High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study

Abstract

BackgroundEarly skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children’s Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling.MethodsData from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling.ResultsOf 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is “good”. Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits.ConclusionsIn a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted.

Essential newborn care practices and determinants amongst mothers of infants aged 0—6 months in refugee settlements, Adjumani district, west Nile, Uganda

“…While we did not directly assess exactly how mothers applied SSC but overall, newborn warm practice was poor. This finding is similar to a study by [46] among Karen refugees that found poor SSC despite of high rates of breast feeding initiation by mothers. Other studies have established poor SSC practices by mothers in various rural African settings [47,48].…”

The influence of a community-level breast-feeding promotion intervention programme on breast-feeding practices in Myanmar

“…Therefore, because the majority of women were already initiating breast-feeding early, the community programme had less influence on changing this behaviour. This was also found in another study of Burmese along the Thai-Myanmar border in which high levels of initiation of breast-feeding was found due to a strong culture of breast-feeding practices (29) . The current study is important for a number of reasons.…”

The Healthy Baby Flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices

“…It is important to reiterate that this nutrition counseling was conducted in what can be considered a food secure population, but likely representative of displaced persons establishments elsewhere under the purview of the United Nations High Commissioner for Refugees. It is also important to note that this population already has baseline data suggesting high rates of breastfeeding initiation and breastfeeding duration [16], which may also positively impact uptake of behavior change education [8]. This pilot follows recommendations from recent systematic studies summarizing findings for appropriate counseling for improved outcomes in infant feedingincluding exclusive breastfeeding, breastfeeding duration, and complementary feedingin meeting diet diversity and minimum acceptable diet requirements for infants six months of age or older [5][6][7][8][9][10].…”