by CHAPTER I
INTRODUCTION
Background of the study
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e. via lactation) rather than using infant formula from a baby bottle or other container (Await et al., 2009). Breastfeeding is the ideal method suited for the physiological and psychological needs of an infant (Subbiah, 2003). Under modern health care, human breast milk is considered the healthiest form of milk for babies (Picciano, 2001). Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children (Gupta et al., 2007). The beneficial effects of breastfeeding in the prevention of morbidity and mortality from diarrhoea in infants have been documented (Gupta et al., 1990). Scientific researches, such as 2007 review for the World Health Organization (WHO), have found numerous benefits of breastfeeding for the infant (Horta et al., 2007).
Exclusive breastfeeding (EBF) means giving infants only breast milk with no addition of other foods or drinks, including water (WHO/UNICEF, 2003). EBF has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mix feeding (Coutsoudis et al., 2001). National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. WHO (2003) recommends EBF for the first six months of life, after which infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years of age or beyond. AAP states that breast feeding also has economic health benefits because breastfeeding results in reduced health care costs. The significantly lower incidence of illness in the breastfed infant also allows the parents more time for attention to siblings and other family duties and reduces parental absence from work and lost income. The WHO recommends that national authorities in each country decide which infant feeding practice should be promoted and supported by their maternal and child health services to best avoid HIV infection transmission from mother to child. Breastfeeding with HIV guidelines established by the WHO suggest that HIV-infected mothers (particularly those in resource-poor countries) practice EBF only, rather than mixed breastfeeding practices that involve other dietary supplements or fluids(Moland et al., 2010). However, a recent study conducted by researchers from the University Of North Carolina School Of Medicine suggests that women infected with HIV can, in fact, breastfeed without transmitting the virus to their children, because components in breast milk are understood as able to kill the virus (Wahl et al., 2012). According to the centre for disease control and prevention (CDC), one of the most highly effective preventive measures a mother can take to protect the health of her infant is to breastfeed. The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, emplrs, and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding.Though nationwide efforts to promote EBF started in Nigeria since 1992, data on this type of infant feeding are however, generally scarce (Lawoyin et al., 2001). Statement of problem Experts agree that breastfeeding is beneficial and have concerns about the effects of artificial formulas. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries (Horton et al., 1996). Breastfeeding declined significantly from 1900 to 1960, due to improved sanitation, nutritional technologies, and increasingly negative social attitudes towards the practice. However, from the 1960s onwards, breastfeeding experienced a revival which continues to the 2000s, though some negative attitudes towards the practice still remain (Riordan and Countryman, 1980). EBF for the first six months of life is estimated to lower infant death by 13% (Jones et al., 2003). Other dangers associated with not breastfeeding as recommended include high infant death rates caused by lowered protection against harmful bacteria and other gastrointestinal infections and slow recovery from illnesses (WHO, 2001b). Infant feeding practices account, to a large extent, for the high rates of malnutrition among children in developing countries (WHO, 2007). In Africa, majority of the mothers fail to practice EBF as recommended (WHO 2006b). This is caused by factors such as lack of self-security, breast soreness, poor infant positioning, mothers’ perception of inadequate milk supply and lack of necessary support and information from health care provider (WHO, 2001b). There are cultural, social and economic barriers to EBF including pre-lacteal feeding, giving drinking water and herbal teas (Shirima, Gebre-Madhin and Greiner, 2001).
Infant feeding methods are a major determinant of infant nutritional status, which in turn, affects infant morbidity and mortality. Among feeding methods, breastfeeding is of particular importance because this practice is fundamental for growth, development, health and survival of infants. Diallo, Bell, Moutquine, & Garrant (2005) stated that about 5.6 million infants die annually because they do not receive adequate nutrition. Breastfeeding therefore has been classified by scientists and health workers as the best natural food for babies and breast milk contains all the necessary nutrients for the healthy growth of the child. The benefits of breastfeeding are numerous ranging from providing the infant with antibodies, to helping ward off risks of illnesses and providing the baby with all his/her nutritional needs (Mundi, 2008). According to the World Health Organization(WHO) (2004), breast milk provides all the energy and nutrients that the infant needs for the first six months of life, and it provides about half or more of a child’s nutritional needs during the second half of the first year, up to one third during the second year of life.
Furthermore, breast milk not only protects the infant against infectious and chronic diseases, but also promotes sensory and cognitive development in addition to contributing to the health and well-being of mothers, helping in birth spacing, reducing the risks of ovarian and breast cancers as well as increasing family and national resources (WHO, 2004). Generally, breastfeeding is practiced all over the world, though with variation in duration. Considering that the introduction of other food supplements at an early age often increase the risks of infections to the infant which may at times lead to life-threatening conditions such as diarrhea, the WHO and United Nations Children’s Fund (UNICEF)(2003), recommended that infants be exclusively breastfed for six months and, thereafter, up to 24 months, introducing other supplements to support the infant’s growth and development. In view of the many benefits afforded by mothers and infants in breastfeeding, governments have also set goals and rates for breastfeeding practices.
The Nigerian government has earmarked six University Teaching Hospitals as Baby Friendly Hospital Initiative (BFHI) centres, in Benin, Enugu, Maiduguri, Lagos, Jos, and Port-Harcourt, with the objective of reducing infant malnutrition, morbidity and mortality, as well as promoting the health of mothers. Since the inception of BFHI in 1991, a series of programmes, seminars, workshops and conferences aimed at promoting breastfeeding practices have been organized. The BFHI itself has proved to be an effective method of improving breastfeeding practices worldwide (Salami, 2006). To further strengthen the practice of exclusive breastfeeding, government also approved a breastfeeding policy in 1998. The code on the marketing of substitutes of breast milk was reviewed and amended in May, 1999, to further introduce stiffer fines and a clearer definition of breast milk substitutes. These measures are aimed at increasing the rate of exclusive breastfeeding as well as the early initiation of breastfeeding so as to achieve the World Summit on Children 1990 goal of universal exclusive breastfeeding for infants up to six months of age (Mundi, 2008).
Statement of the problem
Breastfeeding practices have undergone tremendous medical, cultural and sometimes religious challenges and debate. In an attempt to achieve successful breastfeeding globally by the year 2000, the World Health Organization and United Nations Children’s Fund launched the Baby Friendly Hospital Initiative (BFHI) in 1991. The BFHI is a global effort involving 160 countries, of which 95 of them are in the developing world where Nigeria is inclusive (Salami, 2006). This project is to support, protect, and promote the practice of exclusive breastfeeding for six months and thereafter until 24 months of age. Several medical literatures have also established the superiority of breast milk over the other types of milk for the nourishment of the human infants, offering better health benefits.
