Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: implications for scaling up
Tóm tắt
The practice of exclusive breastfeeding is still low despite the associated benefits. Improving the uptake and appropriating the benefits will require an understanding of breastfeeding as an embodied experience within a social context. This study investigates breastfeeding practices and experiences of nursing mothers and the roles of grandmothers, as well as the work-related constraints affecting nurses in providing quality support for breastfeeding mothers in Southwest Nigeria. Using a concurrent mixed method approach, a structured questionnaire was administered to 200 breastfeeding mothers. In-depth interviews were also held with breastfeeding mothers (11), nurses (10) and a focus group discussion session with grandmothers. Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. Only a small proportion (19%) of the nursing mothers practiced exclusive breastfeeding. The survey showed the major constraints to exclusive breastfeeding to be: the perception that babies continued to be hungry after breastfeeding (29%); maternal health problems (26%); fear of babies becoming addicted to breast milk (26%); pressure from mother-in-law (25%); pains in the breast (25%); and the need to return to work (24%). In addition, the qualitative findings showed that significant others played dual roles with consequences on breastfeeding practices. The desire to practice exclusive breastfeeding was often compromised shortly after child delivery. Poor feeding, inadequate support from husband and conflicting positions from the significant others were dominant constraints. The nurses decried the effects of their workload on providing quality supports for nursing mothers. Breastfeeding mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. Thus, scaling up of exclusive breastfeeding among mothers requires concerted efforts at the macro, meso and micro levels of the Nigerian society.
Tài liệu tham khảo
World Health Organization: WHO Collaborative study team on the role of breastfeeding on the prevention of infant mortality effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: A pooled analysis. Lancet. 2000, 355 (9202): 451-455.
World Health Organization: Infant and young child nutrition: Global strategy for infant and young child feeding, 2001. [http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf]
UNICEF. Progress for children: A report card on Nutrition, 2006 Number 4. [http://www.unicef.org/progressforchildren/2006n4/index_breastfeeding.html#13]
World Health Organization: Indicators for Accessing Breastfeeding Practices. WHO/CDD/SER/91.1. 1991, Geneva: World Health Organization
World Health Organization: The State of Breastfeeding in 33 Countries. 2010, [http://www.worldbreastfeedingtrends.org/]
National Population Commission (NPC) and ICF Macro: Nigeria Demographic and Health Survey 2008. 2009, Calverton, Maryland, USA: NPC and ICF Macro
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group: How many child deaths can prevent this year?. Lancet. 2003, 362: 65-71. 10.1016/S0140-6736(03)13811-1.
Gabriele A, Schettino F: Child malnutrition and mortality in developing countries: Evidence from a cross-country analysis. Analyses of Social Issues and Public Policy. 2008, 8 (1): 53-81. 10.1111/j.1530-2415.2008.00157.x.
Anyamele OD: Urban and rural differences across countries in child mortality in Sub-Saharan Africa. J Health Care Poor Underserved. 2009, 20: 90-98. 10.1353/hpu.0.0199.
World Health Organization: Data Bank on Infant and Young Child Feeding on Nigeria. 2010, [http://www.who.int/nutrition/databases/infantfeeding/countries/nga.pdf]
Nigeria Millennium Development Goals Report, 2001. [http://www.Mdgs.gov.ng]
Cripe ET: Supporting breastfeeding(?):nursing mothers' resistance to and accommodation of medical and social discourses. Emerging Perspective in Health Communication: Meaning, Culture and Power. Edited by: Zoller HM, Dutta MJ. 2008, New York: Routledge Taylor and Francis Group, 63-84.
Schmied V, Barclay L: Connection and pleasure, disruption and distress: Women's experience of breastfeeding. J Hum Lact. 1999, 15 (4): 325-334. 10.1177/089033449901500410.
Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI: American Academy of Pediatrics Section on Breastfeeding: Breastfeeding and the use of human milk. Pediatrics. 2005, 115: 496-506.
Ogunlesi TA: Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting. Matern Child Health J. 2010, 14 (3): 459-465. 10.1007/s10995-008-0440-3.
Henry BA, Nicolau AI, Americo CF, Ximenes LO, Bernheim RG, Oria MOB: Socio-cultural factors influencing breastfeeding practices among low-income women in Fortaleza-Ceara-Brazil: a Leininger's sunrise model perspective. Enfermeria Global. 2010, [http://www.um.es/eglobal]
Otoo GE, Lartey AA, Pérez-Escamilla R: Perceived incentives and barriers to exclusive breastfeeding among Periurban Ghanaian women. J Hum Lact. 2009, 25 (1): 34-41. 10.1177/0890334408325072.
