Healthcare worker perspectives on mother’s insufficient milk supply in Malawi

Abstract

Background Human milk insufficiency is a significant barrier to implementing breastfeeding, and it is identified as a prevalent concern in 60–90% of mothers in low-and-middle-income countries. Breastmilk insufficiency can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants. Studies investigating the impact of breastfeeding interventions to improve milk production highlight inconsistencies between healthcare workers and mothers perceived support, as well as gaps in practical knowledge and training. The aim of this study was to determine perceptions surrounding human milk insufficiency from Malawian healthcare workers. Methods This study is a secondary analysis of 39 interviews with healthcare workers from one tertiary and three district hospitals in Malawi employing content analysis. Interviewed healthcare workers included nurses, clinical officers, midwives, and medical doctors. An inclusive coding framework was developed to identify themes related to human milk insufficiency, which were analyzed using an iterative process with NVivo12 software. Researchers focused on themes emerging from perceptions and reasons given by healthcare workers for human milk insufficiency. Results Inability to produce adequate breastmilk was identified as a prevalent obstacle mothers face in the early postpartum period in both district and tertiary facilities in Malawi. The main reasons given by participants for human milk insufficiency were mothers’ perceived normalcy of milk insufficiency, maternal stress, maternal malnutrition, and traditional beliefs around food and eating. Three focused solutions were offered by participants to improve mother’s milk production – improving education for mothers and training for healthcare providers on interventions to improve mother’s milk production, increasing breastfeeding frequency, and ensuring adequate maternal nutrition pre- and post-partum. Conclusion Health care workers perspectives shed light on the complexity of causes and solutions for human milk insufficiency in Malawi. This research highlights that a respectful professional relationship between health care workers and mothers is an essential bridge to improving communication, detecting human milk insufficiency early, and implementing appropriate interventions. The results of this study may help to inform research, clinical practice, and education in Malawi to improve human milk production.

Navigating Nutrition Inequities

“…Not only do BIPOC women experience reduced produce intake but also stress is associated with perinatal food insecurity, which can interfere with their overall health and potentially milk production and the reduced likeliness to breastfeed exclusively. 39,40 Furthermore, they have more barriers to breastfeeding. BIPOC infants are breastfed the least; about 77.3% of Black infants were never breastfed, 87.1% of Asian infants, and 8l.9% of Latinx infants compared with the national average of 83.1% who were ever breastfed.…”

“…The stress associated with the proposed cut to WIC's fruit and vegetable benefit voucher and the possibility of having to put new clients on the wait-list for services can be another barrier to breastfeeding. Not only do BIPOC women experience reduced produce intake but also stress is associated with perinatal food insecurity, which can interfere with their overall health and potentially milk production and the reduced likeliness to breastfeed exclusively 39,40. Furthermore, they have more barriers to breastfeeding.…”

A balancing act—midwives' and public health nurses' experiences with breastfeeding counselling

“…For example, one previous study reported that lactation-counsellor training courses could improve breastfeeding outcomes [14]. Unfortunately, however, there is a global lack of trained healthcare professionals with up-to-date knowledge and skills for supporting breastfeeding [1,[15][16][17].…”

Comparison of domeperidone versus metoclopramide to increase the milk production in lactating mothers.

“…4 The reasons behind the decreases could be that women have been passing through many challenges to maintain human milk production up to an adequate level. 5 Specific non-pharmacological mediations like providing close skin-to-skin contact to the baby, making earliest milk expression after delivery, maintaining the frequency of pumping up to https://doi.org/10.29309/TPMJ/2023.30.06.7511 2 12 times over a period of 24 hours, counseling for lactating mothers and easing techniques may produce favorable results. 6,7 However, in some mothers lactation gets compromised so pharmacological methods are recommended to enhance their milk supply.…”