Running Head: BREASTFEEDING TEENAGE MOTHERS 1

Teenage Mothers’ Knowledge and Attitudes Towards Breastfeeding

Jovelyn Rafanan

Diana Solis

Cherry Mae Espejo

April Oandasan

Anabelle Bena

Ilocos Sur Community College

BREASTFEEDING TEENAGE MOTHERS 2

Chapter I: Introduction

Despite the advances in neonatal medicine and nutrition, breastfeeding still remains

undisputed as the safest, most practical way of providing optimum nutrition to infants.

Breastfeeding not only satisfies the hunger and thirst of newborn, but it also establishes and

strengthen the bond between the mother and the child.. It provides all the nutrition the newborn

needs during the first six months of life.

Breastfeeding reduces the risks of severe lower respiratory tract infections, sudden infant

death syndrome, acute otitis media, asthma, childhood leukemia, atopic dermatitis, type 1 and 2

diabetes, gastroenteritis, and obesity in children (Ip et al., 2009). It has also been observed that

exclusive breastfeeding for at least six months reduced the probability of urinary tract infections

in female infants (Levy et al., 2009).Furthermore, research suggests breast milk has important

fatty acids that help infants’ brain development and may increase infants’ cognitive skills

(USDHHS, NICHD, 2012). Additionally, a significant association has been found between

infants who were breastfed and higher intelligence test scores (Holme, et al, 2010). Breastfeeding

not only benefit the new born but the mother as well. According to the WHO (2018), there is

strong evidence that breastfeeding has positive short and long term health benefits for both

mother and baby.

Although many studies have focused on the physiologic and immunologic advantages of

breastfeeding, research also has shown that breastfeeding has a positive effect on early maternal

infant bonding (Else-Quest, et al, 2003). The bond which is developed when breastfeeding the

newborn marks the foundation of a developing motherhood (WHO, 2018). Mothers often report

that breastfeeding is a positive emotional experience they share with their infant (Else-Quest, et
BREASTFEEDING TEENAGE MOTHERS 3

al, 2003). Breastfeeding mothers at 4 months after birth were more likely to feel a greater

connection to their infants than those who bottle-fed their infants (Else-Quest et al., 2003).

Moreover, women who breastfeed have a decreased risk of postpartum depression, breast and

ovarian cancers, and type 2 diabetes (Ip et al., 2009).

Aside from the physical and psychological benefits of breastfeeding, it also offers strong

protection against the effects of poverty and is a key strategy in reducing disparities between the

rich and poor (Bartick and Reinhold, 2010) Over the past decade, multiple disasters have

prompted an emphasis on emergency preparedness in America. Young infants are among the

most helpless in disaster situations, but a breastfeeding mother can provide her baby with food,

water, protection, and care. Thus, every mother who initiates breastfeeding is contributing to

emergency preparedness (United Nations Children’s Fund [UNICEF], 2009).

Although 80% of newborns receive breastmilk in nearly all countries, only half start

breastfeeding on the first hour of life, and the rates of exclusive breastfeeding fall well below

50% (Victoria, et al, 2016). In the Philippines, despite numerous benefits of breastfeeding,

decades of recommendations, and even with the creation of the Milk Code, nearly half

of infants are still being deprived of exclusive breastfeeding (Baek et. Al, 2010). Several factors

exists which influence the initiation of breastfeeding. Swigart (2017) states that most problems in

breastfeeding is due to lack of understanding regarding the proper way on how to do it and not

because of the lack of knowledge regarding the benefits that it can provide. Yen-Ju and

McGrath, (2011) found that a lack of breast milk supply was the most common reason that

women stopped breastfeeding prior to the end of the six week postpartum period. However,

literature regarding low breastfeeding rates has indicated that maternal education and
BREASTFEEDING TEENAGE MOTHERS 4

socioeconomic factors play a role in breastfeeding initiation among these young mothers (Thulier

& Mercer, 2099). Furthermore, the Surgeon General’s U.S. Department of Health and Human

