The term exclusive breastfeeding is used to describe the feeding of an infant or young child with breast milk, that is through lactation rather than using infant formula. In recent years, there has been a campaign on the acceptance of exclusive breastfeeding by nursing mothers. The reason is because millions of children die each year due to inadequate nutrition. Therefore, the World Health Organisation (WHO) recommends that all infants be fed exclusively on breast milk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed while receiving appropriate and adequate complementary food for up to 2 years of age and beyond.
According to World Health Organisation (WHO, 1991), sees exclusive breastfeeding as the means in which an infants receives only breast milk with no additional food or liquids, not even water, with the exception of oral rehydration solution or drops/syrups on vitamins, mineral or medicines.
According to Watchtower Bible and Tract Society (2003), breast milk is the best food for the newborns. Breast-fed babies have lower rates of hospital admissions, ear infections, diarrhoea, rashes, allergies and other medical problems than bottle-fed babies. Babies are not the only ones who benefits from breastfeeding. A study of 150,000 women in 30 countries revealed that every year, a woman breast-fed, she cuts her life time risk of developing breast cancer by 4.3% percent. For this reason, some working mother extract breast milk to be used while their child is being cared for by others as required.
Ejebe (2007), an expert in child nutrition, health and development, agreed that breastfeeding is an effective way to provide a baby with a caring environment and complete food which gives protection against diseases and infections. Breastfeeding helps to lower the risk of asthma, protect against allergies and provide improved protection for babies against respiratory and intestinal infections. To have maximum effect, a child need to be fed with breast milk directly from the female human breast, that is via lactation rather than baby bottle or other forms of feeding containers.
Definitions of exclusive breastfeeding
World Health Organization (WHO, 1991), sees exclusive breastfeeding as the means in which an infants receives only breast milk with no additional food or liquids, not even water, with the exception of oral rehydration solution or drops/syrups on vitamins, mineral or medicines.
According to Davies-Adetugbo (1997), exclusive breastfeeding is the giving a child only breast milk and no additional food, water or other fluids with the exception of medicine and vitamins if needed. It is also referred to as the feeding of an infant or young child with breast milk directly from female human breast, through lactation rather than infant formula.
According to Ejebe (2007), breastfeeding is an effective way to providing a baby with a caring environment and complete food that is breast milk directly from the female human breast that is via lactation rather than a bottle or other forms of feeding containers, which give protection against diseases and infections. According to Watchtower Bible and Tract Society (2003), breast milk is the best food for newborn and breast-fed babies have lower rates of hospital admissions, ear infections, diarrhoea, rashes, allergies and other medical problems than bottle-fed babies.
Exclusive breastfeeding is also defined as breastfeeding, which is an unequalled way of providing ideal food for the healthy growth and development of an infant and an intergral part of the reproductive process with important implications for the health of mothers (Krammer, VanDerslice, Popkin and Briscoe, 2001). According to Mundi (2009), exclusive breastfeeding refers to the percentage of children less than six months old who are fed with breast milk alone (without any other liquid or solid) in the past 24 hours of the child breastfeeding within the period of the months.
American Medical Association (2001), stated that exclusive breastfeeding reduces infant mortality due to common children illness such as diarrhoea, pneumonia and helps for a quicker recovery during illness. Exclusive breastfeeding is a feeding in which a baby received only breast milk without additional food or drinks (including water until 6 months. Breastfeeding contributes to the health and well being of mothers which increases family, national resources and helps to secure way of feeding, safe for the child’s environment
In general, the rate of acceptance was 64%. Countries that accepted mostly are Ghana (63%), Benin (70%) and Rwanda (85%) (WHO, 2003). The acceptance rate was also carried out through the use of age. To determine the acceptance of exclusive breastfeeding, a research carried out shows that mothers from socioeconomically privileged groups were more likely to exclusively breastfeed their babies than those from lower socioeconomic class. Our results indicated a correlation between household wealth and level of education, with 13.7% of mothers practicing exclusive breastfeeding from poor households with low education levels compared to those from rich households with secondary education or higher (26.1%). However, the reported prevalence of exclusive breastfeeding among educated Nigerian mothers is relatively low compared to countries like Nepal, Bangladesh and India. The reported low prevalence among educated Nigerian mothers may be attributed to current economic challenges in Nigerian, where mothers may be forced to return to full time work causing a shorter duration of breastfeeding (WHO, 2003).
