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WOMEN'S PERCEPTION OF BABY FRIENDLY AND CONVENTIONAL BABY FEEDING PRACTICES

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

The perception of baby-friendly and conventional baby feeding practices among women is a topic of increasing interest in the field of maternal and child health. Baby-friendly practices typically emphasize exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside appropriate complementary foods up to two years or beyond. In contrast, conventional feeding practices may involve a combination of breastfeeding, formula feeding, and the introduction of solid foods at varying ages. Women's perceptions of these feeding practices can be influenced by cultural norms, social support networks, healthcare provider recommendations, and personal experiences. Understanding women's perspectives on baby-friendly versus conventional feeding practices is essential for informing health promotion efforts, shaping breastfeeding policies, and addressing barriers to optimal infant nutrition. This study seeks to explore women's attitudes, beliefs, and experiences related to baby-friendly and conventional feeding practices, with the aim of identifying factors that influence maternal feeding decisions and behaviors.

Breastfeeding is the process of feeding the infant with mother’s milk, either by direct nipple-baby mouth contact or by expressed breast milk. Breast milk is of two types: Colostrum which is the initial yellowish and sticky milk produced from mother’s breasts from 37 weeks of gestation to about seven days after delivery; and Mature milk which is whitish in color and is effectively produced from about 10th day following delivery(brown,1998).

Exclusive breast feeding is the practice of feeding the infant for the first six months of life on breast milk only, without any other type of food, not even water.

EBF is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. Colostrum is important for the baby as it contains more protein (10% compared to 1% in mature milk),immunoglobulins (IgA)lactoferrin, white blood cells, vitamin A, zinc and less fat. These are important for immune defenses of the baby during the initial days of life.

EBF is associated with multiple advantages to both, the baby and the mother. On the baby’s side, there is acquisition of passive immunity against infection, nutrients for physical and mental development, emotional security and closeness to the mother. Being a dynamic and physiologically sensitive process,

breast milk production is adjusted to suit the infant’s requirement according to environmental changes. For example, breast milk will contain more fat during cold seasons.Dickin(1998)

The current World Health Organization [WHO] recommendations on breastfeeding stipulate that breastfeeding should start immediately following delivery for the baby to get colostrum. The infant should thereafter be exclusively breastfed for up to six months of life, day and night on child’s demand. During this period, no fluids including water should be given to the baby.

However, there is a room for giving oral medication to the infant should he/she fall sick.. Breastfeeding should still continue until the child is two years of age. The use of bottle-feeding, teats and pacifiers is discouraged as it is associated with poor hygiene and the risk of gastrointestinal infection to the infant. Stuart(2000)

Globally, there is a declining trend of breastfeeding, Reasons for declining breastfeeding include lack of confidence that the child is getting enough, increased urban women work load demand that makes them to be separated from their babies for longer hours, decline in social support, discomfort on breastfeeding in public, and intense promotion of commercial milk formulae.

Globally, there are new initiatives to encourage EBF. These include the International Code of Marketing Breast milk Substitutes and Baby Friendly Hospital Initiative [BFHI]. Mothers can obtain information about EBF when they are attending antenatal clinic and following hospital delivery. Mass media like radio and television are also helpful in disseminating public education on breastfeeding.Amin(2000)The mother will also benefit from EBF by experiencing lactational amenorrhea, fast return of the uterus to its normal size, prevention of postpartum hemorrhage, reduced risk of getting cancer of the breast and ovary, low risk of osteoporosis and emotional satisfaction. Also breast milk is cheap compared to other artificial feed.

Evidence-based breastfeeding support is important for achieving breastfeeding recommendations, preventing morbidity and mortality as well as for promoting sustainable development goals (Victora et al., 2016; Rollins et al., 2016; WHO, 2018). The Baby-Friendly Hospital Initiative (BFHI) is a globally implemented health initiative established in 1991 by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). This initiative aims to fulfill the need of evidence-based, high standard support for breastfeeding in facilities offering care for pregnant women, mothers, and newborns. The Ten Steps to Successful Breastfeeding (Ten Steps) are a set of evidence-based breastfeeding support practices that establish the fundamentals of the initiative (WHO, 2020). To be designated as a Baby-Friendly Hospital, facilities are required for full implementation of the Ten Steps practices and policies, as well as commitment to the International Code of Marketing Breastmilk substitutes. Implementation of BFHI includes revision of current hospital practices and training clinicians and staff at the administrative level (WHO, 2018).

Mothers should not be considered as passive receivers of breastfeeding support, but active participants of the support provided to them. Postpartum mothers are highly dependent on professional breastfeeding support in birth hospitals, and on community health services especially during the initial weeks following birth (McFadden et al., 2019, 2015). However, today, hospital stays after childbirth are short, thus generating new challenges in providing families with adequate and appropriate breastfeeding support during their hospital stay (McLelland et al., 2015). Although implementation of the Ten Steps is associated with improved breastfeeding outcomes, such as successful early initiation of breastfeeding and a high prevalence of increased exclusive breastfeedingat the time of hospital discharge (Pérez-Escamilla et al., 2016), there is nevertheless an increasing need to better understand the maternal perspective concerning the support provided to mothers (Munn et al., 2016; Leeming et al., 2017). The maternal point of view and maternal satisfaction with breastfeeding should be considered important when designing interventions to improve breastfeeding support (Ericson et al. 2021, Leeming et al., 2017; Leff et al., 1994). Breastfeeding support that is positively perceived by mothers will lead to the achievement of important health goals in societies (Schmied et al., 2011) such as increased rates of breastfeeding and improved health of mother and infant (Victora et al., 2016). Thus, the needs and expectations of pregnant women and postpartum mothers should be discussed whenever they are provided with breastfeeding support. Interestingly, thus far, there has been little research related to maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals, and therefore the knowledge about this topic remains not only insufficient but also scattered as no previous integrative reviews summarizing evidence about the topic have been published.

