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NSG00180 - CHALLENGES OF EXCLUSIVE BREAST FEEDING AMONG WORKING CLASS WOMEN A CASE STUDY OF UNIVERSITY COLLEGE HOSPITAL IBADAN


ABSTRACT

The research study was conducted to know the challenges of exclusive breastfeeding among working class women: A case study of University College Hospital, Ibadan. Exclusive breastfeeding means infant consumption of human milk with no supplemental liquid or solid except for liquid medicine, vitamin and mineral. The objectives of the study were to examine the challenges faced by working class women on the practice of exclusive breastfeeding, to investigate how regularly breastfeeding of babies can be utilized by working class women in spite of their tight schedule. This study provides expository analysis of the pattern to which those challenges could be dealt with including various factors devices. It also make recommendations which will assist nursing mothers to enhance exclusive breastfeeding so that they can raise healthy children. Self-designed questionnaire was used as instrument for obtaining information from working class women about the study. Random sampling technique from the ante-natal clinic of the hospital which comprise of the family planning, gynecological and maternal and child health clinic was used to get 200 respondents. The analyzed data were represented using data, tables, and percentage. Four research questions were set on the study and solutions were given. From the study, it implies that, men seeing breastfeeding women less attractive, always getting hungry and too tired to work effectively after breastfeeding, short duration of maternity leave, threat at work due to taking frequent break to breastfeed the child, irritation of other workers are challenges faced by working class women. Effective practice ensures a healthy state without any physical, mental, social or emotional handicap so that the child can achieve its full potential, as well as sustaining maternal physical and emotional health.

 

CHAPTER ONE

1.0       INTRODUCTION

1.1       BACKGROUND OF THE STUDY  

            Breastfeeding is a natural process of infant feeding involving two main methods; exclusive and partial with the latter being trendiest. Nevertheless, exclusivity is the absolute and suitable scheme with finest domino effect. However, a good mental, emotional and physical collaboration between the mother and her newborn for desired outcome (Khresheh 2011). Breast milk consists of basic nutrients containing proteins, vitamins and carbohydrate. However, presence of minerals fulfills micronutrient needs and maternal antibodies improves the immune system inhibiting infantile infections like gastrointestinal, respiratory and skin infections and increases physical and neurological growth of the baby. There is increased production of hormones that are responsible for uterine contraction, preventing hemorrhage and maternal mortality. Lactational amenorrhea is mentioned as a natural contraceptive benefactor following exclusivity. On the other hand, breast cancer and ovarian cancer risk prospects are reduced with weight loss preventing early cardiac morbidity and mortality. (Fairbrother and Stanger-Ross 2009.) During 1940s, exclusive breastfeeding was a communal tradition in all corners of the globe; subsequent to the World War II the ritual instigated to diminish and converted to modern trend in the use of fabricated formula milk particularly in the western world in contemporary eras. The nutrients become inevitable as it started to become widespread despite the advice and presage from World Health Organization (WHO) which recommends exclusive infant breastfeeding for the first six months of life and continuing up to two years of age and beyond United Nations Children’s Fund (UNICEF) and Baby Friendly Organization in order to restore the Primitive Tradition. (Coates, 2008)

International Baby Food Action Network IBFAN is a Non-Governmental Organization (NGO) Working with Imetyksen Tuki Ry. to protect and promote by collaborating community and legislate levels. It also collaborates with CRC (Convention on the Rights of the Child) to collect and analyze infant and child feeding in Finland. IBFAN, 2011 received a report from Hasunen and Ryynanen (2006), that demonstrated 99% of Finnish mothers initiated breastfeeding in the maternity ward, 60% mothers continued exclusively until the age of one month, and 50% mothers breastfed exclusively at three months and only 1% of the mothers breastfed exclusively until the newborn was six months. These figures are depicted at the lowest in Scandinavian countries. Breastfeeding exclusivity differs depending on a couple of factors including; personal, physical, psycho-social maternal factors, economic factors and breastfeeding awareness. (IBFAN, 2011).

            Exclusive breastfeeding defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive oral rehydration solution (ORS), drops and syrups (vitamins, minerals and medicines) (World Health Organization (WHO, 2010) has been recommended as the ideal food for infants. A child who is breastfed has a greater chance of survival than a child artificially fed. 

            Breastfeeding promotion activities are carried out worldwide in order to fulfill the WHO and UNICEF recommendation that infants be breastfed exclusively for six months and then the introduction of complementary foods and continued breastfeeding well into the second year (Cattaneo et al., 2016).

            Breastfeeding is well achieved in Nigeria and different breastfeeding promotion activities have been put in place. This has however not translated into adopting the behaviour as evidenced in the National Demographic Health Survey. Exclusive breastfeeding rate decreased from 17% in 2003 to 13% in 2008 (National Population Commission (NPC) Nigeria and ICF Macro, 2009).

            It has been estimated that EBF reduces infant mortality rates by up to 13% in low-income countries (Jones et al., 2012). A large cohort study undertaken in rural Ghana concluded that 22% of neonatal deaths could be prevented if all infants were put to breast within the first hour of birth (Edmund et al., 2006). Reviews of studies from developing countries show that infants who are not breastfed are 6 to 10 times more likely to die in the first months of life than infants who are breastfed (WHO, 2000; Bahl et al., 2009). 