Salami (2006) pointed out that exclusive breastfeeding rates in Nigeria are amongst the lowest in the world, and even compare poorly with other neighbouring countries in the region – Nigeria lags behind Ghana (63%), Republic of Benin (70%) and Cameroon (53%). A substantial improvement of exclusive breastfeeding can be achieved in Nigeria by avoiding the practice of mothers giving water to their babies in addition to breast milk. Okolo and Ogbonna (2002) highlighted that one of the greatest factors influencing the knowledge, attitude and practice of exclusive breastfeeding is their level of education, it is seen to have contributed positively to the acceptance and practice of exclusive breastfeeding
Exclusive breastfeeding promotion programmes should target all mothers, but with special focus on poor and illiterate families, mothers who delivered at home and mothers who have had no antenatal clinic visits. In addition, further research is required to describe the feeding patterns and dietary intake related to complementary feeding, and their effects on children’s growth. Finally, intervention studies, including peer counselling using cluster-randomised controlled trials, are needed to improve exclusive breastfeeding among mothers and those having their first baby in Nigeria.
Reason for acceptance
According to Ijarotimi (2010), the nutritional knowledge of the mothers towards breastfeeding showed that 84.5% agreed that breast milk alone is enough for infant at age 0-6 months. When the nutritional composition of breast milk was compared to commercial formula, 77.5% of the nursing mothers agreed that breast milk was better than commercial formula. Similarly, 98.5% agreed that human breast milk contains some substances that can boost the immunity of infants. In developing countries, several studies have reported that the real income of a household is indeed an important determination of its access to food which in turn is a major determinant of child and maternal nutritional well-being (Cornia, 1994).
According to Breast Feeding from the Public Health Perspective quotes 2008 and 2006. Jones (2008), stated that more than 2000 adults when asked their sources of receiving health information or medical information such as physician, 57 percent used the internet, 68% asked friends while 86 percent asked health professionals and is thus imply that a good number of people are aware and have benefited from the use of breastfeeding.
According to Nigerian Federal Office of Statistics (2006), people seek and find health information from a variety of sources. These have brought increased in acceptance of exclusive breastfeeding particularly among those aged 18-49 years. In conclusion, study showed that a large proportion of mother practiced exclusive breastfeeding with good breastfeeding benefits (WHO, 2003).
Benefits for mothers
Watchtower Bible and Tract Society (2003) stated that a study of 150,000 women in 30 countries revealed that every year a woman breastfed, she cuts her life time risk of developing breast cancer by 4.3 percent. So it turns out that babies are not the only ones who benefits from breastfeeding. It also contributes to the health and well-being of the mothers.
World Health Organisation (1991) also added the following benefits:
- Benefits maternal health: Breastfeeding reduces the mothers’ risk of fatal post-partum haemorrhage, premenepual, breast and ovarian cancer. Frequent and exclusive breastfeeding contributes to delay in the return of fertility (it helps to space children) and helps to protect women against anaemia by conserving iron.
- Help mothers lose weight: Because breastfeeding uses an average of 500 calories a day, it helps the mother to lose weight after giving birth. Breastfeeding also helps in uterus shrinkage, decreased depression and decrease the risk of osteoporosis.
- Bond mother and child: Breastfeeding provides frequent interaction between mother and infant, fostering emotional bonds, a sense of security and stimulus to the baby’s developing brain.
