ArticlePDF Available

A Literature Review of the Factors That Influence Breastfeeding: An Application of the Health Belief Model



Breastfeeding is beneficial for both mother and child. Exclusive breastfeeding rate and early initiation of breastfeeding has not reached desirable level in many countries. Understanding the factors that influence infant feeding will help in promotion, protecting and supporting breast feeding. This review identified the determinants of infant feeding practices and presented it using the Health Belief Model as a frame work. Several data bases were searched with specific keywords and findings reveal that maternal sociodemograhpic characteristic like age, education, parity, economic status, and employment may influence breastfeeding. Other factors include, antenatal attendance, multiple births, type of delivery, previous breastfeeding experience, breastfeeding support, Knowledge of individual's feeding as babies, maternal prenatal feeding intention and infant birth weight. Women will breastfeed as recommended if they are influenced to develop a positive perception about breastfeeding.
International Journal of Nursing and Health Science
2015; 2(3): 28-36
Published online June 10, 2015 (
A Literature Review of the Factors That Influence
Breastfeeding: An Application of the Health Belief
Andy Emmanuel
1, 2
Department of Nursing science, Faculty of Medical sciences University of Jos, Jos, Plateau State, Nigeria
Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
Email address
To cite this article
Andy Emmanuel. A Literature Review of the Factors That Influence Breastfeeding: An Application of the Health Believe Model.
International Journal of Nursing and Health Science. Vol. 2, No. 3, 2015, pp. 28-36.
Breastfeeding is beneficial for both mother and child. Exclusive breastfeeding rate and early initiation of breastfeeding has not
reached desirable level in many countries. Understanding the factors that influence infant feeding will help in promotion,
protecting and supporting breast feeding. This review identified the determinants of infant feeding practices and presented it
using the Health Belief Model as a frame work. Several data bases were searched with specific keywords and findings reveal
that maternal sociodemograhpic characteristic like age, education, parity, economic status, and employment may influence
breastfeeding. Other factors include, antenatal attendance, multiple births, type of delivery, previous breastfeeding experience,
breastfeeding support, Knowledge of individual’s feeding as babies, maternal prenatal feeding intention and infant birth weight.
Women will breastfeed as recommended if they are influenced to develop a positive perception about breastfeeding.
Breastfeeding, Determinants, Health Belief Model, Breastfeeding Intention, Infant Feeding
1. Introduction
Suboptimal breastfeeding is responsible for the death of
1.4 million children and the disability of 44 million globally
(Black et al, 2008). Therefore, it has been recommended that
all women should breastfeed their infants exclusively in the
first six months and subsequently with supplementary
feeding for 2 years for optimal growth and development
(UNICEF, 2013). The World Health Organization and
UNICEF had launched several programmes like the baby
friendly hospital initiative and the International Code of
Marketing of Breast Milk Substitutesin order to protect,
promote and support breastfeeding in response to persistent
decline in the rate of breast feeding globally (Fairbank et al,
2000; UNICEF, 2013). The factors that influence infant
feeding are complex and vary from one setting to another.
Understanding these factors is necessary in addressing the
declining rate of breastfeeding.
Exclusive Breastfeeding for six months is beneficial for
women because it ensures better reproductive and
postmenopausal health (NRDC, 2005; Murimi Dodge, Pope,
& Erickson, 2010). Breastfeeding has a beneficial effect on
the health of women. Studies have shown that breastfeeding
helps in losing pregnancy weight faster (Kramer and Kakuma
2012; Baker Gamborg, Heitmann, Lissner, et al 2008; Sanusi
and Falana, 2013). A study revealed that women who
breastfed lost 4.4kg within a year, while those who did not
breastfeed only lost 2.4 kg (P<0.05) (Dewey, Heinig and
Nommsen, 1993).This underlines the effectiveness of
breastfeeding especially if practiced exclusively in the first
six months, in reducing weight gain during pregnancy.
Breastfeeding promotes uterine contraction, thereby reducing
blood loss after delivery and promotes uterine involution
(NRDC, 2005). Breastfeeding reduces the risk of type 2
diabetes and cardiovascular diseases (Davis, Stichler and
Poeltler, 2012). It also lowers the risk of breast, endometrial
and ovarian cancers (Labbok, 2001; NRDC, 2005; Centre for
Community Child Health, 2006; Huo, Adebamowo, et al
2008; Sule, 2011; Davis, Stichler and Poeltler, 2012).
Absence of menstruation due to breastfeeding serves as
temporary contraception for some women (Kuti, Adeyemi
and Owolabi, 2007).This is effective for some women who
breastfed exclusively for six months (Kuti, Adeyemi and
International Journal of Nursing and Health Science 2015; 2(3): 28-36 29
Owolabi, 2007).Breastfeeding is cost effective as finances do
not have to be set aside for infant formula (NRDC, 2005
Centre for Community Child Health, 2006).Breastfeeding
gives women a sense of bonding with their babies (NRDC,
2005 Centre for Community Child Health, 2006) and
promotes mental health of women (Davis, Stichler and
Poeltler, 2012).
Breastfeeding is also beneficial for the infant. Adequately
breastfed infants grow more rapidly and are healthier than
those who were not (Ukegbu, Ebenebe and Ukegbu, 2010,
Gale, Logan, et al, 2012). Breast milk confers a child with
significant protection against many infectious diseases
because it containsantibodies (immuno globulins) that
strengthen the Childs immunity (Ukegbu, 2010; Murimi et al,
2012; Lamberti, Zakarija-Grković, et al, 2013). Breastfeeding
reduces the incidence of meningitis, malaria, asthma,
respiratory diseases (such as pneumonia), ear infection,
diarrhoea, and urinary tract infection (Ukegbu, 2010;
Murimiet al, 2012; Ibadin et al, 2012; Lamberti et al 2013).
Kramer and Kakuma (2012) posited that in the first six
months of life, exclusive breastfed infants are six times less
likely to die from diarrhoea and 2.5 times less likely to die
from acute respiratory infection. Breastfeeding lowers the
risk of allergy and food intolerance and improve brain
development (Centre for Community Child Health, 2006: 7).
Infants exclusively breastfed for six months have higher IQ,
lower risk of childhood obesity, diabetes and lower risk of
mental health problems, as they enter their teenage (UNICEF,
2010, Davis, et al 2012). Breastfed children have at least six
times greater chance of survival in the early months than
non-breastfed children (UNICEF, 2013). Early breastfeeding
reduce infant morbidity and mortality as a result of the
preventive benefits of breastfeeding in reducing long term
diseases (WHO, 2007).
The aim of this review is to utilise the Health Believe
Model to highlight the factors that influence breastfeeding
practices globally. Understanding these factors and how they
influence various infant feeding practices is important in
improving breastfeeding practice through appropriately
targeted and designed promotion programs.
2. Literature Search
PUBMED and EBSCO were searched using the following
key words; exclusive breastfeeding or formula feeding or
mixed feeding and Health Belief Model, benefit of
breastfeeding, breastfeeding and infant feeding practices.
Articles published from 2005 to date were included. Articles
with information about factors that influence infant feeding
with regards to initiation, mixed feeding, formula feeding,
exclusive breastfeeding and duration of feeding were also
Articles without key words related to the search terms
were excluded. Additional literature was sourced from WHO
and UNICEF websites, reference checking, and text books.
Figure 1. The Health Belief Model (Adapted from Kabiru, Beguy, Crichton, and Zulu, 2011)1.
1The Health Belief Model depicted in Figure1 was originally used by Kabiru et al (2011) in a study of HIV/AIDS among youths in Kenya. For this study the topic has
been changed from HIV/AIDS to breastfeeding
30 Andy Emmanuel: A Literature Review of the Factors That Influence Breastfeeding: an Application of the Health Believe Model
3. Discussion
The Health Belief Model was developed in the 1950s to
explain why medical screening programs in the US were not
successful (Hayden, 2009). Hayden (2009:1) concluded that
“The underlying concept of the original Health Belief Model
is that, health behaviour is determined by personal beliefs or
perceptions about a disease and the strategies available to
decrease its occurrence”. The main constructs of the model
are: perceived susceptibility (individual’s perception of
exposure to danger and likelihood to contract a disease),
perceived severity or seriousness (individual’s perception of
the gravity of disease), perceived barriers and perceived
benefits (Janz and Becker, 1984; Hayden, 2009). Three more
constructs were added later resulting in the expansion of the
Health Belief Model to include modifying variables, cues to
action and self-efficacy (Hayden, 2009). According to
Hayden (2009), the first four constructs are modified by
variables such as culture, past experience, educational level,
skill and motivation to produce the individual perception.
