Enablers and inhibitors of exclusive breastfeeding: perspectives from mothers and health workers in Accra, Ghana

Abstract

Background Despite the health and economic benefits of exclusive breastfeeding, there is evidence of a decline globally and in Ghana. Previous studies addressing this problem are mostly quantitative with only a few of such studies using qualitative or mixed methods to examine the predictors, benefits, ways of improving and managing exclusive breastfeeding, and the challenges associated with exclusive breastfeeding from the perspective of exclusive and nonexclusive breastfeeding mothers, and health workers. This study employs the health belief model to examine the experiences of mothers and health workers regarding exclusive breastfeeding to fill this gap in the literature. Methods A cross-sectional qualitative study involving in-depth interviews was conducted among health workers and mothers attending child welfare clinic at two polyclinics in Madina, Accra-Ghana in 2019. Purposive sampling was used to select health facilities and participants for the study. Twenty participants comprising ten exclusive breastfeeding mothers, six non-exclusive breastfeeding mothers and four health workers were interviewed for the study. The data were analyzed based on emerging themes from inductive and deductive coding. Results The decision to practice exclusive breastfeeding was based on mothers’ work, advertisement on exclusive breastfeeding and education on breastfeeding provided by health workers. Insufficient flow of breast milk, pressure from family and friends, and insufficient breast milk for infants were among the reasons for discontinuing exclusive breastfeeding. The factors that help improve exclusive breastfeeding include eating healthy food and breastfeeding on demand, while counselling and monitoring, restricting advertisement on infant formula and granting maternity leave for breastfeeding mothers were identified as factors that can facilitate the practice of exclusive breastfeeding. Conclusion Different levels of experience affect and shape exclusive breastfeeding practice in Ghana. The decision to practice exclusive breastfeeding, as well as the challenges and strategies employed in managing exclusive breastfeeding, emanates from mothers’ personal experiences and interactions with institutional factors. In view of this, there should be counselling on the management of challenges associated with exclusive breastfeeding and provision of accurate information on exclusive breastfeeding to enable mothers practice exclusive breastfeeding.

Facilitators and barriers associated with breastfeeding among mothers attending primary healthcare facilities in Mpumalanga, South Africa

“…The study utilized the SEM approach and interviewed breastfeeding mothers to understand, mostly, their microsystem of breastfeeding facilitators and barriers ( 60 , 61 ). This study further identified factors that should be considered to improve continuous breastfeeding, including exclusive breastfeeding, like other research areas of improvement ( 13 , 41 ). Mothers lived in poor socioeconomic households and most were unmarried, unemployed, received minimal income, and had low tertiary education, while poor obstetric history was characterized by unplanned pregnancy, late or zero attendance at antenatal care, cesarean mode of delivery, and mothers living with HIV, similar to other studies ( 62 , 63 ).…”

“…In addition, mothers believed that eating healthy foods, such as salted ground nuts, soft porridge, water and tea, and maize-based foods, enabled breastfeeding by producing sufficient breast milk, supported by other research showing that adequate maternal nutrition plays a role in facilitating breastfeeding ( 70 , 73 , 74 ). It is, therefore, important to have nutritionists based at health facilities, especially in rural areas, to provide advice to mothers on the specific type of food to eat in order to produce breast milk ( 41 ).…”

“…Facilitators and barriers to breastfeeding are well-established in other provinces in South Africa ( 34 – 36 ), but data on the totality of breastfeeding pressing issues are scarce in most regions in Mpumalanga province according to Nieuwoudt and colleagues ( 40 ). In addition, previous studies addressing the challenges associated with breastfeeding have been mostly quantitative, with only a few using a qualitative approach, including in South Africa ( 30 , 41 ). Therefore, within the context of Mpumalanga province, characterized by low breastfeeding rates ( 42 , 43 ) and high infant mortality rates in children under 5 years ( 44 ), we explored the facilitators and barriers to breastfeeding by interviewing using a qualitative approach among mothers attending the primary health facilities in Ermelo.…”

Investigating factors that influence the practice of exclusive breastfeeding among mothers in an urban general hospital in Ghana: a cross-sectional study

“…Socioeconomic indicators such as income level, maternal health condition or mental state relation, parity, maternal age, gestational age, educational level, occupation and employment issues were perceived as major confounders to the multiple logistic regression model. These were chosen because many previous studies [14,[17][18][19][20] have reported the influence of socio-economic and cultural factors on the practice of EBF. Missing data was managed using a listwise or case deletion.…”

“…In order to maximize positive perception and attitude toward the practice of EBF in these areas, educational interventions to help women better understand the benefits of EBF is required. While studies on exclusive breastfeeding in Ghana have focused on the knowledge level, socioeconomic and cultural practices as being the major factors affecting the practice of EBF [13,[16][17][18][19], information on the effect of family support from parents, spouse and healthcare professionals on the practice of EBF has remained inadequate.…”