Introduction
Exclusive breastfeeding is defined as giving no other food or drink, not even water, except breast milk for the first six (6) months of life, but allows the infant to receive oral rehydration solution (ORS), drops and syrups (vitamins, minerals and medicines).World Health Organisation (2011) has been recommended as the ideal food for infants. A child who is breastfed has a greater chance of survival than a child artificially fed.
Breastfeeding promotion activities are carried out worldwide in order to fulfil the WHO recommendation that infants be breastfed exclusively for six months and then the introduction of complementary foods and continued breastfeeding well into the second year (Cattaneo, Davanza & Ronfani, 2010).
In line with the effort to promote exclusive breastfeeding, there has been massive campaign to educate mother about the benefits and practice of breastfeeding. In 1997, The United National Children’s Fund (UNICEF) launched an initiative to promote the adoption of “Ten Steps to Successful Breastfeeding” in hospital and other maternity service centres. In Nigeria, the Ministry of Health has been working so hard in doing promotion in order to encourage mother to exclusively breastfeed their infants. In cooperated with this, there are many hospitals that are involved in promoting breastfeeding and these hospital known as “Baby Friendly Hospital”, where they will promoting breastfeeding and ensure that mother will breastfed their infants no matter what is the excuses given by mothers. The new trend now, every hospital or ‘health clinic ‘has putting the logo or sign “No Milk Bottle Allowed” to ensure and to tell the public that breastfeeding is the best choice for their infant.
Despite the known benefits of exclusive breastfeeding, there are mothers who are still not exclusively breastfeeding their babies because of certain obstacles and reasons. There is substantial evidence that maternal education, social class, mother comfort in breastfeeding and religion are related to the decision to initiate and continue breastfeeding (Venancio & Monteiro, 2006). Other aspects such as the desire or attitudes of mothers regarding breastfeeding, working mother, family support, mode of delivery and history of smoking are important in initiation and sustaining exclusive breastfeeding.
Conceptual framework on exclusive breastfeeding
Breastfeeding is the process of feeding the infant with mother’s milk by putting the nipple of the mother’s breast into the mouth of the baby. Breast milk is of two types: Colostrums which is the initial yellowish and sticky milk produced from mother’s breast from 37 weeks of gestation to about seven days after delivery and mature milk which is whitish in colour and is effectively produced from about 10th day following delivery. Exclusive breastfeeding is the practice of feeding the infant for the first six months of life on breast milk only. Without any other type of food, not even water. Exclusive breastfeeding is recommended as the best feeding method for infants up to six months and has a protective effect against mortality and morbidity (Derek, 2012).
According to official publication of the Tanzania Medical Students Association (2009), colostrums is important for the baby as it contains more protein (10% compared to 1% in mature milk), Immunoglobin(IGA), Lactoferrin, white blood cells, vitamin A, Zinc and less fat. These are important for immune defences of the baby during the initial days of life. Exclusive breastfeeding is associated with multiple advantages to both the baby and the mother. On the baby’s side there is acquisition of passive immunity against infection nutrients for physical and mental development, emotional security and closeness to the mother. Being a dynamic and physiologically sensitive process, breast milk production is adjusted to suit the infant’s requirement according to environmental changes for example, breast milk will contain more fat during cold seasons.
The current World Health Organization (WHO, 2011) recommendations on breastfeeding stipulate that breastfeeding should start immediately following delivery for the baby to get colostrums. The infant should thereafter be exclusively breastfeeding for up to six months of life, day and night on child’s demand. During this period, no fluid including water should be given to the baby. However, there is a room for giving oral medication to the infant should he/she fall sick. Breastfeeding should still continue until the child is two years age. The use of feeding bottle, teats and pacifiers is discouraged as it is associated with poor hygiene and the risk of gastrointestinal infection to the infant.
Breast milk as an ideal food for the growth and development of the child
Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants and has a unique biological and emotional influence on the health of both mother and child. The anti-infection properties of breast milk help to protect infant against diseases, and there is an important relationship, between breastfeeding and child spacing (WHO, 2011).
