Background
Methods
Study design
Theoretical basis of the study
Study setting
Study population and sampling procedure
Data collection and measurements
Period | Questions |
---|---|
Pregnancy | - How do you intend to feed your expected baby: (You walk through the baby’s ages and discuss how they intend to feed the baby and with what) • After birth? • During the first three days after delivery? • During the first month (after the first three days) • Between 1 and 6 months of age? - How long after birth do you intend to breastfeed the baby for the first time? - How long do you intend to feed your expected baby with breast milk only? - Why did you think you would feed your baby this way? |
First week | - For this new baby (the name of the baby), how long after birth was she/he breastfed? - [If less than one hour] What do you believe are the advantages of breastfeeding the baby within the first hour after birth? - What factors or circumstances enabled you to breastfeed the baby within the first hour after birth? - [If more than one hour] What factors or circumstances made it difficult for you to breastfeed the baby within the first hour after birth? - Was the baby given (by you or anyone else) anything to eat/drink before he/she was breastfed for the first time? - [If yes] What was given to the baby? - Why was it given to her/him? [Ask for each food/drink that was given to the baby] - Who advised you to give this to the baby? [Ask for each food/drink that was given to the baby] - At the moment, from birth till now, has the baby been given anything to eat or drink other than breastmilk? - What was given to the baby other than breast milk? - What was the reason that triggered you to offer your baby (drink or/food item)? - Who advised you to do that? |
4 months | Now let’s talk about how the baby was fed after these few days. Please think back from the first week through the first few months: - Are you currently breastfeeding the baby? If yes, how often do you breastfeed? - Do you breastfeed 1) on a fixed schedule, or 2) each time the baby asks to be fed, or 3) depends on the mother’s availability? If not, at what age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? - What type of food was given to the baby; if any, what were the reasons that triggered you to offer your baby (drink or food mentioned)? - How did you learn about that? Did you learn it from someone? - From the last visit, in the first week postpartum, till now, did you make some changes in the ways you feed your baby? If yes, what did you change? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices for your child? For every problem, probe to talk more about the problem. - What elements do you believe help you to overcome those challenges? Is it something inside you (physical, mental, or spiritual) or something outside yourself (social and physical context)? |
6 months | Now let’s talk about how the baby was fed after these few months. From the last visit in the fourth month till now, did you make some changes in the ways you feed your baby? If yes, what did you change? Probing questions: - Are you currently breastfeeding the baby? If yes, how often do you breastfeed? - Do you breastfeed 1) on a fixed schedule, or 2) each time the baby asks to be fed, or 3) depends on the mother’s availability? If not, at what age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? - Have you given any food/drink to your baby in addition to breastmilk? - If yes, what was the first food given to your baby? - How old was your baby when you gave him/her this particular food or drink? If food was introduced before six months, ask why. - How did you learn about that? Did you learn it from someone? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices? For every problem, probe to talk more about the problem. - What elements do you believe help you to overcome those challenges? Is it something inside you (physical, mental, or spiritual) or something outside yourself (social and physical context)? |
Ethical considerations
Analysis
Results
Characteristics of the study population
Characteristics, n = 39 | Frequency | Percentage |
---|---|---|
Age of the mother (years) | ||
< 21 | 4 | 10% |
21–30 | 13 | 33% |
> 30 | 22 | 57% |
Marital status | ||
With partner | 32 | 82% |
Ability to read and write | ||
Yes | 37 | 95% |
Education level of the mother | ||
Illiterate | 2 | 5% |
Primary incomplete | 19 | 49% |
Primary complete | 15 | 38% |
Secondary incomplete | 3 | 8% |
Main occupation | ||
Farming | 39 | 100% |
Number of children | ||
0 | 10 | 26% |
1–2 | 21 | 54% |
3+ | 8 | 20% |
Experience in child feeding | ||
Yes | 30 | 77% |
Overview of the results
Barriers | Intentions | Birth | 1 week | 4 months | 6 months | |
---|---|---|---|---|---|---|
Individual level factors | Perceived breastmilk insufficiency | × | × | × | × | |
