FACTORS INFLUENCING THE CHOICE OF INFANT FEEDING PRACTICE AMONG WOMEN OF CHILD BEARING AGE
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CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Breastfeeding has been an essential aspect of infant care across different societies and generations because the survival, growth and development of human infants depend greatly on it. However, alternative methods of feeding infants, including the type of food provided, the timing, the method of feeding and the individuals responsible for feeding, have varied across different cultures and periods (WHO, 2020).
The World Health Organization (WHO) recommends that infants should be exclusively breastfed for the first six months of life, with breastfeeding initiated within the first hour after birth and continued on demand. At six months, safe, nutritionally adequate and age-appropriate complementary foods should be introduced while breastfeeding continues up to two years or beyond (Ulak et al., 2021). Appropriate infant-feeding recommendations are important for improving child health and survival. Evidence from different settings indicates that recommended breastfeeding practices can reduce illness and death among infants while also providing significant health benefits to mothers (Kruger & Gericke, 2011; Ulak et al., 2021).
Breastfeeding is widely regarded as the natural and most appropriate method of providing nourishment to infants. It supplies essential nutrients required for growth and development while offering protection against several childhood illnesses. The nutritional and protective qualities of breast milk make it particularly beneficial during the early stages of life. Colostrum, the thick, yellowish first milk produced towards the end of pregnancy and during the initial days after childbirth, is especially important for newborns. The World Health Organization recommends that newborns receive colostrum and that breastfeeding should begin within the first hour following delivery (WHO, 2021).
Globally, breastfeeding rates and practices differ considerably across countries and regions. Although the nutritional, immunological and economic benefits of breastfeeding are well established, exclusive breastfeeding remains below recommended levels in many parts of the world. Earlier reports have documented variations in breastfeeding initiation, duration and exclusivity. For instance, the 2019 Paediatric Nutrition Surveillance System (PedNSS) report, as cited in the source material, recorded that 61.7% of infants had ever been breastfed, while 27.0% were breastfed for at least six months and 18.5% continued breastfeeding for at least twelve months (CDC, 2011). In many developing countries, inappropriate breastfeeding and complementary feeding practices remain common, with only a proportion of infants receiving breast milk exclusively throughout the first six months of life.
In the United States, breastfeeding reports have also shown differences in exclusive breastfeeding rates at different infant ages. The 2020 Breastfeeding Report Card indicated that approximately 33% of infants were exclusively breastfed at three months, while the rate reduced to 13.3% at six months. Earlier figures from 2011 recorded exclusive breastfeeding rates of 35% at three months and 14.8% at six months.
In India, reports covering the 2015–2016 period indicated that approximately 58% of infants below four months of age were exclusively breastfed, while about 46% of infants below six months received breast milk exclusively (WHO, 2021). These figures demonstrate that maintaining exclusive breastfeeding throughout the recommended six-month period remains a challenge in different parts of the world.
In Ghana, breastfeeding practices have also been associated with early introduction of supplementary foods. Awumbila (2013) reported that only a small proportion of infants below four months were exclusively breastfed, while many children had already been introduced to other forms of feeding by the age of three months. Such practices may reduce the benefits associated with exclusive breastfeeding during early infancy.
In Nigeria, exclusive breastfeeding coverage has remained a public health concern despite efforts to improve infant-feeding practices. Data attributed to the Nigeria Demographic and Health Survey in the original source indicated that approximately 32% of children below six months were exclusively breastfed, representing an improvement from the 13% reported in 2013. However, this level of coverage still indicates that many infants are not receiving the recommended exclusive breastfeeding practices (Kimani-Murage et al., 2011).
