CHAPTER ONE
INTRODUCTION
Background of the Study
Breast feeding is a physiological process through which all mammals feed their babies. Hor nby (2000) defines breast feeding as an act of feeding from the breast. According to Makanjuola (2006) breast feeding is the best type of feeding for infants particularly during the first six months of the child’s life; because it provides the baby with the essential nutritional requirements when exclusively fed with the breast milk. While health according to WHO (2002) is defined as the state of complete physical, mental and social well-being.
Exclusive breastfeeding refers to feeding an infant with breast milk from his or her mother or a wet nurse, or expressed breast milk without any additional solid or liquid foods, except for oral rehydration salt, syrups of vitamins, minerals and medicines (World Health Organization, 2008). Infants should be given exclusive breastfeeding from birth until six months and continues up to two years, with introduction of complementary food at the age of six months (World Health Organization, 2003; National Coordinating Committee on Food and Nutrition, 2010).
Research showed that babies who are breastfed exclusively for 6 months experience less illnesses because breast milk contains nutrients and substances that protect the baby from several infections, some chronic disease and it leads to improved cognitive development (Hafizan, . 2014). Gastroenteritis, or the family of digestive diseases whose primary symptom is diarrhea, occurs less often among exclusively breastfed children and is less severe when it does occur (Clark and Bungum, 2003; Alemayehu . 2009).
WHO recommends that infants should be exclusively breastfed for the first six months and up to two years or beyond. Despite appropriate feeding practice is the most cost effective intervention to reduce child morbidity and mortality, only 38% of children less than 6 months of age are exclusively breastfed in the developing countries (Sefene, . 2013,Kemi and Olurotimi, 2011 ; Tengku, . 2013, UNICEF, 2006; Yadavannavar and Patil, 2011). In a systematic review and meta-analysis of four observational studies from the UK and US in 2004, Martin and colleagues showed there was no association between breastfeeding and mortality from cardiovascular disease (Robinson and Fall, 2012). One and half million infants’ deaths can be avoided each year by exclusive breastfeeding. Children who are exclusively breastfed have protection from several acute and chronic diseases such as, otitis media, respiratory tract infections, atopic dermatitis, gastroenteritis, type 2 diabetes, sudden infant death syndrome, and obesity and asthma during childhood (Al-Akour, 2014).
Several studies have shown that mothers find it difficult to meet personal goals and to adhere to the expert recommendations for continued and exclusive breastfeeding despite increased rate of initiation (Whalen and Cramton, 2010). Some of the major factors that affect exclusivity and duration of breastfeeding include breast problems such as sore nipples or mother’s perceptions that she is producing inadequate milk (Nkala and Msuya, 2011; Cherop, Keverenge-Ettyang, and Mbagaya, 2009; Thurman and Allen, 2008); societal barriers such as employment and length of maternity leave (Thurman and Allen, 2008); inadequate breastfeeding knowledge (Cherop, Keverenge-Ettyang, and Mbagaya, 2009); lack of familial and societal support; lack of guidance and encouragement from health care professionals (Ku and Chow, 2010; Thurman and Allen, 2008). These factors in turn promote the early use of breast milk substitute.
Predictors of breastfeeding and weaning practices vary between and within countries. Urban or rural difference, age, breast problems, societal barriers, insufficient support from family, knowledge about good breastfeeding practices, mode of delivery, health system practices, and community beliefs have all been found to influence breastfeeding in different areas of developing countries (Nkala and Msuya, 2011; Cherop, Keverenge-Ettyang, and Mbagaya, 2009; Thurman and Allen, 2008). Information on the prevalence and factors influencing infant feeding practices is limited in Mauritius and dates back to 2006 (Grummer-Strawn, Kalasopatan, Sungkur, and Friedman, 2001). The breastfeeding at work is influenced by several social and cultural factors that influence the frequency, duration and initiation of breastfeeding practices among mothers (19-21). Economic factors compelling mothers to work during breastfeeding (19,21). Socioeconomic status, race, ethnicity, employer’s attitude and other factors have been found to affect the working mother’s choice whether or not to breastfeed, and how long she breastfeeds her child. The cultural support for breastfeeding differs, still some societies identify the mother as either work oriented or family oriented (mother or worker) and to combine breastfeeding with work seems quiet struggling for working mothers. Most female employees maintain both social roles (mother and worker) simultaneously and reported to negotiate the boundaries on daily basis. Cultural variations in breastfeeding can bring visible change on the effect of the usual demographic variables on breastfeeding prevalence.
