Determinants of exclusive breastfeeding among nursing mothers in Obio - Akpor, Rivers

State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Exclusive Breastfeeding is a unique process that enhances child survival and development.

Breastfeeding is essential for child survival and optimal development of the child. It uniquely

enhances a young child’s psychological, nutritional, and immunological needs. Hanif (2011)

defines exclusive breastfeeding as a method in which newborns only get breast milk throughout

their first six months of life, with the exception of vitamins, mineral supplements, and

medications. They are also not given any other liquids, food, tea, or other herbal preparations.

For the first six months of life, newborns should only be breastfed in order to attain the best

possible growth, development, and health. Therefore, while continuing to nurse for up to two

years or longer, infants should be given supplemental foods that are safe and nutritionally

adequate.

All the nutrients a baby needs in the first six months of life are in breast milk (Datta, 2014). In a

similar vein, Okolo, Omoyibo, and Chimah (2015) noted that breastfeeding (BF) practice is said

to be optimal when breastfeeding has been initiated within the hour of birth; consequently,

exclusive breastfeeding is a practice in the first six months of life; following this, breastfeeding is

continued up until the age of two years while appropriate complementary foods are added. It is

a known truth that infants who begin breastfeeding within the first hour of life are more likely
to have optimum breastfeeding and have a longer probability of doing so exclusively. This will

enhance the infant's nutritional status, encourage healthy growth and development, and

eventually lower morbidity and death.

In Nigeria, the Nigerian Demographic and Health Survey (2018) showed that only 28.7% of

infants were exclusively breastfed under 6 months and only 17.9% of infants were exclusively

breastfed at 45 months. The advocacy of exclusive breastfeeding as the "optimal" feeding

strategy for newborns has drawn more attention in recent decades. This has mostly been

motivated by the growing body of scientific evidence demonstrating the value of exclusive

breastfeeding in lowering infant morbidity and death. Exclusive breastfeeding is recognized as

essential for infants' survival in resourceconstrained environments where poor and sub-optimal

breastfeeding practices frequently result in child malnutrition, which is a major factor in more

than half of all child fatalities (Sokol et al., 2007). In fact, it is predicted that 1 million of the 6.9

million under-five children who died worldwide in 2011 may have been saved if easy-to-use

strategies like exclusive breastfeeding had been used (WHO, 2012). As a result, WHO and

UNICEF advise breastfeeding exclusively for six months, then introducing complementary foods

and continuing for 24 months or beyond. However, some people have failed to adhere to this

ideal because of things like age, parity, occupation, cultural impact, and education, all of which

may be connected to practices of exclusive breastfeeding.

Poor maternal education is often associated with little or no information due to lack of

exposure to the mass media for easy access to information which may influence their

knowledge of EBF and the subsequent practice.

Age is a very strong determinant when it comes to health. This is concretized with the assertion

of Ajayi et al. (2011) that, age is a determinant of exclusive breastfeeding which shows that

mothers between the age of 25-35 are more likely to practice exclusive breastfeeding than

women of 15 – 24 years. Also, the age notwithstanding, the occupation the mothers do can go

a long way in determining the time she will have to practice EBF adequately.

The occupation of the mother may or may not allow her enough time for her child including the

practice of exclusive breast feeding. According to Bonyata (2018) babies should be breastfed at

least 10 – 12 times per day, this practice demands the mother to spend quality time with the

baby which many working mothers are unable to meet up with because they are occupied with

work. Culture being the way of life of a people could also influence the practice of exclusive

breast feeding among mothers. The cultural factors influencing mothers’ decision to breastfeed

their babies according to Kakute et al. (2005) are pressures by village elders and families to

supplement because it is a traditional practice, belief that breastmilk is an incomplete food that

does not increase the infant's weight and belief that all family members should receive the

benefit of food grown in the family farm.

