Background Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding. Conclusion EBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs.
Objectives Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020 (1) with the support of public health system. But, deviating attention of health services towards emergency pandemic situation has resulted in strained health systems and interruptions in humanitarian response leading to eroding access to essential and often life-saving nutrition services. Therefore, optimal breast feeding practices are at risk due to infected mothers’ isolation practices, exhausted public health system and misbeliefs among the community (2). This finds out how Sri Lanka plans to maintain high standards of breast feeding in pandemic situation. Methods We searched for the publications on breast feeding, Sri Lanka in pandemic situation from January 2020 to date. Results As a low and middle income country with an unbeatable public health system, Sri Lanka has already issued an interim guideline for public health staff in continuation maternal and child care services (3). It ensures domiciliary visits by public health midwives (PHMs), although the clinic based teaching sessions on breast feeding have been cancelled. Community awareness has been created that no evidence of transmission of SARS COV-2 via breast milk is available and how the benefits of breast feeding outweigh the risk of infection (4). It is recommended that breast feeding shouldn't be interrupted at all and hand hygienic practices before touching the baby are ideal. Infected mothers can wear a protective mask and rooming in, and kangaroo mother care should be practiced. Sri Lanka already had guidelines on ensuring adequate and appropriate infant feeding guidelines in emergency situations (5). Conclusions Despite the challenges faced by community and public health staff, Sri Lanka make efforts to maintain the achieved breast feeding standards. Further studies are needed to assess the impact of the pandemic on breast feeding practices in near future. Funding Sources None
Objectives The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community. Methods We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints. Results Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement. Conclusions The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF. Funding Sources No funding source.
Objectives Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. Our objective was to explore the maternal perceptions of unrevealed barriers for the provision of promotion, protection and support of optimal exclusive breast feeding (EBF) up to six months. Methods We used in-depth interviews with 16 mothers with infants completed six months, who had been unable to practice EBF, attending six child-welfare clinics in Anuradhapura, Sri Lanka. Initial thematic analysis built upon force field and social learning theories were conducted to identify the barriers for optimal EBF practices during the first six months life. Results Main challenges to EBF were notably clustered at three occasions over the six months and first during the first 2–3 days after the delivery. Factors related to child birth influencing self-efficacy and confidence on establishing breastfeeding included cesarean section, pain and poor positioning due to pain, exhaustion, and perceived “inadequate milk”. Suboptimal policies on ward environment and practice of health staff that could lead to maternal worry and maternal stress related to demand for EBF were also identified as key barriers. Despite the early challenges, mothers who interrupted EBF within the first few days, desired to go back to EBF and was able to do so. The second occasion of cessation of EBF occurred around 2–3 weeks postpartum by introducing water or infant formula. These mothers lacked family support for BF leading to physical and mental exhaustion. Additionally, the mother's perception that “healthy infants should be chubby” also led to introduction of infant formula. On-demand feeding was reported to be a challenge due to misconceptions such as feeding according to a time table. Working mother reported ending EBF between 4 and 5 months, and they lacked self-efficacy, resulting from the lack of enabling environments and social support to express and continue only breast milk. Conclusions Although Sri Lanka has attained the “green” breastfeeding top status, interventions are needed to better the support the BF needs of mothers after cesarean section and to practice on-demand feeding and to improve the support for mothers that are employed in order to optimize EBF until completion of six months. Funding Sources No funding source.
Background Sri Lanka was named as the first-ever 'Green' breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, capacity exists for improvement. This study aims to identify barriers and facilitators for early initiation of breastfeeding (EI) and exclusive BF (EBF) for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice EI and/or EBF, in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2-3 days, 2-3rd week, and 4-5 months post-partum. Early barriers included cesarean section pain, poor latch, maternal exhaustion, Suboptimal maternity ward environment, lack of support for BF led to maternal stress. Around 2-3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was poorly practiced. Around 4 and 5 months EBF ended due to return to work. PHMs reported heavy workload impede support for BF. Conclusion Interruption of EBF are due to specific barriers corresponding to specific periods within first six months. Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, better postnatal ward facilities, demand feeding, support for working mothers and reducing the work load of PHMs in order to optimize EBF.
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