Ojofeitimi EO, Esimai OA, Owolabi OO, Oluwabusi OOF, Olanuga TO: Breastfeeding practices in urban and rural health centers: impact of baby friendly hospital initiative in Ile Ife, Nigeria. Nutr Health. 2000, 14: 119-125. 10.1177/026010600001400204.
Lawoyin TO, Olawuyi JF, Onadeko MO: Factors associated with exclusive breastfeeding in Ibadan, Nigeria. J Hum Lact. 2001, 17 (4): 321-325. 10.1177/089033440101700406.
Tella A, Falaye A, Aremu O, Tella A: A: Hospital-based assessment of breast-feeding behavior and practices among nursing mothers in Nigeria and Ghana. Pak J Nutr. 2008, 7 (1): 165-171. 10.3923/pjn.2008.165.171.
Baumslag N, Michels DL: Milk, Money and madness: The Culture and Politics of Breastfeeding. 1995, Westport, CT: Bergin and Gravey
Blum LM: At the Breast. Ideologies of Breastfeeding and Motherhood in the Contemporary United States. 1999, Boston: Beacon Press
Spencer RL: Research methodologies to investigate the experience of breastfeeding: a discussion paper. Int J Nurs Stud. 2008, 45 (12): 1823-1830. 10.1016/j.ijnurstu.2008.04.008.
Oweis A, Tayem A, Froelicher ES: Breastfeeding practices among Jordanian women. Int J Nurs Pract. 2009, 15: 32-40. 10.1111/j.1440-172X.2008.01720.x.
Grassley J, Eschiti V: Grandmother breastfeeding support: What do mothers need and want?. Birth. 2008, 35 (4): 329-335. 10.1111/j.1523-536X.2008.00260.x.
Cameron R: A sequential mixed model research design: Design, analytical and display issues. Int J Soc Res Meth. 2009, 3 (2): 140-152.
Mertens D: Research and Evaluation in Education and Psychology: Integrating diversity with quantitative, qualitative, and mixed methods. 2005, Boston: Sage, 2
Federal Republic of Nigeria Official Gazette. Report on the 2006 National Population Census, Nigeria. 2009, 96 (2):
Ajibade GO: The Role of Yoruba Traditional Birth Attendants in Global Health Care Delivery. Locating the Local in the Global: Voices on a Globalised Nigeria. Edited by: Akinrinade S, Kolawole M, Mojola I, Ogungbile DA. 2004, New York, USA, 121-135.
Babalola S, Fatusi A: Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009, 9: 43-10.1186/1471-2393-9-43.
Imogie AO, Agwubike EO, Aluko K: Assessing the role of the traditional birth attendants (TBAs) in health care delivery in Edo State, Nigeria. Afr J Reprod Health. 2002, 6 (2): 94-100. 10.2307/3583135.
Fraenkel J, Wallen N: How to Design and Evaluate Research in Education. 1990, New York: McGraw-Hill
Creswell JW: Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 2007, Thousand Oaks, CA: Sage, 2
Strydom H: Ethical aspects of research in the social sciences and human service professions. Research at Grass Roots for the Social Sciences and Human Service Professions. Edited by: de Vos AS, Strydom H, Fouché CB, Delport CSL. 2002, Pretoria, South Africa: Van Schaik Publishers, 62-92. 2
Davies-Adetugbo AA: Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria. Soc Sci Med. 1997, 45: 113-125. 10.1016/S0277-9536(96)00320-6.
Salami KK: Household Social Reproductive Roles and Production of Child Health in Igbo-Ora, Southwestern Nigeria. PhD thesis. 2008, University of Ibadan, Sociology Department
Sobo RA, Sokoya GO, Awonusi PA, Odufuwa BA: Knowledge attitudes and practice of exclusive breastfeeding among rural mothers in Ijebu-Ode, Ogun State, Nigeria. W Afr J Nurs. 2008, 19 (2): 121-124.
Sam V: One million children die yearly in Nigeria: Report. The Punch. 2008, 12: 10-
Uchendu UO, Ikefuna AN, Emodi IJ: Factors associated with exclusive breastfeeding among mothers seen at the University of Nigeria Teaching Hospital. South Afr J Child Health. 2009, 3 (1): 14-19.
African Regional Health Report, (2006). [http://whqlibdoc.who.int/afro/2006/9290231033_rev_eng.pdf]