The individual perception together with cues to action and
self-efficacy determine the health behaviour or action (see
Figure 1).
3.1. Personal Perception
Perceived seriousness, Perceived susceptibility, Perceived
benefits, and Perceived barriers /cost of action are important
determinants of health behaviour. The practice of
breastfeeding in a particular community depends on general
perception of the community about breastfeeding.
3.2. Perceived Seriousness / Perceived
The perception of seriousness is a function of medical
information or knowledge an individual has about a disease
(Hayden, 2009). It may also come from beliefs a person has
about the difficulties a disease would create or the effect it
would have on his or her life in general(Hayden, 2009).The
tendency of engaging in behaviour to reduce risk of a disease
increases with increased perceived risk of the diseases.
An adequate breastfeeding education will enable women to
understand and appreciate the seriousness of health
challenges associated with suboptimal breastfeeding. If
women understood the degree of health challenges that may
arise due to inadequate infant feeding, it is likely that they
will change for the benefit of their health and that of their
baby. Inadequate knowledge regarding breastfeeding
negatively influence infant feeding.
3.3. Perceived Benefits
This is a person’s view of usefulness of new behaviour in
reducing the risk of developing a disease; people tend to
adopt healthier behaviour when they believe a new behaviour
will decrease their chances of developing a disease (Hayden,
2009). If women are aware of the benefits of adequate
breastfeeding for them and their infants, they may likely
practice it. Most women do not practice breastfeeding as
recommended probably because they are ignorant of the
benefit of associated with such practice. Adequate
enlightenment especially during antennal care is vital in
promotion breastfeeding.
3.4. Perceived Barrier
This is an individual’s own evaluation of the obstacles in
the way of him or her adopting a new behaviour. Women
have various experiences with breastfeeding (Schmied and
Barlay, 1999). Mothers commonly complain of painful / sore
nipple or breast (Lamontagne, Hamelin et al, 2008; Raffle,
Ware et al, 2011; Jager (2012), low milk
production(Lamontagne, Hamelin et al, 2008;Raffle, Ware et
al, 2011; Jager, 2012; Mutekanga and Atekyereza, 2007;
Muluye, 2012), Infants refusal to suck (Lamontagne,
Hamelin et al, 2008; Jager (2012), breast infection, maternal
illness (Doherty, Sanders et al, 2012), and Stress(Ugbaoja,
Berthrand, et al, 2013). Others include exclusive
breastfeeding not culturally acceptable (Ugbaoja, Berthrand,
et al 2013; Ajibade, Okunlade et al, 2013), husband refusal
(Ugbaoja, Berthrand et al, 2013) and delayed milk production
after delivery (Mutekanga and Atekyereza, 2007). Most
women can breastfeed as recommended if given the support
they need to overcome barriers associated with breastfeeding
(UNICEF, 2013).
3.5. Modifying Variables
The four major constructs of perception are modified by
other variables such as culture, educational level, past
experiences, skill, socio-demographic variables and
3.6. Maternal Age
The relationship between maternal age and infant feeding
practices differs from place to place. Ogunlesi (2010) posited
that maternal age is not a significant determinant of
breastfeeding. On the other hand, other studies have
demonstrated that maternal age at the time of birth influenced
breastfeeding initiation and duration (Li, Zhang, et al 2004;
Centre for Community Child Health 2006). Studies have
shown that older maternal age is associated with exclusive
breastfeeding and longer duration of breastfeeding (Bolton,
Chow,et al 2009; Ukegbu, et al 2010), while others,
associated low rates of exclusive breastfeeding with younger
maternal age (Qureshi, Oche, et al, 2011; Lawoyin et al, 2001;
Brown, Raynor, et al, 2011). These findings suggest that the
relationship between maternal age and breastfeeding varies
from place to place, therefore, health workers should
understand how maternal age influence breastfeeding
practices in their locality in order to plan better promotion
International Journal of Nursing and Health Science 2015; 2(3): 28-36 31
3.7. Education
The influence of education on infant feeding practices
varies from one setting to another (Centre for Community
Child Health, 2006; Ahmed, 2008; Sapna, Ameya 2009;
Okeh, 2010; Ajibade et al 2013).Maternal education below
secondary level contributed to prelacteal feeding and failure
to practice exclusive breastfeeding (Ogunlesi, 2010).Women
with low level of education are less likely to practice
exclusive breastfeeding (Li,Zhang et al, 2004; Uchendu,
Ikefuna, and Imodi, 2009; Qureshi,Oche et al,2011). On the
other hand, another study reported that lower maternal
education attainment is related to increase in breastfeeding
practices (Lawoyin, et al 2001).Highly educated women may
be able to breastfeed exclusively as recommended because
they are more likely to understand the benefits of
breastfeeding when compared with less educated women
who may not see any need for that but may breastfeed longer
as a tradition. An enlightenment campaign in various
languages centered on the benefits of exclusive breastfeeding
could help improve practice.
3.8. Occupation/Employment
Many scholars posited that maternal employment is in a
continuous competition with breastfeeding (Okeh, 2010;
Raffle, Ware, et al, 2011;Muluye,) and may even be a barrier
to breastfeeding (Velpuri, 2004; Ajibade, Okunlade et al 2013)
especially if there is no adequate planning for breastfeeding
mothers in the workplace. Women’s work may have a
negative impact on breastfeeding because of inadequate time
to breastfeed (Ukwuani and Suchindran, 2003). Working
outside the home after birth was reported to have
significantly reduce the likelihood of exclusive breastfeeding
at six months (Xu, Binns, et al, 2007; Qureshi, Oche, et al
2011; Chuang, Chang, et al, 2010;Matias, Nommsen-Rivers,
et al 2013).Jager, Hartley, et al (2012) identified return to
work as an important factor that influence breastfeeding
because of the challenges women face in trying to sustain
adequate infant feeding practices while working. Women
who are unemployed are less likely to quit breastfeeding
early when compared with women working as administrators
and in manual jobs (Kimbro, 2006) and are more likely to
exclusively breastfeed (Tan, 2011). This implies that women
who work many hours are likely to mix feeding. Occupation
of both parents affects breastfeeding (Lawoyin, Oche et al
A study by Scott, Landers, et al (2001) reported that
mothers who intended to return to full or part time work or
study within 6 months of the birth were less likely to be
breastfeeding at discharge (from hospital) than mothers who
intended to remain at home. Because of the challenges
associated with breastfeeding by working mothers (poor
support for breastfeeding in the work place), WHO ( 2013)
recommended that all women working should be supported
to sustain breastfeeding when they return to work by giving
them a minimum of one break per day to breastfeed or
express breast milk.
3.9. Economic Status
Studies have shown that high socio-economic status was
significantly related to low exclusive breastfeeding rate, and
short duration of overall breastfeeding (Lawoyin, Olawuyi, et
al, 2001; Okeh, 2010; Ekanem, Ekanem, et al 2012; Ajibade,
Okunlade et al, 2013). This is not unconnected to the
employment status of women with high economic status
which has a negative impact on breast feeding. A contrary
opinion was reported by Velpuri, (2004) in which women
with high income status were associated with a high
breastfeeding rate. Adelekan (2003) identified low economic
status as one of the most important determinants of
suboptimal breastfeeding (non-exclusive and short duration)
and concluded that significant improvement in the socio-
economic status of women could help reduce childhood
3.10. Marital Status
Marital status of a woman is an important determinant of
infant feeding practices in some setting (Sika-Bright, 2010;
Ajibade, Okunlade et al 2013). Suboptimal infant feeding is
common with single mothers (Kimani-murage, Madise, et al,
2011; Tampah-Naah and Kumi-Kyereme, 2013).Studes
concluded that single mothers are less likely to breastfeed
adequately and longer due to absence of partners’ support and
confidence compared with married mothers (Lamontagne,
Hamelin, et al, 2008; Ajibade, Okunlade et al 2013). This
conclusion was reached following a chi-square analysis that
indicated a significant relationship (P=0.01) between marital
status and exclusive breastfeeding and duration of
3.11. Parity
The effect of parity on infant feeding and breastfeeding in
particular is inconclusive because in some settings multi
parity has a positive impact on breastfeeding (Ukegbu,
Ukegbu et al, 2010;Qureshi, Oche et al, 2011) while in other
settings, the impact is negative(Uchendu, Ikefuna et al,
2009).Some studies have shown that parity did not confer
any advantage to breastfeeding practice (Ogunlesi, 2010;
Sapna, Ameya ,2009) meaning that breastfeeding behaviour
of primiparous and multiparous women is the same
(Amatayakul, Wongsawasdi et al, 1999).
