Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya

Abstract

Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings.This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro-level policies and interventions that consider the ecological setting are needed.

Factors associated with exclusive breastfeeding in Kenya: a systematic review

“…A study done by Kimani-Murage et al reported that Household food insecurity negatively influenced exclusive breastfeeding. 21 Respondents in the study indicated that one key reason for not breastfeeding optimally was due to inadequate breast milk, which they associated with lack of adequate food to eat. Maternal level of education has also been reported to influence exclusive breastfeeding by some studies.…”

“…17 Kimani-Murage et al also reported giving water and sugar/glucose and/or salt or commercially prepared mixture of water (gripe water) to protect the baby from stomach problems is a common belief not only among mothers but also among community health or social workers that affects the duration of exclusive breastfeeding. 21 Additionally, in a qualitative study conducted in Korogocho and Viwandani slums, socio-cultural beliefs and practices resulted to suboptimal breastfeeding. Some of the mothers considered colostrum as dirty; others believed that breastfeeding while engaging in extra marital affairs was a bad omen or a curse; fear of the evil eye (malevolent glare that is believed to be a curse associated with witchcraft) when breastfeeding in public while others associated breastfeeding with sagging breasts.…”

Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors

“…Women in SSA breastfeed their infants for an average of 14 to 19 months, but only 30% to 46% of them practice EBF for the first 6 months postpartum (Bbaale, 2014;Traore et al, 2014;Kimani-Murage et al, 2015). In order to promote infant feeding practices that will significantly reduce MTCT, Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs have to transcend simply informing mothers about feeding practices and documenting their choices.…”

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

“…Kenya Cohort X Kimani-Murage et al (50) 110 Kenya Qualitative Kishore et al (39) 77 India Cross-sectional X Mahmood et al (13) 123 India Cross-sectional X Maman et al (55) 40 DRC Qualitative Maonga et al (23) …”