Urban poor settlements and slum communities present additional challenges to child health and survival. Across sub-Saharan Africa, urban slum populations are expanding rapidly, with many people living in environments characterised by poor sanitation, overcrowding, inadequate housing and limited economic opportunities. These conditions negatively affect the health and wellbeing of residents. Contrary to the assumption that people living in urban areas always enjoy better health outcomes than rural populations, children in urban slum communities may experience particularly poor health conditions (Kimani-Murage et al., 2011). In Nigeria, children living in slum settlements have been reported to experience higher levels of illness and mortality than some other population groups, including children in rural communities. Consequently, infants born to mothers living in urban slums may be exposed to inappropriate breastfeeding and complementary feeding practices, increasing their vulnerability to nutritional deficiencies and childhood illnesses.
Despite continuous efforts by healthcare service providers to encourage breastfeeding, achieving the recommended levels of exclusive breastfeeding and appropriate complementary feeding remains difficult. This is partly because infant-feeding decisions are influenced by several economic, cultural, religious and social conditions within communities and households. Awumbila (2013) identified these factors as important influences on the feeding choices made by mothers. Similarly, Kimani-Murage et al. (2011) noted that suboptimal breastfeeding and complementary feeding practices may be associated with maternal age, marital status, educational attainment, occupation, antenatal and maternity healthcare experiences, health education, media exposure, cultural beliefs, socioeconomic status and place of residence. Infant-related characteristics, such as birth weight, birth order and the use of pacifiers, may also influence feeding decisions.
These factors demonstrate the need to examine the circumstances that influence mothers' choices of infant-feeding practices. Understanding these factors is important for developing appropriate interventions that encourage exclusive breastfeeding and timely introduction of complementary foods, thereby improving infant nutrition, growth and survival.
1.2 Statement of the Problem
Optimal infant-feeding practices require mothers to initiate breastfeeding within the first hour after childbirth, provide breast milk exclusively during the first six months and continue breastfeeding for two years or longer. From the age of six months, nutritionally adequate, safe and age-appropriate complementary foods should be introduced alongside continued breastfeeding.
Despite the established benefits of recommended infant-feeding practices, inappropriate breastfeeding and complementary feeding remain significant public health concerns in Nigeria. Studies have estimated that thousands of infant deaths occur annually as a result of inadequate breastfeeding practices (GHAI, 2011). Data cited in the original source indicate that only about 32% of Nigerian infants below six months receive exclusive breastfeeding. This suggests that a considerable number of infants are introduced to other liquids or foods before completing the recommended six-month period.
Many Nigerian mothers adopt mixed-feeding practices rather than maintaining exclusive breastfeeding. The early introduction of other foods and liquids may expose infants to infections and increase their risk of nutritional problems. Research has also associated inappropriate breastfeeding practices with childhood illnesses such as otitis media, lower respiratory tract infections and gastrointestinal diseases. The financial burden of treating these preventable illnesses can be considerable, placing additional pressure on families and the healthcare system (Kibet, 2021). These conditions may negatively affect infants' nutritional status, general health and physical development.
Several factors may influence mothers' decisions concerning infant feeding. These include their socioeconomic circumstances, educational background, cultural beliefs, personal preferences and the availability of appropriate health information. Infant-related characteristics may also contribute to the feeding choices made by mothers.
In view of these concerns, there is a need to identify the factors responsible for mothers' choices of infant-feeding practices. Understanding these influences will help healthcare professionals develop appropriate health education strategies that encourage recommended feeding practices, reduce preventable childhood illnesses and deaths, and improve the nutritional wellbeing of infants.
1.3 General Objective
The general objective of this study is to assess the factors influencing the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre in Lagos State.
1.4 Specific Objectives
The specific objectives of the study are to:
1. Determine the infant-feeding practices preferred by women of childbearing age attending Lagos State Primary Health Centre.
2. Examine the relationship between sociodemographic factors and the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre.
3. Determine the influence of cultural factors on the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre.
4. Identify the infant-related factors influencing the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre.
1.5 Research Questions
The following research questions are formulated to guide the study:
1. What infant-feeding practices are adopted by women of childbearing age attending Lagos State Primary Health Centre?
2. How do sociodemographic factors influence the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre?
3. How do cultural factors influence the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre?
4. How do infant-related factors influence the choice of infant-feeding practices among women of childbearing age attending Lagos State Primary Health Centre?
