Breastfeeding provides unmatched health benefits for babies and mothers. It is the clinical gold standard for infant feeding and nutrition, with breast milk uniquely tailored to meet the health needs of a growing baby [1].

Exclusive breastfeeding is defined as the act of feeding the infant only breast milk, with no supplemental liquids or solids except for liquid medicine or vitamin/mineral supplements. During the first 6 months of life, breast milk alone is the ideal nourishment for infants, providing all the necessary nutrients, including vitamins and minerals. To achieve optimal growth, development and health, WHO recommends that for the first six months of age, infants should be exclusively breastfed [2-4].

Poor practices and attitudes toward breastfeeding have been reported to be among the major reasons for poor health outcomes among children, particularly in developing countries. Nonetheless, the promotion and acceptance of practices, such as exclusive breastfeeding, are especially important in developing countries with high levels of poverty and that are characterized by a high burden of disease and low access to clean water and adequate sanitation [5-7]. 

Breastfeeding is considered to be a traditional practice in India and it is believed that it comes ‘naturally’ to Indian mothers. The factors that influence initiation, maintenance and duration of breastfeeding are social and cultural traditions, infant maturity at birth, degree of commitment and literacy of the mother and level of modernity [8].

In spite of convincing evidence of the benefits of breastfeeding, breast feeding rates are less than satisfactory, thus pinpointing large gaps, which need to be identified and addressed. While, a number of studies have assessed knowledge of breastfeeding in different parts of the India; such studies are limited among postnatal mothers in rural areas of District Sirmaur.       

Thus the present study was developed to examine the knowledge towards breast feeding among postnatal mothers of rural areas of District Sirmaur.

Objectives of The Study

To evaluate the knowledge towards breast feeding among postnatal mothers of rural areas of District Sirmaur.

• Research Approach: Descriptive

• Research Design: Hospital based cross-sectional survey design

• Setting of the Study: Pediatric OPD in civil hospital Dadahu

• Study Duration: Between March 2021- August 2021 

• Study Population: Post Natal Mothers came to Pediatric OPD and having children aged less than one year 

• Sample Size: 400 Post Natal Mothers assuming 50% mothers have adequate knowledge regarding Breast feeding, 5% absolute error, 95% confidence level and 5% non-response rate

• Sampling Technique: Convenience Sampling technique

• Sampling Criteria: First five post-natal mothers who came to Pediatric OPD and having children aged less than one year were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria: Post-natal mothers who were willing to participate in the study

• Exclusion Criteria: Post-natal mothers who were not willing to participate in the study

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Checkup and many more

• Questionnaire: The questionnaire contains 20 structured 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 by under the guidance of supervisors and Post-natal mothers were given 30 minutes’ time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage

Present study was developed to evaluate the knowledge towards breast feeding among postnatal mothers of rural areas of District Sirmaur. 

A total of 400 Post Natal Mothers Post Natal Mothers came to Pediatric OPD and having children aged less than one year were selected after explaining the purpose of the study. Among the total mothers, maximum 210 (52.5%) were having age between 26-30 years, educated up to Matric and Senior Secondary 158 (39.5%), Hindu 323 (80.75%), housewife 372 (93%), Multigravida 276 (69%) and delivered in government hospitals 272 (68%) (Table 1).

Table 1: Socio Demographic Characteristics of the Participants

In the present study 12.5% (50) postnatal mothers had very good knowledge (16-20 marks) towards breast feeding, 67.5% (270) having good knowledge (12-15 marks), 17.5% (70) having fair knowledge (8-11 marks) and 2.5% (10) having poor knowledge (<8 marks) (Table 2,3).

Table 2: Responses of the Participants to Various Statements

Table 3: Knowledge towards Breast Feeding among Postnatal Mothers

Maximum = 20, Minimum = 7

Mothers’ good knowledge and positive attitude play key roles in the process of breastfeeding [9]. Breast feeding have multiple benefit to the mother and child but there is still postnatal mother that are not confident and not interest to breast feed their baby. This problem might be due to lack of knowledge on information sources regarding breastfeeding [10].

