Breastfeeding infants is a public health priority because of its considerable benefit. This study aims to demonstrate why exactly this seems to be the case. Recent studies have shown that it protects the health of the infant, decreases the chances of metabolic disorders, and the rate of child mortality.
Contents
Introduction
Social Determinants of Exclusive Breastfeeding
Economic Stability.
Education
Social and Community Context
Culture and family support
Health and Health Care
Implications
References
Introduction
Breastfeeding infants is a public health priority because of its considerable benefit and recent studies have shown that it protects the health of the infant, decreases the chances of metabolic disorders, and the rate of child mortality (IP et al., 2009; Balogun, et al., 2017). It is beneficial to a nursing mother, as it reduces the time for uterine involution and postpartum bleeding, reduces chances of breast and ovarian cancers and helps the mother and child to bond (Gartner et al., 2005; Jernstrom, 2004). Thus, the concern of the World Health Organization (WHO) to encourage the practice in postpartum mothers and to promote Exclusive Breastfeeding (EBF) in infants from 0 to 6 months. Regarding breastfeeding, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO), suggests that newborns are exclusively breastfed throughout the earliest 6 months of their lives and the breastfeeding continued until the 24th month of age (WHO/UNICEF, 2005). However, despite the efforts to make infant formula bioequivalence of breast milk, breast milk remains the surest source of natural nutrition for infants (Imdad et al., 2011). Breast milk contains bioactive factors, digestive enzymes and nutrients useful for infants’ growth, development and immune defence. Several initiatives such as the Baby-Friendly Hospital was launched to promote exclusive breastfeeding. Yet, a survey by Bhattacharjee et al., (2019), reported that in 2017, only 37% of newborns less than 6 months, were exclusively breastfed. This study identified an existent geospatial difference in the practice of absolute breastfeeding and reported a marked heterogeneity across countries in Africa, and the rural, suburban and urban settlements. While the report had it that 1/3 children below the age of 6 months are exclusively breastfed in developing countries, recent findings observed the practice of EBF increased from 33% to 39% from 1995 to 2010 respectively, and major progress noted in West and Central Africa (Haron et al., 2013). Another investigation carried out from 2010 to 2015, on the prevalence of breastfeeding and it's exclusivity up until 6months of infants' age, observed that West Africa and Central Africa ranked low (Issaka et al., 2017). In Nigeria, it is assumed that almost every child is breastfed, but from 1999 to 2013 there was a record of decrease (from 28% to 17%) in the prevalence of exclusive breastfeeding and a low (38%) rate of breastfeeding initiated within the first hours of the childbirth (Adewuyi and Adefemi, 2016). While several factors such as the demand of work and maternal illnesses were faulted as reasons in the decline of exclusivity in breastfeeding (Adewuyi and Adefemi, 2016), Ogbo et al, (2008) sampled the data of 10,225 children below the age of 2 years and recorded that, while 38% of them were predominately breastfed, 14% were exclusively breastfed. Also, the study revealed a geographical variation in breastfeeding patterns within the Country, with the Northern regions having lower prevalence compared to the other regions. A comparative study on the attitude and practice of breastfeeding done in South-western, Nigeria, had shown 57.3% of mothers in rural settlements had a more positive attitude towards breastfeeding, 75.8% had initiated breastfeeding within the first hours of delivery and 79.8% of them practised EBF compared to the 25.9% of their urban equivalents (Balogun et al, 2017 pp. 123-130).
Social Determinants of Exclusive Breastfeeding
Certain factors have fundamental influence over the health status of an individual, they include the political, socio-economic and cultural conditions that could mould the health status of an individual and a nation (Raphael 2008, p.2, WHO, 2008). Citing international directives on exclusive breastfeeding and its conventional advantages, this exercise is less than average in most developing countries inclusive of Nigeria (Haroon et al, 2013; Salami, 2006). In a bid to understand why EBF is at an unsatisfactory level In Nigeria, studies have been done to identify likely trends and factors (Ogbo et al, 2008; Ogunlesi, 2010 pp. 459-465; Agho et a l, 2011, Salami, 2006) and amongst identified elements, Ogbo et al, 2008, mentioned geopolitical location, finance, health services and individual factors (age of the mother, occupation and babies' gender and family condition) as some of the determinants of EBF in nursing mothers. In this review, the Healthy People 2020 approach to Social Determinants of Health ( Healthy People, 2020), would be assessed in regards to the exclusive breastfeeding practices in Nigeria and these include;
- Economic Stability
- Education
- Social and Community Context
- Health and Health Care
- Neighbourhood and built Environment
Economic Stability.
