KNOWLEDGE, PRACTICE AND CHALLENGES OF EXCLUSIVE BREASTFEEDING AMONG WORKING CLASS WOMEN

1.1 Introduction

Exclusive breastfeeding is the infant receives only breast milk and other liquids or solids are not given with the exception of oral rehydration solution or drops/syrups of vitamins, minerals or medicines. Breastfeeding served and continues to serve as an appropriate method through which newborns are offered essential nutrients necessary for optimal growth and intellectual development. Breast milk is regarded as perfect, natural and protective food for newborns. Given that prolonging people’s lives and preventing disease are some of the goals of public health (Brulde, 2011), breastfeeding and/or EBF has been acknowledged as an effective approach to the achievement of these goals. Although breastfeeding is universal in the country, the trend is towards giving other feeds in addition to breast milk. Generally, the practices are more diversified and are characterized by late initiation of breastfeeding, the administration of substances other than maternal milk, and the introduction of weaning foods within one month following the infant's birth.

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

Infant feeding methods are a major determinant of infant nutritional status, which in turn, affects infant morbidity and mortality. Among feeding methods, breastfeeding is of particular importance because this practice is fundamental for growth, development, health and survival of infants. Diallo, Bell, Moutquine, &Garrant (2005) stated that about 5.6 million infants die annually because they do not receive adequate nutrition. Breastfeeding therefore has been classified by scientists and health workers as the best natural food for babies and breast milk contains all the necessary nutrients for the healthy growth of the child.

The benefits of breastfeeding are numerous ranging from providing the infant with antibodies, to helping ward off risks of illnesses and providing the baby with all his/her nutritional needs (Mundi, 2008). According to the World Health Organization (WHO) (2004), breast milk provides all the energy and nutrients that the infant needs for the first six months of life, and it provides about half or more of a child's nutritional needs during the second half of the first year, up to one third during the second year of life. Furthermore, breast milk not only protects the infant against infectious and chronic diseases, but also promotes sensory and cognitive development in addition to contributing to the health and well-being of mothers, helping in birth spacing, reducing the risks of ovarian and breast cancers as well as increasing family and national resources (WHO, 2004).

Generally, breastfeeding is practiced all over the world, though with variation in duration. Considering that the introduction of other food supplements at an early age often increase the risks of infections to the infant which may at times lead to life-threatening conditions such as diarrhoea, the WHO and United Nations Children's Emergency Fund (UNICEF)(2004), recommended that infants be exclusively breastfed for six months and, thereafter, up to 24 months, introducing other supplements to support the infants growth and development.

In view of the many benefits afforded by mothers and infants in breastfeeding, governments have also set goals and rates for breastfeeding practices. The Nigerian government has earmarked six University Teaching Hospitals as Baby Friendly Hospital Initiative (BFHI) centres, in Benin, Enugu, Maiduguri, Lagos, Jos, and Port-Harcourt, with the objective of reducing infant malnutrition, morbidity and mortality, as well as promoting the health of mothers. Since the inception of BFHI in 1991, a series of programmes, seminars, workshops and conferences aimed at promoting breastfeeding practices have been organized.

The BFHI itself has proved to be an effective method of improving breastfeeding practices worldwide (Salami, 2006). To further strengthen the practice of exclusive breastfeeding, government also approved a breastfeeding policy in 1998. The code on the marketing of substitutes of breast milk was reviewed and amended in May, 1999, to further introduce stiffer fines and a clearer definition of breast milk substitutes. These measures are aimed at increasing the rate of exclusive breastfeeding as well as the early initiation of breastfeeding so as to achieve the World Summit on Children 1990 goal of universal exclusive breastfeeding for infants up to six months of age (Mundi, 2008).

These measures notwithstanding, evidence showed that the practice of exclusive breastfeeding (though fast improving) is still low in many parts of the world. In Nigeria, the rate increased from 2% to 20% in infants 0-3 months and from 1% to 8% in infants 4-6 months between 1990 and 1999 (National Planning Commission (NPC)/UNICEF, 2001). The Nigeria Demographic and Health Survey (NDHS) (2008), however, revealed that 97% of Nigerian children under age five were breastfed at some point in their life. A small proportion of infant (13%) were exclusively breastfed throughout the first six months of life.