            Some researchers have proposed that lack of suitable facilities outside of the home, inconvenience, conflicts at work, family pressure and ignorance adversely affect the willingness of women to practise EBF (Ogbonna et al., 2000; Forbes et al., 2003). The need to return to work has also been implicated as a factor interfering with EBF (Mahgoub et al., 2012). 

The Nigerian government established the Baby-Friendly Hospital Initiative (BFHI) in Benin, Enugu, Maiduguri, Lagos, Jos and Port Harcourt with the aim of providing mothers and their infants a supportive environment for breastfeeding and to promote appropriate breastfeeding practices, thus helping to reduce infant morbidity and mortality rates. Despite these efforts, child and infant mortality continue to be major health issues affecting Nigeria. The infant mortality rate for the most recent five-year period (1999-2003) is about 100 deaths per 1,000 live births. EBF rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% EBF in children less than 6 months (WHO, 2009). 

1.2       STATEMENT OF PROBLEM

            This study is meant to investigate the challenges working class women faced in exclusive breastfeeding, to explore their attitude towards the challenges experienced during the breastfeeding period. The decline in exclusive breastfeeding rates despite the efforts made by the governmental and non-governmental organizations.

A more detailed understanding of the challenges that most likely faced due to the attitude of working mothers to exclusive breastfeeding in Nigeria is needed to develop effective interventions to improve the rates of exclusive breastfeeding EBF and thus reduce infant mortality.

            Moreover, the concern of nurses to frequent exposure and contact with the working class mothers and their infants thus requires educating in order to promote, recognize the value, shortcomings and importance of exclusive breastfeeding to this vulnerable group. Therefore, a responsibility as a nurse to provide practical support, advice and follow-up for health professionals without overlooking ethical values.

            Considering the importance of exclusive breast feeding in relation to the health of the nation as a whole, it’s imperative to recognize factors which can influence it as this and more is what the study is meant to achieve.

            The commonest reasons that prevent effective exclusive breastfeeding include lack of lactation, insufficient breast milk and other socio-cultural practices. Also there is a lot of misunderstanding about the constituents of breast milk (of which water is about 80%) an its adequacy in meeting the baby’s need especially when the babies cries constituently amidst hunger or thirst, whereas exclusive breast feeding meets all the required needs of the baby at the first six month of life, and also continues to make a significant contribution to the baby’s nutritional and emotional request in health into the second year.

 

1.3       RESEARCH QUESTIONS

This study will find answers and shed light on the following research questions:

  • What are the challenges faced by working class mother on the choice of exclusive breastfeeding practices?
  • What has occupation of the mother got to do with exclusive breast feeding?
  • What is the effect of socio-economic status of the family on the practice of exclusive breast feeding?
  • What are the challenges faced by working class mother on the practice of exclusive breast feeding?

1.4       OBJECTIVES OF THE STUDY

            The objectives of this study are to identify the challenges been faced by working class women towards exclusive breast feeding of their babies and this can be achieved by the following;

  1. To examine the challenges faced by working class women on the practice of exclusive breast feeding.
  2. Investigate how regularly is exclusive breast feeding of babies be utilized by working class women in spite of their tight schedule.
  3. Identify the relationship between mother occupation and the practice of exclusive breastfeeding.
  4. Identify the social and regional beliefs on the practice of exclusive breastfeeding.
  5. To determine the strategic ways of dealing with the challenges often faced by working class women practicing exclusive breast feeding.

1.5       SIGNIFICANCE OF THE STUDY

            This study is meant to highlight those challenges faced by working class women on exclusive breastfeeding of their child in order to ensure survival by protecting against infection, reducing chance of developing nutritional disorders and encourage maternal-child bonding.

The studies will be an eye opener to the challenges faced by working class women on exclusive breast feeding, providing expository analysis of the pattern to which those challenges could be dealt with including various factors devised.

The study would enlighten working class mothers on the challenges of exclusive breastfeeding on the health of the child and possibly the health of those children who are on mixed breast feeding and make recommendations which will assist nursing mothers to enhance exclusive breastfeeding so that can raise healthy children.

 

 

1.6       SCOPE OF THE STUDY

            The study is limited to the working class women not minding the nature or type of occupation at the pediatrics unit of the University College Hospital UCH

1.7       OPERATIONAL DEFINITION OF TERMS

  1. Breast Milk: Also known as human milk is made from nutrients in the mother’s blood stream and body stores. Has an optimal balance of fat, sugar, water and protein that is needed for baby’s growth and development.
  2. Challenges: the situation of being faced with something that needs great mental or physical effort in order to be done successfully.
  3. Exclusive Breastfeeding: An infant’s consumption of human milk with no supplementation of any kind (no water, juice or nonhuman milk) except for vitamin, minerals and prescribed medications.
  4. Infants: refers to newborn, babies from birth to about months to one year old.
  5. Lactation: describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process can occur with all post-pregnancy, the process of feeding babies with milk is also called breastfeeding or nursing.
  6. Lactational Ammenorrhoea: The method of causing reduced fertility in a woman by nursing a child for a lengthy period.
  7. Multigravida: a woman who has been pregnant more than once
  8. Primigravidas: A woman who is pregnant for the first time, or who has been pregnant once.
  9. Working class women: this refers to the population of blue collar or white collar workers, particularly skilled and semi-skilled labourers