Infant health concerns | × | × | ||||
Poor knowledge | × | |||||
Postnatal discomfort | × | |||||
Group level factors | Family influence | × | × | × | ||
Domestic conflicts | × | |||||
Use of herbal remedies | × | × | × | |||
Society level factors | Limited professional and social support | × | × | |||
Household food insecurity | × | × | ||||
Mothers’ heavy workload | × | × |
Facilitators | Intentions | Birth | 1 week | 4 months | 6 months | |
---|---|---|---|---|---|---|
Individual level factors | Knowledge about the advantages of breastfeeding within the first hour | × | × | |||
Knowledge about the advantages of exclusive breastfeeding for the first six months | × | × | ||||
Confidence in the ability to breastfeed | × | |||||
Group level factors | Social support from family members | × | × | |||
Society level factors | Support from health professionals | × | × | × | × | |
Support from Community Health Workers | × | × | × |
Breastfeeding intentions and reasons behind intentions
“I will breastfeed the baby within the first hour after birth because the first breastmilk protects the baby against diseases and is very nutritious.” (W-13)
“Colostrum contains all the nutrients the baby needs; it is a problem if the baby fails to get it. In addition, breasting the baby immediately after birth stimulates breastmilk production.” (W-7)
“If I recall well for every previous birth, I was encouraged by older mothers to put the baby on breastmilk just to try and stimulate early production of breastmilk. That is the same belief and understanding I still have.” (W-17)
“The source of energy for this is that I am pleased to see my baby putting something in the stomach. Breastfeeding increases our intimacy and the baby feels closer to me as a mother than anyone else. We share life as it used to be during the pregnancy. The increased relationship between me and my baby is the first drive to breastfeed it.” (W-34)
“It is very important to breastfeed the baby exclusively for the first six months in order to protect the baby against diarrhea diseases and the resulting slowed growth, which happens when food is provided before six months.” (W-24)
“It is very important to only breastfeed an infant during the first six-month period because mother’s milk contains all the essential nutrients.” (W-34)
“Immediately after delivering, midwives tell you to breastfeed the baby in their presence and you do and when you arrive home you continue following their instructions.” (W-20)
“It might happen that I do not need to breastfeed immediately after birth for instance as a young and first-time mother that I am, you can understand that I do not know whether I will have to wait either some seconds or hours to initiate breastfeeding.” (W-06)
“It happens that the baby at around four months shows strong signs of not getting enough breastmilk. If it ever happens to me, I cannot exclude giving my baby those few fruits and light porridge.” (W-13)
“The only obstacle to exclusive breastfeeding that I could foresee is what happens very often for the difficult postpartum breastmilk production, which renders early exclusive breastfeeding very challenging. When I experience that concern there is no other option but to give some half warm milk to the baby on a spoon but after strictly ensuring hygiene.” (W-24)
“It may happen that the baby shows interest and eagerness for food even at five months, I will provide to him fruits so that the baby’s growth is not compromised and other food will be given at six months.” (W-03)
Breastfeeding practices
Barriers impeding optimal breastfeeding practices from birth to 6 months of age
“When the baby was seriously coughing at 3 months old, I went to the health center, the health professional staff told me to treat this by providing a mixture made with lemon juice and honey, I did and the baby was cured.” (W-18, month 4)
“Because the baby was crying day and night, when I look back since we arrived home on Friday evening from the health center after delivery, Saturday the child cried all night, but after getting the traditional medicine, the baby stopped crying and slept well.” (W-36, week 1)
“When we reached home after discharge from the health center, my mother-in-law realized that the baby was not passing stools and then decided to provide herbs. The next day, the baby passed a stool, since then there is no problem.” (W-26, week 1)
“From two weeks after birth, the baby used to vomit after breastfeeding episodes, and I thought she may have a problem related to stomach pain and provided wild leaves. She is now getting better.” (W-29, month 4)
“Because the baby used to cry so often during and after breastfeeding episodes, my sister gave him cow’s milk despite the too young age and when she did, the baby was satisfied.” (W-19, month 4)
