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CHALLENGES OF EXCLUSIVE BREASTFEEDING AMONG WORKING MOTHERS (A CASE STUDY OF LAGOS UNIVERSITY TEACHING HOSPITAL, IDIARABA)

 

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DECEMBER,2018

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According to the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life and continuation of breastfeeding and adequate complementary foods for up to two years of age or beyond is important. The objective of this study was to assess the challenges of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba. Using a descriptive research design and a self structured questionnaire, data was collected from 189 respondents, presented in frequency tables, interpreted and analysed using the statistical production for service solution (SPSS) version 20. Result showed that more than half of the respondents (53.4%) are within the age range 33-37 years and a majority (94.7%) were married, most (68.8%) practice Christianity, majority (62.4%) had the secondary level of educational qualification, more than half (59.8%) were self employed with almost half (49.7%) earning an average income status. In this study, majority of the respondents (62.4%) have good knowledge on exclusive breastfeeding and most (63%) got their information from the hospital, likewise majority (59.8%) have good practice of breastfeeding. The most challenging factors of exclusive breastfeeding identify in this study were: health condition of the mother (58.7%), health condition of the baby (52.4%), cracked or sore nipples (39.2%), inadequate production of milk (36.9%) and work schedule (30.2%). there is a significant relationship between knowledge of exclusive breastfeeding and its practice among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idiaraba. Similarly there is a significant relationship between practice of exclusive breastfeeding and respondents’ educational qualification. In conclusion the practice of EBF is influenced by its' knowledge and also educational qualification of respondents. Health condition of mother and baby as well as cracked or sore nipples also hindered the practice of EBF. It is therefore recommended that Health sector should mandate that proper health education is carried out in hospitals for pregnant women receiving antenatal care in their facilities and Nurrses/Midwives should encourage and ensure post partum care is adequately given to both the mother and baby.

TABLE OF CONTENTS
COVER PAGE
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWELDGEMENT
ABSTRACT
GLOSSARY
CHAPTER ONE
1.0      INTRODUCTION
1.1      BACKGROUND OF THE PROJECT

1. PROBLEM STATEMENT
2. OBJECTIVE OF THE STUDY
3. SCOPE OF THE STUDY
4. RESEARCH QUESTIONS
5. SIGNIFICANCE OF THE STUDY
6. RESEARCH HYPOTHESES
7. STATEMENT OF PROBLEM
8. OPERATIONAL DEFINITION OF TERMS

CHAPTER TWO
LITERATURE REVIEW

1. HUMAN BREAST MILK
2. TYPES OF BREAST MILK
3. CONCEPT OF BREASTFEEDING
4. PHYSIOLOGY OF BREASTFEEDING
5. ADVANTAGES OF BREASTFEEDING TO THE MOTHER
6. ADVANTAGES OF BREASTFEEDING TO THE BABY
7. CONCEPT OF EXCLUSIVE BREASFEEDING
8. ADVANTAGES OF EXCLUSIVE BREASTFEEDING TO THE MOTHER
9. ADVANTAGES OF EXCLUSIVE BREASTFEEDING TO THE BABY
10. DISADVANTAGES OF EXCLUSIVE BREASTFEEDING
11. KNOWLEDGE OF BREASTFEEDING
12. PRACTICE OF BREASTFEEDING
13. CHALLENGES OF BREASFEEDING
14. THEORETICAL FRAMEWORK
15. APPLICATION OF THEORETICAL FRAMEWORK TO STUDY

CHAPTER THREE
3.0      RESEARCH METHODOLOGY

1. RESEARCH DESIGN
2. STUDY AREA
3. POPULATION
4. SAMPLING TECHNIQUE
5. INSTRUMENT FOR DATA COLLECTION
6. ETHICAL CONSIDERATION
7. METHOD OF DATA COLLECTION
8. METHOD OF DATA ANALYSIS
9. SAMPLE AND SAMPLING TECHNIQUES

CHAPTER FOUR
4.1      DATA PRESENTATION, INTERPRETATION AND ANALYSIS
4.2      SOCIO-DEMOGRAPHIC CHARACTERISTICS
CHAPTER FIVE

1. DISCUSSION
2. IMPLICATION TO NURSING
3. SUMMARY
4. CONCLUSION
5. RECOMMENDATION
6. REFERENCES

CHAPTER ONE

1. 1.0                                           INTRODUCTION

1.1              BACKGROUND OF STUDY

Breast milk is considered as the most complete nutritional source for infants because it contains the essential fats, carbohydrates, proteins, and immunological factors needed for infants to thrive and resist infection in the formative first year of life [1][2][3]. Based on this, the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life and continuation of breastfeeding and adequate complementary foods for up to two years of age or beyond [4]. Exclusive breastfeeding (EBF) is defined as exclusive intake of breast milk by an infant from its mother or wet nurse or expressed milk with addition of no other liquid or solid with the exception of drops or syrups consisting of vitamins, minerals supplements, or medicine and nothing else for the first six months [4].

