Breastfeeding practices among Syrian refugees in Turkey

Abstract

Background We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian’s infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study. Methods The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11. Results Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as “believing that breastfeeding harms mother’s health”, “adolescent marriages”, “wanting to have as many children as possible”, “giving anise to infants and not breastfeeding at night”, “prelacteal feeding”, “believing that milk is not enough”, “over controlling mother–child interaction by grandmothers, which limits the interaction”, “short pregnancy intervals”, and “not using modern family planning techniques”. We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics. Conclusions Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important.

Supporting Factors and Barriers Related to Early Initiation of Breastfeeding and Exclusive Breastfeeding among Infants of Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study

“…Others believed that introducing food early would lead to a chubby baby, as a sign of good health [60]. Similar traditions were also documented among Syrian refugees in Turkey [59], Lebanon [20], and Germany [60] as well as refugees in Algeria [47] and displaced persons in eastern Ukraine [46].…”

“…It appears that mothers in our study did not view pre-lacteal feedings, consumption of water or herbal tea, and early introduction of foods as a barrier to exclusive breastfeeding. Syrian refugees in Turkey and Jordan as well as Sahrawi refugees in Algeria practiced similar customs [45,47,59]. For instance, sugary water was believed to cleanse the intestines and prevent jaundice by most parents and family members in Syria [59].…”

“…Syrian refugees in Turkey and Jordan as well as Sahrawi refugees in Algeria practiced similar customs [45,47,59]. For instance, sugary water was believed to cleanse the intestines and prevent jaundice by most parents and family members in Syria [59]. Other common beliefs were observed among internally displaced persons in eastern Ukraine, such as giving infants water when the mother felt thirty while it was warm outside [46].…”

“…This suggests that mothers facing increased economic vulnerabilities would be more inclined to initiate breastfeeding early as breast milk is known to be more cost-effective. In addition, Syrian refugees in Turkey and Lebanon stated that breast milk is "free", "less costly and more natural" [51,59]. However, it was also mentioned by the mothers that insufficient maternal nutrition and poor health were major reasons to halt breastfeeding prematurely.…”

“…Among Syrian refugees in Greater Beirut, Lebanon, lactating mothers were found to have higher proportions of nutritional inadequacies and 19.4% of them suffered from anemia [17]. In addition, Syrian refugees in Turkey reported that malnutrition and fatigue of mothers were often the biggest obstacles to breastfeeding [59]. These findings shed the light on the role of adequate maternal nutrition during pregnancy and lactation as it impacts the development and health of the offspring [75,76], which was particularly difficult to achieve among Syrian refugee mothers in Greater Beirut, Lebanon [17,18].…”