Abstract
BackgroundThe World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya.MethodThis study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences.ResultsThe exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding.ConclusionsDeeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.
Highlights
The World Health Organization recommends exclusive breastfeeding for the first six months of life
There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers
The major hindrances identified were cultural barriers propagated by mothers-inlaw and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers
Summary
The World Health Organization recommends exclusive breastfeeding for the first six months of life. Universal coverage of exclusive breastfeeding is estimated to prevent around 13% of all deaths among children under five years of age in low and middleincome countries [2]. Sub-optimal breastfeeding practices contribute to 11.6% of mortality in children under 5 years of age [3]. According to the 2016 Lancet series on breastfeeding, “breast is best” for lifelong health and if optimally practised has the potential to reduce the mortality of 823,000 infant deaths annually, and the greatest potential of all preventive interventions to reduce the annual infant mortality rate [4,5,6]. Breastfeeding provides sustainable long-term health and economic benefits to the infant, mother and the society. Failure to breastfeed is associated with lower intelligence and economic losses valued at 49% of world gross national income [5]
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