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

Abstract

IntroductionDespite the health benefits of breastfeeding for both the mother and the child, early cessation of breastfeeding remains a public health problem in South Africa, attributed to contextual barriers and facilitators. Within the context of Mpumalanga province, which is characterized by low breastfeeding rates and high infant mortality rates in children under 5 years, we explored the facilitators and barriers to breastfeeding among mothers attending the three primary health facilities in Ermelo.MethodsUsing a semi-structured interview guide suggested by the socio-ecological model, three focus group discussions and 12 in-depth interviews were conducted among mothers selected using a purposive sampling. Transcripts from audiotaped and transcribed verbatim interviews were assessed through thematic analysis using NVivo version 10.ResultsMothers were aged between 18 and 42 years and from poor sociodemographic backgrounds. At the individual level, mothers valued breastfeeding facilitated by their commitment, maintaining it, eating healthy foods, and having sufficient breast milk. However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. At the interpersonal level, the family was identified as the main form of support to breastfeeding mothers; however, family interference was also identified as a barrier. At the community level, mothers shared some family beliefs and practices but were still split between societal and cultural norms and traditional beliefs as facilitators or barriers to breastfeeding. At the organizational level, most mothers valued the support provided by healthcare workers on childcare and techniques for breastfeeding at the health facilities. They did however articulate concerns on the miscommunication some healthcare workers offered regarding breastfeeding, which negatively influenced their infant feeding practices.DiscussionIntervention efforts should focus on behaviour change to educate and equip mothers to overcome the barriers that are within their control. Such interventions should further focus on family-centered education and strengthening the proficiency of healthcare workers on advising breastfeeding mothers.

Duration and Sociodemographic Factors Associated with Exclusive Breastfeeding Among Mothers in Urban and Semi-Rural Areas of Libreville and Lambaréné in Gabon

“…6,9 Family guidance and support were also identified as factors contributing to the success of EBF in the Mpumalanga region of South Africa. 16 This finding is not surprising compared to our survey results because the populations of Mpumalanga consist of Bantu people who share similar cultures to those in Gabon. Some factors regularly analysed in the literature, such as the number of prenatal consultations and the existence of breastfeeding preparation sessions, could not be analysed in our study due to the absence of uniform pregnancy follow-up logs; some diaries had pregnancy follow-up pages mentioning these sessions, while others did not, or the parents did not have them during the interviews.…”

“…Other surveys in India, Indonesia, and South Africa highlighted living in an urban area as a factor favouring EBF. 8,9,16,17 On closer reading of these results, the existence of medical structures encouraging mothers to breastfeed before and after birth also make a difference, as there were more "baby-friendly" structures in theses cities.…”

Barriers to Exclusive Breastfeeding for Mothers in Tswelopele Municipality, Free State Province, South Africa: A Qualitative Study

“…A previous study found that although the majority of breastfeeding mothers were opposed to the use of traditional medicine or practices, their family elders proposed their use for the protection of their infants; participants from rural regions regularly reported using traditional medicine or practices [ 44 ]. Numerous studies have reported that women engage in complementary infant feeding practices because of cultural beliefs and family pressures [ 3 , 13 , 16 , 20 , 21 , 31 , 33 , 38 ]. The majority of African societies are unfamiliar with EBF because it contradicts their deeply held cultural beliefs and customs [ 56 ].…”

“…Sociocultural, economic, and healthcare system-related concerns are associated with insufficient lactation practices in South Africa. Social conditions, such as a lack of income, reliance on food purchases, young mothers’ emotions about breastfeeding, and cultural beliefs were the primary determinants of mothers’ breastfeeding behaviors [ 30 , 31 , 32 ]. The breastfeeding process also excludes fathers.…”