Benefits for the child
Impact on the child mental, physical growth and development: Breastfeeding helps to boost baby intelligent quotient (IQ). A study shows that two fatty acid that occurs naturally in breast milk – Docosahexanoic acid (DHA) and Arachidomic acid (AA), seen to make the difference in neural development. The study also show that children who consumed both DHA and AA performed better than other groups in terms of memory problems, solving and language development skills (Watchtower Bible and Tract Society, 2001).
World Health Organisation (2003), stated that the benefits are as follows;
Impact on child’s nutrition: Breastfeeding provides total food security for infants due to breast milk source which is hygienic source of food with the right amount of energy, protein, fat, vitamins and other nutrients compose in the infant in the first six months. It cannot be duplicated. For it is only safe and reliable source of food for infants in an emergency.
Impact on infant survival and health: Breastfeeding promotes recovery of the sick child and help saves lives. Breastfeeding provides a nutrition that is easily digestible. When a sick child loses his or her appetite for other foods, during illness, breastfeeding will help for recovery. For example, during diarrhoea, breastfeeding helps to reduce dehydration, the severity and duration of diarrhoea and the risk of malnutrition. According to Kwazulu (2001), the following are benefits from breastfeeding of a child
Protect against illness; Breast milk especially the first yellow milk called colostrums, contains antibacterial and antiviral agents and level of vitamin A that protect infants against disease.
Saves Lives: Exclusive breastfeeding is the single most effective intervention for preventing child deaths.
World health Organisation (2003), recommends some ways and ten steps policy to follow that can enable mothers to establish and sustain exclusive breastfeeding for 6 months as stated below are to be practiced by nursing mothers;
- Initiation of breastfeeding within the first hours of life.
- Exclusive breasting: That is infants only receive breast milk without any additional food or drink, not even water.
- Breastfeeding on demand: That is as often as the child’s wants it, day and nights.
- No use of bottles, teats or pacifiers.
Ten steps and policy
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding with a half hour of birth.
- Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk unless medically indicated.
- Practice rooming-in: Allowing mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding supports group and refer mothers to them on discharge from the hospital or clinic.
Prevention to some obstacles to exclusive breastfeeding
Promoting and supporting exclusive breastfeeding is very important because despite its many benefits, many women do not breastfeed exclusively due to some obstacles which can also be prevented. Peter (2010) stated that work can be an obstacle for nursing mothers whose work may not allow the practice of exclusive breastfeeding of her baby. She may go to work with her child. But if the nature of her job is not conducive, the baby may be kept in a day care close to her workplace and she might be allow for thirty minutes twice a day to enable her breastfeed such baby. Alternatively, the lactating woman may extract her breast milk and kept properly for administration to the baby by close relative while she is away to work.
World Health Organisation (1991) pointed out the following ways in which some of these obstacles to exclusive breastfeeding can be overcome.
Prevent and treat early problems: Most breastfeeding problems occurs in the first two weeks of life. These problems include cracked nipples, engorgement and mastitis. These can often lead to very early infant supplementation and abandonment of exclusive breastfeeding. Proper positioning and attachment of the baby to the breast and frequent breastfeeding can prevent these problems. Support to the mothers for early initiation is easy to provide through peer support and networks have been effective at prolonging exclusive breastfeeding.
Restricting commercial pressures: Aggressive marketing of infant formula often gives new mothers and families the impression that human milk is less modern and thus less healthy for infants than infant formula. Enforced restrictions on marketing of infants formula are part of the efforts to support and prolong exclusive breastfeeding.
Provide timely and accurate information: Many women and family members are unaware of the benefits of colostrums and exclusive breastfeeding. Women are encouraged not to listen to myths, misinformation and mixed messages about breastfeeding. Ensuring that women receive complete, accurate, timely and consistent information, is fundamental for any programme promoting exclusive breastfeeding.
