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Effect of Exclusive Breastfeeding Education on Exclusive Breastfeeding Practices among Nursing Mothers in Nigeria

Abstract

Exclusive breastfeeding is an important public health intervention for improving infant and maternal health. It involves feeding an infant only breast milk during the first six months of life, except for medicines, oral rehydration solutions, or vitamin and mineral supplements when medically indicated. Appropriate exclusive breastfeeding practices provide infants with essential nutrients and immune protection and may reduce the risk of common childhood infections, while also providing health benefits for mothers. Exclusive breastfeeding education is an important health promotion intervention that provides mothers with information and practical skills concerning the benefits of exclusive breastfeeding, early initiation, breastfeeding frequency, correct positioning and attachment, management of common breastfeeding difficulties, expression and storage of breast milk where appropriate, and the importance of avoiding unnecessary prelacteal feeds and other liquids or foods during the first six months. In Nigeria, exclusive breastfeeding practices may be affected by inadequate knowledge, cultural beliefs, family influence, misconceptions about breast milk sufficiency, maternal employment, lack of workplace support, early introduction of complementary foods or liquids, and limited access to skilled breastfeeding counselling. Effective exclusive breastfeeding education may improve mothers' knowledge, confidence, and ability to maintain recommended breastfeeding practices. Against this background, this study investigates the effect of exclusive breastfeeding education on exclusive breastfeeding practices among nursing mothers in Nigeria. The study is anchored on the Health Belief Model (HBM), Social Cognitive Theory (SCT), and Knowledge-Attitude-Practice (KAP) framework. The Health Belief Model explains health-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding mothers' decisions to practice exclusive breastfeeding. Social Cognitive Theory emphasizes the interaction between knowledge, behavioural capabilities, self-efficacy, social influences, and environmental conditions in shaping breastfeeding behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from exclusive breastfeeding education may influence breastfeeding practices. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how exclusive breastfeeding education may influence exclusive breastfeeding practices among nursing mothers in Nigeria. The study adopts a quantitative quasi-experimental research design. Primary data will be collected from nursing mothers with infants aged below six months in selected communities and healthcare facilities in Nigeria using a structured interviewer-administered questionnaire and, where appropriate, a breastfeeding observation checklist. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible mothers. Where feasible, selected participants or healthcare facilities will be assigned to intervention and comparison groups. Mothers in the intervention group will receive structured exclusive breastfeeding education covering the definition and benefits of exclusive breastfeeding, early initiation, breastfeeding frequency and demand feeding, appropriate positioning and attachment, management of common breastfeeding difficulties, expression and storage of breast milk where applicable, maternal nutrition and hydration, and the importance of avoiding unnecessary water, herbal preparations, other liquids, and foods during the first six months. Exclusive breastfeeding practices will be assessed using indicators such as initiation of breastfeeding, exclusive breastfeeding status, frequency of breastfeeding, avoidance of prelacteal feeds, avoidance of other liquids and foods, appropriate breastfeeding technique, and continuation of exclusive breastfeeding up to six months where applicable. Breastfeeding information may be assessed through validated maternal recall measures and, where feasible, supporting health records. Descriptive statistics will be used to summarize participants' sociodemographic and maternal characteristics, exposure to exclusive breastfeeding education, and breastfeeding practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple logistic regression analysis, will be employed to determine the effect of exclusive breastfeeding education on exclusive breastfeeding practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and the robustness of the findings. The study anticipates that exclusive breastfeeding education will have a significant positive effect on exclusive breastfeeding practices among nursing mothers in Nigeria. Mothers exposed to structured exclusive breastfeeding education are expected to demonstrate improved knowledge of recommended breastfeeding practices and a greater likelihood of maintaining exclusive breastfeeding. Education may improve mothers' confidence, breastfeeding skills, and ability to manage common difficulties while reducing misconceptions about breast milk adequacy and the perceived need to introduce water or other foods and liquids before six months. However, education alone may not guarantee sustained exclusive breastfeeding because mothers may face barriers such as early return to work, inadequate maternity leave, limited workplace breastfeeding support, family and cultural influences, maternal health challenges, and limited access to skilled lactation support. Consequently, exclusive breastfeeding education is expected to be most effective when combined with supportive family and workplace environments, baby-friendly healthcare practices, maternity protection policies, and accessible breastfeeding counselling. This study is expected to contribute to the literature on infant feeding, maternal and child health, breastfeeding, health education, nutrition, and public health in Nigeria by providing empirical evidence on the effect of exclusive breastfeeding education on exclusive breastfeeding practices among nursing mothers. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, hospitals, primary healthcare facilities, midwives, nurses, nutrition professionals, community health workers, maternal and child health programmes, development partners, and policymakers regarding strategies for improving exclusive breastfeeding. The study will also provide evidence-based recommendations for strengthening exclusive breastfeeding education during antenatal and postnatal care, expanding community-based breastfeeding counselling, improving maternity and workplace support, strengthening baby-friendly healthcare services, addressing cultural misconceptions about infant feeding, and promoting appropriate infant and young child feeding practices across Nigeria.

Keywords: Exclusive breastfeeding education, exclusive breastfeeding practices, nursing mothers, breastfeeding, infant feeding, maternal health, child health, breastfeeding education, infant nutrition, health education, public health, Nigeria.