1.1 Introduction
Breast feeding which is the act of feeding babies with breast milk. This is a universal cultural practice among human species of all races. However, there are commonly observable variations in the frequency and exclusiveness of application of breast milk in the feeding of babies. Nurses play a major role in the promotion and implementation of Primary Health care (Paho, 2021). 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. Breastfeeding provides the healthiest beginning for the infant (NIYCF, 2006-2010).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Exclusive breastfeeding (EBF) is the application of breast milk alone in the feeding of a baby for at least four months and if possible six months of life, without the addition of water, food or drinks. The baby however receives vitamins, minerals and medicines in the form of drops and syrup as need arises (WHO,1981). The World Health Organization WHO (2001) received the optional duration of EBF to six months of life. The second type of breastfeeding, predominant breastfeeding (PBF), on the other hand, implies that the infants predominant source of nourishment is breast milk. The infant in this type receives in addition of breast milk, water and water based drinks (WHO 2001). Complimentary breastfeeding (CBF) or mixed feeding occurs where factory produced baby formula is the primary source of nourishment for the infant, the breast milk given occasionally. This practice offers mother chance to attend to their daily activities while nannies and house helps attend to babies: This present study was however concerned with exclusive breastfeeding.
Promotion of breastfeeding, particularly EBF, has been the focus of many public health and nutrition programmes and activities in recent years. Thus a joint World health Organization/ united Nations children’s fund (WHO/UNICEF) meeting on infant and young child feeding was held in Genera in 1979 and the emphasis was on breast feeding. In 1981 the combined force of the W.H.O and UNICEF produced the W.H.O international code of marketing of breast milk substitute. The main aim of the code obviously was to safeguard the practice of breast feeding. To enhance breastfeeding practices, WHO launched the baby friendly hospital initiative in 1992 as a primary intervention strategy for promoting and strengthening national health systems. The initiative has been implemented in 138 countries (including Nigeria) and the number of hospitals world wide designated baby friendly has risen from 6,300 in 1995 to nearly 40,000 by mid 2008 (WHO, 2009). Cataldo De Bryne and whitney (1999) asserted that EBF is an unequalled way of providing ideal food for the healthy growth and development of infants. The authors explained that nutritionally, breast milk is a complete food for the infant, providing all the nutrients needed for the first month of life.
Psychologically, breastfeeding permits an initial bonding between mother and child. Economically, breast-milk economizes on house hold expenditures on food and requires no itensils, water or fuel for preparation. However, the lactating woman do not have higher nutrient requirements and make substantial time to breastfeeding. Berg and Brenms (1989) cited breast milk for it’s anti-infective properties, lower incidence of diarrhea diseases, allergies and other illness among breastfed infants. It removes the danger of malnutrition caused by dilution of bottle feed and of infection caused by unhygienic preparation (Berg and Brenms, 1989).
However, it seems that EBF is still not widely accepted campaign by government and non-governmental organizations have gone far, but it appears not to be yielding expected dividend. The question that are yet to be answered, lies in determining those factors which can predict levels of acceptance or rejection of EBF. Possible predictor could be sourced from social mographic circumstances of the mothers. For instance such social demographic factors as religious affiliation, occupation, educational status, parity, age, as well as location are deemed to be capable of influencing adoption of exclusive breastfeeding. Parity has to do with the number of deliveries a woman has had. Breastfeeding, in Nigeria is still the norm as most mothers breastfeed their babies traditionally. However, exclusive breastfeeding is an innovation to the traditional way of feeding an infant where mothers starts complementary feeding as early as two months of life or even less. A woman who has nursed several babies successfully before may not be easily convinced to stop by giving her infant water and native concoction. She may not see why she should change her method of feeding, since she has successfully used such to nurse her older children (Mathai, 1983).