Statement of the Problem
Several factors affect mother’s infant feeding choices and options, including their social roles, availability of artificial baby milks, cultural norms and hospital birth practices. A woman’s return to work has frequently been found to be a main contributor to the early termination of breastfeeding. There are many issues that disrupt mother’s breastfeeding plan at work. Commonly cited issues are lack of workplace breastfeeding facilities, lack of family support, mother’s inadequate knowledge about breastfeeding and feeling of embarrassment.
Working mothers often face inflexibility in the working hours, unable to find facility for childcare at or near the workplace, lack privacy for breastfeeding, place to store breast milk (refrigerator), limited paid maternity leave and fear over job insecurity. Almost all mothers can breastfeed, as long as they have correct information and support from their family, employer, health care system and society. Often healthcare providers have limited knowledge and training on breastfeeding and breastfeeding support at work. A study described that significant number of primary healthcare providers were unable to provide mothers with the necessary information on breastfeeding.
As a result of the increase rate of diarrhea among breastfeeding mothers, global campaign urges mothers to be baby friendly, however, in most developing countries of the world like Nigeria, malnutrition is still a life threatening issue particularly among the poor and low income earners. The most affected are babies and children under five years of age. High mortality rates are still persisting among the babies who are not breastfed4 In Nigeria, despite increasing level of campaign on exclusive breastfeeding, there is still a wide gap between knowledge and practice of breast feeding since most mothers do not appreciate practicing it appropriately.
Objectives of the Study
The broad objective of this study is the Factors affecting the practice of exclusive breastfeeding among mothers attending model PHC Esan Central LGA of Edo State. The following specific objectives were formulated;
- To establish the Practice of breast feeding among mothers attending model PHC Esan Central LGA of Edo State.
- To determine whether exclusive breast feeding is practiced among mothers attending model PHC Esan Central LGA of Edo State
- To determine factors that could hinder the practice of exclusive breast feeding among mothers attending model PHC Esan Central LGA of Edo State.
- To establish factors that could enhance exclusive breastfeeding among mothers attending model PHC Esan Central LGA of Edo State.
Research Question
- Do women of Esan Central LGA of Edo State breastfeed their babies
- Is exclusive breast feeding being practiced among mothers attending model PHC Esan Central LGA of Edo State?
- What are the possible factors that could hinder the practice of exclusive breast feeding among mothers attending model PHC Esan Central LGA of Edo State?
- What are the factors that could enhance exclusive breastfeeding among mothers attending model PHC Esan Central LGA of Edo State?
Significance of the Study
It is expected that the finding from this research will be of benefit to student, teachers, nursing mothers, medical practitioners, and the Ministry of Health and the government at all levels among others. The study will be of help to them in the following areas:
Scope of the Study
This study investigates Factors affecting the practice of exclusive breastfeeding among mothers attending model PHC Esan Central LGA of Edo State. The study is limited to all mothers who’s babies are within 6 months who are breastfeeding attending model PHC Irrua living in the metropolis of Irrua.
Operational Definition of Term
The following terms are operationally defined for the study:
Exclusive: The state of being in a relationship with someone where you are officially boyfriend and girlfriend, and there is no-one else involved. Usually attained after going on a couple of good dates with someone.
Breastfeeding: is the milk from the mother, or another lactating mother (in case of unwilling mothers and royalty), has nourished, protected and helped raise babies since time immemorial. Like all mammals humans possess mammary glands for the purpose of feeding their infants before they are ready for food from other sources.
Mothers: is the female parent of a child. Mothers are women who inhabit or perform the role of bearing some relation to their children, who may or may not be their biological offspring.
Exclusive breastfeeding: Exclusive breastfeeding is the practice of feeding the infant for the first six months of life on breast milk only; without any other type of food, not even water.
Nutritional Immunology: It centers on studying the mechanisms underlying the modulation of immune responses by nutritional, naturally occurring and orally active compounds.
Passive Immunity: Refers to the short term immunity which results from the introduction of antibodies from another person or animal.
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