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CHALLENGES OF EXCLUSIVE BREASTFEEDING AMONG WORKING CLASS WOMEN

Abstract

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. 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. 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). 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 the 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.

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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