerals and medicines in the form of drops and syrup as need arises (WHO,1981). The World Health Organization WHO (2001) received the optional duration of EBF to six months of life. The second type of breastfeeding, predominant breastfeeding (PBF), on the other hand, implies that the infants predominant source of nourishment is breast milk. The infant in this type receives in addition of breast milk, water and water-based drinks (WHO 2001). Complimentary breastfeeding (CBF) or mixed feeding occurs where factory produced baby formula is the primary source of nourishment for the infant, the breast milk given occasionally.

The 2008 Lancet Series on Maternal and Child Undernutrition indicated that suboptimum breastfeeding, especially not exclusively breastfeeding a child for the first six months of life, results in 1.4 million deaths and 10 % of the disease burden in children younger than five years in low-income and middle-income countries. Other statistics indicate that one hundred and thirty-five million babies are delivered annually, but only 42 % (57 million) initiate breastfeeding within the first hour after birth, 39 % are breastfed exclusively during the first six months, and 58 % continue breastfeeding up to the age of two years. Several studies have reported barriers accounting for this situation, including returning to work after delivery. Others have stated factors that determine the success of exclusive breastfeeding even upon return to work, indicating that a supportive workplace and working environment are essential. Yet, the Nigeria 2010 Population and Housing Census Report showed an increasing trend of women joining the labourforce. Guendelman et al. note that the challenge of balancing breastfeeding and paid work is an important reason for breastfeeding cessation in the first six months. In Nigeria, the success of exclusive breastfeeding is subject to the nature of a women’s job and occupation, especially at places where women are engaged in industrial work away from home, and long working hours. Elsewhere, Magner, and Phillipi attribute cessation of breastfeeding within the first month to returning to work. Aryeetey and Goh note that exclusive breastfeeding in Nigeria usually lasts for a median of about three months, which, incidentally coincides with the maternity leave period. Cai et al. in their 2012 “global trends in exclusive breastfeeding” indicate that the early cessation of exclusive breastfeeding favours the use of commercial breast milk substitutes, often of poor nutritional quality. Recently, Fosu-brefo and Arthur in their work titled “effect of timely initiation of breastfeeding on child health in Nigeria” acknowledged that interventions that improved child health and prevented childhood diseases included early breastfeeding initiation. Also, the factors acknowledged locally in Nigeria, Ayton and colleagues have identified several others that are harmfull

y associated with effective breastfeeding, such as delays in and/or failure of early breastfeeding initiation. Exploring the constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria, Agunbiade and Ogunleye note that early introduction of complementary feeding, based on false beliefs that it is only beneficial to infants less than six months, adversely affects breastfeeding initiation and sustainability. In China and Western Kenya, several factors accounted for low EBF prevalence among working mothers. Early return to work, limited flexibility of work hours, lack of privacy, as well as a feeling of being watched and judged, lack of support including networks, tiredness and emotional support at work were cited as challenges facing working mothers. Mother’s work outside the home, father’s type of occupation (demanding occupations) which may limit their support for mothers to breastfeed and shorter maternity leave regulation also hindered EBF practice among professional working mothers in Vietnam, who all intended to exclusively breastfeed. These studies report that although most working mothers leave the maternity ward breastfeeding exclusively, the practice is quickly abandoned, mostly due to work and employment related factors.

1.2 Statement of problem

Although breastfeeding may not be completely abandoned, its exclusivity was mostly interrupted by these factors. Some of the factors hindering exclusive breastfeeding initiation and practice in Nigeria and elsewhere include poor knowledge of mothers, lack of mother’s confidence, lack of skills about appropriate breastfeeding methods and challenges with other work problems during lactation. These challenges may be amplified among working mothers in Nigeria, and could include giving substitutes other than maternal milk, early introduction of weaning foods, or shorter duration of EBF due to demands from work.

While data indicate that only about 36 % of infants younger than six months are exclusively breastfed in developing countries, national surveys concluded that Nigeria’s exclusive breastfeeding rate at six months is currently about 52%. Exclusive breastfeeding is a new method of breastfeeding which has been introduced by WHO/UNIEF. These two bodies have tasted it and find it successful for solving many problems in an infant. Unfortunately, few mothers adopt exclusive breast feeding (Grange, 1992); WHO, 2001) What could be peculiar to them? What do they have in common which are lacking among those who reject exclusive breastfeeding? This study exploreworking class mothers with a view of finding answers to these questions.

