Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa

Abstract

BackgroundExclusive breastfeeding (EBF) for the first six months of life is the most important determinant of child health and development, and is the recommended feeding practice for all mothers. However, EBF rates remain low in South Africa. This study aimed to prospectively explore enablers or barriers to success among mothers who planned to exclusively breastfeed their infants for the first six months of life, in KwaZulu-Natal, South Africa.MethodsA qualitative, longitudinal cohort design was adopted. Women were recruited during pregnancy from the catchment area of two hospitals (one urban and one rural) and purposively sampled to include working women, teenagers, and HIV positive pregnant women. This analysis relates to 22 women, from 30 women recruited, who planned antenatally to exclusively breastfeed for six months. These mothers were interviewed monthly for six months postpartum. Infant feeding practices were explored at each visit using in-depth interviews and 24 h feeding recall assessment. Framework analysis was conducted for qualitative data, and quantitative data analyzed using descriptive statistics.ResultsA total of 125 interviews were conducted between November 2015 and October 2016. Among 22 mothers who planned to exclusively breastfeed for six months, 17 reported adding other food or fluids before six months, and five reported exclusively breastfeeding successfully for the first six months. Key themes showed that all mothers relied strongly on health workers’ infant feeding advice and support. All mothers experienced challenges regardless of whether they succeeded in EBF, including inappropriate advice from health workers, maternal-baby issues, pressure from family members and returning to school and work. However, those who were successful at EBF for six months reported that high breastfeeding self-efficacy, HIV status and cultural meaning attached to breastfeeding were underlying factors for success.ConclusionHealth workers are key players in providing infant feeding information and support, yet some health workers give mothers infant feeding advice that is not supportive of EBF. Strategies to improve health workers’ competency in infant feeding counselling are needed to better prepare pregnant women to overcome common breastfeeding challenges and build mothers’ confidence and self-efficacy, thus increasing EBF rates.Electronic supplementary materialThe online version of this article (10.1186/s13006-017-0135-8) contains supplementary material, which is available to authorized users.

Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa

“…Support provided by health workers and community health workers has a huge role to play [44], and can effectively improve breastfeeding practices [1]. Our findings support other studies which show that breastfeeding challenges, including breast conditions and perceived insufficient milk, were among the important reasons for stopping breastfeeding [12,[44][45][46].…”

Exclusive breastfeeding in first-time mothers in rural Kenya: a longitudinal observational study of feeding patterns in the first six months of life

“…Apart from two reported instances where nurses advised mothers to use gripe water we did not find health workers' advice to counter the message for exclusive breastfeeding, however the existence of a prolonged nurses' strike during the data collection period reduced opportunities for consultation. This differs from a study in South Africa where nurses were reported to give prelacteal feeds in facilities and offer inappropriate feeding advice [27].…”

Breast Feeding among Mothers Attending Immunization Clinic at Health Centresin Rivers State Nigeria: An Institutional-based Survey

“…In contrast, bad odour of breastmilk and fear of the evil eye while breastfeeding were reported as reasons for not breastfeeding in a Tanzanian study [11]. Also, Jama et al [12] reported inappropriate advice from healthcare workers and pressure from family members as the leading reasons for not breastfeeding among mothers in a South African study. The reasons reported in our study are thus potential areas for intervention and support for breastfeeding mothers in order to promote the practice of exclusive breastfeeding.…”

“…Studies done in Nigeria identified breastfeeding not being satisfying to babies, cultural beliefs, poor spousal, family and work place support, need to return to work, maternal health problems and need for a baby to learn to eat other foods as leading barriers to breastfeeding among the mothers studied [8][9][10]. In other parts of the world, additional barriers to breastfeeding identified include breastfeeding affects mothers appearance, fear of the evil eye while breastfeeding and inappropriate advice from health care workers [11,12].…”