“When you give birth you will not be without your mother” A mixed methods study of advice on breastfeeding for first-time mothers in rural coastal Kenya

Abstract

BackgroundExclusive breastfeeding for the first 6 months of life is currently recommended by the World Health Organization, but mixed feeding earlier than this commonly occurs in rural coastal Kenya. Mothers may receive conflicting advice on breastfeeding from various sources including health workers, relatives and community members. We aimed to find out how first-time mothers learn to breastfeed, who advises them on infant feeding and what advice they obtain in case of any breastfeeding problems.MethodsTo identify advisers, a questionnaire on socio-demographic status, place of delivery, household members, education and help received on breastfeeding, breastfeeding problems, name of advisers and their relationship to the mothers was administered to 50 new first-time mothers in Jaribuni, Kilifi (population approximately 18,000). Summary statistics were obtained using frequencies, medians and interquartile ranges (IQR). Focus group discussions (FGDs) were held amongst 4 groups of mothers who had answered questionnaires; 4 groups of their named advisers; and 1 group of community health workers in order to explore breastfeeding practices, problems and advice given. FGDs were analysed by thematic framework analysis.ResultsFirst-time mothers were young (median age 18, IQR 17–21, range 14–26 years) and 42 % were single. Living in extended families was the norm and married women lived with their husband’s family. All had a female family member or neighbour helping with childcare in the perinatal period. The main advisers on breastfeeding were their mother or older female members of their husband’s family. Married first-time mothers felt obliged to follow their mother-in-law’s advice to maintain good relationships and show respect within the household. Breastfeeding problems were reported by 80 % of respondents. Nipple pain (56 %) was the most reported problem, then breast engorgement (48 %) and insufficient milk supply (38 %). Most problems were treated at home without consultation with health workers. Concerns were raised about co-sleeping, breastfeeding whilst lying down, and insufficient milk supply. Advisers would like more information on breastfeeding in order to help mothers.ConclusionsInterventions to increase knowledge of, and facilitate optimal breastfeeding practices in first-time mothers should include those family members who advise and assist with childcare around the time of delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-016-0069-6) contains supplementary material, which is available to authorized users.

Exclusive breastfeeding in first-time mothers in rural Kenya: a longitudinal observational study of feeding patterns in the first six months of life

“…The reasons for introduction were similar to those found in other qualitative studies: to calm the baby, to reduce hunger and to teach the baby about different foods [28,30]. Participants in our study were young and those who were married were under pressure to obey their mother-in-law's advice else they faced the possibility of being returned to their parental home [12].…”

“…Researchers counselled the mothers with breastfeeding difficulties and referred them to health facilities when this impaired infant feeding but the persistence of problems in positioning implies that there may be conflicting advice from other sources in the community. Fears of suffocating the baby with the breast blocking the baby's nose if held too close during breastfeeding had been noted in a recent study in the same location [12].…”

“…Risk factors for early interruption were identified as prelacteal feeding, discarding of colostrum and being a first-time mother. A recent mixed-methods study of 50 first-time mothers and their advisers in a rural coastal community in Kenya described multiple problems in practicing breastfeeding in the first month of life [12].…”

Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment

“…before and during breastfeeding (21,(28)(29)33,49,60,63,65) . in the oropharynx (38)(39)(44)(45)52,61,65,68,(70)(71) .…”

Abstracts

“…Our study of the social networks of first‐time mothers included focus group discussions with them, their advisers and a group of community health workers based in a rural population in coastal Kenya (Jaribuni and Kauma locations of Kilifi County; Talbert et al, ). Fifty mothers with newborns were identified by dispensary nurses, by community health workers, and by other participants.…”