More than seven in ten (76%) children of ages 6-9 months received complementary foods. 16% ofinfants less than six months of age were fed with a bottle with nipple, and the proportion bottle fed peaked at 17% among infant in the age ranges of 2-3 and 4-5 months. However, less than half of infants (38%) were put to the breast within one hour of birth and only 68% started breastfeeding within the first day. Relatively, among children born in the five year preceding the survey in Benue State, showed that 97.8% of children ever breastfed. 64.1% started breastfeeding within one hour of birth. 90.2% began breastfeeding within 1 day and 38.7% introduce pre-lacteal feed. Only 0.5% children were exclusively breastfed. These proportions indicate a marginal level of decline from the 1990, 1991, 1999, 2003 and the 2008 surveys (NDHS, 2008).

Therefore, in Edo State where the research was carried out, the activities that was conducted is to examine the Knowledge, Practice and Challenges of Exclusive Breastfeeding among Working Class Women.

1.3 Statement of Problems

Investigation revealed that the percentage of mothers practicing breastfeeding, it should not be surprising that Nigeria is still saddled with high incidence of malnutrition and its associated infant mortality. Many factors have been adduced to influence these practices. The decisions are very often influenced more by other factors than by health considerations alone. According to Sika-Bright (2010), the factors which influence the decision to exclusively or non-exclusively breastfeed include; mother's marital status, employment status, friends method of feeding their babies, social support and baby's age. 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.

The Nigerian Integrated Child Health Cluster Survey (ICHCS, 2003), indicated that a major area of need in infant breastfeeding was early initiation. The survey indicated a decline from 56% in 2000 to 34% in 2002. The Nigeria Demographic and Health Survey (NDHS, 2008) reports also revealed a 13% exclusive breastfeeding rate which is a decline from 17% indicated in 2003 report. The 2008 report further revealed that 34% of infants aged 0-5 months were given plain water in addition to breast milk, while 10% were given milk other than breast milk. Only 32% of infants' under-24 months of age were still on breast milk. Therefore, the study purposed to examine the Knowledge, Practice and Challenges of Exclusive Breastfeeding among Working Class Women in Esan Local Government Secretariat, Ekpoma in Edo State.

1.4 Aim and Objectives of Study

The aim of the study is to examine the Knowledge, Practice and Challenges of Exclusive Breastfeeding among Working Class Women in Esan Local Government Secretariat, Ekpoma in Edo State. In achieving this aim, the following specific objectives were laid out as follows:

1. To assess whether mother's age, level of education and occupation has influence on the practice of exclusive breastfeeding;
2. To assess how effective exclusive breastfeeding is for children under-five;
3. To assess whether mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives);
4. To investigate the problems encountered by working class women during exclusive breastfeeding of children under-five; and
5. To determine if family views regarding breastfeeding influence working class mother’s decision to exclusively breastfeed.

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:

• Does mother's age, level of education and occupation influence the practice of exclusive breastfeeding?
• Do mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives)?
• Do family views regarding breastfeeding influence working class mother’s decision to exclusively breastfeed?
• How effective is exclusive breastfeeding for children under-five?
• What are the challenges encountered by working class women during exclusive breastfeeding of children under-five?

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.

Hypothesis One

• H0: Working Class Women's age, level of education and occupation does not influence the practice of exclusive breastfeeding
• H1: Working Class Women's age, level of education and occupation influence the practice of exclusive breastfeeding

Hypothesis Two

• H0: There are no significant challenges encountered by working class women during exclusive breastfeeding of breastfeeding of children under-five
• H1: There are significant challenges encountered by working class women during exclusive breastfeeding of breastfeeding of children under-five

1.7 Significance of Study

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 Working class Breastfeeding mothers, helpers and the populace of Nigeria.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

1.8 Scope of Study

The scope of the research is focused on the Knowledge, Practice and Challenges of Exclusive Breastfeeding among Working Class Women in Esan Local Government Secretariat, Ekpoma in Edo State.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. 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.
2. Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Research material: availability of research material is a major setback to the scope of the study.
4. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
5. 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).

1.10 Operational Definition of Terms

Exclusive Breastfeeding: Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution or drops/syrups of vitamins, minerals or medicines.

Perception: Knowledge, Practice, Attitudes and beliefs about exclusive breastfeeding.

Under-fives: Children who are less than five years old, especially those who are not in full-time education.