“Because the baby was suffering from constipation, my mother-in-law told me to give boiled water, and then I did.” (W-35, month 4)
“The baby used to cry often while seeing older children eating even during the night and I could spend sleepless nights. I thought the baby was not having enough breastmilk and then decided to feed semi-solid items.” (W-28, month 4)
“I disrupted the exclusive breastfeeding at one week and a half before six months and started giving fruits to the infant because she had been sick and lost weight. When they took measurements and found that the baby had regressed from the previous visit, I decided to give her some fruits before she attained the full six months in order to rehabilitate her.” (W-15, month 6)
“For instance, if we go for farming and do not have time to come and prepare our lunch, we are bound to having dinner only and therefore one meal a day. In this situation, even the infant does not have that opportunity to be breastfed before we are back from the farm. I personally observe this and I am conscious of the negative effects as regards the infant.” (W-26, month 6)
“Some of us have to wait until the baby cries to feel the need to breastfeed every time we are busy with household chores or on-farm activities.” (W-5, month 6)
“Only limited time can hinder doing so. For instance, one can say I am going uphill for animal fodder, and then in the farmland activities once back home, then follow domestic responsibilities like cooking, and all those really pre-empt us from fulfilling our responsibilities as mothers such as entertaining our kids. With that, I cannot mislead you and say that I am up to doing it.” (W-1, month 4)
“Challenges are obvious because, if a mother has gone to bed hungry without food, a baby cannot get any breastmilk to suck. In this case, the only thing the mother can do to content the baby is carry him/her on her back the next day morning until you get some little breastmilk. Otherwise, if you have enough and adequate food as a mother, I do not see anything that can preclude you from breastfeeding your baby as much as possible.” (W-22, month 6)
“It happens that here at home I have disputes with my partner and, in that case, I am completely in a different and unhappy mood. With that distress you would understand that I cannot have any intimacy with my baby while breastfeeding.” (W-10, month 6)
Facilitators of breastfeeding practices from birth to 6 months of age
“I knew that the child should be breastfeed immediately after birth within 30 minutes, as we were informed during the antenatal education that the first milk that comes is very important for child development.” (W-29, week 1)
“The most important thing is that knowledge of the nutrition value that the baby gets from breastmilk that he/she cannot get anywhere else. Once you have that knowledge and you have your own breast that is all! Again, the first and foremost is the willingness to breastfeed exclusively right from birth.” (W-34, week 1)
“Immediately after birth, right after I left the delivery room, the midwife told me and was monitoring whether I’m breastfeeding him right and the baby is sucking well.” (W-21, week 1)
“We are taught by the health workers. Before we used to give food to children before they reached 6 months of age because, when they saw other people eat, they became greedy and wanted to eat, but today we understand the importance of exclusive breastfeeding for the first six months. We are instructed by health workers, nurses at the Health Centre, and during our gathering for village kitchen activities. Giving hard food to a child before this age is dangerous because its stomach is not yet adapted to this kind of food.” (W-30, month 6)
“Because I was not able to sit down and to hold the baby, the caretaker helped me to hold and put the baby on the breast when I left the delivery room.” (W-07, week 1)
“Also, my husband is helping me in cooking and doing other household duties in these early days after delivery.” (W-11, week 1)
Discussion
Breastfeeding intentions
Breastfeeding practices
Barriers to, and facilitators of, breastfeeding practices
Through the lens of the TPB
Conclusion
Recommendations
- Educating mothers about the physiology of breastmilk production in order to address beliefs about their breasts’ anatomical shortcomings
- Informing women about how to recognize the true signs of baby hunger cues
- Targeting male partners’ involvement in caregiving and other household responsibilities traditionally performed by mothers
- Involve other important influential family and community members in EBF promotion interventions
- Integrating self-efficacy-enhancing strategies into healthcare professionals’ dialogue with mothers during antenatal and early postpartum periods.