3.12. Primiparity/Low Parity
Primiparous women are more likely to desire or plan to
breastfeed than multiparous women (Lee, Rubio, et al 2005;
Leuung, Hung, et al, 2003). In some settings longer duration
of breastfeeding has been associated with low parity
suggesting that fewer children in the home incur less cost to
women’s time (Uchendu, Ikefuna et al, 2009). It has been
demonstrated that primiparous women were twice as likely to
be breastfeeding at discharge when compared with
multiparous women; however, there was no association
between parity and overall duration of breastfeeding (Scott,
32 Andy Emmanuel: A Literature Review of the Factors That Influence Breastfeeding: an Application of the Health Believe Model
Landers et al, 2001).
3.13. Multiparity/High Parity
Studies have shown that high breastfeeding rate is
associated with multiparity (Ukegbu, Ukegbu et al, 2010;
Qureshi, Oche et al, 2011). A study revealed that women with
fewer than five children are likely to record low exclusive
breastfeeding duration. (Qureshi, Oche et al, 2011). Tan,
(2011) opined that multiparity is associated with the practice
of exclusive breastfeeding. This means that, primiparous
mothers are less likely to breastfeed exclusively (Lawoyin,
Olawuyi et al, 2001).
3.14. Antenatal Care
Adequate counseling about breastfeeding during antenatal
care could significantly improve breastfeeding(Sapna, Ameya
2009). Antenatal attendance is a potential determinant of
infant feeding practice (Agho, et al 2009; Ghwass and
Ahmed, 2011). Antenatal care increases the likelihood of
early breastfeeding initiation (Ogunlesi, 2010). Mothers who
did not attend antenatal clinic during pregnancy may have a
poor initiation and exclusivity of breastfeeding (Ogunlesi,
3.15. Multiple Births
Mothers of twins face more challenges than mothers of
singletons when it come exclusive breastfeeding. A study
revealed that insufficient milk for the twins and time for
breastfeeding are common causes of early cessation of
breastfeeding among mothers of twins (Damato, Dowling, et
al, 2005). Another study revealed that 89.4% of women with
twins initiated breastfeeding and that support for mothers of
twins to overcome breastfeeding problem over the first 6
weeks may result in a longer duration of breastfeeding
(Damato, Dowling, et al, 2005). Mothers of twins can
breastfeed for the recommended duration if supported
(Damato, Dowling et al2005).
3.16. Type of Delivery
Mothers who had a normal delivery tend to have a positive
attitude towards breastfeeding and had less stressful
experiences with breastfeeding than mothers who gave birth
through caesarean section (Imhonde, Shaibu, et al, 2012;
Carlander, Edman, et al 2009). Caesarean delivery is
associated with formula feeding and low milk production (Li,
Zhang et al, 2004). In a study of the effects of maternal care
practice on breastfeeding, DiGirolamo, Grummer-Strawn et
al, (2008) concluded that type of delivery (vaginal versus
caesarean) had no influence on breastfeeding practices. Patel,
Liebling et al (2003) also reported that type of delivery had
no impact on breastfeeding.
3.17. Birth Weight/Infant Size
Low birth weight infants are less likely to exclusively
breastfeed (Matias, Nommsen-Rivers et al 2012; Butte,
Lopez-alatcon et al, 2002) and may be associated with the
belief that breast milk substitute is required to make up the
low weight (Matias, Nommsen-Rivers,2012).
4. Cue to Action/ Self Efficacy
Cues to action are events, people or things that move
people or things that move people to change their behaviour
e.g. illness of a family members, media report, mass media
campaign while self-efficacy is belief in one’s ability to do
something. Self-efficacy is influenced by personal
accomplishment (personal experience), vicarious experience
(individual performances whether live, recorded or printed),
verbal persuasion from health care professionals, peer
counsellors, family members or personal friends,
physiological and affective state (excitement or satisfaction,
enhances self-efficacy while pain, fatigue, anxiety or stress
reduces ones sense of self efficacy) (Danis, 1999).
4.1. Previous Experiences with
Breastfeeding experience helps in building confidence and
confidence is a potential determinant of breastfeeding
(Brodribb, Fallon, et al 2008; Meedya, Fahy et al,
2010).Women with little or no previous breastfeeding
experience require additional support to be able to breastfeed
adequately (Kronborg, Væth,et al 2007) women with
breastfeeding experience are more likely to intend
tobreastfeed than those who never had any experience
(Mclnnes, Love,et al, 2001). Health beliefs, experience of
friends and family could encourage or discourage
breastfeeding (Raffle, Ware et al, 2011).A study reported that
less confident women are four to five times more likely to
experience breastfeeding failure (Dennis, 1999).Furthermore,
a longitudinal study of pregnant women in Australia to
determine the influence of antenatal services on
breastfeeding revealed that mothers with high breastfeeding
confidence were more likely to breastfeed compared with
women with low breastfeeding confidence (79.3% versus
50.5%) (Blyth, Creedy et al, 2004).
4.2. Breastfeeding Support
4.2.1. Support from Family and Friends
Women who enjoyed support from family and friends are
likely to breastfeed longer (Wambach and Cohen, 2009).
Presence of mother in-law in the home increased
breastfeeding self efficacy and has implication for continuing
breastfeeding (Ku and Show, 2010). Social support by
women’s partners (husbands encouraging wives to breastfeed)
may promote, and prolonged breastfeeding (Lamontagne,
Hamelin, 2008;Meedya, Fahy et al, 2010; Scott, Landers et al,
2001; Tan, 2011; Brown, Raynor et al, 2011). Grandmothers
are influential in infant feeding choices and can positively
influence breastfeeding, especially if they are aware of
recommended practices (Kerr, Dakishoni, et al, 2008;
Grassley and Eschit, 2008).
International Journal of Nursing and Health Science 2015; 2(3): 28-36 33
4.2.2. Support from Health Workers
Clinicians and health workers may have an influential role
in breastfeeding initiation and continuation (Li, Laung et al,
2004). Professionals can sometimes have a negative
influence when they provide women with breastfeeding
information and recommendations that are confusing
(Lamontagne, 2008).Post natal support from experts increase
breastfeeding duration (Brown, Raynor et al,2011).
Kronborg, Væth et al, (2007) reported that home visits in
the first 5 weeks following birth may prolong the duration of
exclusive breastfeeding. This assertion was made after
observing a significant increase in the duration of
breastfeeding of breastfeeding with an intervention which
focused on assisting women to overcome obstacle to
breastfeeding. Ahmed (2008) identified support for mothers
immediately after delivery as a way of overcoming
breastfeeding problems and enhancing confidence.
4.3. Knowledge of Individuals Feeding as
Women who knew how long they were breastfed as a child
showed a longer duration of exclusive breastfeeding and total
breastfeeding than those who did not (Ekstrom, Widström, et
al 2003; Forster, Mclachlan et al, 2006). Therefore, women
who do not know how they were breastfed as babies or who
knew they were formula or mixed fed require counselling
during antenatal care.
4.4. Maternal Prenatal Intention
Maternal prenatal intention to breastfeed has an impact on
infant feeding practices (Donath, Amir and ALSPAC study
Team, 2003). High intention and self efficacy increase the
likelihood to breastfeed for 6 months (Wilhelm, Rodeherst, et
al, 2008). All women should be guided to plan for
breastfeeding of their children in the antenatal period.
Knowledge of individuals’ feeding as babies
5. Conclusion
Individual perception about breastfeeding is governed by
modifying variables, cues to action and self efficacy. A
successful breastfeeding promotion program depends on the
understanding of the factors that influence perception.