For infants to survive, grow, and develop properly they require the right proportion of

nutrients. Breast milk is rich in nutrients and anti-bodies and contains the right quantities of fat,

sugar, water, and protein. These nutrients are major pre-requisites to the health and survival of

the baby. The report from the Nigerian Demographic and Health Survey (2018) showed that in

Rivers State, more than half (52.0%) did not start breastfeeding their children within one hour

of birth. Certainly, several factors would have interplayed, influencing the women’s practice of

EBF. The tertiary health care institutions having the major population of women attending both
antenatal and postnatal clinics were considered appropriate to carry out a study of this sort to

perused the socio-demographic determinants of the practice of exclusive breastfeeding among

mothers.

Ideally, mothers are expected to exclusively breastfeed their babies for at least six months as

recommended by World Health Organization. But some mothers still find it difficult to do so

due to certain factors which in one way or the other interfere with their practice of exclusive

breastfeeding. These make them resort to other forms of infant feeding such as bottle feeding

and inclusive breastfeeding which is not too healthy for the children. When a mother fails to

breastfeed her child exclusively, it can increase the chances of a high incidence of diseases such

as gastrointestinal infection, dehydration, pneumonia, diarrhea, bacterial meningitis,

respiratory tract infection, necrotizing enterocolitis, and even malnourishment of the child,

which are all detrimental to the health of the infant. Thus, several organizations including

UNICEF are making effort to ensure an increase in the practice of exclusive breastfeeding

among mothers yet, many do not still practice it. Thus, a perusal of the factors influencing its

practice becomes very necessary to inform a better option and to re-strategize in such efforts.

Hence, this study was aimed at investigating determinants of the Practice of Exclusive

breastfeeding among nursing mothers in Obio/Akpor local government

1.2 Statement of the Problem

The statement of the problem encapsulates the intricate challenges besieging the attainment of

optimal exclusive breastfeeding practices among mothers in the geographical locale of

Obio/Akpor local government. This multifaceted predicament is underscored by a myriad of

factors, including but not limited to, the maternal age spectrum, occupational exigencies,

profound cultural influences, and discernible educational differentials. The interplay of these

variables contributes to the nuanced complexity of the exclusive breastfeeding landscape in this

region. Maternal age emerges as a salient determinant, as elucidated by Ajayi et al. (2011),

positing that mothers within the age bracket of 25-35 exhibit a higher proclivity toward

practicing exclusive breastfeeding compared to their counterparts aged 15-24. This age-centric

predilection introduces an intriguing dimension, warranting a comprehensive exploration into

the socio-psychological and demographic dynamics that underpin such disparities.

Occupational constraints, as expounded by Bonyata (2018), present a formidable impediment

to the consistent practice of exclusive breastfeeding. The demanding nature of contemporary

work environments, often requiring substantial time commitments, raises pertinent questions

about the feasibility of adhering to the recommended breastfeeding frequency of 10-12 times

per day, as advocated by experts. This invites an in-depth examination of the intricate balance

between maternal professional obligations and the imperative of ensuring optimal infant

nutrition.

Cultural influences, as delineated by Kakute et al. (2005), contribute a distinctive layer of

complexity to the exclusive breastfeeding paradigm. Pressures from village elders and families

to supplement breastfeeding due to entrenched traditional practices, coupled with beliefs

about breast milk's perceived inadequacy, pose formidable challenges. Unraveling the cultural

intricacies that shape maternal decisions in this context necessitates a nuanced exploration of

societal norms, values, and their impact on infant feeding practices.

Moreover, educational differentials, as highlighted in the context of poor maternal education,

raise questions about information accessibility and its influence on exclusive breastfeeding

knowledge and subsequent practices. The nexus between educational attainment, exposure to

mass media, and the resultant impact on exclusive breastfeeding warrants meticulous

investigation to discern potential intervention points.

In light of these challenges, a comprehensive academic inquiry beckons—one that involves an

exhaustive review of existing literature, empirical studies to discern prevailing trends, and a

critical evaluation of potential interventions. This multifaceted examination serves not only to

dissect the determinants of exclusive breastfeeding practices but also to inform evidence-based

strategies aimed at ameliorating the existing constraints in Obio/Akpor local government.