Exclusive breastfeeding was also identified as a way of spacing birth or planning families, supporting this line of argument, Nonye (2014), maintained that exclusive breastfeeding delays the return of ovulation and may give a longer period of infertility. The continual survival of babies is known to rely heavy on the milk provided by the mother. When the mother curdles and feeds her baby, the baby feels reassured, loved and catered for (Nwoye, 2009). He further opined that the mother also experienced a deep satisfaction by realizing that she has done a noble job by giving her baby what no other person can.
Exclusive breastfeeding has numerous nutritional immunological and psycho-social benefits. For the mother, it enhances her relation to her infant, it is inexpensive, and it is intrinsically convenient and may be effective in preventing breast cancer. Breast feeding is the best food available for infants and is nutritionally superior to infant formula and to cow’s milk (Elger, 2007). It contains the right proportion of fats, proteins, vitamins and minerals, in relation to cows’ milk. It contains several additional amino acids necessary for mental development.
Agbalaka (2011) stated that motherhood is a rewarding careers. To be a mother is difficult and dangerous but no one else can replace her. The power of doing good and doing harm is beyond the measure and it is done in private where no one can stop the but themselves. He further went on to state that children need relationship with their mothers. Nothing else can substitute for this need. Such relationship gives the child security. Deprived and unhappy children will grow up to make bad parents, who in turn bring up more unstable children.
American Academy of Paediatrics(2007), recommended that woman should breastfeed their babies exclusively for six months. It is also recommended that children should receive breastfeed milk for the first year of life. According to Christemssonk (2007), full breastfeeding means that the baby may have been exclusively breastfeed. Also means that the baby receives nothing other than breasts milk. Exclusive breastfeeding can be seen as the act of feeding the baby with the natural milk from the mother for the period of six months.
Today, the increasing concerns over maternal and child health have led to much emphasis on the multiple advantages of breastfeeding. The initial secretion from the mammary gland is a yellowish fluid containing protein and sugar but not fat, which is cholesterol and is replaced by milk within two or three days. Others containing concentrated protective antibodies for the baby and is important for the growth of the baby. The height of lactation, up to 1.5 litres of milk may be formed each day and to supply the nutrients for this, it is important for the mother to have adequate supplies in her diet. It is particularly important for her to take supplementary, calcium, phosphate, vitamin D to guide against decalcification of her bones and teeth.
Exclusive breastfeeding and mothers’ health
It is extremely unusual for a mother to be unable to breastfeed in the country on account of ill health; even diabetic mothers breastfeed satisfactorily. Breastfeeding can have a significant impact on a mother’s health. Nursing mother’s burn 500 or more calories in a day than woman who are not pregnant or nursing because they work to speed up their weight loss after child birth. Also breastfeeding causes the womb to contrast and reduces blood flow after delivery and creates a less chance that the mother will later develop breast or even cancer of the uterus.
One thing that is not in doubt is the effect of a healthy diet, breastfeeding mothers’ need to maintain a well balanced diet that includes variety of fresh fruits, vegetables, calcium, parental vitamins and a mineral amount of caffeine, to produce enough milk for their babies. Overall Fred (2008) opined that, ifa breastfeeding mother is properly instructed and knows all the precautions she should take; exclusive breastfeeding can be a rewarding and even relaxing experience.
Importance of exclusive breastfeeding and family planning
According to Egbunonu (2013), a significant number of woman of child bearing age that need family planning are lactating mothers. In advanced countries, breastfeeding declined with industrialization. He further maintained that in Nigeria almost all mothers initiate breastfeeding at birth but do not maintain it for a reasonable period.
The need for family planning in child survival strategies is recognized by Labbok (2009), who opined that, breastfeeding is an important area of the strategy and it is beneficial both to the mother and the child. Consenting to Labbok’s opinion, the writer suggested that breast milk is the ideal, best for infant’s food. It contains immunoglobine and bodies that fight infection. It protects against allergy, it is economical, it makes for bonding and love for the mother. Breast milk helps uterine contraction and ovulation furthermore, it reduces the chance of the mother developing breast cancer it also gives complete satisfaction and fulfilment of motherhood and lactation amenorrhea resulting from breastfeeding can be used for family planning.
According to Happer and Row (2010), it is ordinary the case that the sucking action of the baby on the mother’s breast, prevents ovulation. As long as no ovulation take place no new conception is possible. This is usually true as long as the mother is completely breastfeeding her baby. Total breastfeeding means that she nurses him six to eight times a day according to the needs of the baby, and does not give him solid food. Under these condition 86% of women do not ovulate during the first three months after birth.