Maternal sociodemograhpic characteristic like age, education,
parity, economic status, and employment may influence
breastfeeding. Other factors include, antenatal attendance,
multiple births, type of delivery, previous breastfeeding
experience, breastfeeding support, Knowledge of individual’s
feeding as babies, maternal prenatal feeding intention and
infant birth weight.A positive perception about breastfeeding
will result in self-efficacy and intention to breastfeed as
1. Enlightenment campaign about benefits of exclusive
breastfeeding for mother and child should be done
using various languages in order to accommodate
women who do not understand English and those with
low educational level.
2. Breastfeeding counseling during antenatal care should
be centered on solving problems associated with
3. Government should liaise with all employers of labour
to ensure and improve breastfeeding support in the
work place.
4. Extending maternity leave to six months for all working
mothers could promote exclusive breastfeeding for six
months. The six months leave could be limited to
maximum of three children.
5. Economic empowerment may improve breastfeeding in
some settings.
6. Special support should be given to young mothers;
women who were formula or mixed fed as babies and
mothers of twins during the postnatal period.
[1] Adelekan, D.A. 2003. Childhood nutrition and malnutrition in
Nigeria. Nutrition. 19(2): 179-181.
[2] Agho, K.E., Dibley, M.J., Odiase, J.I. &Ogbonmwan, S.M.
2009. Determinants of exclusive breastfeeding in Nigeria.
BMC Pregnancy and Childbirth. 11(1): 22-26.
[3] Ahmed, A.H. 2008. Breastfeeding preterm infants: an
educational program to support mothers of preterm infants in
Cairo, Egypt. Pediatric Nursing. 34(2): 125-30, 138.
[4] Ajibade, B., Okunlade, J., Makinde, O., Amoo, P. &Adeyemo,
M. 2013.Factors influencing the practice of exclusive
breastfeeding in rural communities of Osunstate, Nigeria.
European Journal of Business and Management. 5(15): 49-53.
[5] Amatayakul, K., Wongsawasdi, L., Mangklabruks, A.,
Tansuhaj, A., Ruckphaopunt, S., Chiowanich, P., Woolridge,
M.M., Drewett, R.F. et al. 1999. Effects of parity on
breastfeeding: a study in the rural setting in northern Thailand.
Journal of Human Lactation: Official Journal of International
Lactation Consultant Association. 15(2): 121-124.
[6] Baker, J.L., Gamborg, M., Heitmann, B.L., Lissner, L.,
Sorensen, T.I. & Rasmussen, K.M. 2008. Breastfeeding
reduces postpartum weight retention. The American Journal of
Clinical Nutrition. 88(6): 1543-1551.
DOI:10.3945/ajcn.2008.26379 [doi].
[7] Black, RE, Morris, SS and Bryce 2008.Where and why are 10
million children dying every year? Lancet. 361:2226-2234.
[8] Blyth, R.J., Creedy, D.K., Dennis, C.L., Moyle, W., Pratt, J.,
De Vries, S.M. & Healy, G.N. 2004. Breastfeeding duration in
an Australian population: the influence of modifiable antenatal
factors. Journal of Human Lactation: Official Journal of
International Lactation Consultant Association. 20(1): 30-38.
DOI: 10.1177/0890334403261109.
[9] Bolton, T.A., Chow, T., Benton, P.A. & Olson, B.H. 2009.
Characteristics associated with longer breastfeeding duration:
an analysis of a peer counseling support program. Journal of
Human Lactation: Official Journal of International Lactation
Consultant Association. 25(1): 18-27. DOI:
34 Andy Emmanuel: A Literature Review of the Factors That Influence Breastfeeding: an Application of the Health Believe Model
[10] Brodribb, W., Fallon, A., Jackson, C. &Hegney, D. 2008. The
relationship between personal breastfeeding experience and
the breastfeeding attitudes, knowledge, confidence and
effectiveness of Australian GP registrars. Maternal & Child
Nutrition. 4(4): 264-274.
[11] Brown, A., Raynor, P. & Lee, M. 2011. Young mothers who
choose to breast feed: the importance of being part of a
supportive breast-feeding community. Midwifery. 27(1): 53-59.
[12] Butte, N.F., Lopez-Alarcon, M.G. & Garza, C. 2002. Nutrient
adequacy of exclusive breastfeeding for the term infant during
the first six months of life; World Health Organization,
[13] Carlender, AK., Edman, G., Christensson, K., Andolf, E and
Wiklund, I. 2010. Contact between mother child and partner
and attitudes towards breastfeeding in relation to mode of
delivery. Sexual And Reproductive Health Care 1(1): 27-34
[14] Centre for Community child Health 2006. Breastfeeding
promotion: practice
resources. on 13 July
[15] Chuang, C., Chang, P., Chen, Y., Hsieh, W., Hurng, B., Lin, S.
& Chen, P. 2010. Maternal return to work and breastfeeding: a
population-based cohort study. International Journal of
Nursing Studies. 47(4): 461-474.
[16] Damato, EG., Dowling, DA., Standing, TS., & Schuster, SD.
2005. Explanation for cessation of breastfeeding in mothers of
twins. J.Hum.Lact; 21 (3): 296-304.
[17] Damato, EG., Dowling, DA., Madigan, EA.,
&Thanatttherakul, C. 2005. Duration of breastfeeding for
mothers of twins. Clinical Research; 34 (2): 201-209.
[18] Davis, S.K., Stichler, J.F. &Poeltler, D.M. 2012. Increasing
Exclusive Breastfeeding Rates in the WellBaby Population.
Nursing for Women's Health. 16(6): 460-470.
[19] Dewey, K.G., Heinig, M.J. &Nommsen, L.A. 1993. Maternal
weight-loss patterns during prolonged lactation. The American
Journal of Clinical Nutrition. 58(2): 162-166.
[20] Dennis, C.L. 1999. Theoretical underpinnings of breastfeeding
confidence: a self-efficacy framework. Journal of Human
Lactation : Official Journal of International Lactation
Consultant Association. 15(3): 195-201.
[21] DiGirolamo, A.M., Grummer-Strawn, L.M. & Fein, S.B. 2008.
Effect of maternity-care practices on breastfeeding. Pediatrics.
122 Suppl2S43-9. DOI:10.1542/peds.2008-1315e [doi].
[22] Doherty, T., Sanders, D., Jackson, D., Swanevelder, S.,
Lombard, C., Zembe, W., Chopra, M., Goga, A. et al. 2012.
Early cessation of breastfeeding amongst women in South
Africa: an area needing urgent attention to improve child
health. BMC Pediatrics. 12(1): 105.
[23] Donath, S. & Amir, L.H. 2003. Relationship between prenatal
infant feeding intention and initiation and duration of
breastfeeding: a cohort study. ActaPaediatrica. 92(3): 352-356.
[24] Ekanem, I., Ekanem, A., Asuquo, A. &Eyo, V. 2012. Attitude
of working mothers to exclusive breastfeeding in Calabar
municipality, Cross River State, Nigeria. Journal of Food
Research. 1(2): p71.
[25] Ekström, A., Widström, A. &Nissen, E. 2003. Breastfeeding
support from partners and grandmothers: perceptions of
Swedish women. Birth. 30(4): 261-266.
[26] Fairbank, L., O'Meara, S., Renfrew, M.J., Woolridge, M.,
Sowden, A.J. & Lister-Sharp, D. 2000. A systematic review to
evaluate the effectiveness of interventions to promote the
initiation of breastfeeding. Health Technology Assessment
(Winchester, England). 4(25): 1-171.
[27] Forster, D.A., McLachlan, H.L. & Lumley, J. 2006. Factors
associated with breastfeeding at six months postpartum in a
group of Australian women. Int Breastfeed J. 1(1): 1-12.
[28] Gale, C., Logan, KM., Samankumaran, S., Pakinson, JR.,
Hyde, MJ and Modi, N. 2012. Effect of breastfeeding
compared with formulafeeding on infant body composition: a
systematic review and meta analysis. Am. J. Clinnutr; 95: 656-
[29] Ghwass, M.M.A. & Ahmed, D. 2011. Prevalence and
predictors of 6-month exclusive breastfeeding in a rural area
in Egypt. Breastfeeding Medicine. 6(4): 191-196.
[30] Grassley, J. &Eschiti, V. 2008. Grandmother breastfeeding
support: what do mothers need and want? Birth. 35(4): 329-
[31] Hayden, J.A. 2009. Introduction to health behavior
theory.NewyorkJones & Bartlett Publishers.
