Background: Breast milk is the best milk for the baby. It is beneficial for the baby as well as the mother, family, and nation.&nbsp;In spite of an established fact, still, a very low percentage (44.2%) is implementing it. Objective: The objective of this study&nbsp;was to find out the knowledge, concerns, and difficulties in breastfeeding and the obstacles in the practicing breastfeeding.&nbsp;Materials and Methods: A cross-sectional study was done at pediatric clinics in Warangal. A total of 1010 lactating mothers who&nbsp;were presenting for regular check-ups were enrolled. After taking oral consent, mothers were interviewed through a predesigned&nbsp;questionnaire containing 50 questions on pre- and post-natal counseling received, and knowledge of exclusive breastfeeding,&nbsp;importance of skin-to-skin contact (SSC), and their educational status and hygiene. The entire session of interview was carried out&nbsp;in the optimum privacy to create a favorable environment of acquiring the data. Results: Of 1010 mothers enrolled, only 25.4%&nbsp;had received antenatal counseling, 15.8% had received postnatal counseling regarding exclusive breastfeeding, 56.4% followed&nbsp;exclusive breastfeeding (EBF), and SSC was maintained by only 2%, after delivery which played an important role in breastfeeding,&nbsp;p=0.000003 for antenatal counseling and EBF. Conclusion: More attention should be given in educating mothers when they&nbsp;conceive, regarding breastfeeding, its problems and skills, during their first visit to health-care professionals

Bhargavi, S Devi Priya

Kumar, G Raj

Kumar, K Naresh

Nikhitha, V

Surender, K

English

Atharva Scientific Publications (E-Jounals)