Normally, the first menstruation of breastfeeding mother is so-called withdrawal bleeding which means that it was not preceded by an ovulation. This will be the case, for 95% of mothers who are totally breastfeeding; their first menstruation will not be preceded by an ovulation. Breastfeeding delays the resumption of ovulation and the return of the menstrual cycle; this is most reliable in the first six months. Lactation amenorrhea, which is the breast feeding, related suppression of the menstrual cycle after birth is associated with a decreased ability to become pregnant. It has been observed that if a woman is fully or nearly breastfeeding, in not less than six months (postpartum) she is about 98% protected against any un-planned pregnancy (Happer & Row, 2010).
The need for exclusive breastfeeding
Child health benefits
Human milk is species-specific and all substitute feeding preparations differ markedly from it, making human milk uniquely superior for infants feeding. Exclusive breastfeeding is the reference or normative model against which all alternative feeding method must be measured with regard to growth, health, development, all other short and long-term outcomes. In additions human fed premature infants receive significant benefits with respect to protection and improve developments outcomes compared with formula fed premature infants (WHO, 2011).
Infection diseases
Research in developed and developing countries of the world, including middle-class population in developed countries provides strong evidence that human milk feeding decreases the incidences and/or severity of a wide range of infectious diseases including bacterial meningitis, bacteria, diarrhoea, respiratory tract infection, necrotizing enterocolits media, unitary tract infection, and late-onset sepsis in preterm infants. In addition, tosteomatal infant mortality rates in the United States are reduced by 21% in breastfed infants (WHO, 2011).
Neuro development
Breastfeeding has been associated with slightly enhanced performance on tests of cognitive development.Breastfeeding during a painful procedure for new born screening provides analgesia to infants (WHO, 2011).
Maternal health benefits
Important health benefits of breastfeeding and lactation are also described for mothers. The benefits include decreased postpartum bleeding and more rapid uterine involution attributable to increased concentrations of oxytocin, decreased menstrual blood loss and increased child spacing attributable to lactational amenorrhea, earlier return to pregnancy weight, decreased risk of hip fractions and osteoporosis in the post menopausal period (WHO, 2011).
Community benefits
In addition to specific health advantages for infants the mothers’ economic, family and environmental benefits have been described. These benefits include the potential for decreased annual health care cost, decreased costs for public, health programs such as a special supplement nutrition program for woman, infants and children (WIC), decreased parental employee observes and associated loss of family income, more time for attention, to siblings and other family matters as a result of decreased infant illness; decreased environmental burden for disposal of formula, cans and bottles and decreased energy demands for production and transport of artificial feeding products (WHO, 2011).
Composition of breast milk
Protein 1.5%
Fat 3.5%
Lactose 7.0%
Water 87.8%
Salt 0.2%
Derek (2012), stated that breast milk is an alkaline fluid, bluish white in colour with a specific gravity. It is actively involved in to prevention of infections. It is also immunizing agent especially against diarrhoea which is a great killer of children.
Advantages of exclusive breastfeeding for the baby
Uni and Richard (2008) in their study noted that infants exclusively breastfed directly from the breast is likely to be contaminated by pathogenic organisms and the incidence of neonatal infection as therefore reduced especially that of gastroenteritis and ever death. Breastfeeding reduces exposure to pathogens in the environment, giving protection by immunization, providing antibacterial and antiviral substances and supplies the correct mix and density of nutrients. The immature infants gut is adapted to the nutrition and protection of breast milk. Antibodies from cholesterol and breast milk protect the gut and provided some immunity against other infections. Babies on breast milk alone never get constipated and no nagging cries at night.
Advantages of exclusive breastfeeding for the mother
Christemssonk (2007) stated that mothers are able to maintain a unique physical and devotional bond with their babies during breastfeeding. Breastfeeding directly contribute to increase birth intervals by tending to reduce the resumption of fertility in the mother, this is more pronounced with exclusive breastfeeding. It is related to lactation amenorrhea and has lead to new recommendations for decisions by individuals on family planning (WHO, 2011).
