CHAPTER ONE

INTRODUCTION

• Background of the Study

Breastfeeding is among the most effective public health interventions to promote child survival and development. Exclusive breastfeeding (EBF), or providing an infant with breast milk only for the first six months of life, is globally recommended by international health agencies such as the World Health Organization (WHO) and UNICEF (WHO, 2021). Despite its well-documented benefits, including reduced infant mortality, improved immune function, and long-term health outcomes, global exclusive breastfeeding prevalence is still not optimal. Worldwide, only 44% of infants less than six months of age are exclusively breastfed, with significant variation between developed and developing countries (Victora et al., 2016).

Exclusive breastfeeding rates in developing countries are generally higher due to cultural perceptions, unavailability of formula, and strong neighbourhood support systems. For instance, exclusive breastfeeding in Sub-Saharan Africa is between 30% and 60%, and countries such as Rwanda have up to 87% rates (UNICEF, 2019). However, in industrialized nations, rates of exclusive breastfeeding tend to be lower owing to reasons like urbanization, maternal work participation, and availability of infant formula. In the United States, for instance, only around 25% of infants have been exclusively breastfed for the first six months although there is extensive awareness of its advantages (Centers for Disease Control and Prevention [CDC], 2020).

Historically, breastfeeding has been influenced by cultural, economic, and medical factors. In the early 20th century, the development of infant formula and aggressive marketing led to a decline in breastfeeding in most industrialized countries, including the United States (Wolf, 2003). However, at the turn of the 20th century, there was a resurgence of interest in breastfeeding promotion because of scientific proof of its effectiveness and public health promotion of breastfeeding as the optimal infant feeding method (Rollins et al., 2016). There are still barriers to exclusive breastfeeding despite these promotions, particularly for vulnerable groups.

In the US, social-demographic factors such as income, education, and race influence breastfeeding to a great extent. African American women, for example, experience lower exclusive breastfeeding rates compared to their White peers due to institutional inequalities, absence of support, and culture (Johnson et al., 2015). Work by mothers and workplace policies play a significant part in breastfeeding experiences. Working mothers feel inadequacies such as scant maternity leave and inadequate lactation support at the workplace, which pose a challenge to their exclusive breastfed status (Mirkovic et al., 2014).

Socio-cultural elements also make significant contributions to breastfeeding practice. Societal attitudes, family traditions, and cultural beliefs towards breastfeeding can encourage or discourage exclusive breastfeeding. For instance, public breastfeeding is frowned upon in some societies, which can result in the discouragement of mothers to continue breastfeeding (Bentley et al., 2003). Further, the attitudes of family members, particularly grandmothers, can encourage a mother to exclusively breastfeed (Grassley & Eschiti, 2011).

Exclusive breastfeeding is also significantly determined by medical and health concerns. In-hospital practices, such as the Baby-Friendly Hospital Initiative (BFHI), have also been shown to improve breastfeeding through the promotion of skin-to-skin contact and rooming-in (Perrine et al., 2012). Medical procedures such as cesarean delivery and health complications for either mother or infant may, however, negatively impact the initiation and exclusivity of breastfeeding (Hobbs et al., 2016). The other deciding factor is access to lactation education and support, as those mothers who have professional guidance are likely to succeed at exclusive breastfeeding (Meek & Hatcher, 2017).

Environmental determinants like workplace policies, community support, and public facilities also influence exclusive breastfeeding practices. In the USA, the Affordable Care Act (ACA) mandated workplace accommodations for breastfeeding mothers such as break time and private places for pumping (Hawkins et al., 2015). Implementation of these policies remains inconsistent, and many mothers still find it difficult to manage work and breastfeeding. Community support, for instance, peer mentoring and lactation support groups, has been noted to increase success with breastfeeding, particularly among the low-income segments (Anderson et al., 2018).

In Wake County, North Carolina, exclusive breastfeeding determinants can be a result of the interplay of these factors. The diversity of the county population, socioeconomic disparity, and exposure to healthcare facilities create a specific context to investigate breastfeeding. Identification of the localized barriers and facilitators is an important step in guiding evidence-based interventions for exclusive breastfeeding. Globally, EBF is practised for the first six months due to its proven health advantages, but merely 44% of babies are exclusively breastfed with disparities between the developed and developing world. In the USA, EBF rates are around 25%, susceptible to social-demographic, cultural, and work factors. In the past, formula marketing in the 20th century reduced the rate of breastfeeding, but with present public health programs, its revival has been promoted. Wake County, North Carolina, with socioeconomic and cultural diversity, has unique challenges and opportunities for exclusive breastfeeding. This study aims to explore these determinants to further promote breastfeeding practice in the region.

• Statement of the Problem

Exclusive breastfeeding is highly recommended as it provides many health benefits to both infants and mothers. However, not many mothers adhere to this practice, especially in industrialized countries like the United States, where only 25% of infants are exclusively breastfed for six months. Different factors like income, culture, healthcare, and work policy determine whether Wake County mothers can exclusively breastfeed. Unfortunately, there is not enough local research to understand these factors well enough to make it challenging to create effective programs to support breastfeeding mothers.

The problem is worse for some groups, like African American mothers, who often face problems like reduced access to breastfeeding assistance and unfriendly workplaces. Cultural values and societal norms can also make it difficult for mothers to breastfeed. Without a proper understanding of these issues, it’s challenging to improve breastfeeding rates in Wake County. This study aims to determine the determinants of exclusive breastfeeding in the area in a bid to enhance the support to be provided to infants and mothers.

• Research Questions
  • Main Research Question

What are the key determinants influencing exclusive breastfeeding practices among mothers of infants aged 0-6 months in Wake County?

• Specific Research Questions

1. What social-demographic factors influence exclusive breastfeeding practices among mothers of infants aged 0-6 months in Wake County?
2. How do socio-cultural factors impact exclusive breastfeeding practices among mothers of infants aged 0-6 months in Wake County?
3. What medical and health-care-related factors influence exclusive breastfeeding practices among mothers of infants aged 0-6 months in Wake County?
4. What environmental factors affect exclusive breastfeeding practices among mothers of infants aged 0-6 months in Wake County?

Read More: Nursing Project Topics with Materials