1.3 Purpose of the Study

The purpose of the study is to systematically investigate and analyze the determinants

influencing the practice of exclusive breastfeeding among nursing mothers in Obio/Akpor local

government.

The specific objectives of the study are:

1. To assess the impact of maternal age on the practice of exclusive breastfeeding in

Obio/Akpor local government?

2. To explore the influence of occupational constraints on the consistent practice of exclusive

breastfeeding in Obio/Akpor local government?

 3. To analyze the cultural factors shaping maternal decisions regarding exclusive

breastfeeding in Obio/Akpor local government?

4. To investigate the impact of maternal education on exclusive breastfeeding practices

Obio/Akpor local government?

1.4 Research Questions

The research questions guiding the study are:

1. How does maternal age impact the practice of exclusive breastfeeding in Obio/Akpor local

government?

2. What are the challenges posed by occupational constraints in maintaining consistent

exclusive breastfeeding practices among working mothers in the specified region?

3. How do cultural factors, including norms and pressures from community elders and families,

influence maternal decisions regarding exclusive breastfeeding in Obio/Akpor?

4. What is the relationship between maternal education levels, exposure to mass media, and

the knowledge and implementation of exclusive breastfeeding among mothers in the study

area?

1.5 Hypotheses

The following hypotheses stated in null form, guided the study

1. There's no impact of maternal age on the practice of exclusive breastfeeding in Obio/Akpor

local government
2. There's no influence of occupational constraints on the consistent practice of exclusive

breastfeeding in Obio/Akpor local government

3. Cultural factors do not shape maternal decisions regarding exclusive breastfeeding in

Obio/Akpor local government

4. There's no impact of maternal education on exclusive breastfeeding practices Obio/Akpor

local government

1.6 Significance of the Study

The study holds significance for various stakeholders involved in maternal and child health,

including:

1. Healthcare Professionals: The findings can inform healthcare providers about the specific

challenges faced by nursing mothers in Obio/Akpor, enabling them to tailor their support and

guidance to enhance exclusive breastfeeding practices. This insight can contribute to more

effective antenatal and postnatal care.

2. Policymakers: Policymakers at both local and national levels can benefit from the study's

recommendations to formulate targeted interventions and policies aimed at promoting

exclusive breastfeeding. This may involve creating supportive workplace environments,

implementing educational programs, and addressing cultural factors influencing maternal

decisions.

3. Community Advocates: Organizations and individuals advocating for maternal and child

health can utilize the study's results to tailor awareness campaigns and community-based
initiatives. Understanding the local determinants of exclusive breastfeeding is crucial for

developing culturally sensitive interventions.

4. Mothers and Families: The study's insights can directly benefit nursing mothers and their

families by providing them with a better understanding of the factors influencing exclusive

breastfeeding practices. This knowledge can empower mothers to make informed decisions

about infant feeding, ultimately contributing to improved child health outcomes.

5. Researchers and Academia: The study adds to the body of knowledge in maternal and child

health, providing researchers and academia with nuanced insights into the specific

determinants of exclusive breastfeeding in a defined geographical context. This contributes to

the academic discourse and may guide future research endeavors.

6. International Organizations: Organizations such as UNICEF and WHO, which advocate for

optimal infant feeding practices globally, can benefit from understanding the localized

challenges identified in this study. This knowledge can contribute to the refinement of global

guidelines and strategies for promoting exclusive breastfeeding.

In summary, the study's significance extends to those directly involved in healthcare delivery,

policy formulation, community advocacy, maternal decision-making, and academic exploration,

all of whom play crucial roles in the broader landscape of maternal and child health.

1.6 Scope of the Study

The scope of the study encompasses nursing mothers in Obio/Akpor local government, aiming

to investigate the determinants influencing the practice of exclusive breastfeeding within this

specific geographical context. The study will focus on maternal age, occupational constraints,

cultural influences, and educational differentials as key factors shaping exclusive breastfeeding

practices.

Geographically, the study will be delimited to Obio/Akpor local government to provide a

localized and context-specific examination of exclusive breastfeeding practices. However, the

temporal scope extends to the present, allowing for a contemporary analysis of the prevailing

factors affecting infant feeding practices.