[32] Huo, D., Adebamowo, C., Ogundiran, T., Akang, E., Campbell,
O., Adenipekun, A., Cummings, S., Fackenthal, J. et al. 2008.
Parity and breastfeeding are protective against breast cancer in
Nigerian women. British Journal of Cancer. 98(5): 992-996.
[33] Imhonde, H., Shaibu, H., Imhonde, J. &Handayani, L. 2012.
Type of Birth, Depression and Anxiety as determinates of
Breastfeeding Attitude among Nursing Mothers. International
Journal of Public Health Science (IJPHS). 1(2): 49-54.
[34] Ibadin, O., Ofili, N., Morrison, O. &Nkwuo, E. 2012.
Exclusive Breastfeeding and Malaria in Early Infancy:
Experience from Benin City, Nigeria. Journal of Medicine and
Biomedical Research. 11(1): 116-122.
[35] Jager, M.D, Hartley, K., Terrazas, J. & Merrill, J. 2012.
Barriers to breastfeeding-a global survey on why women start
and stop breastfeeding;European Journal of Obstetrics
and Gynaecology. 7(1): 25-30.
[36] Janz, N.K. & Becker, M.H. 1984. The health belief model: A
decade later. Health Education & Behavior. 11(1): 1-47.
[37] Kabiru, C.W., Beguy, D., Crichton, J. & Zulu, E.M. 2011.
HIV/AIDS among youth in urban informal (slum) settlements
in Kenya: what are the correlates of and motivations for HIV
testing? BMC Public Health. 11685-2458-11-685.
[38] Kerr, RB., Dakishoni, L., Shumba, L., Msachi, R &Chirwa, M
2008. “We grandmothers know plenty “Breastfeeding,
complementary feeding and multifaceted role of grandmothers
in Malawi. Social Science and Medicine; 66 (5): 1095-1105.
[39] Kimani-Murage, E.W., Madise, N.J., Fotso, J.C., Kyobutungi,
C., Mutua, M.K., Gitau, T.M. &Yatich, N. 2011. Patterns and
determinants of breastfeeding and complementary feeding
practices in urban informal settlements, Nairobi Kenya. BMC
Public Health. 11396-2458-11-396. DOI:10.1186/1471-2458-
International Journal of Nursing and Health Science 2015; 2(3): 28-36 35
[40] Kimbro, R.T. 2006. On-the-job moms: work and breastfeeding
initiation and duration for a sample of low-income women.
Maternal and Child Health Journal. 10(1): 19-26.
[41] Kramer, M. &Kakuma, R. 2012. Optimal duration of
exclusive breastfeeding (Review). TheCochrane Library; 8: 1-
40. JohnWiley& Sons, Ltd
[42] Kronborg, H., Væth, M., Olsen, J., Iversen, L. & Harder, I.
2007. Effect of early postnatal breastfeeding support: a
clusterrandomized community based trial. ActaPaediatrica.
96(7): 1064-1070.
[43] Ku, C and Chow, SK. 2010. Factors influencing the practice
of exclusive breastfeeding among Hong Kong Chinese women:
a questionnaire survey. Journal of Clinical Nursing; 19:2334-
[44] Kuti, O., Adeyemi, A.B. &Owolabi, A.T. 2007. Breast-feeding
pattern and onset of menstruation among Yoruba mothers of
South-west Nigeria. European J.of Contraception and
Reproductive Healthcare. 12(4): 335-339.
[45] Labbok, M.H. 2001. Effects of breastfeeding on the mother.
Pediatric Clinics of North America. 48(1): 143-158.
[46] Lamberti, L.M., Zakarija-Grković, I., Walker, C.L.F.,
Theodoratou, E., Nair, H., Campbell, H. & Black, R.E. 2013.
Breastfeeding for reducing the risk of pneumonia morbidity
and mortality in children under two: a systematic literature
review and meta-analysis. BMC Public Health. 13(3): 1-8.
[47] Lamontagne, C., Hamelin, A. & St-Pierre, M. 2008. The
breastfeeding experience of women with major difficulties
who use the services of a breastfeeding clinic: a descriptive
study. International Breastfeeding Journal. 3(17): 1-13.
[48] Lawoyin, T.O., Olawuyi, J.F. &Onadeko, M.O. 2001. Factors
associated with exclusive breastfeeding in Ibadan, Nigeria.
Journal of Human Lactation: Official Journal of International
Lactation Consultant Association. 17(4): 321-325.
[49] Lee, H.J., Rubio, M.R., Elo, I.T., McCollum, K.F., Chung,
E.K. &Culhane, J.F. 2005. Factors associated with intention to
breastfeed among low-income, inner-city pregnant women.
Maternal and Child Health Journal. 9(3): 253-261.
[50] Leung, T., Tam, W., Hung, E., Fok, T. & Wong, G. 2003.
Sociodemographic and atopic factors affecting breastfeeding
intention in Chinese mothers. Journal of Paediatrics and
Child Health. 39(6): 460-464.
[51] Li, L., Zhang, M., Scott, J.A. &Binns, C.W. 2004. Factors
associated with the initiation and duration of breastfeeding by
Chinese mothers in Perth, Western Australia. Journal of
Human Lactation : Official Journal of International Lactation
Consultant Association. 20(2): 188-195.
DOI:10.1177/0890334404263992 [doi].
[52] Matias, S.L., Nommsen-Rivers, L.A. & Dewey, K.G. 2012.
Determinants of exclusive breastfeeding in a cohort of
primiparousperiurbanperuvian mothers. Journal of Human
Lactation : Official Journal of International Lactation
Consultant Association. 28(1): 45-54.
[53] McLnnes, R.J., Love, J.G. & Stone, D.H. 2001. Independent
predictors of breastfeeding intention in a disadvantaged
population of pregnant women. BMC Public Health. 1:10.
DOI: doi:10.1186/1471-2458-1-10.
[54] Meedya, S., Fahy, K. &Kable, A. 2010. Factors that positively
influence breastfeeding duration to 6 months: a literature
review. Women and Birth. 23(4): 135-145.
[55] Muluye, D., Woldeyohannes, D., Gizachew, M. &Tiruneh, M.
2012. Infant feeding practice and associated factors of HIV
positive mothers attending prevention of mother to child
transmission and antiretroviral therapy clinics in Gondar Town
health institutions, Northwest Ethiopia. BMC Public Health.
12240-2458-12-240. DOI:10.1186/1471-2458-12-240.
[56] Murimi, M., Dodge, C.M., Pope, J. & Erickson, D. 2010.
Factors that influence breastfeeding decisions among special
supplemental nutrition program for women, infants, and
children participants from Central Louisiana. Journal of the
American Dietetic Association. 110(4): 624-627.
[57] Mutekanga, E. &Atekyereza, P. 2007. The relationship
between child breastfeeding and infant health: The case of
Rukungiri District in Uganda. Journal of Social Development
in Africa. 22(2): 63.
[58] Natural Resource Defence Council 2005. .Benefit of
breastfeeding. Available: [29 May 2013].
[59] Ogunlesi, T.A. 2010. Maternal socio-demographic factors
influencing the initiation and exclusivity of breastfeeding in a
Nigerian semi-urban setting. Maternal and Child Health
Journal. 14(3): 459-465.
[60] Okeh, U.M. 2010. Breastfeeding and the mother–child
relationship: A case study of Ebonyi State University Teaching
Hospital, Abakaliki. African Journal of Primary Health Care
& Family Medicine. 2(1): doi: 10.4102/phcfm.v2i1.97
[61] Patel, R.R., Liebling, R.E. & Murphy, D.J. 2003. Effect of
operative delivery in the second stage of labor on
breastfeeding success. Birth. 30(4): 255-260.
[62] Qureshi, A.M., Oche, O.M., Sadiq, U.A. &Kabiru, S. 2011.
Using community volunteers to promote exclusive
breastfeeding in Sokoto State, Nigeria. Pan African Medical
Journal. 10.
[63] Raffle, H., Ware, L.J., Borchardt, A.R. & Strickland, H.A.
2011. Factors that influence breastfeeding initiation and
persistence in Ohio’s Appalachian region.
Ohio: Voinovich School of leadership and public affairs at
[64] Sanusi, R. &Falana, O. 2013. The Nutritional Status of
Mothers Practicing Breast Feeding In Ibadan, Nigeria. African
Journal of Biomedical Research. 12(2): 107-112.