Vol 6 | Issue 8 | August 2019 Indian J Child Health 455
Original Article
Impact of mothers’ knowledge and support for sustaining exclusive breastfeeding
K Surender1, K Naresh Kumar2, V Nikhitha2, S Devi Priya Bhargavi2, G Raj Kumar3
 From 1Associate Professor, Department of Pediatrics, Kakatiya Medical College, Mahatma Gandhi Memorial Hospital, 2Pharm D, 3Assistant Professor, 
Department of Pharmacy Practice, Balaji Institute of Pharmaceutical Sciences, Warangal, Telangana, India
Correspondence to: Dr. K. Surender, Department of Pediatrics, Mahatma Gandhi Memorial Hospital, Warangal, Telangana, India. 
E-mail: surenderkagitapu@gmail.com
Received - 30 June 2019 Initial Review - 26 July 2019 Accepted - 14 August 2019
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. It is the evergreen gift given by a mother 
to her baby [1]. Results from the epidemiological studies and 
growing knowledge of the roles of epigenetics, stem cells, and the 
developmental origins of health and disease lend strong support 
to the ideas proposed by Vahlquist. Breastfeeding promotion 
is important in both rich and poor countries alike and might 
contribute to the achievement of the forthcoming sustainable 
development goals [2]. Lactogenesis is a phenomenon involving 
many hormones and reflexes. Two hormones directly affecting 
breastfeeding are prolactin and oxytocin, and estrogen is indirectly 
involved in lactation [3]. Successful breastfeeding depends on 
maternal factors, infant response to breastfeeding, and various 
psychophysiological factors.
Many studies have proved that women with positive or stronger 
maternal attitude and positive obstetric experiences are more 
likely to succeed and continue with breastfeeding [4]. Pregnancy, 
childbirth, and compatibility with the newborn might constitute 
the most perceptive developmental stage in a woman’s life [5]. 
Successful breastfeeding is dependent on mother’s physiological, 
social, and psychological factors [6]. Skin-to-skin contact (SSC) 
might have a long-term positive effect on breastfeeding. The 
postpartum depressive symptoms are seen in 20–40% of women, 
which affect both the mother and infant. In preterm infants, 
daily SSC between the mother and her infant has been shown to 
decrease maternal postpartum depressive symptoms [7].
The WHO defines exclusive breastfeeding (EBF) as the 
practice of feeding only breast milk (including expressed breast 
milk) to the baby and allows the baby to receive vitamins, minerals, 
or medicine. Water, breast milk substitutes, other liquids, and 
solid foods are excluded [8]. The WHO recommends EBF for the 
first 6 months, with supplemental breastfeeding continuing for 
2 years and beyond [9]. Appropriate measures should be taken to 
improve training in breastfeeding counseling and the number of 
trained professional counselors, at all levels should be increased. 
Selection of motivated health care workers is an important 
factor contributing to the improvements in breastfeeding results. 
Antenatal counseling helps in educating the mothers for initiation 
of breastfeeding immediately after delivery and practicing EBF 
for the first 6 months of baby’s life. All pregnant women should 
be informed about the profits and management of breastfeeding 
on a priority basis during antenatal visits [10].
MATERIALS AND METHODS
This was a cross-sectional study done at different pediatric 
hospitals in Hanmakonda, Telangana, India. The mothers who 
ABSTRACT
Background: Breast milk is the best milk for the baby. It is beneficial for the baby as well as the mother, family, and nation. 
In spite of an established fact, still, a very low percentage (44.2%) is implementing it. Objective: The objective of this study 
was to find out the knowledge, concerns, and difficulties in breastfeeding and the obstacles in the practicing breastfeeding. 
Materials and Methods: A cross-sectional study was done at pediatric clinics in Warangal. A total of 1010 lactating mothers who 
were presenting for regular check-ups were enrolled. After taking oral consent, mothers were interviewed through a predesigned 
questionnaire containing 50 questions on pre- and post-natal counseling received, and knowledge of exclusive breastfeeding, 
importance of skin-to-skin contact (SSC), and their educational status and hygiene. The entire session of interview was carried out 
in the optimum privacy to create a favorable environment of acquiring the data. Results: Of 1010 mothers enrolled, only 25.4% 
had received antenatal counseling, 15.8% had received postnatal counseling regarding exclusive breastfeeding, 56.4% followed 
exclusive breastfeeding (EBF), and SSC was maintained by only 2%, after delivery which played an important role in breastfeeding, 
p=0.000003 for antenatal counseling and EBF. Conclusion: More attention should be given in educating mothers when they 
conceive, regarding breastfeeding, its problems and skills, during their first visit to health-care professionals.
Key words: Exclusive breastfeeding, Pre- and post-natal counseling, Skin-to-skin contact
Surender et al. Mothers knowledge and support for EBF
Vol 6 | Issue 8 | August 2019 Indian J Child Health 456
were breastfeeding, formula feeding, and mixed feeding were 
included in the study. Mothers having children >4 years of age 
and not given consent were excluded from the study. After taking 
institutional ethical committee permission and oral consent 
from the mothers, they were interviewed through a predesigned 