Age is sometimes associated with breast feeding. Omololu (1996) pointed out that younger mothers tended to be fashion conscious believing that their breast would sag if they get involved in breastfeeding. The younger mothers may also be over conscious of their body and looks and may not be willing to breastfeed the baby anywhere as the baby demand. Location as indicated by Okehialam (1986), Berg and Brems (1989), Barnes, Harjit and Stephers (1990), Cataldo (1990), Guashuddin and kalair (2004), Okehialam is an environmental factor, which could also be associated with breast feeding pattern. In the rural area, the extended family system still predominates and the nursing mothers to adopt or reject exclusive breastfeeding may be dependent on who takes health decision in the family.
This, of course, could be the mother-in-law, father-in-law, or any of the extended family members who is close by. In the urban area, the nuclear family predominates and the decision to adopt EBF will be only between the woman and her husband. Apart from this, the mother in the urban area may have to go to school or work which will take her out of the house regularly. This may have an impact on adoption of EBF, since the mother is likely not going to school with her baby and may not have opportunity to comeback and breastfeed the baby when necessary.
Occupation of the mother places the mother in a social class. The mother may tend to follow what is fashionable or acceptable within the social class in which she be long (Wanmani and Tumwine, 2005).
These dwindling attitudes regarding the practice of exclusive and non-exclusive breastfeeding have been attributed to several socio-economic, cultural and socio-demographic factors as it affects the development of children. Thus, this research project purposed to examine the Exclusive Breastfeeding amongst Nursing Mothers in Benue State, Nigeria.
1.3 Statement of Problem
Exclusive breastfeeding is a new method of breastfeeding which has been introduced by WHO/UNIEF. These two bodies have tasted it and find it successful for solving many problems in an infant. Breastfeeding practices have undergone tremendous medical, cultural and sometimes religious challenges and debate. 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 (UNICEF; WABA, 2003).
It is not definite or clear whether demographic factors significantly or insignificantly influence the practice of exclusive and non-exclusive breastfeeding. It is worthy of note that up till recently, the principal foci of attention has been demographic factors and the practice of exclusive breastfeeding. None of the studies conducted over the years concern itself much with demographic factors and the effectiveness of exclusive breastfeeding in the development of under-fives in Benue State.
1.4 Aim and Objectives of the Study
The aim 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. In achieving this aim, the following specific objectives were laid out as follows to:
- To find out the perception on exclusive breastfeeding among postnatal mothers.
- 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;
- Identify the behaviour and feelings of participants towards exclusive breastfeeding of participants;
- Investigate any kind of support for breastfeeding mothers on exclusive breastfeeding.
1.5 Research Questions
This study sought to provide answers to the following specific research questions:
- 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?
- What is the extent of EBF adoption by nursing mothers?
- How does educational status of nursing mothers relate to their extent of adoption of EBF?
- To What extent does parity relate to adoption of EBF by nursing mothers?
- What is the relationship between the age of the mother and adoption of EBF?
1.6 Significance of Study
A study of this kind will be useful in many ways. There will be research if the nursing mothers in Enugu State College of Education Technical do practice EBF. The finding will be useful to health educators and all those interested in passing the information based on the principles of EBF. If the finding prove negative, then suggestions will be to health educators especially those working with mothers the need to increase their effort towards the teaching of the principles and practice of EBF to mothers.
This finding will be useful to such government agencies as UNICEF and WHO, who are interested in promoting EBF. Thus they will use the finding to evaluate the EBF programe so far and also plan strategies for improvement.
There will be research on parity, religious affiliation, age and location to the effect of EBF adoption in the area of study. Knowing this will help health workers, particularly health educators in planning their health instruction and teachings of EBF. Attention should then be given to all nursing mothers irrespective of parity, age, religious affiliation to help and encourage them to adopt EBF.
1.7 Scope of Study
This research project is focused on examining the Exclusive Breastfeeding amongst Nursing Mothers in MCH clinic day at University of Benin Teaching Hospital (UBTH), Benue State, Nigeria.
1.8 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.9 Operational Definition of Terms
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),
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