CHAPTER ONE

INTRODUCTION

Background of Study

Nurses play a major role in the promotion and implementation of Primary Health care (www.paho.org/English/DD/DIN/alma-ata declaration.htm). Since nurses are the bedrock in the delivery of healthcare, they frequently need to be updated with adequate knowledge so that they, in turn, spread adequate information and skills to mothers and the community as a whole. However, the health and nutritional status of children and mothers are intimately linked. This means that mothers and their children form a biological and social unit; the health and nutrition of one cannot be divorced from another. Therefore, children have the right to access safe and nutritious food. These factors are important for achieving full potential growth and development. Women also have the right to adequate food and the right to decide how to feed their children and to have correct information and conditions that will enable them carry their decisions. They also have the right to maternity protection and nutrition (NIYCF, 2006-2010). Breastfeeding provides the healthiest beginning for the infant. With the risk of Mother to Child Transmission of HIV through breast feeding, health workers need guidance on how to address issues of optimal infant feeding on one hand whilst minimizing the risk of MTCT and the risk of infants dying from improper feeding practices on the other hand (NIYCF, 2006-2010). In the recent past with the unfolding detail about HIV/AIDS and MTCT, the need for consistent and clear messages in relation to optimal infant and young child feeding practices has become more apparent. The National Infant Young Child Feeding (NIYCF) operational Strategy builds on the past and continuing achievements in promoting optimal infant and young child feeding. These include exclusive breast feeding for six months and continued breastfeeding up to 2 years with introduction of appropriate timely complementary feeding, the implementation and monitoring of the International Code of Marketing of breast milk substitutes and the rights of working women to maternity protection. In the past decade, the government has implemented programmes aimed at improving the welfare of infants and young children. The government has 1 also enacted a legislation to reduce the marketing of breast-milk substitutes. Currently, various community-based initiatives (HIV positive living support groups, Home based Care support groups, etc), do not adequately include infant feeding issues in their agenda. However, recognition of these structures is cardinal for the implementation of various chosen successful breastfeeding initiatives in the Baby Friendly Hospital Initiative (BFHI). These include breast feeding and child survival and Baby Friendly Hospital Initiatives. Additionally, the effective referral system between health facilities and community needs to be strengthened where they do not exist.

1.2 Statement of the Problem:

There has not been a mechanism put in place to keep proper or concrete records on the activities as well as indicators of Exclusive Breastfeeding and mothers support groups in hospitals, polyclinics and health centres in Nigeria. There has however been occasional figures produced from special exercises or survey carried out. For instance, (World Linkages, Nigeria, July 2000; Country Profile), in a study in the upper East region in Nigeria, revealed that among children less than two months old, 43 percent are exclusively breastfed. By the fourth to the fifth month, the figure drops to 22 percent. Moreover, on the average, globally, only 39 per cent of babies breastfeed exclusively, even in the first four months of life (UNICEF; WABA, 2003).

1.3 Research Questions

The question therefore is what the contemporary views of mothers and helpers about exclusive Breastfeeding at University of Benin Teaching Hospital (UBTH) are, though without previous concrete reports or record in place.

Do the breastfeeding mothers know how important the exclusive breastfeeding is and how to do it?

Do they have confidence and where do they turn to when they face difficulty?

Are people around them such as fathers and grandmothers supportive especially when mothers have to resume employment soon after delivery?

1.4 The Purpose of the Study:

The purpose of the study is to ascertain the current feelings and views of a cross-section of the Breastfeeding mothers on a MCH clinic day at University of Benin Teaching Hospital (UBTH), about exclusive Breastfeeding in order to develop appropriate strategies.

1.5 Significance

It is hoped that the findings of the study will provide a current perceptual database that will inform all of us and more importantly the policy makers on the feelings and views of the mothers about exclusive breastfeeding so that appropriate alternatives to motivate the indulgence of exclusive breastfeeding and its support, would be developed by Breastfeeding mothers, helpers and the populace of Nigeria.

1.6 Objectives of the Study

 1.6.1 Main objective

The main objective of the study is to find out the perception on exclusive breastfeeding among postnatal mothers.

 1.6.2 Specific Objectives

Assess the level of Breastfeeding mothers’ views about the benefits of exclusive breastfeeding;

Determine the level of breastfeeding mother’s views about barriers to exclusive breastfeeding;

Find the feelings towards exclusive breastfeeding

Identify the behaviour of participants;

Investigate any kind of support for breastfeeding mothers on exclusive breastfeeding.

1.7 Operational Definitions: – These are precise descriptions of how to derive a value for characteristics the researcher is measuring. It also entails how specific these characteristics are ;

Exclusive breastfeeding – This means giving a baby only breast milk, and no other liquids or solids, not even water unless medically indicated. This should be for the first 6 months (NIYCF, 2007).

Exclusive replacement feeding – This is the process of feeding a child who is not breastfeeding with a diet that provides all the nutrients the child needs until the child is fully fed on family foods. Infant formula is recommended for exclusive replacement feeding when AFASS (Acceptable, feasible, affordable, sustainable and safe) is met (NIYCF, 2007).

Heat Treated Expressed Breast milk – This means that a mother expresses breast milk and heats it so that the HIV present in breast milk is destroyed making it safe to feed the infant (NIYCF, 2007),

Wet Nursing -This refers to breastfeeding by another woman, who is HIV-negative.

This may only be considered in special situations such as in case of an orphaned infant and

the family can not meet AFASS. The wet nurse should be tested every three months (NIYCF, 2007).

Infant – A baby under one year of age or from birth to 12 months of age (NIYCF, 2007),

Knowledge – To have information in one’s mind as a result of experience or because you have learned or been told (Oxford Advanced Learner’s Dictionary, 2005).

Attitude – The way one thinks, feels or behaves about somebody or something (Oxford Advanced Learner’s Dictionary, 2005).

Bottle feeding – Feeding an infant from a bottle, whatever is in the bottle including expressed milk (NIYCF, 2007).

Breast milk substitute – Any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose (NIYCF, 2007).

Complementary feeding – Child receives both breast milk or a breast substitute and solid (or semi-solid) food, recommended from the time the baby is 6 months old (NIYCF, 2007).

Complementary food – Any food, whether manufactured or locally prepared; suitable as a complement to breast milk or to infant formula when either becomes insufficient to satisfy the nutritional requirements of the infant (NIYCF, 2007).

Mixed feeding – Partial breast feeding and giving some other milk (NIYCF, 2007).