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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 91-95

Motivators and disincentives to exclusive breastfeeding among mothers in Zaria, Northwestern Nigeria


1 Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
2 Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria

Date of Submission11-Sep-2015
Date of Acceptance30-May-2016
Date of Web Publication21-Jun-2016

Correspondence Address:
Dr. Abdulkadir Isa
Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State
Nigeria
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DOI: 10.4103/2384-5147.184356

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  Abstract 

Background: Human milk remains the best food for infant optimal nutrition, growth, and development. Breastfeeding among mothers however remains challenging with an increasingly less proportion of mothers' breastfeeding their babies and even far less practicing exclusive breastfeeding (EBF). Bearing in mind the complexities in deciding infant nutrition in our communities, the study explored the motivators and disincentives to EBF among mothers and assessed mothers' perception of key stakeholders in influencing infant nutrition decision-making. Objective: To evaluate factors that motivate/deter mothers from exclusively breastfeeding their babies in Zaria. Methods: The study was a cross-sectional study of mothers in Zaria as part of a national multicenter breastfeeding survey. Information was obtained using a specifically designed structured interviewer-administered questionnaire on mothers' knowledge and practices of breastfeeding and their perception of the attitude of significant others to EBF. Focus-group discussions were held with groups of predefined significant others (fathers and grandmothers), and in-depth interviews were also conducted. Results: Ninety-seven percent of mothers have heard of EBF while 68% had a correct perception of the concept. The percentage of those that ever breastfed was 98.1% while only 2% practiced EBF. Motivation to EBF appeared to be the conviction on the benefits of EBF. Reasons for not supporting EBF were mainly surrounding the perceptions that babies like adults must drink water even if once a day and the inadequacy of human milk as sole infant nutrition within the first 6 months of life. Mothers perceived mainly health workers as promoters and supportive of EBF and breastfeeding in general while religious leaders and relatives, particularly fathers and grandmothers, though aware of EBF, were least supportive. Conclusion: Almost all mothers were aware of EBF; however, only a few (2%) exclusively breastfed their babies. Incentives to EBF appear to go beyond information and knowledge of breastfeeding. More needs to be done to understand other factors which influence mothers will to exclusively breastfeed.

Keywords: Exclusive breastfeeding, human milk, infant feeding, partial breastfeeding


How to cite this article:
Isa A, Laila H, Ishaku H, Suleman M, Nuhu OW. Motivators and disincentives to exclusive breastfeeding among mothers in Zaria, Northwestern Nigeria. Sub-Saharan Afr J Med 2016;3:91-5

How to cite this URL:
Isa A, Laila H, Ishaku H, Suleman M, Nuhu OW. Motivators and disincentives to exclusive breastfeeding among mothers in Zaria, Northwestern Nigeria. Sub-Saharan Afr J Med [serial online] 2016 [cited 2019 Oct 16];3:91-5. Available from: http://www.ssajm.org/text.asp?2016/3/2/91/184356


  Introduction Top


For the attainment of improved child survival, optimal growth, and development, adequate nutrition during infancy remains a sine qua non. The World Health Organization (WHO) and the adapted national infant and young child feeding policy recommend exclusive breastfeeding (EBF) for the first 6 months of life. [1],[2],[3],[4] After 6 months, infants should receive nutritionally adequate and safe complementary foods while continuing to be breastfed until the age of 2 years or beyond. [1],[2],[3],[4],[5],[6] Despite the known benefits of breastfeeding and much more of EBF, the practice of EBF among mothers continues to decline while the 2015 target (50% rate) remains a mirage. [4],[5],[6] In Nigeria, EBF rate dropped from 17% to 13% between 2003 and 2008. [4],[5],[6] Even so, the breastfeeding rates and decline vary between the different geopolitical regions of Nigeria with the Northwestern region having the lowest as well as the greatest decline in rates. [4],[5],[6] Similarly, reasons for these variations perhaps differ among these regions. [7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] In Southeastern Nigeria, [10],[11] stress in the mother, being a single parent, and mother's refusal to exclusively breastfeed were associated with declining and low EBF rates. While in Northcentral [15],[16] and Southwestern [7],[17] Nigeria, reasons including resumption to work, inadequate milk, ignorance, peer/family influence, maternal illness, low maternal education, and nonutilization of orthodox obstetric facilities were identified as disincentives to EBF. This study evaluates the motivators and disincentives to EBF among mothers in Zaria, Northwestern Nigeria.