[65] Sapna, S., Ameya, A., Rooma, S., Aarti, P., Rashid, A. &
Narayan, K. 2009. Prevalence of exclusive breastfeeding and
its correlates in an urban slum in western India. International
eJournal of Science Medicine & Education. 3(2): 14-18.
[66] Schmied, V. & Barclay, L. 1999. Connection and pleasure,
disruption and distress: women's experience of breastfeeding.
Journal of Human Lactation : Official Journal of
International Lactation Consultant Association. 15(4): 325-
[67] Scott, J., Landers, M., Hughes, R.M. &Binns, C. 2001. Factors
associated with breastfeeding at discharge and duration of
breastfeeding. Journal of Paediatrics and Child Health. 37(3):
36 Andy Emmanuel: A Literature Review of the Factors That Influence Breastfeeding: an Application of the Health Believe Model
[68] Sika-Bright, S. 2010. Socio-cultural factors influencing infant
feeding practices of mothers attending welfare clinic in Cape
Coast, Ghana. Department of Sociology and Anthropology,
University of Cape Coast.
[69] Sule, E.A. 2011. Breastfeeding and breast cancer, a veritable
association among Nigerian women? Continental J. Medical
Research 5 (2): 1 – 5
[70] Tan, K.L. 2011. Factors associated with exclusive
breastfeeding among infants under six months of age in
peninsular malaysia. Int Breastfeed J. 6(2): 1-7.
[71] Tampah-Naah, AM., & Kumi-Kyereme. 2013. Determinants
of exclusive breastfeeding among mothers in Ghana: a cross-
sectional study. International Breastfeeding Journal; 8:13
[72] Uchendu, U., Ikefuna, A. &Emodi, I. 2009. Factors associated
with exclusive breastfeeding among mothers seen at the
University of Nigeria Teaching Hospital. South African
Journal of Child Health. 3(1): 14-19.
[73] Ugboaja, J., Berthrand, N., Igwebge AO & Obi-Nwosu, A.
2013. Barriers to postnatal care and exclusive breastfeeding
among urban women in South-eastern Nigeria;
Nigerian Medical Journal. 54(1): 45-50.
[74] Ukegbu, A., Ukegbu, P., Onyeonoro, U. &Ubajaka, C. 2010.
Determinants of breastfeeding patterns among mothers in
Anambra State, Nigeria. South African Journal of Child
Health. 5(4): 112-116.
[75] Ukwuani, F.A. &Suchindran, C.M. 2003. Implications of
women's work for child nutritional status in sub-Saharan
Africa: a case study of Nigeria. Social Science & Medicine.
56(10): 2109-2121.
[76] UNICEF 2010. Improving exclusive breastfeeding practices.
Available:[12th July
[77] UNICEF 2013. Breastfeeding. Available: [5th August
[78] Velpuri, J. 2004. Breastfeeding Knowledge, and Attitudes,
Beliefs, and Intentions regarding Breastfeeding in the
Workplace among Students and Professionals in Health-
Related Fields.
[79] Wambach, KA and Cohen, SM. 2009. Breastfeeding
experiences of urban adolescent mothers. Journal of
paediatric nursing; 24(4): 244-254
[80] Wilhelm, S.L., Rodehorst, T.K., Stepans, M.B.F., Hertzog, M.
&Berens, C. 2008. Influence of intention and self-efficacy
levels on duration of breastfeeding for midwest rural mothers.
Applied Nursing Research. 21(3): 123-130.
[81] WHO 2013. Essential nutrition actions: Improving maternal,
newborn, infant and young child health and nutrition. Geneva:
World Health Organization.
[82] World Health Organization 2007. Planning guide for national
implementation of the Global Strategy for Infant and Young
Child Feeding.Geneva. WHO.
[83] Xu, F., Binns, C., Zheng, S., Wang, Y., Zhao, Y. & Lee, A.
2007. Determinants of exclusive breastfeeding duration in
Xinjiang, PR China. Asia Pacific Journal of Clinical Nutrition.
16(2): 316.
... Susceptibility and severity can be referred to as risk vs. consequences and can be merged and treated together [37]. In addition, we extended the HBM by adding one extra factor that may influence breastfeeding behaviors: socio-cultural factors [7]. Thus, in this study, we evaluated four distinct factors that may influence maternal health behaviors and they include perceived benefits, perceived barriers, perceived threat, and socio-cultural factors. ...
... In the context of our study, perceived barriers refer to those things that prevents a mother from adopting appropriate behaviour towards maternal health. According to the health belief model [7], perceived barrier affects behaviors negatively. Thus, higher perceived barriers are likely to affect maternal health behaviors negatively. ...
... Women who are struggling with these barriers are more likely going to be discouraged from adopting appropriate maternal health behaviors. This results is in line with the findings from [40] [7]. The implication is that persuasive interventions which will be able to reduce these perceived barriers can promote appropriate maternal health behaviour by making it easier and simpler for users to adopt appropriate behaviors and improve their health and wellbeing throughout their pregnancy. ...
... In the beginning of being a mother, a complaint that is often disruptive is the lack of milk production so that it is afraid of not being able to meet the needs of children. In addition, some complaints such as nipple pain, breast swelling, blisters, pain due to childbirth or other health problems (7,8). ...
... Mothers who have the opinion that breastfeeding is beneficial to their own health and that of their offspring and if they are not breastfeeding will choose to breastfeed and provide exclusive breastfeeding. This is in accordance with the Health Belief Model theory (7) Mother's knowledge and perception about breastfeeding is obtained from the information she obtained from reading, listening or observation. ...
Full-text available
ackground: The World Health Organization (WHO) recommends exclusive breastfeeding during the first 6 months of a child’s life. But the rate of exclusive breastfeeding is still low. Various factors affect the duration of exclusive breastfeeding. Work is often the reason for the failure of exclusive breastfeeding.Objectives: The research aims to describe the perceptions of female labours regarding breastfeeding and formula milk. Method: This research method is qualitative research. Data was collected through observation, in-depth interviews with 6 nursing labours, 5 lactation counsellors and focus group discussions (FGD) involving 10 labours. Results: Perceptions of female labours regarding breast milk and milk are vary. Some labours think that breast milk is the best food for their children. But other labours think that formula milk is better than breast milk because it contains additional substances not found in breast milk. Conclusions:Labours’ perceptions about breast milk and formula milk are still diverse. Interventions to improve mothers’ understanding of the benefits and advantages of breastfeeding need to be carried out to support the success of exclusive breastfeedingKeywords: Perception, Female Labour, Formula, Breastfeeding, exclusive breastfeeding
... The rising rate of maternal and infant mortality, despite government initiatives and vaccination programs, inspired researchers to evaluate the information needs and resource usage of pregnant women at the University of Calabar Teaching Hospital in Calabar. 5 ...
Full-text available
The primary goal of this study was to look into the relationship between pregnant women's information needs and resource utilization at the University of Calabar Teaching Hospital in Calabar, Nigeria. To achieve the study's goal, four null hypotheses were developed to guide the investigation. A literature review was conducted based on the variables under investigation. The study used a survey research design. For the study, two hundred (200) respondents were chosen as samples. The purposive and accidental sampling techniques were used to make the selection. The instrument used for data collection was the "Information Need and Pregnant Women Resource Utilization Questionnaire (INPWRUQ)." The instrument's reliability was estimated using the test-retest reliability method. The statistical analysis techniques used to test the hypotheses under study were Product Moment Correlation Analysis. To a relative degree of freedom, the hypotheses were tested at the 0.05 level of significance. The analysis revealed that pregnant women's resource utilization is significantly related to their need for health information, nutrition information, delivery information, and breastfeeding information. Based on the findings, it was suggested, among other things, that the government provides libraries and free medical care to encourage women to seek health information. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact:
... The theoretical underpinnings of this study hinges on the Health Belief Model (HBM), on the premise that the decision of mothers to practice EBF depends on their knowledge of exclusive breastfeeding, the perceived benefits of exclusive breastfeeding, the perceived threats to exclusive breastfeeding and the cues to action for breastfeeding [14,15]. This means that, if the perceived benefit of exclusive breastfeeding is greater than the perceived threat, a mother is likely to practice exclusive breastfeeding while the reverse may be true. ...