Services (2011)states that it is crucial that mothers receive support and education on

breastfeeding benefits to make an informed decision since the breastfeeding education that a

mother receives can be an influencing factor that affects her infant feeding intention. In terms of

economic aspect, there seems to be an inverse relationsip between development and

breastfeeding, Victoria, et al. (2016) claimed that less than one in every five children are

breastfed by the age of 12 months and further claimed that breastfeeding incidence at 12 months

decreases by ten percent for each doubling in national gross domestic product per person. It

implies that as a nation progresses and develops, breastfeeding becomes neglected. This can be

attributed to increased access to to breastmilk substitutes.

Another contributing factor that was identified which can also influence breastfeeding is

the age of the mother (McGrath and Kanhadilok, 2015). Thulier & Mercer (2009) revealed

disparities in breastfeeding knowledge among teenage pregnant mothers. This is supported by

the results of the study conducted by Spagnoletti (2018) which revealed that only 38.5% of

teenage mothers breastfeed longer than six months. Baek, et al (2010) also revealed that most of

the cases of newborn children who are not being breastfed come from first time or primiparous

mothers (Baek et. Al, 2010). A look at the practice of breastfeeding performed by first time

young mothers, in most cases, shows the reality of being mothers, and it is suggested that it will

be good to explore the different practices and the level of knowledge of mothers on exclusive

breastfeeding and factors affecting it (WHO, 2005).

BREASTFEEDING TEENAGE MOTHERS 5

Significance of the Study

Maternity, specifically during adolescence is a case of great social relevance in which the

causes, risks and consequences to the health of the mother and the child are investigated

(Liamputtong et al.,2015). Adolescent pregnancy and motherhood is of clinical significance

since at this stage the young mind and body of the adoscent is still developing and the mother has

not fully matured yet to care for a child. As such, teenage mothers may not be physically and

psychologically ready to breastfeed their children. It is then necessary for health care providers

to provide the necessary support and environment to assist these adolescents to establish and

sustain breastfeeding. Midwives are often in a position to plan interventions that help promote

breastfeeding. The literature shows an area where health care providers can improve

breastfeeding outcomes through breastfeeding education (Yen-Ju & McGrath, 2011). Assessing

the the knowledge and attitudes of teenage mothers is necessary to identifying the current

knowledge and practices that need to be strengthened, supported, modified, or changed. This

study could be of great help in improving the compliance of mothers towards breastfeeding

which will not only benefit the child and the mother but also the community since breastfeeding

is a very efficient, effective and economical way of preventing newborn diseases, malnutrition

and death. The results of the study will provide localized knowledge on the needs for

breastfeeding support especially teenage mothers. The results of the study will be also be used to

develop localized information, education, and communication materials. Moreover, the study can

be used as a basis for future researchers conducting similar studies.

BREASTFEEDING TEENAGE MOTHERS 6

Theoretical Framwework

The Interactive theory of breastfeeding is a middle-range theory developed by Primo and

Bandao (2017) based on Imegene King’s Conceptual model associated with certain elements of

the breastfeeding process. It describes and explains the breastfeeding process by analyzing the

factors that influence breastfeeding. Primo and Brandao (2017) identified several major concepts

in the Interactive Theory of Breastfeeding namely:

mother-child dynamic interaction; woman’s biological conditions; child’s

biological conditions; woman’s perception; child’s perception; woman’s

body image; space for breastfeeding; mother’s role; organizational

systems for the protection, promotion and support of breastfeeding; family

and social authority; woman’s decision making; stress; and time of

breastfeeding. (p1193).

Figure 1 presents the conceptual model of the interactive theory of breastfeeding (Primo

and Barandao, 2017). It shows how the different concepts interact with one another to influence

the breastfeeding process.