questionnaire containing 50 questions on pre- and post-natal 
counseling received, knowledge of EBF, importance of SSC, their 
educational status, and hygiene.
The entire session of interview was carried out in optimum 
privacy to create a favorable environment for acquiring the data. 
For statistical analysis, IBM SPSS software Version 20.0 was 
used. Chi-square test was done for statistical significance. In all 
instances, p<0.05 was considered statistically significant. Data 
analysis was done using ANOVA. Charts were prepared from 
Microsoft Excel 2010 Version and results analyzed, tabulated 
with comparative tables, line diagrams, and bar charts.
RESULTS
In the present study, we collected the data from a total population 
of 1010 mothers both breastfeeding and formula feeding, and 
results were found as below mentioned tables. Table 1 shows the 
demographic details of 1010 mothers and different parameters 
collected.
Table 2 describes the number of mothers receiving antenatal or 
postnatal counseling, SSC, timing of initiation of breastfeeding, 
use of colostrum, and knowledge of breastfeeding, partner 
support, and duration of feeding.
Table 3 shows the comparison association antenatal counseling 
received and EBF.
Table 4 shows the association between the 1st h initiation of 
breastfeeding and EBF.
DISCUSSION
The sample of our study comprises postpartum mothers (1010), 
of which only 25.4% (257) had received counseling during their 
antenatal visits regarding breastfeeding. Alison Stuebe concluded 
that most of the mothers make decisions about infant feeding 
early in pregnancy [11]. Early in prenatal care, if obstetrician 
can educate mothers about the health impact of infant feeding 
and address potential obstacles to breastfeeding, they could 
Table 1: Demographic details wise distribution of mothers
Demographics Number Percentage
Age
19–24 536 53
25–30 409 40
31–36 59 5.8
37–42 6 0.5
Education
None 44 4
Primary 117 12
Secondary 356 35
Graduation 424 42
Postgraduation 69 7
Type of delivery
Normal 223 22
Cesarean 787 77.9
Type of feeding
Exclusive breastfeeding 562 56
Formula feeding 117 11
Both 331 33
Delivery wise distribution
Para 1 628 62.8
Para 2 339 33.5
Para 3 41 4.05
Para 4 2 0.19
Table 2: Breastfeeding practice wise distribution of mothers
Practices Number Percentage
Antenatal counseling
Yes 257 25.4
No 753 74.8
Postnatal counseling
Yes 160 15.8
No 850 84.1
Skin-to-skin contact
Yes 18 2
No 992 98
1st h initiation
Yes 337 33.3
No 673 66.7
Colostrum discarded
Yes 572 56.6
No 321 35.9
Knowledge of breastfeeding
Yes 954 94.4
No 56 5.5
Knowledge of breast milk
Yes 633 62.6
No 377 37.3
Knowledge of exclusive breastfeeding
Yes 519 51.3
No 491 48.6
Knowledge of risks of not breastfeeding
Yes 201 19.9
No 809 80.09
Hygiene
Washing 298 33.3
Wiping 614 68.7
Partner support
Yes 934 92.4
No 76 7.5
Duration of feeding
10 min 548 61.3
20 min 177 19.8
30 min 168 18.2
Surender et al. Mothers knowledge and support for EBF
Vol 6 | Issue 8 | August 2019 Indian J Child Health 457
play a powerful role in improving health outcomes across two 
generations [11]. In the present study, 56.4% (562) of mothers 
followed EBF, which was higher in comparison to a study 
conducted by Yılmaz et al. [12], where it was observed in 38.9% 
of mothers.
It was observed that most of the C-section mothers, which 
were 77.9% (787) held their baby after a long time, whereas 22.0% 
(223) normal delivered mothers held their babies immediately. 
Beiranvand et al. concluded that SSC after delivering through 
cesarean section was possible and this resulted in higher maternal 
satisfaction level. As the holding of baby is not done immediately, 
there might be a chance of decreased bonding between the mother 
and baby which might lead to delayed suckling reflexes of the 
baby [13]. Postnatal counseling plays a major role in educating 
mothers on breastfeeding. Among the total mothers, only 15.8% 
(160) received postnatal counseling and the rate of EBF was 
1.31 times higher among such mothers. The observed association 
between counseling and EBF prevalence is in accordance with the 
study findings from Bahir Dar, Ethiopia [14].
In the present study, majority of the mothers had given birth 
through cesarean delivery 77.9% (787) and only 22.1% (223) 
through normal delivery. Of 100%, only 2% had maintained SSC. 
This could be mainly due to lack of proper knowledge on SSC. 
The other reasons could be delayed shifting from the labor room, 
mother lacking energy or being unconscious due to anesthesia, 
and mother or baby’s observation. Oche et al. concluded that 
knowledge and practice of EBF was low in their study where 
94.4% of mothers knew that breast milk was good for health, but 
only 62.6% had awareness of its immune properties [15].
Angelsen et al. proposed that a longer duration of breastfeeding 
benefits cognitive development; hence, feeding should be 
continued up to 24 months, whereas our study showed that only 
51.9% gave feeding up to 2 years, 35.2% up to 1 year, 12.0% up to 
3 years, and 0.6% up to 4 years [16]. Our study showed that only 
33.3% and 42.7% of mothers have followed washing and wiping, 
respectively, during breastfeeding. Hygienic conditions such as 
washing and wiping should be maintained during breastfeeding 
to prevent infections. According to Mannion et al., mothers 
feel more capable and confident about breastfeeding when they 
receive positive attitude from their partners. Our study reveals that 
