Abstract
BackgroundThe benefits of breastfeeding are well-recognised. The majority of first-time mothers in the Lao People's Democratic Republic however do not follow WHO guidelines of exclusively breastfeeding for the first six months, and less than half breastfeed for two years. UNICEF identified lack of exclusive breastfeeding as the second highest risk factor for under 5 mortality in Lao PDR, closely following lack of skilled delivery care. This study explored the reasons and influences behind first-time mothers' breastfeeding practices, as well as the role of attitudes, beliefs and experiences in influencing those practices.MethodsA qualitative research design was chosen for this exploratory study. Two districts in Vientiane were selected, and in each district four focus group discussions, two with six first-time mothers and two with health staff were undertaken. In addition, sixteen in-depth interviews with first-time mothers and seven individual key informants were conducted.ResultsParticipants demonstrated positive attitudes towards breastfeeding and recognised its importance. Despite this, breastfeeding practices were suboptimal. Few exclusively breastfed for the first six months of the baby’s life and most of the first-time mothers included in the sample had stopped or planned to stop breastfeeding by the time the infant was 18 months of age. Work was named as one of the main reasons for less than ideal breastfeeding practices. Traditional beliefs and advice from health staff and the first-time mothers' own mothers, were important influences on breastfeeding practices. First-time mothers also cited experiencing tension when there were differences in advice they received from different people.ConclusionOverall, the mothers were well-informed on the benefits of breastfeeding, and displayed positive attitudes towards it. Nevertheless, few maintained optimal breastfeeding practices in the first two years of the infant’s life. Further effort needs to be directed at addressing knowledge and non-knowledge barriers to optimal breastfeeding practices. Of particular importance is working with employers, developing supportive employment policies, providing postnatal support and working with lay people and health professionals. Research is also needed to identify the optimal combination of interventions to promote good breastfeeding practices.
Highlights
Other dietary restrictions were based on medical advice and included avoidance of fermented food, such as fermented pork meat with vegetable or fermented fish sauce
We found universal antenatal care (ANC) attendance in the group of first-time mothers included in the in-depth interviews which is consistent with the above cross-sectional study [19]
Given the well-documented benefits of BF, further effort needs to be directed towards increasing the understanding of the benefits of exclusive breastfeeding (EBF) of first-time mothers, lay people and health professionals
Summary
The majority of first-time mothers in the Lao People's Democratic Republic do not follow WHO guidelines of exclusively breastfeeding for the first six months, and less than half breastfeed for two years. UNICEF identified lack of exclusive breastfeeding as the second highest risk factor for under 5 mortality in Lao PDR, closely following lack of skilled delivery care. Important is the timely initiation of BF (within 1 hour after birth), exclusive breastfeeding (EBF) for the first 6 months, and continued BF until the child is at least. 24 months old (1-6-24 model) [1,2,3,4] Breastfeeding benefits both the mother and her baby. Other benefits include decreased risk of subsequent breast and ovarian cancers and hip fractures [9]
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