BREASTFEEDING TEENAGE MOTHERS 7

Figure 1. Conceptual framework of the Interactive Theory of Breastfeedi

Statement of the Problem:

This study aims to determine the knowledge and attitudesof teenage mothers towards

breastfeeding. Specifically, it seeks to answer the following questions:

1. What is the profile of the respondents in terms of:

a. Sociodemographic profile, and

b. Maternal and obstetric profile?

2. What are the sources of breastfeeding information and support of the respondents?

3. What is the level of knowledge and attitudes of teenage mothers towards breastfeeding?

4. Is there a significant relationship between the profile of the respondents and their level of

knowledge and attitudes towards breastfeeding.

BREASTFEEDING TEENAGE MOTHERS 8

5. What Information, education, and communication materials can be developed to improve

breastfeeding support, knowledge, and attitudes?

Conceptual Framework

The researchers will utilize the input-process-output model as shown in figure 1 as a basis

for developing an educational material/brochure on breastfeeding.

Input Process
I. Profile of the Output
respondents: 1. Data Collection
2. Analysis of data Locally developed
a. Sociodemog and Information,
raphic interpretation Education, and
profile Communication
b. Maternal Material on
and obstetric breastfeeding
profile

II. Sources of
breastfeeding
information

III. Knowledge and

attitudes towards
breastfeeding

Figure 1

The conceptual model of this study present the input, process, and output approach of the

research. The input includes the sociodemographic andmaternal and obstetric profile of the

respondents , the sources of breastfeeding information and the knowledge and attitudes towards

breastfeeding.
BREASTFEEDING TEENAGE MOTHERS 9

In this model, the process mechanism is divided into two phases – the data collection

phase and the analysis and interpretation phase.. The data collection phase involves the

administration of the questionnaire to gather the necessary data needed for the study. The data

analysis and interpretation phase involves the use of statistical tools to analyze data and also

involves the analysis and interpretation of findings. The final component of the model is the

output where the researchers will develop Information, Education, and Communication material

on breastfeeding based on the research findings.

Scope and limitations of the study:

This study aims to determine the knowledge and attitudes of teenage mothers towards

breastfeeding. The respondents of the study will be teenage mothers between ages of 13 – 19

years who gave gave birth 5 years prior to the start of the study in Santa Catalina, Ilocos Sur. In

measuring the level of knowledge and attitudes towards breastfeeding, the Australian

breastfeeding knowledge and attitude questionnaire will be adapted.

Hypothesis

Based on the literature review, the researchers hypothesized that there is a significant

relationship between the knowledge and attitudes towards breastfeeding and their socio-

demographic and obstetric profiles.

Assumptions

Based on the problem, the researchers presume that:

1. Breastfeeding knowledge and attitudes are influenced by certain factors.
2. Breastfeeding knowledge and practices can be changed or modified.
3. Teenage mothers have difficulty breastfeeding their children
4. Teenage mothers are lessskilled and knowledgeable in terms of breastfeeding
BREASTFEEDING TEENAGE MOTHERS 10

CHAPTER II

Research Methodology

This chapter presents the research design that will be used in the study, the setting and

sources of data, the data collection procedure and tool that will be used, and the method of data

analysis that will be used.

Research Design

The descriptive-correlational method of research will be used in this study. It is

descriptive since the profile of the respondents and the knowledge and attitudes towards

breastfeeding will be described. It is correlational because the respondents’s knowledge and

attitudes will be correlated with their profile.

Setting And Sources Of Data

Those who will be considered eligible to participate in the study will be mothers who

gave birth between the ages of 13 – 19 years and gave birth 5 years prior to the start of the study

and currently living in Santa Catalina, Ilocos Sur. Mothers who gave birth at more than 19 years

of age; those who gave birth in their teenage years but gave birth more than 5 years ago prior to

the start of the study, and those who are not currently residing in Santa Catalina will be excluded

to participate in the study. Santa Catalina was specifically selected since all of its barangays

have increasing incidence of teenange pregnancies.

