Abstract
BackgroundSri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka.MethodsWe conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed.ResultsMain barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding.ConclusionEBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs.
Highlights
Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020
Initiation of breastfeeding Facilitators of early breastfeeding initiation All mothers knew about the concept of early initiation of breastfeeding
It is encouraging that our study shows that public health midwives (PHMs) try to encourage normal vaginal delivery, their efforts have been insufficient to reduce the number of unnecessary C-sections, indicating that reducing cesarean section rates will require a whole health care systems approach
Summary
Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka. The global recommendations for breastfeeding include initiation of breastfeeding during the first hour after birth, practicing exclusive breastfeeding (EBF) up to 6 months, continuing breastfeeding for at least 2 years and practicing on-demand feeding [2]. Skin to skin contact since birth provides a nurturing environment that allows for early breastfeeding initiation, provides protection from hypothermia, and promotes the establishment of a healthy microbiota in the newborn [2]. Current scientific evidence indicates that breastfeeding is associated with lower rates of infections among infants [5] including diarrhea [6], respiratory tract infections [6], otitis media [7] and allergic rhinitis [8]. In 2016, the United Nations reaffirmed EBF as a human right and called for all countries to keep close oversight of marketing practices of infant formula companies [12]
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