Economic stability to a great extent informs the socio-economic status of an individual and the same is said of nursing mothers (Ogbo et al, 2015). According to previous studies, the higher the socio-economic status of the nursing mother (Agho et al., 2011), the higher the tendencies of adopting EBF and as observed by Ogbo et al., 2015, women from wealthier families give exclusive breastfeeding to their infants compared to their counterparts.Nonetheless, the economic stability of these nursing mothers is assessed based on employment, characterized by the presence or absence of a Job. A study by Splendor et al, 2019, sampled a number of first time nursing mothers, in South-Eastern Nigeria and of the 83.6% who were employed, 62.1% were to return to work 3 to 4 months after delivery. This finding supports other claims that women in public or private engagement do not breastfeed for long nor practice exclusively in breastfeeding because of the time demanded by work and the need to work due to the country's economic challenges (Agunbiade and Opeyemi, 2012; Adewuyi and Adefemi, 2016).
Education
This refers to the level of formal education attained by the nursing mother and its influence on the practice of EBF; Ogbo et a l., 2015, in his study, identified that among other factors in Nigeria, women with atleast a primary level of education were more likely to exclusively breastfeed their newborns than women with no formal education. Similarly, Okafor et al, 2012 observed that in Lagos, Nigeria, women with secondary education were 8 times more prone to exclusively breastfeed their newborns when compared with those without any formal education. Even so, Agho e t al. (2011), correlated economic stability and level of formal education and realized that 26.1% of women with secondary education, from wealthy household practised EBF unlike the 13.7% obtained from women in poor homes and without a formal education. One of the reason suggestive of this observation is that educated mothers are inclined to follow antenatal instructions (Splendor et al, 2019).
Social and Community Context
Under this umbrella, the following would be discussed to understand how they influence the practice of exclusive breastfeeding in Nigeria.
Age
Some studies believed that the older the age of the mother, the more experienced she would be at breastfeeding, and the more the tendencies for her to exclusively breastfeed her newborn up until 6 months of age (Lawoyin et al, 2001).Similar to the findings by Ukegbu et al, 2011 and Qureshi et al, 2011, Ogbo et al, 2015 reported that mothers within the ages of 25- 34 years in South-East Nigeria are more likely to practice EBF than those below this age range.
Culture and family support
When Adegoke and Anthony (2008) studied the influence of culture on health practices in south-west Nigeria, they concluded that substantial therapeutic interventions can be effective if it acknowledges the place of culture in health practices. Fortunately, the practise of breastfeeding is embedded in the various cultures across the ethnic groups in Nigeria (Gartner et al, 2005), but the concern is how well EBF is embraced (Agunbiade and Oyeyemi, 2012). In a typical Nigerian culture, a child is groomed by both the mother, paternal and maternal grandmothers respectively; a practice that has significance on decisions on how and if the child is weaned. Sometimes, these other women encourage nursing mothers to give herbal concoctions to the newborns to preserve their health; a practice which relegates the place of exclusive breastfeeding and exposes the infant to contaminations (Agunbiade and Opeyemi, 2012). In North-Western Nigeria, mothers consider colostrum as dirt and harmful,and they give animal milk, water, honey, almond and wash outside from the Quran to the newborn while they wait for fresh breast milk (Oche et al., 2011). Unfortunately, in South-Eastern Nigeria, Uchendu et al (2009), observed that about 52% of nursing women who never practised EBF, did so because of opposition from family members.
Health and Health Care
Various health care conditions, such as pregnancy care, mode of delivery and postnatal care are identified to be of influence to breastfeeding practices (Benova et al, n.d). While birth by traditional attendants is still a common practice in Nigeria, Agho et al . 2011, observed that EBF rate was higher in mothers who were delivered by professional health attendants than the traditional ones, and noted a lower rate (6.0%) of EBF exercises among nursing mothers with no prenatal care compared with the rate (23.5%) of EBF in infants born of mothers with more than 3 prenatal visits. Considering delivery by professional health workers, it is believed that on delivery at health facilities and during prenatal clinical visits, mothers have better access to information and campaigns on breastfeeding (Ukegbu et al, 2011; Okafor et al, 2014). Similar to the findings by Gawayan et al, 2014; Ogbo et al, 2015 noted that even among women with good access to health facilities and professionals, socioeconomic position and family pressures plays a bigger role in the decision of exclusive breastfeeding. It was noted that misconceptions and misinformation from these health professionals negatively affect the EBF practice. According to the study by Utoo et al, in 2012, 22.2% of health professionals in South-South Nigeria, indicated sagging of the breast as a con of breastfeeding; misinformation which could be relayed to nursing mothers and consequently discourage the practice. According to Ogbo et al ., 2015 and Benova et al . 2020, women who delivered their baby through a cesarean section are less likely to do exclusive breastfeeding.