The respondents of the study will be identified by looking into the records of the Rural

Health Unit and the barangays. Table 1 presents the population of the study.
BREASTFEEDING TEENAGE MOTHERS 11

Table 1. Population of women in Sta. Catalina , Ilocos Sur who gave birth at 13-19 years

during the last 5 years

Barangay Population
Cabaroan
Cabbittaogan
Cabuloan
Pangada
Paratong
Poblacion
Sinabaan
Subec
Tamorong

DATA COLLECTION PROCEDURE AND TOOLS

Data will be gathered using a guided questionnaire checklist adapted by the researchers

from the Australian Breastfeeding Knowledge and attitude Questionnair. The tool comprises of

two parts. Part 1 will determine the profile of the responsdents and part 2 will determine the

breastfeeding knowledge and attitude of the respondents on breastfeeding. The tool will be

validated by the municipal health officer of Sta. Catalina Ilocos Sur.

After the approval of the study, the researchers will have the questionnaire validated by

the municipal health officer of the municipality. After incorporating the comments and

suggestions of the validator, the researchers will ask permission from the municipal mayor to

conduct the study in the aforementioned municipality. After securing the approval of the mayor,

a communication letter will also be forwarded to the barangay captains of the different barangays

seeking their permission to conduct the study in their jusrisdiction. An informed consent will be

secured from the respondents after explaining to the the purpose of the study and their

participation. After securing the consent of the respondents, the researchers will personally
BREASTFEEDING TEENAGE MOTHERS 12

administer the questionnaire and answer any questions or clarifications the respondents may have

on the study.

Statistical treatment of data

The following statistical tools will be used in the treatment of data.

1. Frequency count and percantages will be used to describe the profile of the respondents.
2. Frequency count and percentages will be used to describe the source of information.
3. Mean will be used to describe the level of knowledge and attitudes of the response
towards breastfeeding and
4. Correlation Analysis will be used to determine the relationship between the profile of the
respondents and their level of knowledge and attitudes towards breastfeeding.

Ethical Considerations for Research

Researchers have a moral responsibility to ensure the conduct of ethical research. The

researchers will present and explain the purpose of the study to the municipal and barangay

officials and especially to the respondents prior to the administration of the questionnaire.

Participation in the research is voluntary. A written informed consent will be secured

from the respondents after only explaining to them the purpose of the study and the significane

and purpose of their participation. It will also be explained to the respondents that the data that

will be gathered will be treated with utmost confidentiality. The respondents were also assured

that no risks of harm or malice will befall due to their participation in the study.
BREASTFEEDING TEENAGE MOTHERS 13

Breastfeeding Knowledge and Attitude Questionnaire

I. Profile of the Respondent:

A. Sociodemographic Profile

Name (optional): ___________________________________

Barangay: _________________________

Age: _______ Religion: _______________

What is the highest level of education completed?

_____ Senior High School

_____ Junior High school

_____ Elementary Graduate

_____ Elementary Undergraduate

_____ No formal Schooling

B. Maternal and Obstetric Profile

Gravidity: How many times have you been pregnant?

____1 ____2 ____3 ____4 ____5

Parity: How many times have you given birth to a child more than 20 weeks of age?

____1 ____2 ____3 ____4 ____5

Term: How many times have you delivered a full term baby (38 – 42 weeks)?

____0 ____1 ____2 ____3 ____4 ____5

Preterm: How many times have you delivered a premature baby (21 weeks to 37 weeks)?
BREASTFEEDING TEENAGE MOTHERS 14

____0 ____1 ____2 ____3 ____4 ____5

Abortion: How many times have you experienced abortion? (termination of pregnancy at less

than 20 weeks AOG)

____0 ____1 ____2 ____3 ____4 ____5

Living Children: How many children do you have that are alive?

____0 ____1 ____2 ____3 ____4 ____5

Birth Attendance: Who was present and assisted you in giving birth?