Full-text available
Background Despite the health and economic benefits of exclusive breastfeeding, there is evidence of a decline globally and in Ghana. Previous studies addressing this problem are mostly quantitative with only a few of such studies using qualitative or mixed methods to examine the predictors, benefits, ways of improving and managing exclusive breastfeeding, and the challenges associated with exclusive breastfeeding from the perspective of exclusive and nonexclusive breastfeeding mothers, and health workers. This study employs the health belief model to examine the experiences of mothers and health workers regarding exclusive breastfeeding to fill this gap in the literature. Methods A cross-sectional qualitative study involving in-depth interviews was conducted among health workers and mothers attending child welfare clinic at two polyclinics in Madina, Accra-Ghana in 2019. Purposive sampling was used to select health facilities and participants for the study. Twenty participants comprising ten exclusive breastfeeding mothers, six non-exclusive breastfeeding mothers and four health workers were interviewed for the study. The data were analyzed based on emerging themes from inductive and deductive coding. Results The decision to practice exclusive breastfeeding was based on mothers’ work, advertisement on exclusive breastfeeding and education on breastfeeding provided by health workers. Insufficient flow of breast milk, pressure from family and friends, and insufficient breast milk for infants were among the reasons for discontinuing exclusive breastfeeding. The factors that help improve exclusive breastfeeding include eating healthy food and breastfeeding on demand, while counselling and monitoring, restricting advertisement on infant formula and granting maternity leave for breastfeeding mothers were identified as factors that can facilitate the practice of exclusive breastfeeding. Conclusion Different levels of experience affect and shape exclusive breastfeeding practice in Ghana. The decision to practice exclusive breastfeeding, as well as the challenges and strategies employed in managing exclusive breastfeeding, emanates from mothers’ personal experiences and interactions with institutional factors. In view of this, there should be counselling on the management of challenges associated with exclusive breastfeeding and provision of accurate information on exclusive breastfeeding to enable mothers practice exclusive breastfeeding.
... Younger maternal age and lower household income were similarly associated with decreased probability of breastfeeding initiation and continuation (Ahluwalia et al., 2005;Brown et al., 2014;Cohen et al., 2018;Meedya et al., 2010;Pitonyak et al., 2016;Thulier & Mercer, 2009). Primiparous women, compared to multiparous, have a greater delay from delivery to first breastfeeding attempt and report more breastfeeding problems (Emmanuel, 2015;Hackman et al., 2015). Moreover, primiparous mothers aged 35 years or older are less likely to initiate exclusive breastfeeding (Kitano et al., 2016). ...
Objectives Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women. Design 155 pregnant women participated in this longitudinal study. Methods Expectant mothers completed a questionnaire and then 2-years after the child’s birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined. Results Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers’ intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years. Conclusion Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.
... The level of knowledge among the Arab mothers with regards to exclusive breastfeeding influences delayed initiation and early cessation of breastfeeding. Emmanuel (38) reported that inadequate knowledge about exclusive breastfeeding may cause mothers to turn to a combination of breastfeeding and formula feeding or formula feeding alone. This is especially true when the mothers perceived that their milk supply was inadequate for their babies' needs. ...
Full-text available
Breastfeeding is known to provide health benefits for newborns and breastfeeding mothers. The World Health Organization and Health Canada recommend exclusive breastfeeding for the first six months of an infant’s life. However, the rates of exclusive breastfeeding practices among Arab immigrant mothers are lower when compared with rates for non-immigrant Canadian mothers and mothers in the immigrants’ countries of origin. Critical ethnography was used to explore the contextual factors that influence the initiation and exclusive breastfeeding practices by Arab immigrant mothers in Canada. Critical ethnography, using individual in-depth interviews was employed to explore the breastfeeding practices among immigrant Arab mothers in Alberta, and factors influencing the mothers’ decision or ability to breastfeed exclusively. Exploratory and open-ended questions were used. Face-to-face interviews were conducted with ten women for 1 and 1 and ½ hours . Participant selection criteria included Arab mothers who were within six months postpartum, aged 18–49 years, and who have resided in Canada for less than five years. An analysis of the qualitative narrative data indicated that knowledge and traditional infant feedingpractices primarily influenced Arab immigrant mothers’ initiation and exclusive breastfeeding practices. The findings from this study have the potential to facilitate supportive culturally safe and sensitive interventions that are tailored to address Arab mothers’ breastfeeding concerns and needs, so that exclusive breastfeeding might be promoted within this population in Canada. Further, the research will provide information needed for addressing some key challenges relating to culture, religion, and the healthcare system. Key words: Arab immigrant mothers, exclusive breastfeeding
... Our study did not find that the mother's age was a predictor of EBF. A review of Emmanuel's books has shown the association of maternal age with higher EBF levels (45). Similar studies in rural Uttar Pradesh (46) and southern India (36) found a strong correlation between EBF and maternal age. ...
Aim:Exclusive breastfeeding (EBF) is very important for the growth and development of the baby. The purpose of this study was to identify the prevalence of EBF practices, to assess the factors associated with those practices, and to find the barriers to EBF practices in the rural community.Materials and Methods:A cross-sectional study based on systematic questioning was carried out involving 252 mothers with children between the ages of 6 and 9 months in the southern Chennai community and the nearby districts of Chengalpattu and Kanchipuram from October 2018 to October 2019. Multiple logistic regression was used to determine factors associated with EBF.Results:Seventy percent (184/252) of mothers following EBF habits had a child older than six months. About 58% of mothers started breastfeeding within one hour of birth, and 32.53% reported colostrum feeding. An apparent shortage of milk (58.82%) was a common problem reported by the mothers leading to EBF discontinuation. Children of working mothers [Odds ratio (OR) 3.32; 95% confidence interval (CI) 1.13, 9.70], urban dwellers (OR 6.67; 95% CI 1.12, 39.66) and children in urban areas (OR 12.47; 95% CI 2.05, 75.90) were less likely to be breastfed exclusively as indicated in the multivariate regression analysis. No relationships were found between the child's gender, method of childbirth, medical advice, or nutritional management before meals and EBF.Conclusion:Working mothers and those living in urban areas were at greater risk of non-compliance with EBF. The national impact of urban sprawl and the impact on EBF activities should be studied in depth.
Full-text available
Background and Purpose: Exclusive breastfeeding means babies are given only breast milk and nothing else; no other milk, food, drink, not even water for one day (24hrs) before the survey was conducted. It prevents 13% of childhood mortality; i.e. at least 1.2 million children worldwide would be saved every year. The purpose of this study was to investigate the factors influencing exclusive breastfeeding practices among female health workers in Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State. Methodology: A descriptive cross-sectional study was carried out on 150 healthcare workers in Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State. Data were collected by a self-administered questionnaire. The first part of the questionnaire included questions about socio demographic characteristics of respondents while the other five parts of the questionnaire consisted of practice of exclusive breastfeeding, factors influencing practice of exclusive breastfeeding, duration of maternity leave and practice of exclusive breastfeeding, method of delivery and practice of exclusive breastfeeding and availability of help at home and practice of exclusive breastfeeding respectively. The instrument for data collection was validated questionnaire with reliability coefficient of 0.80, using Cronbach's alpha test. Data analysis, including descriptive and analytical statistics was performed using SPSS ver. 23. A P≤0.05 was considered statistically significant. Results: The findings showed that majority of the respondents had high knowledge and are practicing exclusive breast feeding (171, 57%). The overall practice was highly adequate. There was a significant relationship between the duration of maternity leave and practices of exclusive breastfeeding, type of delivery and practices of exclusive breastfeeding and homes availability of help at home and practices of exclusive breastfeeding. Conclusion: The present study showed a high practicing of Exclusive Breastfeeding among female health workers in Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State. Intensive awareness creation on benefits of exclusive breast feeding should be carried out for mothers during antenatal period.
