Strengths and Barriers in Achieving “Green Status” of Breastfeeding; The Story of Frontline Health Care Workers in Sri Lanka

Abstract

Abstract Objectives The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community. Methods We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints. Results Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement. Conclusions The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF. Funding Sources No funding source.