CHAPTER TWO.

REVIEW OF RELATED LITERATURE

This chapter plays a crucial role in establishing the context and rationale for investigating the

Determinants of exclusive breastfeeding among nursing mothers in Obio - Akpo, Rivers State

There are 4 major subheads, conceptual framework, theoretical framework, empirical review

and summary of literature review

2.1 Conceptual Framework

2.1.1 Exclusive Breastfeeding

Exclusive breastfeeding is a practice in infant nutrition characterized by the provision of breast

milk as the sole source of nourishment for the newborn, without the incorporation of

supplementary foods or liquids, including water. This approach is advocated and endorsed by

various health authorities, including the World Health Organization (WHO) and the American

Academy of Pediatrics, for the initial six months of an infant's life.

The rationale behind exclusive breastfeeding lies in the unique composition of breast milk,

which is tailored to meet the specific nutritional demands of a growing infant. It encompasses a

plethora of bioactive compounds, antibodies, and essential nutrients crucial for optimal

development and the establishment of a robust immune system. The immunological benefits

derived from maternal antibodies in breast milk contribute significantly to the infant's defense

against infections and diseases during this critical period of vulnerability. (Ayanate 2019)

Furthermore, exclusive breastfeeding has been linked to a myriad of health advantages for both

the infant and the lactating mother. Infants who undergo exclusive breastfeeding tend to

experience lower rates of respiratory and gastrointestinal infections, reduced risk of allergies,

and enhanced cognitive development. Moreover, the act of breastfeeding fosters a unique

bonding experience between the mother and the infant, promoting emotional well-being.

(Wosu 2022)

In an academic context, exclusive breastfeeding is a subject of ongoing research, exploring its

multifaceted implications on infant health, maternal well-being, and public health policies. The

discourse often delves into socio-economic factors influencing the prevalence and adherence to
exclusive breastfeeding practices, as well as the potential challenges and interventions to

promote its widespread adoption.

2.1.2 Nursing Mother

A nursing mother is a woman who is actively breastfeeding her child, providing nourishment

and sustenance through the act of breastfeeding. This involves the direct application of the

infant to the breast, allowing the baby to suckle and consume the mother's milk. The term

"nursing" in this context refers to the maternal act of breastfeeding, which serves as a primary

means of providing essential nutrients, antibodies, and emotional bonding between the mother

and the infant.(Ovundah 2017).

Nursing mothers play a pivotal role in the well-being of their infants, as the composition of

breast milk is uniquely tailored to meet the nutritional requirements of a growing baby. The act

of nursing goes beyond mere sustenance, encompassing a complex interplay of biological,

emotional, and psychological elements that contribute to the holistic development of the child.

(Ovamele 2009)

In broader terms, a nursing mother is a woman who has embraced the responsibility of

breastfeeding as a fundamental aspect of caring for her infant. This role involves dedication,

commitment, and an understanding of the nutritional and emotional significance that

breastfeeding holds in promoting the health and development of the child.

2.2 Empirical Review

According to Aborigio (2012) Determinants of early breastfeeding (EBF) are factors that

influence the practice of breastfeeding, which can be biological or a combination of economic,

environmental, cultural, and social factors. Some determinants include perceived incentives

and barriers to EBF, such as milk insufficiency, family pressure, breast and nipple problems, and

maternal employment. Other factors include the risk of diseases from poor sanitation, readily

available breast milk after birth, and high costs of infant formula.

Arora et Al in their study posited that Research has shown that lower socioeconomic status,

prior planning on EBF duration, maternal unemployment, hospital delivery facilities with

breastfeeding promotion services, and having a baby girl are all positively associated with EBF.

However, some determinants have been less straightforward, such as the connection between

breastfeeding mothers' level of education and desirable or undesirable breastfeeding practices.

Educated mothers in Western Uganda were more inclined to use prelacteal feeds but also

prepared nutritionally good complementary food for their children.