Definition of Breastfeeding Categories

Breastfeeding practice was categorized into three in accordance with the WHO guidelines: EBF, predominant breastfeeding, and partial breastfeeding.

Where EBF implied, an infant had received only human milk from his/her mother or a wet nurse, or expressed human milk and no other liquids or solids with the exception of drops of syrup consisting of vitamins, mineral supplements, or medicines from birth to the first 6 months of life.

Predominant breastfeeding: The infant's predominant source of nourishment had been human milk. However, the infant may also have received water and water-based drinks such as tea and local herbal drops.

Partial breastfeeding: When infant's feeding includes nonhuman milk foods such as animal/powdered/condensed milk and/or solid/semi-solid food (i.e., cereals, vegetables, fruits, lentils or meat).


  Methods Top


The study was a cross-sectional descriptive study as part of a national multicenter breastfeeding survey conducted in both rural and urban Zaria. A specifically designed questionnaire was administered by trained interviewers to consenting respondents who were mothers within childbearing age and had breastfed a child not more than 2 years from the time of interview. This was to prevent recall bias. Information obtained includes sociodemographic and economic characteristics of the respondents, their knowledge, attitudes, and practices related to breastfeeding, and perception of predetermined significant others' attitude toward EBF. Focus group discussions (FGDs) were conducted with a 12-member group, each of fathers and grandmothers to document their opinion on EBF and contributions in the choice and execution of infant feeding practices. Discussions were conducted in Hausa language, documented and recorded, and subsequently transcribed and translated. Mothers who successfully practiced EBF, mothers who began to but did not complete EBF, mothers who were aware of but refused practicing EBF, and postnatal health-care workers were interviewed in-depth using a semi-structured questionnaire. Data obtained were analyzed using  SPSS Version 18.0. Chicago: SPSS Inc. and qualitative and quantitative data presented in frequency tables, percentages, and charts as appropriate.


  Results Top


One-hundred and six mothers were interviewed in the study, of which 60.4% of the mothers were located in rural communities in Zaria while 39.6% were in cosmopolitan/urban area of Zaria. Nine (8.5%) respondents were within the age range 15-19 years [Table 1]. Of the 106 mothers, 15.1%, 16%, 19.8%, and 49.1%, respectively, had no education, primary, secondary, and tertiary education. About 2.8% of the respondents were single, 95.3% were married, and the remaining 1.9% were widows. Monogamy accounted for 61.5% of the marriages whereas the remaining 38.5% were in a polygamous marriage setup. A third (33.1%) of the mothers was fulltime homemakers [Figure 1].
Figure 1: Occupation of mothers

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Table I: Age distribution of respondents


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Ninety-seven percent of the interviewed mothers have heard of EBF while 68% had a correct perception of the concept of EBF with more of the rural respondents (74%) compared to the urban (59%) having the correct concept (P = 0.348). The major sources of information were from health facilities (92.2%), media (60.8%), and 19.6% from friends and relatives. No respondent received information from religious centers or schools.

The percentage of those that ever breastfed was 98.1% while only 2% practiced EBF. Some mothers (43%) fed their babies only human milk for 5 months and below; 56% never attempted EBF but rather partially or predominantly breastfed their babies from birth. Of those who were self-employed, only 3.6% practiced EBF while 2.6% of mothers who were students or full-time homemaker put together and none of those in paid employment practiced EBF. About 16% (16.2%) of working mothers who breastfed felt their job affected their ability to exclusively breastfeed; 58% took their babies to their workplace while only 32.6% of the workplace was reported to have any form of facility for babies. Only 2% of those who ever attended any antenatal care (ANC) or support group sessions exclusively breastfed while none of those who did not attend practiced EBF.

