For mothers and babies, breastfeeding has unrivalled health advantages. Breast milk is specially adapted to fulfil the health demands of a developing baby, making it the clinical gold standard for infant feeding and nutrition [1].

Exclusive breastfeeding is the practice of giving the baby nothing but breast milk, with the exception of liquid medication or vitamin/mineral supplements. Breast milk is the best food for infants during the first six months of life because it contains all the essential elements, including vitamins and minerals. WHO advises that newborns should only be breastfed for the first six months of life in order to ensure optimal growth, development, and health [2-4].

Poor nursing habits and attitudes are reportedly among the main causes of children's poor health outcomes, especially in underdeveloped nations. However, in developing nations with high levels of poverty, a high burden of disease, and little access to clean water and proper sanitation, the promotion and acceptance of practises, like exclusive breastfeeding, is particularly crucial [5-7]. In India, breastfeeding is seen as a customary practice and is thought to come "naturally" to Indian moms. Social and cultural norms, infant maturity at birth, level of commitment, mother's literacy, and degree of modernity are the elements that affect breastfeeding initiation, maintenance, and duration [8].

Despite compelling evidence of the advantages of breastfeeding, rates are less than ideal, indicating significant gaps that must be found and filled. While numerous researches have evaluated breastfeeding knowledge in various regions of India, there are few of these studies in Himachal Pradesh. In order to investigate this, the current study was created in Himachal Pradesh among females of reproductive age group.                

Objectives of the Study

To evaluate the knowledge towards breast feeding among reproductive age group females in Himachal Pradesh.   

Research Approach 

Descriptive

Research Design

Cross-sectional survey design

Study Area

Whole state of Himachal Pradesh

Study Duration

Between July 2022 to September 2022

Study Population

All reproductive age group females who were staying in the Himachal Pradesh for 12 months or more

Sample Size

400 reproductive age group females, assuming 50% have adequate knowledge regarding Breast Feeding, 5% absolute error, 95% confidence level, and 5% non-response rate

Study Tool

A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding breast feeding was created. The questionnaire was initially pre-tested on a small number of females to identify any difficulty in understanding by the respondents [9]

Description of Tool

Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

Questionnaire

The questionnaire contains 20 structured breast-feeding knowledge related questions having three options (yes, no, don’t know).  The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good,60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (< 8) = poor

Validity of Tool 

By the experts in this field

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated among reproductive age group female residents of the state for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected.

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

Ethical Considerations 

Participants confidentiality and anonymity were maintained. 

Present study was developed to evaluate the knowledge towards breast feeding among reproductive age group females of Himachal Pradesh (Table 1). A total of 400 females were participated, maximum 205 (52.5%) were having age between 26-30 years, educated up to Matric and Senior Secondary 153(38.25%), Hindu 373(93.25%) and housewife 332 (83%). In the present study 13% (52) females had very good knowledge (16-20 marks) towards breast feeding, 66.75% (267) having good knowledge (12-15 marks), 17.25% (69) having fair knowledge (8-11 marks) and 3% (12) having poor knowledge (<8 marks). Table 2 shows the responses of the participants to various statements and Table 3 Shows the knowledge towards breast feeding among reproductive age group females.

Table 1: Socio Demographic Characteristics of the Participants

Table 2: Responses of the Participants to Various Statements

Table 3: Knowledge Towards Breast Feeding Among Reproductive Age Group Females

Maximum = 20 Minimum = 7

Table 4: NFHS data on Breast Feeding in Himachal Pradesh

Despite compelling evidence of the advantages of breastfeeding, rates are less than ideal, indicating significant gaps that must be found and filled. While numerous research has evaluated breastfeeding knowledge in various regions of India, there are few of these studies in Himachal Pradesh. In order to investigate this, the current study was created in Himachal Pradesh among females of reproductive age [10].

Although, the present study demonstrated good knowledge among females but still there was room for improvement as there is a significant gap in knowledge.

According to Infant and Young Child Feeding (IYCF) guidelines, Government of India recommends that initiation of breastfeeding should begin immediately after birth, preferably within one hour. The World Health Organization (WHO) recommends continued breastfeeding up to 2 years of age or beyond [11].

In terms of the child's health, nutrition, and development as well as the mother's health, breastfeeding has both immediate and significant long-term effects. An infant's mortality and morbidity from diarrhoea, respiratory and other infections, otitis media, necrotizing enterocolitis, and sudden infant death syndrome are reduced when nursing is practised properly (SIDS). It is also well known that breastfeeding helps mothers delay childbirth by encouraging lactational amenorrhea and lowering the risk of breast and ovarian cancer^. [12,13].

