Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

Abstract

Background: Despite national efforts to promote exclusive breastfeeding (EBF), South Africa's EBF rate is only 32 %. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, 4-8 weeks, 10-14 weeks and 20-24 weeks. Methods: This community-based mixed-methods study collected data within a prospective cohort study on sociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data. Results: The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). Exclusive breastfeeding decreased from 34% at 4-8 weeks to 9.7% at 20-24 weeks. Mixed feeding with infant formula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers' attributes (wellbeing, experiences and relationships) with the code mother's stress the strongest barrier, Mother's knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother's positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby's health were strong enabling factors.

Review of the Nutrition Situation in Jordan: Trends and Way Forward

“…Other potential challenges could be the lack of sufficient breastfeeding knowledge among healthcare providers and their key role in encouraging lactating mothers [ 72 ]. Inadequate breastfeeding practices and premature weaning may also be due to the lack of designated maternity facilities such as lactation rooms in shopping malls, airports, and the workplace, lack of community or home support to the breastfeeding mother, high rates of prelacteal feeding, and the growth of infant formula milk companies in the market [ 37 , 72 , 77 , 78 , 79 , 80 ]. In terms of complementary feeding, although most infants were introduced to solid, semi-solid, or soft foods as per the WHO recommendations [ 15 ], less than half of those aged 6–23 months received a minimum acceptable diet and minimum diet diversity.…”

Lockdown-Associated Hunger May Be Affecting Breastfeeding: Findings from a Large SMS Survey in South Africa

“…A 2015 Canadian study postulated that household food insecurity could be a predictor of breastfeeding initiation due to concerns on the cost of alternate feeding, but concerns over their own food and nutrient intake and the quality or quantity of breastmilk they produced may lead some mothers to introduce formula milk [ 28 ]. Reducing hunger in mothers by improving household food security and improving breastfeeding self-efficacy in mothers could lead to higher rates of exclusive breastfeeding [ 25 , 29 ].…”

“…COVID-19 is likely to increase stress levels in women. The stress that mothers from low-income households in South Africa experience could include concerns about their breastmilk supply, their access to food, having regular meals, and relationship difficulties in the home [ 29 ]. Women, in particular, face an increased care burden due to COVID-19, and this further increases the stress on them [ 30 ].…”

The effects of mothers’ babies feeding practices on postpartum depression

“…Studies conducted in various countries have reported the prevalence of postpartum depression between 8.6% and 44.8%. [4][5][6][7] Studies in Turkey reported this prevalence to be 14.6% to 27.7%. [8][9][10] It is reported that biological, psychological and sociocultural factors are effective in the etiology of postpartum depression.…”