Over the last couple of decades, there has been an increasing interest in the promotion of exclusive breastfeeding as the ‘best’ feeding method for newborns. This, to a large extent, has been inspired by mounting scientific evidence on the importance of exclusive breastfeeding in reducing infant morbidity and mortality. In resource limited settings where poor and sub- optimal breastfeeding practices frequently result to child malnutrition which is a major cause of more than half of all child deaths, exclusive breastfeeding is regarded as imperative for infants’ survival. Indeed, of the 6.9 million under five children who were reported dead globally in 2011 [5], an estimated 1 million lives could have been saved by simple and accessible practices such as exclusive breastfeeding. Consequently, the WHO and UNICEF have recommended exclusive breastfeeding for six months, followed by introduction of complementary foods and continued breastfeeding for 24 months or more [5].
Breastfeeding has many health benefits for both mother and infant. Breast milk contains all the necessary nutrients the infant needs in the first six months of life. Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also have long term benefits for the mother and child, such as reducing the risk of obesity in childhood and adolescence [6]. The advantages include a lower risk of gastrointestinal infections for the baby, more rapid recuperation after birth and delayed return of menstrual periods (a natural method of family planning). Breastfeeding also provides infants with superior nutritional content that is capable of improving the immunity and possible reduction of future health care spending [7].
EBF for six months is important for both infant and maternal health. Infants who are not exclusively breastfeeding are more likely to develop gastrointestinal infections, not only in developing but also in industrialized countries [8]. The risk of mortality due to diarrhea and other infections can increase many-fold in infants who are either partially breastfed or not breastfed at all [8]. During the first two months of life, infants who are not breastfed are nearly six times more likely to die from infectious diseases than infants who are breastfed; between 2 and 3 months, non-breastfed infants are 4 times more likely to die compared to breastfed infants [8].
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.

There are many benefits of practicing breastfeeding but it has been shown that there are barriers to the optimal practice of breastfeeding. Some of these barriers include hospital practices, advertisement of breast mill substitutes and lack of support for the breastfeeding mother. Many women identify their employment as a barrier to optimal breastfeeding [7].

It is almost certain that women who return to work before their babies are six months old will face challenges in adhering to the practice of EBF.

The researcher is motivated to carry out this study due to the challenges observed that may be incurred by working mothers who intend to practice EBF.

1.2  STATEMENT OF PROBLEM

In Nigeria, breastfeeding is universal with almost all babies being breastfed but the practice of EBF is rare with only 17% of children younger than six months being exclusively breastfed [9]. This has led to an increased incidence of morbidity from infectious diseases, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia and sudden infant death syndrome [10]. The benefits of exclusive breastfeeding for both mother and child are universally acknowledged by health providers, global health agencies and lay people [11].

Many attempts to promote EBF have achieved less than the desired outcomes and in order to comprehend the dynamics of this practice, a number of studies have been conducted in Nigeria and in many parts of the world [11]. Much of these studies have focused on knowledge and attitude of EBF, health outcomes of exclusive and nonexclusive breastfeeding and prospective positions of husbands in breastfeeding decisions. Much less attempts however, have been made at examining the factors affecting the practice of EBF among nursing mothers. This research therefore seeks to assess knowledge, practices and challenges of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.

1.3     OBJECTIVE OF THE STUDY

The broad objective of this study is to assess the challenges of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.
The specific objectives are to:

1. Assess the importance of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.
2. Assess the practice of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.
3. Assess the challenges of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.

1.4              SIGNIFICANCE OF STUDY

The findings of this study will help inform of the importance of breastfeeding to both mother and baby. It will also help inform mothers and the community at large on the effect the practice of non-exclusive breastfeeding will have on both mother and baby which will improve the overall practice of breastfeeding and also improve the child’s well-being. The findings will further help the healthcare practitioners in creating policies that will enhance the practice of breastfeeding and also to identify the challenges of breastfeeding practice which in turn will promote educating the mothers on the best way to practice breastfeeding despite these factors. It will help to inform the policies targeted at behaviours among mothers that seek to enhance the practice of the exclusive breastfeeding in Nigeria.
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.

1.5              RESEARCH QUESTIONS

1. Do the working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba have adequate knowledge about exclusive breastfeeding?
2. What percentage of working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba practice exclusive breastfeeding?
3. What are the challenges of exclusive breastfeeding among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba?

1.6     RESEARCH HYPOTHESES

Ho1: There is no significant association between the knowledge of exclusive breastfeeding and its practice among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.
Ho2: There is no significant association between the practice of exclusive breastfeeding and the educational qualification of working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba.

1.6     SCOPE OF STUDY

This study will be carried out among working mothers attending antenatal clinic in Lagos University Teaching Hospital, Idi-araba to assess the challenges of exclusive breastfeeding. Participants will be obtained from a random sampling of working mothers who attended antenatal visit within the study duration.

1.7     OPERATIONAL DEFINITION OF TERMS

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:
Challenges: factors that may prevent the mother from carrying out exclusive breastfeeding effectively.

Exclusive Breastfeeding: It is an act of giving infant breast milk only for the first six months of life, introducing complementary feeds after six months though breastfeeding continues till two years of life.

Working mothers: These imply women who are engaged in a business or work and have under-five children and attends antenatal clinic in Lagos University Teaching Hospital, Idi-araba.

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