Neighbourhood and Built Environment
As reported by several studies, there are variations in the practice rate of EBF across the geopolitical regions of Nigeria. Agho et al, 2011 in his study reported that EBF was least practised in the North West and North East of Nigeria. Similarly, nursing mothers from Southern Nigeria were more educated, wealthier and had better access to health facilities and more likely to be employed, thus they are more prone to early initiation of breastfeeding, yet less likely to continue exclusively due to factors such as the need to resume work by these mothers (Ogbo et al, 2015). In regards to the place of residence, Splendor et al, 2019 started that it is significantly associated with knowledge of exclusive breastfeeding and the level of knowledge EBF is significant in determining its practice (Agho et a l, 2011). A comparison between the urban and rural community within the same geopolitical zone in South East, Nigeria revealed that 91% of urban residing nursing mothers, had the right knowledge and attitude towards exclusive breastfeeding than the 89% of rural nursing mothers (Maduforo and Onurah, 2011).
Implications
In 2018, Nigeria's Demographic and Health Survey (NDHS), revealed that across the country, only 29% of children below 6 months of age were breastfed and the average duration of excluded breastfeeding was at 2.8 months (Benova et al, 2020). The Baby-Friendly Hospital Initiative (BFHI), was birthed from the 1990 Innocenti Declaration and was launched in 1991, this initiative was inaugurated to encourage exclusive breastfeeding for infants from the earliest 6 months of age and sustained till 1 year of age (WHO/UNICEF, 2009). This initiative was adopted in Nigeria in 1992 (ogunlesi et al, 2004), and a lot of this depended on the visitation of Baby-Friendly Hospitals by the nursing mothers;Ndiokwelu et al, 2016 reported that 74% of mothers among the study sample were aware of exclusive breastfeeding due to information obtained from the hospital through the nurses. Despite the high level of awareness, Ndiokwelu et al 2016, reported that merely 31.5% of the respondents practised exclusive breastfeeding, this shows a poor result of the BFHI. Ojofetimi et al, 2000 discovered that BHFI existed in the Urban and rural areas of Southern, whilst more impact and response was recorded in the urban settlements than the rural, in the rural areas, most pregnant mothers are delivered of their babies at home and by traditional birth attendants (Ogbo et al, 2015 p. 259).
As part of the local efforts to improve infant health through nutrition, Nigeria has adopted a series of policies to enhance the EBF rates, with the inability of the BFHI to evoke a much anticipated response, the National Breastfeeding Policy was created in 1998, a policy which was put in place to give flexibility to women in the workforce (Madurofo and Onuaha, 2011), however,Wurogyi and Etuk, (2016 pp. 534-554), cited the lack of adequate legal backing to back the freedom of women to exclusively breastfed their newborns for 6 months,as employees in the labour force; and only very few states embraced the 6 months leave initiative for breastfeeding mothers (Federal Ministry of Health,2020). With the failed attempt to improve the practice of EBF (Ogbo et al, 2016), in 2001, the National Policy on Food and Nutrition was adopted and then in 2005, National Policy on Infants and Young Child Feeding (Ogbo et al, 2016).
Yet, as of 2018, the child mortality rate was ranked at 69 deaths out of 1000 children, whereas the mortality rate of less than 5-year-old children was at 132 deaths per 1000 children (Guardian, 2019). Agho et al, 2011 studied the rate of EBF across various states in Nigeria and observed that Nigeria had a low practice of EBF compared to various neighbouring countries. It is worthy of note that, the cultural practices such feeding the newborns with herbs or water at the onset of birth exposed these infants to contaminations from infections and elides them of the antibiotics from colostrum thus increasing the rate of mortality and comorbidities in these infants (Agunbiade et al, 2012, Agho et al, 2011).
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