Common reasons mentioned for not exclusively breastfeeding was human milk alone would not be enough and baby needs water while those who breastfed exclusively adduced optimal growth, development, and brilliance of the infant as reasons for doing so. About 67.7% of the mothers perceived having healthy babies as benefits of EBF while 25% perceived EBF as economical and cheap. More explicit was information from the FGDs where fear of thirst and inappropriateness of breastfeeding without water as well as inadequacy of human milk as infant nutrition was stated as reasons for not exclusively breastfeeding infants. Mothers mainly perceived health workers as promoters and supportive of EBF and breastfeeding in general [Figure 2] while religious leaders and relatives were least supportive. The interviews and FGDs also documented that grandmothers and fathers were mostly aware of EBF but were not of the opinion of its implementation nor supportive of their spouses to exclusively breastfeed. Reasons for not supporting EBF mainly revolved around the perception that babies like adults must drink water even if once a day. Postnatal health-care workers encouraged and supported mothers to exclusively breastfeed and were available to discuss lactation challenges.
Figure 2: Mothers' perception of supportive attitude of significant others

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  Discussion Top


The age distribution of the respondents followed the normal reproductive age pattern with most (71%) of the respondents aged between 20 and 34 years in keeping with findings from other studies. [7],[9],[15] Information about EBF is widely distributed though the concept remains unclear in up to 32% of respondents. Awareness of EBF was almost total (97%) suggesting impressive, wide dissemination of information on EBF. Misconceptions on the definition of EBF, however, still exist as about 1 in 4 and 1 in 2 of rural and urban mothers respectively could not define EBF accurately. This gap between awareness and knowledge may be related to the components of communication including the context, content, clarity, appropriateness, and medium of dissemination of the information. Barriers to these components of communication could have as well been contributory, such that while content, clarity and unambiguous information may be of importance to the rural mother's understanding; appropriateness, medium, and psychological barriers may be of more importance to the industrial urban mother. This becomes even more important when the sources of information as also documented by other studies [9],[15] were mainly health facilities and media which are usually not individual centered but dependent highly on individual interest and commitment. Conversely, schools and religious centers (the major guides of culture, tradition, and norms in life) which are focused towards education and bringing about positive change in individuals were not involved at all or identified by any respondent as sources of information on EBF. This identifies a possible disconnect between the information received and the motivation to implement which could be bridged if these institutions could access, own and vigorously disseminate information on EBF with the same zeal as do the health institutions and media.

The EBF rate was much lower than the 14% reported for Kaduna state and the 13% national average. [4] This EBF rate coupled with the 56% who never attempted EBF indicate a huge gap between awareness and practice and that despite the wide dissemination of information on EBF efforts are not yielding the desired attitudinal change. In addition to inadequate information, lack of appropriate knowledge could be contributory to this as evident from the survey where mothers who agreed to exclusively breastfeed their babies cited knowledge and practical experience of unequalled benefits of EBF as their motivation while those who did not expressed unfounded fears of thirst and inadequacy of human milk alone as nutrition as reasons dissuading them from EBF. This suggests a lack of knowledge of the composition of human milk and indeed remains a great challenge to overcome.

The possible explanation for the gap between awareness and practice of EBF appears to be even more complex when the perception of the influence of significant others on choice and practice of infant feeding is juxtaposed with awareness, knowledge, and motivation. Health care providers were mostly supportive of EBF as reported by (>70%) mothers while religious leaders and in-laws were documented to least offer support though the study did not further document whether they even went ahead to out rightly discourage EBF. Keeping in view the relative closeness and influence wielded by in-laws and religious leaders on families in comparison to health-care providers and coupled with the not overwhelming support from spouses documented, it becomes more plausible that mothers were less likely to be neither motivated nor receive the required support to exclusively breastfeed.