_____ Obstetrician

_____ Doctor (General practitioner)

_____ Nurse

_____ Midwife

_____ Traditional birth attendant

_____ None

Type of delivery:

_____ Normal Spontaneous Delivery

_____ Assisted Vaginal delivery (forceps or vacuum assisted delivery)

_____ Caesarean Delivery

Place of Delivery:

_____ Hospital

_____ Rural health Unit

BREASTFEEDING TEENAGE MOTHERS 15

_____ Birthing home/lying in clinic

_____ at home

_____ other, please specify__________________

Site of prenatal care: Where did you receive Prenatal care?

_____ Hospital

_____ Rural health Unit

_____ Birthing home/lying in clinic

_____ Private clinic

_____ at home

_____ other, please specify

Site of post-partum care: Where did you receive post-partum care?

_____ Hospital

_____ Rural health Unit

_____ Birthing home/lying in clinic

_____ Private clinic

_____ at home

_____ other, please specify

II. Sources of Information.

Breastfeeding Information Source: What where your information sources for breastfeeding?
BREASTFEEDING TEENAGE MOTHERS 16

_____ Obstetrician _____ Books

_____ Physician (GP) _____ Magazines

_____ Nurse _____ Social media

_____ Midwife _____ Breastfeeding websites

_____ Mother _____ TV

_____ Grandmother _____ radio

_____Friends _____ Newspapers

_____ husband/partner _____ Pamphlets, brochures

_____ Others, please specify: ___________________

Preferred format for breastfeeding information: In what format do you prefer to learn about

breastfeeding?

_____Small group discussion _____Short lecture

_____Pamphlets/Brochures _____ Posters

_____ TV advertisements _____ Radio advertisements

_____ Social media based advertisements

_____ Others, please specify: ______________________

III. Knowledge and Attitude on Breastfeeding

The next group of questions relate to your attitude towards breastfeeding. Please indicate
how much you agree or disagree with the statements by mark the appropriate response
with a check mark.

Statements Strongly Disagre Neutral Agree Strongly

disagree e (3) (4) Agree
(1) (2) (5)
BREASTFEEDING TEENAGE MOTHERS 17

1. Infant formula is more easily digested than breast

milk.*
2. Breast milk is the ideal food for babies
3. Formula feeding is a good way of letting fathers
care for the baby.*
4. Breastfeeding & formula feeding are both equally
acceptable methods of feeding infants.*
5. Breastfeeding increases mother-infant bonding.
6. A mother knows instinctively how to breastfeed.*
7. Breastfeeding provides health benefits for infants
that cannot be provided by infant formula.
8. Mothers who smoke should formula feed their
babies. *
9. Breastfeeding is incompatible with working
outside the home. *
10. Fathers feel left out if a mother breastfeeds. *
11. Breastfed babies need to be fed too often.*
12. Infant formula is as healthy for an infant as breast
milk.*
13. Infant formula is as healthy for an infant as breast
milk.*
14. Formula feeding is the better choice if the mother
plans to go out to work.*
15. The benefits of breast milk last only as long as the
baby is breastfed.*
16. Mothers who formula feed miss one of the great
joys of motherhood.
17. A mother who occasionally drinks alcohol should
not breastfeed her baby. *
18. Formula feeding is more reliable because you can
calculate the exact quantity of milk the baby is
getting.*
19. Current infant formulas are nutritionally
equivalent to breast milk.*
20. Women should not breastfeed in public places
such as restaurants.*

The next group of questions relate to your knowledge towards breastfeeding. Please
indicate how much you agree or disagree with the statements by mark the appropriate
response with a check mark. If you are unable to give a response to a statement, mark the
first response column headed “don’t know”.
BREASTFEEDING TEENAGE MOTHERS 18

