Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study

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Abstract

Background

Breastfeeding, particularly exclusive breastfeeding, is essential to ensure the short- and long-term health of infants and mothers. Sub-optimal breastfeeding practices currently take place in low income countries contributing to morbidity and mortality. This research explored the challenges and opportunities around exclusive breastfeeding in a large city in Ethiopia to inform a larger breastfeeding intervention.

Methods

Fathers and mothers who had children less than 2 years of age, and who could speak, and understand Tigrigna were recruited from two health centres located in Mekelle, Ethiopia. Two focus group discussions (FGDs) with fathers and two FGDs with mothers ( n = 42) were conducted using a semi-structured interview guide to explore the challenges and opportunities related to breastfeeding. Discussions were audio-recorded and transcribed in Tigrigna and translated to English. The data were manually analysed using thematic analysis, generating open codes which were grouped to form themes.

Results

Four themes with 11 sub-themes emerged. The themes identifies were: conflicted emotions on the birth of baby (feeling happy and feeling worried); perspectives on intergenerational approaches (old-fashioned beliefs of grandparents and the power of science, breastfeeding in public, breastfeeding knowledge); gender roles as barriers and enablers (the burden on women, changes in men’s roles and the financial status of the household); the role of healthcare (delivery of health information to parents, the role of health care providers and perceptions of inadequate milk supply).

Conclusion

Parents reported a range of opportunities with respect to breastfeeding, including the power of a scientific approach, the positive role of healthcare, and shifts within gender roles that maximized the potential support from fathers. However, there remains a tension between the beliefs of older generations and current best-practice. Parents continue to need ongoing support in order to practice optimal breastfeeding.

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Most cited references 44

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Factors that positively influence breastfeeding duration to 6 months: a literature review.

Shahla Meedya, Kathleen Fahy, Ashley Kable (2010)

What modifiable factors positively influence breastfeeding duration to 6 months postpartum? This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding. An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified. Modifiable factors that influence women's breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy. The modifiable factors that are positively associated with breastfeeding duration are the woman's breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

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Maternal perceptions of insufficient milk supply in breastfeeding.

Lisa R. Gatti (2008)

Improving the duration of exclusive breastfeeding is a national and international priority. Insufficient milk supply is one of the most commonly cited reasons for early cessation or decreased exclusivity in women who have initiated breastfeeding. This paper is an integrative review of current research pertaining to perceived insufficient milk (PIM). CINAHL, MEDLINE, and PubMed were searched combining "human milk" and "milk supply" and "perceived milk supply." Articles were limited to original research studies related to healthy, full-term breastfeeding dyads conducted over the past 10 years. Critical review indicated robust findings, limitations, and gaps in this body of literature. A lot of women discontinue breastfeeding during the first few weeks of the post-partum period because of PIM and approximately 35% of all women who wean early report PIM as the primary reason. Many women utilize infant satisfaction cues as their main indication of milk supply and many researchers, clinicians, and breast-feeding women do not evaluate actual milk supply. The relationships between PIM and socioeconomic or demographic variables as well as early breastfeeding behaviors have not been adequately addressed in the literature. Recommendations include improvement of maternal education about behaviors to ensure adequate supply, assessment of milk supply, and infant cues as well as further research into the root causes of PIM. Practitioners involved with maternal child health can improve their care of women and infants by understanding the subjective nature and questionable accuracy of PIM and changing assessment of milk supply.

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Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: a cross-sectional study

Getnet Mekuria, Melkie Edris (2015)

Background Exclusive breastfeeding is the most widely known and effective intervention for preventing early-childhood deaths. Optimum breastfeeding practices can prevent 1.4 million deaths worldwide among children under five every year. The aim of this study was to assess the prevalence of exclusive breastfeeding and associated factors among mothers who have an infant less than six months old in Debre Markos, Northwest Ethiopia. Methods A community based cross-sectional study was conducted from April 1 to 30, 2013. A simple random sampling technique was used from a list of all mothers who had an infant less than six months old obtained from the health extension workers (HEWs) registration book in all kebeles (neighbourhoods) of the city. A total of 423 mothers with infants less than six months old were included in this study. Data were collected using questionnaires administered at interview. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with exclusive breastfeeding. Results The prevalence of exclusive breastfeeding during the seven days before the survey was 60.8% (95% CI: 55.8%, 65.8%). Those mothers who were unemployed [AOR = 1.98 (1.21, 3.22)], received breastfeeding counseling during antenatal care (ANC) [AOR = 2.44 (1.53, 3.91)], received infant feeding counseling during postnatal care (PNC) [AOR = 5.03 (3.04, 8.31)], didn’t give prelacteal feeding [AOR = 3.44 (1.88, 6.33)] and had adequate knowledge about breastfeeding [AOR = 2.57 (1.57, 4.19)] were more likely to practice EBF than their counterparts. Conclusions Although the prevalence of exclusive breastfeeding was lower in the study area than international recommendations, rates were higher than found in other studies. Recommendations for improving exclusive breastfeeding include better support for working mothers through extending maternal leave and establishing work-site day care centers for infants, expanding the urban health extension program so that more pregnant women and mothers can be taught about appropriate infant and young child feeding practices and how to express their milk, thereby increasing their breastfeeding knowledge.

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Author and article information

Contributors

Kidane Tadesse Gebremariam: Kidane.tadesse@mu.edu.et

Oksana Zelenko: o.zelenko@qut.edu.au

Znabu Hadush: hadiszinabu@gmail.com

Afework Mulugeta: afework.mulugeta@gmail.com

Danielle Gallegos: danielle.gallegos@qut.edu.au

Journal

Journal ID (nlm-ta): Int Breastfeed J

Journal ID (iso-abbrev): Int Breastfeed J

Title: International Breastfeeding Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1746-4358

Publication date (Electronic): 30 March 2020

Publication date PMC-release: 30 March 2020

Publication date Collection: 2020

Volume: 15

Electronic Location Identifier: 20

Affiliations

[1 ]GRID grid.1024.7, ISNI 0000000089150953, School of Exercise and Nutrition Sciences, , Queensland University of Technology, ; Brisbane City, QLD Australia

[2 ]GRID grid.30820.39, ISNI 0000 0001 1539 8988, School of Public Health, College of Health Sciences, , Mekelle University, ; Mekelle, Ethiopia

[3 ]GRID grid.1024.7, ISNI 0000000089150953, School of Design, , Queensland University of Technology, ; Brisbane City, QLD Australia

[4 ]GRID grid.1024.7, ISNI 0000000089150953, Centre for Child Health Research, , Institute of Health and Biomedical Innovation, ; Brisbane City, QLD Australia

Article

Publisher ID: 265

DOI: 10.1186/s13006-020-00265-0

PMC ID: 7104505

PubMed ID: 32228718

SO-VID: 7f090776-69b5-4e49-825c-97132b074dc9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 February 2019

Date accepted : 19 March 2020

Funding

Funded by: Queensland University of Technology (QUT) PhD student allocation and the Child and Adolescent Health (CAH) theme of Institute of Health and Biomedical Innovation (IHBI), QUT.

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: exclusive breastfeeding,focus groups,parents,perceptions,attitudes,barriers,ethiopia

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: exclusive breastfeeding, focus groups, parents, perceptions, attitudes, barriers, ethiopia

Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study

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Advocacy for Maternal and Women’s Health

Most cited references 44

Factors that positively influence breastfeeding duration to 6 months: a literature review.

Maternal perceptions of insufficient milk supply in breastfeeding.

Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: a cross-sectional study

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