BREASTFEEDING EXPERIENCES OF MOTHERS AND HEALTH CARE WORKERS FROM TWO DISTRICTS IN THE EASTERN CAPE. Authors: J Nyarko1, V Fordjour Afriyie1, A Feeley2, R Rassool2, M Williams3, L Steenkamp3   Maternal, Child and Women’s Health & Nutrition, Nelson Mandela Bay Health District, Eastern Cape UNICEF SA Faculty Health Sciences, Nelson Mandela Metropolitan University

BACKGROUND South Africa has been known as a country with poor exclusive breastfeeding rates due to the early introduction of complementary food. Although initiation rates of breastfeeding remain high at around 88%, research shows a fast decline which results in EBF rates of (<10%) (Shisana et al., 2013). The early introduction of complementary foods is common in South Africa (Du Plessis et al., 2013). Factors associated with early introduction of complementary foods includes (Du Plessis, 2015): lack of knowledge the perceived insufficiency of breastmilk to satisfy an infant’s needs cultural practices societal influences

AIM AND OBJECTIVES The aim was to explore perceptions of healthcare workers and experiences of mothers regarding breastfeeding and support for breastfeeding; and describe challenges that may prevent mothers from breastfeeding.

METHODOLOGY A qualitative research design utilising focus group discussions was implemented at six sites in two health districts. Participants (n=29) were invited to voluntarily participate and to provide informed consent. Focus group discussions were audio recorded and transcribed verbatim before content analysis was done using ATLAS.ti by a researcher experienced in qualitative data analysis.

METHODOLOGY

NELSON MANDELA BAY DISTRICT

AMATHOLE DISTRICT

RESULTS THEME 1 : PARTICIPANTS REFLECTED ON THE ADVANTAGES AND DISADVANTAGES OF BREASTFEEDING

RESULTS- HEALTH BENEFITS NMB MOTHERS AMATHOLE MOTHERS NMB HCW “…and I’ve hear that it is healthy and nutritious for the baby” “ it is very rare that a child gets sick” “prevent diarrhea and chest infections.” “Protects against infections, yes” “My children are bright at school and healthy” “has antibodies also, the breastmilk” All the urban clients were aware of the nutritional and health benefits of breastfeeding indicating that the ANC messages are effectively disseminated at PHC facilties.In the rural areas there seem to be less and a more simplified awareness as participants did not spontaneously reflected on the health benefits in detail. These differences between urban and rural areas may be related to a larger nutrition presence in the urban areas All the urban clients were aware of the nutritional and health benefits In the rural areas there seem to be less and a more simplified awareness HCW were more aware of cognitive benefits

RESULTS- MATERNAL AND INFANT BONDING NMB AND AMATHOLE MOTHERS “I’m a 29 year old mom, I have one child, I breastfed up until she was two years …we’ve bonded so much (making hugging gesture)”. “Breastfeeding is actually very nice because of the bonding thing, you become closer to your baby, its like you just don’t wanna let go…that my experience” Both urban and rural areas reflected on the emotional connotation that breastfeeding invokes and emphasized that they felt closer to their infants.

RESULTS- ECONOMIC BENEFITS AND CONVENIENCE CONVENIENCE BENEFITS “If you breastfeed now it is better for your pocket,” ….“you don’t have to wake up during the night to make a bottle, you can feed your child anytime and its warm …you don’t have to wake up everybody at home”. “If there is nothing to feed the child, the breast is always there”. All urban and rural participants and HCW were well aware of the affordability of breastfeeding. Within the urban group convenience seemed to be an important motivator with only one of the rural participants mentioning it

RESULTS THEME 1 : PARTICIPANTS REFLECTED ON THE ADVANTAGES AND DISADVANTAGES OF BREASTFEEDING

RESULTS- TIME CONSTRAINTS AND LOGISTICS NMB MOTHERS AMATHOLE MOTHERS “poor attachment can lead to breast engorgement so the mother, the breast can be swollen and painful”; “some women choose not to breastfeed because of a lack of milk from the breast”. “I feel the HIV mothers that are not on treatment, they can transmit the disease to their child”; “students cannot breastfeed properly since they are at school” “breastfeeding is time consuming and you always have to take the child with you wherever you are if you want to breastfeed” “it is time consuming” All the urban clients were aware of the nutritional and health benefits of breastfeeding indicating that the ANC messages are effectively disseminated at PHC facilties.In the rural areas there seem to be less and a more simplified awareness as participants did not spontaneously reflected on the health benefits in detail. These differences between urban and rural areas may be related to a larger nutrition presence in the urban areas Urban areas were more scientific in their approach, possibly due to more input from the clinics in the area. Even in rural areas the fast pace of living has caught up with a time honoured tradition of feeding and bonding with baby.

THEME 2: BREASTFEEDING SUPPORT RESULTS THEME 2: BREASTFEEDING SUPPORT Add family. Remove midwives. Misconceptions, supporting data…

RESULTS SUPPORT FROM HCW SUPPORT FROM FAMILY “I don’t know the ladies but they are in hospital, they will encourage you to breastfeed your child”; “got the support from my grandmother, she taught me how to hold the baby, how I should breastfeed, eat a lot, and drink tea, always drink tea” “The nurses also encourage you a lot, that it is good that you breastfeed”. “there’s a belief to old people that, their children, like us, we were mix fed, and have no problems, so now it’s a big challenge”. “They (the men) encourage breastfeeding because artificial feeds are expensive”. Fix b Participants from urban and rural areas had similar positive narratives regarding support for breastfeeding from HCW Participants from urban and rural areas had support from maternal mothers, grandmothers and even fathers.

THEME 3 : CHALLENGES TO BREASTFEEDING, PARTICULARLY WORKING MOTHERS RESULTS THEME 3 : CHALLENGES TO BREASTFEEDING, PARTICULARLY WORKING MOTHERS

RESULTS Long working hours and multiple jobs Expressing breastmilk known practice but little experience “.. a working mother, she will go to work from 6 o’clock to 4o’clock, be at home between 4 and 6. At 7 o’clock she goes to moonlight somewhere, then, she does not have time to bf because she thinks it is important to put money on the table, but if we educate these mothers, and say you can {P8: You can express}, you can express.. so that this child is always on breastmilk up until the child finishes the 6 months”; “you have to start immediately, don’t express now because next month you are going back to school, when your baby is full with just the one and slept, express the other one, put the milk in the small plastic, write the date and stick it there, close it and put it on the deep freezer, every time you breast feeding, you must do that, on the one you did not breastfeed on, even if you breastfed on both, express afterward and see if there won’t be anything that comes out. When you are starting, there won’t be a lot of milk coming out but as you go on, all will be ok”. Participants indicated the need for more information, and awareness in general, related to work and breastfeeding Education on expressing breastmilk manually needed

WAY FORWARD The factors above provide an opportunity to increase breastfeeding knowledge and to change misconceptions among family members or older females in communities. More effort is needed to change the mindset of the older generation about breastfeeding in order to improve exclusive and optimum breastfeeding practices “formula can fall but, porridge in granny, it will never fall, (laughter), because they (the grannies) are there”.

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