Early initiation of breast-feeding in Ghana: barriers and facilitators

Abstract

To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breast-feeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

“…22 The belief that breast milk does not become available until 3 days after birth is another common reason for delaying breast-feeding among mothers in rural India and Ghana. 23,24 Mothers may also delay feeding because the newborn has not cried for milk. 24 Several of these determinants, including maternal education, number of pregnancies and surrogates for socio-economic status, were examined but did not confound the association between breast-feeding initiation time and neonatal mortality.…”

Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries

“…The focus in this paper is not to describe these gaps nor is it a detailed description of the types of constraints that interventions need to address and, where they exist, facilitators to closing these gaps; these are covered in the accompanying papers. [7][8][9]13,14 Also included in this volume are two papers detailing how specific formative research findings were used to make decisions about the content and delivery of the intervention. These papers cover the two main community-based approaches to reducing neonatal mortality, namely women's groups 11 and home visits by community-based volunteers.…”

“…In all settings, the perceived quality and usefulness of the visits is low, counseling skills of ANC providers poor and delivery of health education messages ineffectual, as for example detailed in the accompanying paper on early initiation of breastfeeding. 13 ANC currently appears to be a missed opportunity both for health education and for delivery of essential interventions such as intermittent presumptive treatment with antimalarials in endemic countries.…”

“…Use of prelacteals is ubiquitous in all settings; the practice of discarding colostrum is more variable, and importantly it is not always the predominant constraint to prompt initiation. A major constraint was a lack of awareness of the benefits of prompt initiation in Ghana, 13 where the national breastfeeding program had concentrated its efforts more on health facilities than on the community, missing many of the key influencers of the practice. Furthermore, the main attention had been on encouraging exclusivity rather than on early initiation.…”

“…13 Finally, many newborn care practices are culturally embedded, and achieving the ideal practice may not be feasible. For example, promoting immediate wrapping and delay of the first bath for at least a day to reduce the risk of hypothermia may meet strong resistance.…”