Other factors that hitherto occupied important positions as incentives to EBF appear to be greatly modified by above dynamics; only 2% of those who attended ANC exclusively breastfed their babies though none of those who did not attend ANC practiced EBF and while none of those who were in paid employment practiced EBF with 16.2% of them suggesting work interfered with their will to exclusively breastfeed possibly compounded by lack of facilities for infants at place of work, 2.6% of the nonemployed (students and full-time homemaker) and 3.6% of self-employed practiced EBF. This implies that though satisfactory attendance of a proper ANC service and availing a mother more time away from her work could enhance her will to breastfeed exclusively but does not necessarily translate to EBF as most of those who were full time homemakers and those who were self-employed still did not exclusively breastfeed their babies suggesting that other intricate factors may be playing a role. A 2% rate of EBF among those who had ANC is quite worrisome. Although the study could not document the adequacy of ANC attendance nor the quality of care and services rendered including the content, medium, process, and level of information made available to clients. It is possible that these important factors that will influence clients' decision and bring about behavioral change were lacking or suboptimal in the services rendered to pregnant women in this study and thus resulted in low EBF rates among mothers who had ANC.


  Conclusion Top


The incentives to EBF appear to be complex and go beyond information, knowledge, and maternity leaves. More needs to be done to understand, identify and address other factors which intricately influence will and resolution to enable efficient translation of awareness, knowledge and will into conviction and actual practice of EBF.

Recommendations

It is recommended that a review of communications on EBF be conducted after undertaking a study to identify specific barriers to communication among urban and rural mothers as well as to study the efficiency of our ANC services. Encourage purposeful collaboration with schools and religious centers to access, own and participate in the dissemination of appropriate information on EBF to improve knowledge on EBF. Explore community and home education of mothers, their spouses and family alongside maintaining the high-level health facility dissemination of information on EBF attained with information redesigned specifically to target these significant others.

Acknowledgement

We appreciate the Nigerian Academy of Science for their support and all respondents who participated in the study.

Financial Support and Sponsorship

Support was received from NAS.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Indicators for Assessing Breastfeeding Practices: Report of an Informal Meeting. Geneva: World Health Organization; 1991.  Back to cited text no. 1
    
2.
World Health Organization. The Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2003.  Back to cited text no. 2
    
3.
World Health Organization. Indicators for Assessing Infant and Young Child Feeding Practices. Washington, D.C., USA: World Health Organization; 2008.  Back to cited text no. 3
    
4.
Federal Ministry of Health. Saving newborn lives in Nigeria: Newborn health in the context of the Integrated Maternal, Newborn and Child Health Strategy. Abuja: Federal Ministry of Health, Save the Children. Revised 2 nd edition. Jhpiego; 2011.  Back to cited text no. 4
    
5.
Nigeria Demographic and Health Survey 2008. National Population commission Federal Republic of Nigeria, Abuja Nigeria; 2008.  Back to cited text no. 5
    
6.
Summary Findings of Cross-sectional Nutrition Survey Northern Nigeria 2012. National Bureau of Statistics; 2012.  Back to cited text no. 6
    
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Okafor IP, Olatona FA, Olufemi OA. Breastfeeding practices of mothers of young children in Lagos, Nigeria. Niger J Paediatr 2014;41:43-7.  Back to cited text no. 7
    
8.
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9.
Ukegbu U, Ukegbu PO, Onyeonoro UU, Ubajaka CF. Determinants of breastfeeding patterns among mothers in Anambra State, Nigeria. SAJCH 2011;5:112-6.  Back to cited text no. 9
    
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Ugboaja JO, Berthrand NO, Igwegbe AO, Obi-Nwosu AL. Barriers to postnatal care and exclusive breastfeeding among urbanwomen in Southeastern Nigeria. Niger Med J 2013;54:45-50.  Back to cited text no. 10
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Illyasu Z, Kabir M, Abubakar IS, Galadanci NA. Current knowledge and practice of exclusive breastfeeding among mothers in Gwale LGA of Kano State. Niger Med Pract 2005;48:50-5.  Back to cited text no. 14
    
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Awogbenja MD. Factors influencing breastfeeding practices factors influencing breastfeeding practices among mothers in Lafia Local Government area of Nasarawa State, Nigeria. PAT 2010;6:126-38.  Back to cited text no. 15
    
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Agbo HA, Envuladu EA, Adams HS, Inalegwu E, Okoh E, Agba A, et al. Breast feeding among working class mothers: A study of female resident doctors in tertiary health institutions in Plateau State. J Med Res 2013;2:112-6.  Back to cited text no. 16
    
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