Statements Don’t Strongly Disagre Neutral Agree Strongly

know disagree e (3) (4) Agree
(1) (2) (5)
1. A woman with mastitis should express and discard
her milk from that breast until treatment is
complete.*
2. A correctly positioned baby will suck at the breast
with a different action to that used by a baby feeding
from a bottle.
3. Breastfed infants require extra water in hot
weather.*
4. It is expected that breastfed infants will regain their
birth-weight by two weeks of age.
5. Exclusive breastfeeding (no other fluids or solids)
is the most beneficial form of infant feeding for the
first six months of life.
6. In the first few weeks after birth a normal breastfed
infant will usually feed 8-12 times in 24 hours.
7. A breastfeeding woman should be advised to wean
if she becomes pregnant.*
8. It is normal for an adequately breastfed 2 –week old
infant to only pass a bowel motion every 3 days or
so.*
9. Women who have breastfed have a lower incidence
of premenopausal breast cancer.
10. A mother who weaned her baby because of a low
milk supply will be unlikely to produce enough milk
for any subsequent babies.*
11. A woman who has had a previous benign breast
biopsy is usually unable to breastfeed.*
12. Breastfed infants are less likely to become obese
children.
13. All women with cracked nipples should express
their milk and rest the nipples for 24 hrs.*
14. The nutritional properties of breast milk are only
effective for 9 months postpartum.*
15. Breastfeeding protects against rubella. *
16. Introducing complementary feeds (water or formula)
interferes with the establishment of breastfeeding.
17. A nipple shield should be used if there are any
problems with the infant attaching to the breast.*
18. Removal of breast milk (either by breastfeeding or
expressing) is essential to maintain milk production.
19. The nutritional content of breast milk changes
BREASTFEEDING TEENAGE MOTHERS 19

throughout a breastfeed.
20. Formula fed infants have more ear infections than
breastfed infants.
21. The most common cause of cracked nipples is poor
positioning and attachment of the infant at the
breast.
22. In most cases a breastfeeding mother must
temporarily wean her baby while she is taking
prescription medications. *
23. Growth of breastfed infants differs from that of
formula fed infants.
24. In general, the most appropriate advice to give a
woman with a low milk supply is to increase the
frequency of breastfeeds.
25. A woman being treated for postpartum depression
can continue to breastfeed.
26. Breastfeeding reduces the incidence of
gastroenteritis in the infant.
27. Only feeding from one breast at each feed is a
management option for a woman with an oversupply
of breast milk.

References
BREASTFEEDING TEENAGE MOTHERS 20

Baek, J., Glover, S., Laditka, S., Liu, J., Ogbuano, C. and Probst, J. (2010). Reasons why women

do not initiate breastfeeding

Liamputtong, P., McMichael, C. and Watts, M.C., (2015). Early motherhood: a qualitative study

exploring the experiences of African Australian teenage mothers in greater Melbourne,

Australia. BMC Public Health 15: 873

McGrath, J. and Kanhadilok, S. (2015). An Integrative Review of Factors Influencing

Breastfeeding in Adolescent Mothers. Journal of Perinatal Education 24(2) 119–127.

doi: 10.1891/1946-6560.24.2.119

Primo, Cândida & Brandão, Marcos. (2017). Interactive Theory of Breastfeeding: creation and

application of a middle-range theory. Revista Brasileira de Enfermagem. 70. 1191-1198.

10.1590/0034-7167-2016-0523.

Spagnoletti, B. (2018). Moralising Rhetoric and Imperfect Realities: Breastfeeding Promotions

and the Experiences of Recently Delivered Mothers in Urban Yogyakarta, Indonesia.

Asian Studies Review 42(1) 17-38. https://doi.org/10.1080/10357823.2017.1407291

Swigart, T., (2017). Breastfeeding practices, beliefs, and social norms in low-resource

communities in Mexico: Insights for how to improve future promotion strategies

Thulier D., and Mercer J. (2009). Variables associated with breastfeeding duration. Research

gate retrieved from www.researchgate.net

Victoria, C. G., Bahl, R., Barros, A. J., Franca, G. V., Horton, S., Murch, S…Rollins, N. C.

2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect
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World Health Organization, (2018). World Breastfeeding Week. Retrieved from

https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/ retrieved on September

15, 2019

Yen-ju H. and McGrath J. (2011). Predicting breastfeeding duration related to maternal attitudes

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