Although more than 80% of neonates receive breast milk in nearly all countries, only about half begin breastfeeding within the first hour of life, and rates of exclusive breastfeeding are well below 50% in most of the countries. NFHS-5 data on breastfeeding in Himachal Pradesh showed that there was an increase in breastfeeding within one hour of birth from 41.1% to 45.1%. Also, there was a rise in the exclusive breastfeeding rate from 67.2% to 69.9% (Table-4) [14]. 

As it can help to improve child and maternal health, nutrition, economy, intelligence, and human capital while reducing inequalities, optimal breastfeeding practices are potentially one of the top interventions for reducing under-five mortality and are crucial for the achievement of many of the recently announced Sustainable Development Goals by 2030. Reduced IQ and $302 billion, or 0.49% of global gross national income, in economic losses are linked to suboptimal nursing [15,16]. Furthermore, inadequate breastfeeding contributes to higher health-care expenditures and increased vulnerability to infections among infants. Strengthening awareness through community-based counselling, antenatal education, and support systems can significantly enhance breastfeeding outcomes. The results of this study show that women should be educated about the benefits of breastfeeding habits to ensure long-term improvements in maternal and child well-being.

The current study draws the conclusion that although the study subjects had decent knowledge on breastfeeding, there was still potential for development because there is a sizable knowledge gap in this area. The promotion of breastfeeding can be bolstered further by a number of neighbourhood initiatives. In order to encourage breastfeeding, we also advise stepping up public health information, education, and communication (IEC) programmes. During their antenatal follow-up visits, healthcare professionals should educate all women on breastfeeding, especially those with low educational attainment and no prior breastfeeding experience. It is important to find ways to remove these obstacles, especially for working women.

1. Centers for Disease Control and Prevention. “Why it matters.” CDC, 21 Sept. 2021, www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html.

2. Martin, C.R. et al. “Review of infant feeding: Key features of breast milk and infant formula.” Nutrients, vol. 8, no. 5, 2016, pp. 279.

3. Al Ketbi, M.I, et al. “Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates.” International Breastfeeding Journal, vol. 13, 2018, pp. 26–28.

4. World Health Organization. “Exclusive Breastfeeding.” WHO, 14 Sept. 2022, www.who.int/elena/titles/exclusive_breastfeeding/en/.

5. Vijayalakshmi, P. et al. “Knowledge, attitudes, and breastfeeding practices of postnatal mothers: a cross-sectional survey.” International Journal of Health Sciences (Qassim), vol. 9, no. 4, 2015, pp. 364–374.

6. Gupta, Arun. “BPNI: 10 years of its work.” Journal of the Indian Medical Association, vol. 100, 2002, pp. 512–15.

7. Magawa, R. “Knowledge, attitudes and practices regarding exclusive breastfeeding in southern Africa—Part 2.” Consultancy Africa Intelligence, 2012, www.consultancyafrica.com. Accessed 12 Sept. 2022.

8. Sai Sunil Kishore, M. et al. “Breastfeeding knowledge and practices amongst mothers in a rural population of north India: A community-based study.” Journal of Tropical Pediatrics, vol. 55, no. 3, 2009, pp. 183–188.

9. Dukuzumuremyi, J.P.C. et al. “Knowledge, attitude, and practice of exclusive breastfeeding among mothers in east Africa: A systematic review.” International Breastfeeding Journal, vol. 15, 2020, pp. 70.

10. “Knowledge and importance of exclusive breastfeeding.” Nursing Answers, 13 Sept. 2022, nursinganswers.net/essays/knowledge-and-importance-of-exclusive-breastfeeding-health-essay.php.

11. Indian Medical Association. Operational Guidelines of IYCF, 15 Sept. 2022, ima-india.org/windata/Operational-Guidelines.pdf.

12. Stuebe, Alison. “The Risks of Not Breastfeeding for Mothers and Infants.” Reviews in Obstetrics and Gynecology, vol. 2, no. 4, 2009, pp. 222–231.

13. Breastfeeding Promotion Network of India (BPNI). “Breastfeeding in the 21st century: Epidemiology, mechanisms.” 16 Sept. 2022, www.bpni.org/Article/Breastfeeding-in-the-21st-century-epidemiology-mechanisms.pdf.

14. NFHS-5 Himachal Pradesh. “Fact sheet.” IM4Change, 19 Sept. 2022, www.im4change.org/docs/Himachal%20Pradesh%20NFHS-5%20Factsheet.pdf.

15. World Health Organization. “Global nutrition targets 2025: Extension to 2030.” WHO, 17 Sept. 2022, www.who.int/nutrition/global-target-2025/discussion-paper-extension-targets-2030.pdf.

16. UNICEF. State of the World's Children 2019, 17 Sept. 2022, www.unicef.org/media/60806/file/SOWC-2019.pdf.