Briton (2009) opined that Pre-breastfeeding practices are crucial for the success of EBF, as the

frequency and duration of suckling are key determinants of milk production and nutrient

content. Prelacteal feeds are discouraged unless medically sanctioned, but they are widely used

and offered to neonates. In some cases, the practice is rooted in tradition and mistaken beliefs

about breastfeeding. For example, in rural northern Ghana, new-borns to primiparous mothers

are given wet nurses or herbal teas while the mother undergoes cultural cleansing.

Duncan (2012) posited in his study that the determinants of EBF are numerous and varied

across different countries and groups. Public health interventions designed to promote EBF
should consider a broad spectrum of these determinants to improve success rates. He further

opinied that breastfeeding is a common practice in rural communities in Africa, where women

are expected to do so due to cultural practices. Studies have shown that women's decisions on

exclusive breastfeeding (EBF) can be influenced by factors such as partner attitudes, paternal

involvement in breastfeeding promotion programs, social stigma, economic circumstances,

maternal age, and family influences. The influence of family is particularly strong on decisions

regarding EBF, with young mothers below 19 being less socially independent.

Grandmothers are one of the most widely reported sources of influence on infant feeding

across Africa, Asia, and South/Latin America. They play a crucial role in providing information

and advocacy for breastfeeding. Weaning is a process that comprises three related stages:

introduction of complementary foods, period of complementary feeding along with

breastfeeding, and cessation of breastfeeding. Inadequate food intake and poor nutrient

content of weaning foods can lead to negative growth outcomes such as stunting and wasting.

(Ayanate 2015)

The debate over the optimal duration of exclusive breastfeeding has led to the "weanling's

dilemma," which involves different views and discussions over the universality of the optimal

duration (six months). Critics argue that the recommendation to exclusively breastfeed all

infants in all populations is driven by biomedical considerations and that delayed

complementary feeding contributes to growth faltering.(Wosu 2016).

2.3 Theoretical Framework

The Theory of Planned Behavior (TPB) is a useful framework for studying exclusive

breastfeeding. This theory, developed by Icek Ajzen, focuses on the intention to perform a

behavior and suggests that this intention is influenced by three key factors: attitude toward the

behavior, subjective norms, and perceived behavioral control.(Ayanate 2019). It focuses on

three key factors: attitude towards the behavior, subjective norms, and perceived behavioral

control. Attitude involves an individual's evaluation of the behavior, subjective norms consider

social influences and expectations, and perceived behavioral control reflects the ease or

difficulty of performing the behavior. TPB provides a structured approach for investigating the

interplay of attitudes, social influences, and perceived control in breastfeeding practices.

2.4 Summary of Literature

This chapter explores the determinants of exclusive breastfeeding among nursing mothers in

Obio - Akpo, Rivers State. Exclusive breastfeeding is a practice where breast milk is provided as

the sole source of nourishment for the newborn, without the incorporation of supplementary

foods or liquids. It is advocated by health authorities like the World Health Organization (WHO)

and the American Academy of Pediatrics, for the initial six months of an infant's life. The unique

composition of breast milk, including bioactive compounds, antibodies, and essential nutrients,

contributes to optimal development and the establishment of a robust immune system.

Nursing mothers play a pivotal role in the well-being of their infants, as the composition of

breast milk is uniquely tailored to meet the nutritional requirements of a growing baby.

Research has shown that lower socioeconomic status, prior planning on EBF duration, maternal

unemployment, hospital delivery facilities with breastfeeding promotion services, and having a
baby girl are all positively associated with EBF. However, some determinants have been less

straightforward, such as the connection between breastfeeding mothers' level of education and

desirable or undesirable breastfeeding practices. Theoretical frameworks like the Theory of

Planned Behavior (TPB) can be useful for studying exclusive breastfeeding. TPB focuses on three

key factors: attitude toward the behavior, subjective norms, and perceived behavioral control.

Attitude involves an individual's evaluation of the behavior, subjective norms consider social

influences and expectations, and perceived behavioral control reflects the ease or difficulty of

performing the behavior. This framework provides a structured approach for investigating the

interplay of attitudes, social influences, and perceived control in breastfeeding practices.