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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.
CHAPTER ONE
INTRODUCTION
Background
to study
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 [1] . 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 [2] . Several studies have reported barriers accounting for this
situation, including returning to work after delivery [3] . 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 [4] . Yet, the Nigeria 2010 Population and Housing Census Report
showed an increasing trend of women joining the labour force [5] . 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 [6] . 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 [7, 8] . Elsewhere,
Magner, and Phillipi attribute cessation of breastfeeding within the first
month to returning to work [9] . 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 [10] . 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 [11] . 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
[12] . Also, the factors acknowledged locally in Nigeria, Ayton and colleagues
have identified several others that are harmfully associated with effective
breastfeeding, such as delays in and/or failure of early breastfeeding
initiation [13] . Exploring the constraints to exclusive breastfeeding practice
among working class 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 [14] . 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 [15] ,
as well as a feeling of being watched and judged, lack of support including
networks, tiredness and emotional support at work [16] 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 [17] , 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.
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 [16, 18, 19] . 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 [20] , national surveys concluded
that Nigeria’s exclusive breastfeeding rate at six months is currently about 52
% [18] . Although higher than the national average, the exclusive breastfeeding
prevalence of 60 % in the Upper West Region is lower than the desired national
target. The popularity or otherwise of exclusive breastfeeding among gainfully
employed women is yet to be characterized in this region of Nigeria. The
current study therefore aimed to assess the prevalence, and predictors of
exclusive breastfeeding among professional working mothers in the Upper West
Regional capital of Nigeria.
Objectives
of the Study
Specific
Objectives
Assess the level of Working class
Breastfeeding mothers’ views about the benefits of exclusive breastfeeding;
Determine the level of working class
Breastfeeding mother’s views about barriers to exclusive breastfeeding;
Significance
It is hoped
that the findings of the study will provide a current perceptual database that
will inform all of us and more importantly the policy makers on the feelings
and views of the mothers about exclusive breastfeeding so that appropriate
alternatives to motivate the indulgence of exclusive breastfeeding and its
support, would be developed by Working class Breastfeeding mothers, helpers and
the populace of Nigeria.
1.6
Operational Definitions: –
These are
precise descriptions of how to derive a value for characteristics the
researcher is measuring. It also entails how specific these characteristics are
measured (Will, March, 2004).
Perception – Knowledge, Practice, Attitudes
and beliefs about exclusive breastfeeding.
Exclusive Breastfeeding – Only breast milk
to feed the baby, without any additional food or drink, not even water, for six
months.
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