1.1 Introduction
Breastfeeding is the process of giving breast milk to newborns. Within the human species, this is a shared cultural practice among all racial groupings. However, it is common to see variations in the frequency and exclusiveness of breast milk application during newborn feeding. The majority of nurses advocates for and carries out primary healthcare (Paho, 2021). Since nurses are the backbone of healthcare delivery, it's frequently important to keep them informed about current developments so they can give moms and the community at large the knowledge and skills they need. However, there is a tight relationship between the nutritional status and general health of mothers and children. Breastfeeding provides an infant with the healthiest start in life (NIYCF, 2006–2010).
This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.
1.2 Background of Study
Breastfeeding is unequaled way of providing ideal food for the health, growth and development of infants and most natural way of feeding them in all traditions. It is an integral part of the reproductive process with important implications for the health of the mother. Human milk is the most appropriate of all available types of milk, that is uniquely adapted for infant nutrition as it components consistently adopt to the child's need and environmental challenges. Breast milk contains virtually all the nutrients antibodies and anti-oxidants an infant needs to thrive for the first six months of life (Abasiattai, Umana, Nyong and Eyo, 2014).
The benefits of breast feeding for mothers and infants have been widely recognized and researched studies have shown that breastfeeding is superior to infant formula feeding because of its protective properties against illness, in addition to its nutritional advantages (Sadoh, Oniyelu, 2011). Considering the extensive benefits of breastfeeding, the world Health organization and the American Dietetic Association recommended exclusive breast feeding of infants for the first six months and continued breastfeeding with complementary foods up to twelve (12) months of age (ADA Report, 2001). Despite widespread efforts to encourage breastfeeding, the rates in the United States (U.S) have remained low (Pugh, 2002).
Exclusive breastfeeding (EBF) refers to the exclusive intake of breast milk or expressed breast milk by an infant without the addition of any other liquid or solids, with the exception of oral drops or syrups containing vitamins, mineral supplements or medicines. Exclusive breastfeeding advocated the world over as the optimal mode of feeding for young infants in the first months of life, followed by breast milk and complimentary feeds thereafter till two years of age or beyond. When the infants are exclusively breastfed for the first six months of life, their immune system is stimulated and this goes hand in hand with protecting them from disease like diarrhea and acute respiratory infections, which are considered to be two of the major causes of infant mortality in developing world. When breastfeeding is practiced exclusively, it is associated with a lower risk of HIV transmission than mixed feeding.
Other advantages of exclusive breastfeeding include reduction in post partum bleeding, improvement in home status later in life and protection against breast and ovarian cancers. Other benefits include lactational amenorrhea which enhances child spacing, early mother-infant bonding and reduction in infant abandonment and child abuse. EBF also provides social and economic benefits to the family and the nation as well as a sense of satisfaction to most nursing-mothers (Madhu, Chowdary and Masti, 2009).
Breastfeeding is accepted as the natural form of infant feeding. For mothers to be able to breastfeed exclusively to the recommended six months, it is important to understand the factors that affect exclusive breastfeeding, studies of non pregnant high school students suggest that attitudes toward infant feeding begin to form well before pregnancy. Previous research has shown that maternal attitudes toward breastfeeding and perceptions of infant health benefits of breastfeeding influence the decision of breastfeed. Man demographic factors such as maternal age, marital status, education, race, nature of work, cultural factors, parity number of children at home and social support, urban versus rural residence and employment policies have been shown to potentially affect a nursing-mother's decision (Dubois, Girard, 2003).
Among all of these factors, mother's education had greater impact on nutritional status of children. However, it does not mean that mothers with high education level had healthy children only. Many studies outside the south-south region and very few within the region have been carried out to ascertain most factors that affect exclusive breastfeeding practices among nursing mothers. For instance, Tan (2011) researched on factors associated with exclusive breastfeeding among infant under six months of age in Peninsular Malaysia, he found that the prevalence of exclusive breastfeeding among mothers with infant aged between one and six months was one percent (Abasiattai et al, 2014).
In the study on knowledge and practice of exclusive breast-feeding among antenatal attendees in Uyo, southern Nigeria revealed that the level of knowledge and practice of exclusive breastfeeding by women in Uyo is poor and as such none of the women belonged to a breastfeeding support group and the most common source of information on exclusive breastfeeding was the antenatal health talk.
Other efforts made toward the determination of factors affecting exclusive breastfeeding practices among nursing mothers are the works of Setegn, Belachew, Gerbaba, Deribe, Denshaw and Biadgilign (2012) on factors associated with exclusive breastfeeding practices among mothers in Goba District, discovered that the prevalence of exclusive breastfeeding for infant aged less than six months in the study area was 71-3 percent as measured by last 24 hours recalled period preceding the survey date.