They further stated that breastfeeding lowers the life time risk of breast and ovarian cancer and as well inhibiting the nature of menstruation and allows woman to build up their stores of iron and alleviate anaemia. Musa (2011) stated that breastfeeding costs less than bottles feeding. There is no formula to buy, nothing to process, no packaging, no fossil fuel used in transportation and no waste to dispose of. Successful breastfeeding brings a great sense of calm, emotional pleasure and satisfaction, also fulfilment of motherhood and feminity. It helps the mother to recover after delivery.
People’s opinion about infants poor feeding
Faced with the increasing infants’ morbidity and mortality in a world rapidly adducing technologically, the UNICEF, WHO, with support of world teachers, health experts and non-governmental organizations launched the baby friendly hospital initiative (BFHI) in June 1991. It was realized that the achievement of exclusive breastfeeding globally would not be possible in an environment where breast milk substitutes are freely distributes. This was the opinion of Njepuone (2009) when he maintained that the sales promotion and economic growth of the multinational infant food manufacturers are encouraged through aggressive marketing and intensive promotion. Many mothers and health care providers have been wrongly made to believe that infants under six months require extra fluids in addition to breast milk especially in hot climate.
Obstacles faced by mothers during exclusive breastfeeding
Christemssonk (2007) stated that the following are some of the obstacles of exclusive breastfeeding and should any of these occur, measures should be taken to deal with them.
They include:
- Diminished secretion of milk: This may be due to absence of milk secreting tissue in the breast or reduction of the number of milk secreting cells. Anxiety and lack of self confidence makes the mother to produce less amount of milk hence poor let down reflex.
- Inability to breastfeed exclusively: This is situation where by the mother fails to breastfeed her baby very well on demand for at least 8 to 10 times in 24 hours. This may be as a result of ignorance and at times the nature of work or business or the mother may create this problem. To prevent this problem new trend of expressing breast milk has been mapped out for working class mothers. The mother can express the breast and keep the milk for the baby in a flask to last for 12 hours or in deep freezer to last for 24 hours without the milk going sour.
- Cosmetic reasons: Mothers refuse to exclusively breastfeed because of fear of alteration in the breast figure or shape. It should be disclosed to such mothers that nature has made it that breast must go flabby whether sucked by baby or not as this will help to prevent. Such problem posed to exclusive breastfeeding
- Modernization: Some mothers refuse to breastfeed their babies exclusively because they feel that breastfeeding babies exclusively is not for modern woman so they depend on cow’s milk in order to show themselves as belonging to the high class. Many women perceive their bodies not only as internally fragmented but as split off from themselves as persons and as incumbents of social roles.
- Class and education: A woman’s level of education and social class affects her motivation to breastfeed but their effects are different in parts of the world. In many industrialized countries, breastfeeding nowadays is becoming woman more common among educated and upper class women.
Solutions to obstacles faced by mothers during exclusive breastfeeding
Njepuone (2009) suggested that the following solutions to obstacles faced by mothers during exclusive breastfeeding:
- Primary health centers and mass media should educate the rural women on the importance of exclusive breast feeding.
- Seminars and workshops should be organized in different higher institutions and secondary schools for nursing mothers to obtain necessary knowledge and right practices for breast feeding.
- Mothers who are doing exclusive breast feeding should eat adequate and balanced diet to help for the flow of the breasts milk.
- Mothers should put bib on the children before breast feeding; so that the child should not dirty his wears, if he throws out the breast milk from his mouth.
- Mothers should build confidence that the milk will come. There is considerable variation in the time and manner in which the milk comes in. It often starts to come in on the third or fourth day of the baby’s life. It tends to come earlier in mothers who have had a child before later in new mother.
- Mothers should breast feed their babies or regular schedules based on their office rules when working. Some offices allow that children are brought to their mother at (6am, 9am, 12noon, 3pm, 6pm, 2am). This schedule varies from office to office and the nature of the job.
References
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Christemssonk, J. (2007). Separation distress in the human Neonate in the Absence of maternal body contact. Acts Paediatric 32 (5): 468 – 473.
Derek, I. J. (2012). Where there is no doctor (7th ed.). United Kingdom: Safar USA Ltd.
Egbunonu, C. (April, 5th 2013). A Breastfeeding baby is never constipated: Sunday Times, pp 11
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