breastfeeding mothers have a good partner support (92.4%) [17].
Bruno Tongun et al. concluded that 52% of mothers initiated 
breastfeeding, whereas in our study, 33.3% of mothers had early 
initiation of breastfeeding [18]. Sohail and Khaliq observed that 
27.9% of mothers had discarded the colostrum believing it to be 
non-nutritious, whereas our study reveals that 56.6% of mothers 
had discarded colostrum [19]. The limitations of the study are due 
to the lack of information from mothers and unavailability, the 
previous medical history of the infants was not collected.
CONCLUSION
Mothers should be educated regarding breastfeeding from early 
periods of pregnancy and it should be a continuous process 
for increased rate of EBF. Lack of knowledge, support, and 
sensitization are few vital reasons for limiting breastfeeding 
practices. To overcome the barriers such as lack of mother’s 
knowledge, family support, and counseling (pre- and post-natal), 
there is a need of health-care professionals to bring out the 
positive impact of breastfeeding process and support the breastfed 
mothers for a healthy and better society.
REFERENCES
1. Paul VK. Introduction to pediatrics. In: Paul VK, Bagga A, editor. Ghai 
Essential Pediatrics. 8th ed. New Delhi: CBS Publisher; 2013. p. 1-6.
2. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. 
Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong 
effect. Lancet 2016;387:475-90.
3. Lawrence RA, Lawrence RM, editors. Physiology of lactation. In: 
Breastfeeding: A Guide for the Medical Profession. 8th ed. London: Mosby; 
2005. p. 56-72.
4. Newton N, Newton M. Psychologic aspects of lactation. N Engl J Med 
1967;277:1179-88.
5. Rahmani F, Seyedfatemi N, Asadollahi M, Seyedrasooli A. Predisposing 
factors of postpartum depression. Iran J Nurs 2011;24:78-87.
6. Krouse AM. The family management of breastfeeding low birth weight 
infants. J Hum Lact 2002;18:155-65.
7. Cooijmans KH, Beijers R, Rovers AC, de Weerth C. Effectiveness of skin-
to-skin contact versus care-as-usual in mothers and their full-term infants: 
Study protocol for a parallel-group randomized controlled trial. BMC 
Pediatr 2017;17:154.
8. World Health Organization. Promoting Proper Feeding for Infants and 
Young Children. Geneva: World Health Organization; 2004. Available from: 
http://www.who.int/nut/inf.htm. [Last accessed on 2005 Feb 24].
9. Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ 2008;336:881-7.
10. Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal 
counselling on exclusive breastfeeding. J Ayub Med Coll Abbottabad 
2012;24:116-9.
11. Stuebe A. The risks of not breastfeeding for mothers and infants. Rev Obstet 
Gynecol 2009;2:222-31.
12. Yılmaz E, Doğa Öcal F, Vural Yılmaz Z, Ceyhan M, Kara OF, Küçüközkan T, 
et al. Early initiation and exclusive breastfeeding: Factors influencing the 
attitudes of mothers who gave birth in a baby-friendly hospital. Turk J 
Obstet Gynecol 2017;14:1-9.
13. Beiranvand S, Valizadeh F, Hosseinabadi R, Pournia Y. The effects of skin-
to-skin contact on temperature and breastfeeding successfulness in full-term 
newborns after cesarean delivery. Int J Pediatr 2014;2014:846486.
14. Azeze GA, Gelaw KA, Gebeyehu NA, Gesese MM, Mokonnon TM. 
Exclusive breastfeeding practice and associated factors among mothers in 
Boditi town, Wolaita Zone, Southern Ethiopia, 2018: A community-based 
cross-sectional study. Int J Pediatr 2019;2019:1483024.
15. Oche MO, Umar AS, Ahmed H. Knowledge and practice of exclusive 
breastfeeding in Kware, Nigeria. Afr Health Sci 2011;11:518-23.
16. Angelsen NK, Vik T, Jacobsen G, Bakketeig LS. Breast feeding and 
Table 3: Antenatal counseling received versus EBF
Antenatal 
counseling received
EBF
Yes (%) No (%) Total
Yes 175 (68.09) 82 (31.90) 257
No 387 (51.39) 366 (48.60) 753
Z score=21.64, p=0.000003, significant at p<0.05. EBF: Exclusive breastfeeding
Table 4: 1st h initiation of breastfeeding versus EBF
1st h initiation of 
breastfeeding
EBF (%)
Yes No Total
Yes 186 (55.2) 151 (44.8) 337 (33.3)
No 190 (28.2) 483 (71.7) 673 (66.7)
Z score 69.85, p<0.00001. EBF: Exclusive breastfeeding
Surender et al. Mothers knowledge and support for EBF
Vol 6 | Issue 8 | August 2019 Indian J Child Health 458
cognitive development at age 1 and 5 years. Arch Dis Child 2001;85:183-8.
17. Mannion CA, Hobbs AJ, McDonald SW, Tough SC. Maternal perceptions of 
partner support during breastfeeding. Int Breastfeed J 2013;8:4.
18. Bruno Tongun J, Sebit MB, Mukunya D, Ndeezi G, Nankabirwa V, 
Tylleskar T, et al. Factors associated with delayed initiation of breastfeeding: 
A cross-sectional study in South Sudan. Int Breastfeed J 2018;13:28.
19. Sohail J, Khaliq A. Knowledge, attitude and practice of mothers regarding 
colostrum feeding to new borns in rural Pakistan: A cross-sectional study. 
Khyber Med Univ J 2017;9:192-6.
Funding: None; Conflict of Interest: None Stated.
How to cite this article: Surender K, Kumar KN, Nikhitha V, Bhargavi SDP, 
Kumar GR. Impact of mothers’ knowledge and support for sustaining 
exclusive breastfeeding. Indian J Child Health. 2019; 6(8):455-458.
Doi: 10.32677/IJCH.2019.v06.i08.015


Impact of mothers’ knowledge and support for sustaining exclusive breastfeeding

https://atharvapub.net/IJCH/article/download/1703/1321/

Impact of mothers’ knowledge and support for sustaining exclusive breastfeeding

Abstract

Similar works

Full text

Available Versions

Atharva Scientific Publications (E-Jounals)