Attitude Of Working Mothers Towards Exclusive Breast Feeding
[A Case Study of GENERAL HOSPITAL UGHELLI]

INTRODUCTION

Essentially, mother's milk has antibodies which are not present in infant formula. These antibodies are what protect the body and the boost the immune system of infant to enable them fight disease. The human milk in the right proportion also helps in robust and all round development of re infant (Jones, 1993: Tiwari, Zahariya and 2008). Hence absence of such antibodies and lack of adequate nutrients and vitamins in infant's formula, also the easy contamination of bottles and other artificial feeding methods exposes the infants to various diseases like respiratory tract disease, skin infection, diahorrea which is a serious problem in infants (Jone, 1993).

Exclusive breastfeeding is encouraged and recommended to all mothers worldwide with efforts being made both in the private and public sector as a way of achieving the Millennium Development Goals (MDGs) on improving maternal health. These efforts are also directed at reducing infant morbidity and mortality related to mixed-feeding as breast milk is very vital for the newly born babies. According to UNICEF (2010), exclusive breastfeeding is giving baby breast milk only and nothing else, not even sips of water except for medicines prescribed by the doctor or nurse for the first six months of life.

According to World Health Organization (2006), in 1991, United Nations International Children’s Fund (UNICEF) and World Health Organization (WHO) began an international campaign called  Baby Friendly Hospital Initiative. This initiative was meant to promote, protect and support breastfeeding. Most hospitals in Nigeria have Baby Friendly Initiative. One of the ten steps for Baby Friendly Initiative states that there should be no advertising of formula products used for babies under six months. In line with this agreement, Nigeria prohibits the advertisement of such products on all media in an effort to promote exclusive breastfeeding.

Consequently, this necessited the Innocent Declaration commendation of 1990 by WHO/UNICEF Policy makers that all infants should be fed exclusively on breast milk from birth to 6 months of age (Galtry, 2003). However, this clarion call is to be answered by all mothers, in our contemporary society women are actively involved in paid job which has strict laws and codes of conduct which may not enable them have adequate time, to practice exclusive breastfeeding. In this study the researcher sets out to unravel those socio-economic determinates of exclusive breastfeeding among working mother's in General Hospital Ughelli in order to give recommendations that will help improve the rate of exclusive breast feeding.

1.1 BACKGROUND OF THE STUDY

The 2008 Lancet Series on Maternal and Child Under-nutrition indicated that suboptimum breastfeeding, especially not exclusively breastfeeding a child for the first six months of life, results in 1.4 million deaths and 10 % of the disease burden in children younger than five years in low-income and middle-income countries [1]. Other statistics indicate that one hundred and thirty-five million babies are delivered annually, but only 42 % (57 million) initiate breastfeeding within the first hour after birth, 39 % are breastfed exclusively during the first six months, and 58 % continue breastfeeding up to the age of two years [Al-Sahab, B. Lanes, A Feldman, Mc Tamin, H. 2010]. Several studies have reported barriers accounting for this situation, including returning to work after delivery [American Academic of Pediatrics, 2012]. Others have stated factors that determine the success of exclusive breastfeeding even upon return to work, indicating that a supportive workplace and working environment are essential [Arnold, M. Culture and Anarachy, 2012]. Yet, the Nigeria 2010 Population and Housing Census Report showed an increasing trend of women joining the labour force [Bartick M. Reinhold, 2010]. Guendelman et al. note that the challenge of balancing breastfeeding and paid work is an important reason for breastfeeding cessation in the first six months [Bharati: S. R, 2010]. In Nigeria, the success of exclusive breastfeeding is subject to the nature of a women’s job and occupation, especially at places where women are engaged in industrial work away from home, and long working hours [Bartick M, 2010]. Elsewhere, Magner, and Phillipi attribute cessation of breastfeeding within the first month to returning to work. Aryeetey and Goh note that exclusive breastfeeding in Nigeria usually lasts for a median of about three months, which, incidentally coincides with the maternity leave period [Chigbnu, 2010]. Cai et al. in their 2012 “global trends in exclusive breastfeeding” indicate that the early cessation of exclusive breastfeeding favours the use of commercial breast milk substitutes, often of poor nutritional quality. Recently, Dana, W. Price A, Simon and Schuster (2017) in their work titled “effect of timely initiation of breastfeeding on child health in Nigeria” acknowledged that interventions that improved child health and prevented childhood diseases included early breastfeeding initiation. Also, the factors acknowledged locally in Ghana, Ayton and colleagues have identified several others that are harmfully associated with effective breastfeeding, such as delays in and/or failure of early breastfeeding initiation. In China and Western Kenya, several factors accounted for low EBF prevalence among working mothers. Early return to work, limited flexibility of work hours, lack of privacy [Chye, J and Lim, C. 2018], as well as a feeling of being watched and judged, lack of support including networks, tiredness and emotional support at work [Etzel, 2013] were cited as challenges facing working mothers. Mother’s work outside the home, father’s type of occupation (demanding occupations) which may limit their support for mothers to breastfeed and shorter maternity leave regulation also hindered EBF practice among professional working mothers in Vietnam [Galtry, 2013], who all intended to exclusively breastfeed. These studies report that although most working mothers leave the maternity ward breastfeeding exclusively, the practice is quickly abandoned, mostly due to work and employment related factors. Although breastfeeding may not be completely abandoned, its exclusivity was mostly interrupted by these factors. Some of the factors hindering exclusive breastfeeding initiation and practice in Nigeria and elsewhere include poor knowledge of mothers, lack of mother’s confidence, lack of skills about appropriate breastfeeding methods and challenges with other work problems during lactation [Gay, 2016]. These challenges may be amplified among working mothers in Nigeria, and could include giving substitutes other than maternal milk, early introduction of weaning foods, or shorter duration of EBF due to demands from work.

While data indicate that only about 36 % of infants younger than six months are exclusively breastfed in developing countries [Gbadegeshin, 2017], national surveys concluded that Nigeria’s exclusive breastfeeding rate at six months is currently about 52 % [Esterik, 2011]. Although higher than the national average, the exclusive breastfeeding prevalence of 60 % in the Upper West Region is lower than the desired national target. The popularity or otherwise of exclusive breastfeeding among gainfully employed women is yet to be characterized in this region of Nigeria. 

1.2 AIM OF THE STUDY

The current study therefore aimed to assess the prevalence, and predictors of exclusive breastfeeding among professional working mothers in General Hospital Ughelli.