Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now?

Abstract

BackgroundIncreasing the rate of exclusive breastfeeding (EBF) to 50% in the first six months of life is one of six major global targets set by the United Nations Decade of Nutrition, and is essential to achieve the sustainable development goals to eradicate hunger and end malnutrition by 2030.MethodsA survey using multistage random sampling design included 99 primary health care (PHC) clinics in all 11 districts in KwaZulu-Natal (KZN). All mothers and caregivers of infants 14 weeks of age attending the clinics in the study period were requested to participate in a structured interview to explore feeding practices since birth. As non-maternal caregivers may not have detailed knowledge of feeding practices, they provided limited information about current feeding practices. Respondents who consistently reported giving no other food or fluids except breastmilk since birth were classified as practising exclusive breastfeeding (EBF), and those who were currently breastfeeding but had given other food or fluids since birth were categorised as practising mixed breastfeeding (MBF).ResultsA total of 4172 interviews were conducted with mothers and caregivers of 14 week old infants. Among mothers 49.8% were EBF, 23.1% were MBF and 27.0% were not breastfeeding. Among non-maternal caregivers 11.8% reported EBF, 23.4% MBF and 62.3% were not giving breastmilk. Higher education (OR 0.6, 95% CI 0.4–0.8) and being in the highest socio-economic tertile (OR 0.7, 95% CI 0.6–0.9) were risk factors for not practising EBF, while returning to work (OR 0.3, 95% CI 0.2–0.3) or school (OR 0.2 95% CI, 0.1–0.3) was associated with less EBF. HIV-positive mothers were more likely to have never started breastfeeding (OR 3.6, 95% CI 2.7–4.8). However, they were similar in having stopped breastfeeding by 14 weeks (OR 1.1, 95% CI 0.9–1.4) compared to HIV-negative mothers, and, they had similar rates of EBF at 14 weeks of age (OR 1.0, 95% CI 0.9–1.3).ConclusionsEstimates of breastfeeding practices at 14 weeks in KZN are higher than previously shown. However, particular challenges that should be addressed if international targets for EBF are to be achieved include improving breastfeeding practices of HIV positive mothers and supporting all mothers, particularly working or schooling mothers to continue giving breastmilk while they are away from their children.

Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa

“…KZN is the largest of 11 provinces in South Africa with a population of over 11 million people. Antenatal and postnatal services are provided at local primary health care (PHC) clinics, with almost universal coverage of antenatal care [16]. Over 90% of women deliver in a health facility, usually the district hospital, although some larger clinics perform deliveries [31].…”

“…In recent years several breastfeeding support initiatives have been implemented including mother-baby friendly initiative (MBFI) [14], kangaroo mother care (KMC), SMS support for pregnant women and mothers (MomConnect) [15], and the KwaZulu-Natal initiative for Breastfeeding Support (KIBS) described below, of which this study forms a component. Recent evidence from the KIBS baseline suggests that exclusive breastfeeding practices have improved in KZN [13], but that challenges remain for working mothers and those who are HIV positive [16].…”

“…Returning to work is one of the biggest challenges that women face in sustaining breastfeeding. Shorter durations and lower rates of breastfeeding among working women have been shown in many settings globally, including in South Africa [16,[24][25][26][27]. A range of interventions can improve breastfeeding rates among working women, these include paid maternity leave, flexible working hours, educating mothers how to continue breastfeeding while away from their child, and facilities for lactating mothers in the workplace [28][29][30].…”

“…We describe factors associated with EBF at 14 weeks and explore reasons for early breastfeeding cessation. In particular, we focus on changes in infant feeding practices among mothers who have returned to work or school and mothers reporting themselves HIV positive, who are at high risk of poor breastfeeding practices [16].…”

Breastfeeding advice for reality: Women's perspectives on primary care support in South Africa

“…Two districts, Tshwane (urban, in Gauteng Province) and Ugu (rural, in KwaZulu‐Natal Province), were selected for their differing historical infant feeding contexts: KwaZulu‐Natal has a history of strong political will to support breastfeeding (Horwood et al, ), whereas in Gauteng, women living with HIV historically practised predominantly formula feeding until the national declaration of support for breastfeeding in 2011. In PHC clinics, women receive infant feeding information antenatally mainly from nurses and lay counsellors and sometimes nutritionists.…”