Abstract
BackgroundExclusive breastfeeding (EBF) for the first six months of life is the most important determinant of child health and development, and is the recommended feeding practice for all mothers. However, EBF rates remain low in South Africa. This study aimed to prospectively explore enablers or barriers to success among mothers who planned to exclusively breastfeed their infants for the first six months of life, in KwaZulu-Natal, South Africa.MethodsA qualitative, longitudinal cohort design was adopted. Women were recruited during pregnancy from the catchment area of two hospitals (one urban and one rural) and purposively sampled to include working women, teenagers, and HIV positive pregnant women. This analysis relates to 22 women, from 30 women recruited, who planned antenatally to exclusively breastfeed for six months. These mothers were interviewed monthly for six months postpartum. Infant feeding practices were explored at each visit using in-depth interviews and 24 h feeding recall assessment. Framework analysis was conducted for qualitative data, and quantitative data analyzed using descriptive statistics.ResultsA total of 125 interviews were conducted between November 2015 and October 2016. Among 22 mothers who planned to exclusively breastfeed for six months, 17 reported adding other food or fluids before six months, and five reported exclusively breastfeeding successfully for the first six months. Key themes showed that all mothers relied strongly on health workers’ infant feeding advice and support. All mothers experienced challenges regardless of whether they succeeded in EBF, including inappropriate advice from health workers, maternal-baby issues, pressure from family members and returning to school and work. However, those who were successful at EBF for six months reported that high breastfeeding self-efficacy, HIV status and cultural meaning attached to breastfeeding were underlying factors for success.ConclusionHealth workers are key players in providing infant feeding information and support, yet some health workers give mothers infant feeding advice that is not supportive of EBF. Strategies to improve health workers’ competency in infant feeding counselling are needed to better prepare pregnant women to overcome common breastfeeding challenges and build mothers’ confidence and self-efficacy, thus increasing EBF rates.
Highlights
Exclusive breastfeeding (EBF) for the first six months of life is the most important determinant of child health and development, and is the recommended feeding practice for all mothers
We defined exclusive breastfeeding according to the World Health Organization (WHO) definition [3], which states that the infant receives only breast milk from his or her mother or expressed breast milk, and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines. These results relate to 22 participants who stated their plans to exclusively breastfeed for six months during the enrolment visit conducted prior to delivery
Our study suggests that advice given by health workers to mothers experiencing challenges with breastfeeding is one of the key determinants influencing mothers’ feeding practices [31]
Summary
Exclusive breastfeeding (EBF) for the first six months of life is the most important determinant of child health and development, and is the recommended feeding practice for all mothers. There is consistent and robust evidence, globally, of the importance of breastfeeding, exclusive breastfeeding (EBF), for improving child health and development and reducing infant mortality [1, 2]. EBF among South African mothers has increased in recent years, but is still well below global targets, with an estimated 31.6% of infants being exclusively breastfed for the first six months [5]. Despite high rates of breastfeeding initiation, early cessation of breastfeeding and mixed feeding before six months of age are common practices amongst mothers in South Africa (SA) [6]. The 2016 South Africa Demographic and Health survey showed that among children aged 0–5 months, 25.2% were not breastfed at all, 11.4% were receiving breastmilk and other milk, and 17.6% were being given complementary feeds [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