Full-text available
p>Exclusive breastfeeding is providing nutrition only breast milk for babies at the age of 0-6 months. The coverage of exclusive breastfeeding in Banten Province reached 61.6% in 2016. The value is still far from the national target of 80%. Infants who do not get exclusive breastfeeding are at risk of experiencing malnutrition in infancy. This study aims to identify the factors of exclusive breastfeeding in the village of Kalanganyar, Banten. This research used descriptive analytic design. The research sample was taken using a purposive sampling technique which included 96 nursing mothers who had babies aged 6-24 months in Kalanganyar Village. The data collected was processed using univariate analysis to obtain a preliminary picture of exclusive breastfeeding in Kalanganyar Village. The results showed that the factors identified were, mother's age, education, occupation, type of labor, parity, breastfeeding experience, income, exclusive breastfeeding education, knowledge, attitude, motivation, and breastfeeding facilities. The researchers recommend further research with a design that can identify the relationship between these factors and the use of multivariate analysis to determine the factors that most influence the exclusive breastfeeding. BAHASA INDONESIA ABSTRAK: ASI eksklusif adalah memberikan nutrisi hanya ASI bagi bayi pada usia 0-6 bulan. Cakupan pemberian ASI eksklusif di Provinsi Banten mencapai 61,6% pada Tahun 2016. Nilai tersebut masih jauh dari target nasional yaitu sebesar 80%. Bayi yang tidak mendapatkan ASI Eksklusif berisiko mengalami gizi buruk pada masa balita. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor pemberian Air Susu Ibu (ASI) Eksklusif di Desa Kalanganyar, Banten. Penelitian ini menggunakan desain deskriptif analitik dengan instrumen penelitian berupa ceklist. Sampel penelitian diambil menggunakan teknik purposive sampling meliputi 96 orang ibu menyusui yang memiliki bayi usia 6-24 bulan di Desa Kalanganyar. Data yang terkumpul diolah menggunakan analisis univariat untuk mendapatkan gambaran praktif pemberian ASI Eksklusif di Desa Kalanganyar. Hasil penelitian menunjukkan faktor-faktor yang berhasil diidentifikasi yaitu, usia ibu, pendidikan, pekerjaan, jenis persalinan, paritas, pengalaman menyusui, penghasilan, edukasi ASI eksklusif, pengetahuan, sikap, dan motivasi ibu. Peneliti merekomendasikan agar dilakukan penelitian lanjut dengan desain yang dapat mengidentifikasi hubungan antar faktor-faktor tersebut serta penggunaan analisis multivariat untuk menentukan faktor yang paling berpengaruh terhadap pemberian ASI eksklusif.</p
Full-text available
Objectives. Exclusive breastfeeding for the first 6 months of life is still rare among nursing mothers. This study aimed to identify the factors influencing breastfeeding practices among mothers in Anambra State, Nigeria. Methods. A prospective cohort study was conducted in three comprehensive health centres of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Anambra State, between September 2006 and June 2007. The breastfeeding practices of 228 nursing mothers were assessed at enrolment when attending the maternal and child welfare clinics for BCG immunisation, and at follow-up visits at 6, 10, 14, 20 and 24 weeks. In addition, four focus group discussion sessions (one in each centre) were held, involving a total of 35 nursing mothers. Results. Most mothers 190 (83.3%) were aged between 20 and 34 years. The majority (208, 91.2%) had good or very good knowledge of breastfeeding. The main source of breastfeeding education was government health facilities (80.85%), but only 110 mothers (48.2%) initiated breastfeeding immediately (<1 hour) after delivery. The exclusive breastfeeding (EBF) rate fell from 143 (62.7%) at birth to 85 (37.3%) at 24 weeks. EBF was significantly associated with older maternal age, higher parity, delivery at a government facility, a positive family attitude towards EBF, and breastfeeding education from a government health facility (p<0.05). Focus group discussion showed that mothers believed that adequate nutrition and physical, financial and emotional support to them would increase EBF practice. Conclusion. The rate of EBF was low among the mothers, and the factors identified that may influence its practice have important implications for breastfeeding intervention programmes. Activities to promote EBF should be focused on specific groups of women and locations in which it is poorly practised. In addition, support to the mothers is necessary.
Full-text available
Suboptimal breastfeeding practices among infants and young children <24 months of age are associated with elevated risk of pneumonia morbidity and mortality. We conducted a systematic review and meta-analysis to quantify the protective effects of breastfeeding exposure against pneumonia incidence, prevalence, hospitalizations and mortality. We conducted a systematic literature review of studies assessing the risk of selected pneumonia morbidity and mortality outcomes by varying levels of breastfeeding exposure among infants and young children <24 months of age. We used random effects meta-analyses to generate pooled effect estimates by outcome, age and exposure level. Suboptimal breastfeeding elevated the risk of pneumonia morbidity and mortality outcomes across age groups. In particular, pneumonia mortality was higher among not breastfed compared to exclusively breastfed infants 0-5 months of age (RR: 14.97; 95% CI: 0.67-332.74) and among not breastfed compared to breastfed infants and young children 6-23 months of age (RR: 1.92; 95% CI: 0.79-4.68). Our results highlight the importance of breastfeeding during the first 23 months of life as a key intervention for reducing pneumonia morbidity and mortality.
HIGH LEVELS OF INFANT and child mortality are major manifestations of health care crises in developing countries, and Uganda is no exception. This article is based on a study that was conducted in the Ugandan district of Rukungiri in 2004 to investigate the relationship between early childhood nutritional practices and child health. The key findings from this study indicate that child malnutrition is still high, and is manifested in high prevalence of malnutrition-related diseases like measles, kwashiorkor and intestinal worms. In particular, the paper discusses the relationship between infant breagfeeding and health. It emerged from the study findings that a majority of mothers initiated breastfeeding immediately the child was born, but were unable to sustain this practice up to two years and above, due to a number of factors predicated either on ignorance or lack of knowledge and cultural beliefs.
This study examined Type of Birth, Depression and Anxiety as determinates of Breastfeeding attitude among Nursing Mothers in Edo and Kogi State Nigeria. A total of two hundred (200) currently Breastfeeding mothers participated in the study. This comprises of a hundred and twenty breastfeeding mother drawn from the General Hospital Auchi Edo State and eighty drawn from Ajaokuta Steel Medical Centre Kogi State. A questionnaire was used in collecting data. The questionnaire consisted of four sections. The demographic variables, Breastfeeding attitude scale, Depression and Anxiety sub-scales. Results of the study revealed that mothers who had normal delivery reported positive attitude towards breastfeeding than mothers who gave birth through caesarian section (t=3.38, df 198 P < 0.05). There were no significant differences in the reported attitude of mothers scoring high and low on the Zung depression inventory towards breastfeeding. Likewise there were no significant differences in the reported attitude of mothers scoring high or low towards breastfeeding. Results obtained also shows that there was an interaction effect between type of delivery and depression on breastfeeding attitude among nursing mothers. An interaction existed also between type of Delivery and anxiety; Depression and anxiety but surprisingly, type of delivery, depression and anxiety did not have an interaction effect on the prediction of breastfeeding attitude among nursing mothers. Based on the findings of this study, it was recommended that there is need for counseling and enlightenment campaign embarked upon by government, and non-governmental organization as well as all health professional concerned within Nigeria to eliminate this wrong attitude and belief about Caesarean section birth as well as campaign on the nutritional values of breastfeeding milk to children. The need for mothers who went through CS to be counseled on the need to believe in themselves as well as the benefit of breastfeeding to the child and mother is very important. DOI: Full Text: PDF
Attitude of working mothers on breastfeeding was studied between December, 2011 and February, 2012 in Calabar Municipality, Cross River State, Nigeria. One hundred willing mothers were interviewed using self-administered questionnaires, for literate mothers and oral administration of questionnaires to illiterate mothers. Data were analyzed using student's t-test and chi-square statistics. Our results have confirmed that some factors such as age, tribe, religion, occupation, marital status, educational status, health status, socio-economic status, attendance at anti-natal clinics, number of children and diverse opinions have affected the attitudes of working mothers towards EBF. We concluded that attitude of working mothers to EBF is influenced by some demographic and socio-economic factors.
Conference Paper
The Ohio Department of Health commissioned this research to examine the individual attitudes and beliefs, social norms, cultural practices and other socio-ecological barriers that hinder Appalachian women who receive Women, Infants, and Children (WIC) benefits from breastfeeding. Group interviews (N = 19) comprised of women receiving WIC benefits (N = 176) were held in Ohio's Appalachian region. A mixed-method approach was utilized to identify facilitators and barriers to breastfeeding initiation and persistence. The study and its findings were framed by the social-ecological model (McLeroy, Bibeau, Steckler, & Glanz, 1988); Loyal Jones' (1994) writing on Appalachian values; and Ruby Payne's (2005) framework for understanding poverty. As a result of the study, we identified culturally competent strategies to enhance the effectiveness of WIC Program breastfeeding services in this area to increase breastfeeding initiation as well as long-term breastfeeding.