Address social barriers: Attitudes that undervalue breastfeeding discourage women from breastfeeding. These attitudes may be communicated in the media and reflected in the advice of relatives and friends. Successful efforts depends not only on the mothers but on those who influence her feeding decision such as her doctor, mother-in-law and husband.
Create supportive work environment: Few mothers are provided with paid maternity leave or time and a private place to breastfeed or extract her breast milk. Legislation around maternity leave and policies that provides time, space and support for breastfeeding in the work places could reduce one of the barriers to exclusive breastfeeding.
Establish good practice in health facilities: Distribution of free samples of infant formula and the use of glucose water and separation of mothers from newborn are obstacles to the establishment of good feeding in health services. Adopting the baby friendly hospital initiative, “ten steps to successful breastfeeding” and enhancing the skills of health care providers to support exclusive breastfeeding would help to ensure the best start for infants.
Diet during breastfeeding
Little and Anderson (1989) stated that women who are breastfeeding need to be careful about what they eat, drink, since food eaten can be passed to the baby through breast milk, just like during pregnancy so they should eat proper and adequate food as it helps the mother and child to stay healthy. Their daily intake of food should include protein, carbohydrate, vitamin and mineral for they are necessary to keep mothers in good nutritional state and better lactation.
American Medical Association (2001). Indicators for assessing infant and young child feeding practices. Washington D.C., USA
Cornia, S.B. (1994). Breastfeeding practices in a public health field practice area in Sri Lanka: a survival analysis. International Breastfeeding Journal 2; 13
Davies-Adetugbo, A. A. (1997): Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State. Soc Sci Med, 45:113-125.
Ejebe, V. (2007). Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 117:e380-e386.
Federal Office of Statistics [Nigeria] and IRD/Macro International Inc: Nigeria Demographic and Health Survey 2006. Columbia, Maryland: Federal Office of Statistics and IRD/Macro International Inc;
Ijarotimi, O.S. (2010). Breastfeeding practices and health-seeking behavior for neonatal sickness in a rural community. Journal of Tropical Pediatrics; 51; 366-376.
Jones, G. (2008). The Bellagio Child Survival Study Group: How many child deaths can we prevent this year? Lancet, 362(19):65-71.
Kramer, M. VanDerslice, J., Popkin, B. and Briscoe, J. (2001). Promotion of Exclusive Breastfeeding Intervention Trial (PROBIT); A Randomized Trial in the Republic of Belarus. Journal of American Medical Association 285(4): 413-420.
Kwazulu, N. (2001); Infant and young child feeding indicators and determinants of poor feeding practices in Ghana: a review of National Family Health Survey data. Food & Nutrition Bulletin, 31(2):314-333.
Little, R.E. and Anderson, K.W. (1989). Maternal Alcohol Use During Breastfeeding and Infant Mental and Motor Development at One Year. NEJM 321(7):428-30.
Mundi, K. (2009). Factors Associated With Exclusive Breastfeeding in Ibadan, Nigeria. Journal of Human Lactation, 17(4):321-325.
Okolo, S.N. and Ogbonna, C. (2002). Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding baby-friendly hospital initiative (BFHI) Practices. European Journal of Clinical Nutrition 56; 438-441.
Peter, O. (2010). Primary Health Care for Sustainable Development, the Working Mother and Breastfeeding. Journal of Neonatal Study, 9 (34): 65-7.
Salami, L. (2006): Factors influencing breastfeeding practices in Edo state, Nigeria. African Journal of Food Agriculture Nutrition and Development, 6(2):1-12.
Watchtower Bible and Tract Society (2003). Children, What they Need from Parents. Pennsylvania; Watchtower.
Watchtower Bible and Tract Society (2001). Drug Abuse; Is There A Solution? Pennsylvania; Watchtower.
World Health Organisation (2003): The Global Strategy for Infant and Young Child Feeding. Geneva: WHO.
World Health Organisation (1991): Indicators for Assessing Breastfeeding Practices: Report of an informal meeting. Geneva: WHO.