The determinants of breastfeeding in the Torres Strait

Abstract

The purpose of this study was to investigate the influences upon breastfeeding in the Torres Strait Islands. The health benefits of breastfeeding are well recognised. A previous study by Dyke et al., (1996) had found that although the breastfeeding rates on hospital discharge at Thursday Island Hospital were close to the national average, these rates dropped markedly in the first weeks and months of the baby's life. Two main approaches were used in this study, one was community based, utilising a qualitative design and the other was hospital based, using the WHO/U N ICEF Baby Friendly Hospital Initiative (BF H I) Assessment. A qualitative design was chosen as the most appropriate study design in order to explore the information, beliefs and experiences of families in the Torres Strait in relation to infant feeding. The study was conducted over four weeks and was based on Thursday Island. Most of the mothers come from the outer islands a number of weeks prior to their expected date of confinement to await the birth of their baby, however, some high risk mothers need to go to Cairns Base Hospital due to complications. Members of the community were categorised into four study groups, pregnant women, mothers, fathers and grandmothers/aunties. This was done in order to gain a comprehensive picture of the current situation within the community in regards to breastfeeding. These study groups participated in focus group discussions and indepth semi structured interviews. Participant observation was also used to gain an insight into issues such as public breastfeeding. The WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) Assessment framework was also utilised as a means of assessing current hospital practices in terms of breastfeeding. Health care staff in the community, both on Thursday Island and other islands were interviewed according to the W HO/UNICEF BFHI Assessment criteria. This was to establish current practices in regard to breastfeeding management and the existence of breastfeeding policy and staff training on breastfeeding. The results of this component of the study would indicate that a number of steps need to be taken in order for Thursday Island Hospital to be accredited as a Baby Friendly Hospital, according to the criteria developed by WHO/UNICEF Baby Friendly Hospital Initiative. The predominant themes which emerge reveal that although breastfeeding is espoused by all to be the best way to feed a baby, there are a number of barriers which make breastfeeding difficult. The combination of the belief that formula is fairly close in composition to breastmilk and the lack of knowledge and misconceptions which abound, particularly in relation to the management of breastfeeding, mean that very few mothers are able to make a well informed choice about the feeding of their baby. As in other studies (Scott et al, 1997; Holmes et al. ,1997) the reasons given for early cessation of breastfeeding are predominantly related to concerns regarding the mothers milk supply and sore nipples . Mothers were often unaware of what to do in these situations. Combined with this is the culture of bottle feeding which means that much traditional knowledge about breastfeeding and how a breastfed baby behaves has been lost. The expectation that a baby sleeps for four or more hours, or that the baby should sleep all night is a common misconception. There is an underlying belief that although breastfeeding is the best way to feed a baby, bottle feeding with formula is a highly acceptable alternative. Structural issues include the non acceptance of public breastfeeding, the attitude towards breastfeeding mothers and alcohol consumption , or going out to socialise, as well as the perception that if a mother is planning to resume employment, breastfeeding could not be maintained.