A critical examination of the above cited study by different authors and researchers show that there is no consistency to ascertain to which extent the factors mentioned above affect exclusive breastfeeding practices among nursing-mothers and which of the factors has the prevalence effects or influence.
The researcher in the current study is interested to investigate the effect of educational level, nature of work and the mother's age on the practices of exclusive breastfeeding among nursing-mothers in Uyo Local Government Area in Akwa Ibom State.
1.3 Statement of Problem
Investigation revealed that poor knowledge and attitudes of nursing-mothers toward breastfeeding has generated a lot of controversy in our modern society, influence practices and constitute barriers to optimizing the benefits of the Baby friendly initiative (BFI) aims to provide a supportive environment for breast-feeding and also encourages mothers to know and practice the ten steps to clinics (Abasiattai et al., 2014).
Despites the known benefits of exclusive breastfeeding to nursing mothers and infants based on anecdotal and empirical evidence, which the World Health Organisation (WHO) has recommended 2 years breastfeeding. First 6 months exclusive breastfeeding; more than 8 times breastfeeding of the baby for day in the first 3 months of the infants life. The attitude of most nursing-mothers of the infant's life and the attitude of most nursing-mothers is a reverse of this recommendation WHO/UNICEF Article February 2nd, 2014).
Studies have revealed that most nursing-mothers in the urban area denied their babies exclusive breastfeeding up to four months from birth, and that most of the highly socio-economic status nursing mothers have not exclusively breastfed their babies. Moreover, it is observed that most poor nursing-mothers especially in the rural areas over exclusively breastfed their babies beyond six months and over two years of breastfeeding infants. The unequal situations have posed a lot of questions to medical health scholars and health researchers against which factors are responsible or militate against these attitudes of nursing-mother toward exclusive breastfeeding.
However, a gamut of factors not limited to race and cultural characteristics, infant health problems, socio-economic status and some psychosocial factors may hamper the full realization of the baby friend initiative and also information about the beliefs and knowledge that may constitute barriers and in turn affect practices needed in order to optimally utilize the benefits of the baby friendly initiative. Consequently, a number of studies have assessed knowledge, attitude and practice of breastfeeding in different parts of the world, states and local governments. However, such studies are not limited to nursing-mothers in Uyo Local Government Area.
Against the above premise the study investigated the factors affecting exclusive breastfeeding practice among nursing-mothers in Uyo local government area of Akwa Ibom State.
1.4 Aim and Objectives of the Study
The aim of the study is to investigate the factors affecting exclusive breastfeeding among-nursing mothers in Uyo Local Government Area. In achieving this aim, the following specific objectives were laid out as follows to:
- Investigate the effect of educational level of mothers on exclusive breastfeeding;
- Assess the effect of the nature of work of the mothers on exclusive breastfeeding;
- Determine the level of breastfeeding mother's views about barriers to exclusive breastfeeding;
- Identify the effect of nursing mother’s age on exclusive breastfeeding; and
- Investigate any kind of support for breastfeeding mothers on exclusive breastfeeding.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- 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?
- What is effect of educational level of nursing-mothers on exclusive breastfeeding practice?
- What is effect of nursing-mothers’ age on exclusive breastfeeding practice?
- What is effect of the nature of work of the nursing-mothers on exclusive breastfeeding practice?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H01: There is no significant relationship in exclusive breastfeeding practice between educated and uneducated nursing-mothers in Uyo Local Government Area.
- H02: There is no significant relationship between the nature of work of nursing mothers and exclusive breastfeeding practice in Uyo Local Government Area.
- H03: There is no significant relationship between the nursing-mothers age and exclusive breastfeeding practice in Uyo Local Government Area.
1.7 Significance of Study
The following are the significance of this research, which is stated as follows:
- The problem of exclusive breastfeeding practice is an embraced investigation that hunts for solution and benefits for families and individuals in our society.
- The study will eradicate the perception of nursing mothers that babies during the first six months of exclusive breastfeeding continue to be hungry.
- The study will also be useful to health personnel and medical health officers for effective advise and counselling during ante-natal and post-natal clinics.
- The study will also help government and State Ministry of Health to plan for orientation programmes for nursing-mothers in various communities.
1.8 Scope of Study
This scope of this research is focused on the Factors Affecting Exclusive Breastfeeding Practice Among Nursing Mothers using Uyo Local Government Area of Akwa Ibom State, Nigeria as a case study.
The study is delimited to the nursing-mothers within Uyo metropolis.
The study investigates only the educational level, nature of work and age factors on exclusive breastfeeding practice among nursing-mothers in Uyo Local Government Area.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- 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.
- 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).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 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).
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:
It refers to 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).