Mothers may have feelings of guilt and shame for not breastfeeding their child (Thomson et al., 2015). These negative feelings may be notably present specifically in the context of BFHI which emphasizes the importance of breastfeeding. A previous review suggested that breastfeeding support adherent to the Ten Steps may create unrealistic expectations about breastfeeding for mothers. Therefore, the support and care in the context of Baby-Friendly Hospital may unintentionally trigger negative emotional experiences for mothers (Fallon et al., 2019).

The lived experiences and perceptions of mothers giving birth in Baby-Friendly hospitals should be considered significant and a source of a better understanding of breastfeeding support and promotion from a maternal viewpoint. In addition, including the maternal viewpoint will help to understand and describe shortcomings in breastfeeding support that may exist in Baby-Friendly hospitals. The aim of this review was to synthesize the existing literature on maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals. In addition, we aimed to describe possible differences in maternal perceptions and experiences of breastfeeding support between Baby-Friendly hospitals and non-Baby-Friendly hospitals if a comparative design was used.

1.2 STATEMENT OF THE PROBLEM

The study aims to explore women's perceptions of baby-friendly and conventional baby feeding practices. Specifically, it seeks to investigate how women perceive and experience the recommendations and implementation of baby-friendly feeding practices compared to more conventional methods. This research will delve into factors such as cultural influences, societal norms, healthcare guidance, and personal preferences that shape women's attitudes towards these feeding approaches. By examining women's perspectives, the study aims to contribute to a better understanding of the challenges and benefits associated with both baby-friendly and conventional baby feeding practices, ultimately informing efforts to promote optimal infant nutrition and maternal well-being.

1.3 OBJECTIVES OF THE STUDY

The main objective of the study is to examine women's perception of baby friendly and conventional baby feeding practices

Specific objectives

1. To explore women's perceptions of baby-friendly feeding practices in comparison to conventional baby feeding methods.

2. To investigate the factors influencing women's attitudes towards baby-friendly and conventional feeding practices.

3. To examine the potential impact of societal norms and cultural beliefs on women's adoption of baby-friendly versus conventional feeding approaches.

1.4 RESEARCH QUESTIONS:

1. How do women perceive the benefits  youand drawbacks of baby-friendly feeding practices compared to conventional methods?

2. What sociocultural factors shape women's attitudes and preferences towards baby-friendly versus conventional feeding practices?

3. How do women's personal experiences and interactions with healthcare professionals influence their decisions regarding baby feeding methods?

1.5 RESEARCH HYPOTHESES:

H1. Women who have positive experiences with baby-friendly feeding practices will perceive them more favorably than conventional methods.

H2. Sociocultural factors such as familial traditions and societal norms will significantly influence women's preferences for baby-friendly or conventional feeding practices.

H3. Women who receive consistent support and education from healthcare professionals regarding baby-friendly feeding practices will be more likely to adopt them compared to those who do not receive such support.

1.6 SIGNIFICANCE OF THE STUDY

Understanding women's perceptions of baby-friendly and conventional baby feeding practices is crucial for promoting optimal infant nutrition and maternal well-being. This study provides valuable insights into how cultural, social, and personal factors influence feeding decisions, informing healthcare professionals to tailor support and education for mothers and infants.

1.7 SCOPE OF THE STUDY

The study aims to explore women's perceptions of both baby-friendly and conventional baby feeding practices, encompassing attitudes, beliefs, and preferences regarding feeding methods, as well as factors influencing their choices and experiences.

1.8 LIMITATIONS OF THE STUDY

The study may not adequately capture cultural or socioeconomic diversity, potentially limiting its generalizability. Additionally, self-reporting bias could affect the accuracy of data collected. The study design might not account for other factors influencing women's perceptions beyond feeding practices. Moreover, the sample size and recruitment methods might not ensure representativeness of the target population.

1.9 DEFINITION OF TERMS

1. Women's Perception: The subjective understanding, beliefs, attitudes, and viewpoints held by women regarding a particular subject or topic, in this case, baby feeding practices.

2. Baby-Friendly Practices: Refers to feeding and care practices that are in alignment with the principles outlined by the Baby-Friendly Hospital Initiative (BFHI), which promotes breastfeeding and skin-to-skin contact between mother and baby immediately after birth.

3. Conventional Baby Feeding Practices: Traditional or commonly accepted methods of feeding infants, which may include breastfeeding, formula feeding, or a combination of both, as well as the introduction of solid foods at a certain age.

4. Perception: The way in which something is interpreted, understood, or perceived by an individual or group, which can be influenced by personal experiences, cultural beliefs, societal norms, and other factors.

5. Feeding Practices: Refers to the methods, routines, and approaches used by caregivers to provide nutrition to infants, including breastfeeding, bottle-feeding, introducing solid foods, and the timing and frequency of feedings. 

6. Attitudes: Refers to the feelings, opinions, or evaluations that individuals hold towards a particular subject or behavior, which can influence their actions and decision-making processes.

7. Beliefs: The convictions or acceptance that something is true or exists, often based on personal experiences, cultural teachings, or social influences, which can shape attitudes, behaviors, and perceptions related to baby feeding practices.

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