1.3 Objectives of the study

The researcher’s work is centred on working mothers in Nigeria and their breast feeding habit. The main aim of carrying out this study therefore is to:

  1. Critically examine the concept of breast feeding
  2. Find the positive and negative effects of breast feeding to working mothers and their infants.
  3. Identify the problems of breast feeding among working mothers in Enugu.
  4. Proffer or recommend possible solutions to the problems.

1.4 Research questions

  1. What is the concept of breast feeding?
  2. What is the positive and negative effect of breast feeding to working mothers and their infants?
  3. What are the problems of breast feeding among working mothers in Enugu?
  4. What are the solutions to the problems?

1.5 Significance of the study

In view of the present problem of working mothers and breast feeding and the dangers of inadequate breast feeding and the adverse effect on mothers and infants, the research study will help the individual mothers, physical education administration, health workers and the entire local government area, especially for those mothers who because of ignorance or selfish interest do not want improvement on adequate breast feeding of the infants. The findings and recommendations of this research are also expected to help the state and the local government area in drawing plans to improve on the breast feeding practices and working mothers.

There will be research on parity, religious affiliation, age and location to the effect of EBF adoption in the area of study. Knowing this will help health workers, particularly health educators in planning their health instruction and teachings of EBF. Attention should then be given to all nursing mothers irrespective of parity, age, religious affiliation to help and encourage them to adopt EBF.

1.6 Scope of study

The problems of breastfeeding are indeed a universal one.The research attempts to give an insight into the importance of adopting Exclusive breast feeding among working class mothers. The area covered by this study is Enugu State.

1.7 Definition of terms

Breast-feeding:

This is the process of a woman feeding her baby with the milk from her breast.

Lactation:

Lactation is the production of milk from the breast after giving birth.

Nutrition:

This is the process of supplying and receiving nourishment.

HIV:

Is a virus which reduces people resistance to illness and can cause Acquired Immunodeficiency Syndrome (AIDS). HIV is an abbreviation for human Immunodeficiency virus.

1.8 Organization of Study

The study is divided into five chapters. Chapter one deals with the study’s introduction and gives a background to the study. Chapter two reviews related and relevant literature. The chapter three gives the research methodology while the chapter four gives the study’s analysis and interpretation of data. The study concludes with chapter five which deals on the summary, conclusion and recommendation.

Chapter Five

Conclusion And Recommendation

5.1 Conclusions

Among this group of professional working mothers, breastfeeding initiation at birth was near universal, although sustained and exclusive breastfeeding till the sixth month of life was low at 10.3 %. Mothers were well informed about exclusive breastfeeding and its benefits; however, this knowledge did not translate into practice. Based on the findings, professional working mothers may require more supportive post-delivery follow ups. Also, policies aimed at improving EBF rates among professional working mothers should include maternity leave extension and educational programs that encourage knowledge into practice. Collaboration between various stakeholders including Nigeria Health Service, Ministry of Health, Department of Employment and Labour Relations, and all heads of professional organizations/institutions may yield the breastfeeding-friendly policies and breastfeeding-sensitive work environments being advocated for by this work.

5.2 Recommendations

Following the findings from this study, the following recommendations are therefore made:
Government and non government organizations involve in the promotion of exclusive breastfeeding should organize more training programme for health workers in the ante- natal and post-natal/child welfare unit and staff should be encouraged to participate in such programmes, where they can update their knowledge with latest information on exclusive breastfeeding, since they constitute the greatest means of information dissemination on exclusive breastfeeding.

Promotion of exclusive breastfeeding should involve programmes that will capture not only nursing mothers and health workers, but other members in the communities most especially husbands and older women who are involved in child care. Younger generations such as adolescents need to have a reasonable knowledge of exclusive breastfeeding and its many benefits even before child bearing age.

Facilities such as crèche should be provided by various governments and private organization at work place and in higher institution of learning, to enable nursing mothers who are working or studying continue breastfeeding without jeopardizing their work or study. Employers should also be encouraged to give nursing mothers extra break time to be able to perform this very important act of breastfeeding.

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