1.6 Significance of the Study
Infant-feeding practices are important determinants of children's nutritional status, growth and general health. Inappropriate breastfeeding practices, particularly failure to exclusively breastfeed during the first six months of life and the inadequate introduction of complementary foods, are major risk factors for childhood illnesses, malnutrition and mortality.
This study is therefore important because it seeks to examine the factors influencing mothers' choices of infant-feeding practices. By identifying the knowledge, attitudes and practices of mothers concerning infant feeding, the research may help increase awareness of the importance of appropriate breastfeeding and complementary feeding.
The findings are expected to benefit mothers by providing useful information about recommended infant-feeding methods, the benefits of breastfeeding and the appropriate time to introduce complementary foods. Improved awareness may encourage mothers to adopt feeding practices that support the healthy growth and development of their children.
The study may also be beneficial to healthcare workers, particularly nurses, midwives and other maternal and child health professionals. The findings may assist them in identifying common challenges faced by mothers and improving the health education and counselling provided during antenatal, postnatal and child welfare services.
Furthermore, the research may provide useful information for healthcare administrators and policymakers when developing programmes and interventions aimed at improving infant nutrition and reducing preventable childhood illnesses. It may also serve as a reference for students and future researchers interested in breastfeeding, complementary feeding and maternal and child health.
1.7 Justification of the Study
This study is necessary because inappropriate infant-feeding practices remain an important concern affecting child nutrition, health and survival. Although the benefits of exclusive breastfeeding and timely complementary feeding are well established, several mothers continue to adopt feeding practices that do not fully comply with recommended guidelines.
Investigating the factors that influence mothers' feeding decisions is expected to contribute to a better understanding of existing practices and the challenges associated with appropriate infant feeding. The findings may provide mothers with relevant information about suitable feeding methods and encourage the adoption of practices that promote healthy infant development.
The study will also identify possible barriers to recommended infant-feeding practices and provide evidence-based recommendations for addressing them. These recommendations may assist healthcare professionals and policymakers in developing appropriate health education programmes and interventions that promote age-appropriate infant feeding.
Ultimately, the findings may contribute to improving infant-feeding standards and supporting policies aimed at sustaining recommended breastfeeding and complementary feeding practices in Nigeria.
1.8 Scope of the Study
This study examines the factors influencing the choice of infant-feeding practices among women of childbearing age. It focuses specifically on women of childbearing age attending Lagos State Primary Health Centre in Lagos State.
The study covers the different infant-feeding practices adopted by mothers and examines how sociodemographic characteristics, cultural influences and infant-related factors contribute to their feeding choices.
1.9 Operational Definitions
Colostrum Feeding: This refers to the practice of feeding a newborn with colostrum, which is the first thick, yellowish breast milk produced during the initial days following childbirth, usually before mature breast milk becomes established.
Complementary Feeding: This refers to the introduction of safe, nutritious and age-appropriate solid, semi-solid or soft foods to an infant from six months of age, alongside continued breastfeeding.
Exclusive Breastfeeding: This refers to feeding an infant with breast milk only for the first six months of life, without giving other foods or liquids, including water, except oral rehydration solution, vitamins, minerals or medicines when medically indicated.
Infant Feeding: This refers to the different methods used to nourish infants. These may include exclusive breastfeeding, predominant breastfeeding, mixed feeding or feeding without breast milk.
Mixed Feeding: This refers to the practice of feeding an infant with breast milk alongside other milk, liquids or foods before the recommended age for introducing complementary foods.
Predominant Breastfeeding: This refers to a feeding method in which breast milk remains the infant's main source of nourishment, although the infant may also receive certain liquids, such as water, water-based drinks, fruit juice or oral rehydration solution, but not other milk or solid foods as part of the predominant feeding classification.
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