Therefore, the present study aimed at evaluating the knowledge regarding breastfeeding among post-natal women with children less than one year of age. To our best knowledge, this was the first study in this area of District Sirmaur. Although, the present study demonstrated good knowledge among mothers 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].

Breastfeeding has both short-term and major long-term effects on the health, nutrition and development of the child as well as mother’s health. Appropriate breastfeeding practices prevent child mortality and morbidity from diarrhea, respiratory and other infections, otitis media, necrotizing enterocolitis and Sudden Infant Death Syndrome (SIDS). The maternal benefit of breastfeeding in birth spacing by promoting lactational amenorrhea and reduction in breast and ovarian cancer has also been well established [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 breast feeding in district Sirmaur showed that there was increase in breastfeeding within one hour of birth from 52.1% to 67.9%. Also there was rise in exclusive breast feeding rate from 60.4% to 75.9 %. (Table 4) [14].

Table 4: NFHS Data on Breast Feeding in District Sirmaur

Optimal breastfeeding practices are potentially one of the top interventions for reducing under-five mortality and are essential for the achievement of many of the newly launched Sustainable Development Goals by 2030, as it can help to improve child and maternal health, nutrition, economy, intelligence and human capital, while reducing inequalities. Suboptimal breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0.49% of the world gross national income [15,16].

The finding of present study indicates that post-natal mothers should be made aware about the importance of breastfeeding practices.

Limitations

The present study has certain limitations such as cross sectional in nature, all the participants were at postpartum having children aged less than one year and small sample size that made difficult to generalize the findings. Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote breast feeding among postnatal mothers.

However, despite of these limitations, the present study findings may be helpful to the health professionals and policy makers in designing the interventions to promote breast feeding practices.

The present study concludes that the mothers have a good knowledge toward breast feeding but still there was room for improvement as there is a significant gap in the breastfeeding knowledge. Breastfeeding can be strengthened further through various community programmes. We also recommend strengthening the public health Information, Education and Communication (IEC) campaigns to promote breast feeding.

Healthcare providers should provide breastfeeding education to all women during their antenatal follow-up visits, especially women with low educational qualifications and no past breastfeeding experience. Solutions should be provided to overcome the barriers to breastfeeding, especially for working mothers.

1. Center for Disease Control and Prevention. “Why breastfeeding matters.” CDC, September 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, May 2016, article 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, July 2018, article 26.

4. World Health Organization. “Exclusive breastfeeding.” WHO, September 2021, 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, vol. 9, no. 4, October 2015, pp. 364–374.

6. Gupta, A. “BPNI: 10 years of its work.” Journal of the Indian Medical Association, vol. 100, 2002, pp. 512–515.

7. Magawa, R. “Knowledge, Attitudes and practices regarding exclusive breastfeeding in southern Africa part 2.” Consultancy Africa, 2012, www.consultancyafrica.com.

8. Kishore, M.S. 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, June 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, article 70.

10. NursingAnswers. “Knowledge and importance of exclusive breastfeeding.” NursingAnswers, September 2021, nursinganswers.net/essays/knowledge-and-importance-of-exclusive-breastfeeding-health-essay.php.

11. Indian Medical Association. Operational Guidelines of Infant and Young Child Feeding (IYCF). September 2021, ima-india.org/windata/Operational-Guidelines.pdf.

12. Stuebe, A. “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. “Breastfeeding in the 21st century.” BPNI, September 2021, www.bpni.org/Article/Breastfeeding-in-the-21st-century-epidemiology-mechanisms.pdf.

14. National Family Health Survey-5. NFHS-5 Factsheet: Sirmaur. September 2021, rchiips.org/NFHS/NFHS-5_FCTS/HP/Sirmaur.pdf.

15. World Health Organization. Global Nutrition Targets 2025: Discussion Paper on Extension to 2030. September 2021, www.who.int/nutrition/global-target-2025/discussion-paper-extension-targets-2030.pdf.

16. UNICEF. The State of the World’s Children 2019. September 2021, www.unicef.org/media/60806/file/SOWC-2019.pdf.