Protecting both infant and mother: perceptions of infant feeding practices in rural Haiti

Abstract

Background Global recommendations for optimal breastfeeding include early initiation, exclusivity for six months, and continued breastfeeding for two years and beyond. Although breastfeeding is near universal in Haiti, gaps in optimal practices persist. Determinants of breastfeeding practices are complex, and a contextualized understanding is needed to strengthen breastfeeding support interventions. We conducted a qualitative study to explore mothers’ perceptions of factors influencing breastfeeding practices in rural Haiti. Methods Focus group discussions were held in eight rural communes participating in a nutrition project. Study participants (n=86) were recruited from mothers’ support groups. A moderator facilitated the focus groups in Haitian Creole using a question guide to elicit observations about community breastfeeding practices related to early initiation, colostrum feeding, complementary foods and beverages, and breastfeeding cessation. Focus groups were recorded, and three observers took notes which were compiled into a single report of key points and validated by participants following each session. Quotes representing the key points were selected from the audio recordings, translated into English and analyzed to identify explanatory themes. Results Participants described breastfeeding for 12-18 months as the norm in study areas, with early and frequent use of additional foods and beverages. Three explanatory themes were identified, related to concerns for (i) infant well-being, including digestive health, nutritional needs and contentment; (ii) transmission of negative maternal emotional and physical states through breast milk; and (iii) maternal well-being, including effects on breastfeeding practices of maternal illness, hunger, stress, and competing time pressures. Underlying all these concerns is the context of rural poverty and the cultural meanings of breastfeeding. Conclusions Findings suggest that practices which compromise global breastfeeding recommendations may persist because of their perceived value in addressing concerns for infant and maternal well-being in the challenging context of rural poverty, food insecurity and poor health. Multi-sectoral interventions are needed to mitigate these underlying contributors and create an enabling environment for early, exclusive and continued breastfeeding.

Determinants of continued breastfeeding in children aged 12–23 months in three regions of Haiti

“…The most commonly reported beliefs are that: (i) breast milk is no longer necessary for a well developed child aged 12-18 months; (ii) the nutritional quality of breast milk deteriorates with time which may lead to the formation of worms in the child; and (iii) it is necessary to stop breastfeeding when becoming pregnant again for fear of harming the fetus (29)(30)(31). These beliefs, which have been reported in our study region (12), also align with the findings that continued breastfeeding prevalence was significantly lower in children who had a younger sibling (13.0%) or whose mother was pregnant (15.5%).…”

“…This finding aligns with a meta-analysis of DHS data from 153 countries between 1995 and 2013, in which most national breastfeeding indicators were not strongly associated, with only a moderate correlation (Pearson r=0•54) between exclusive and continued breastfeeding at 1 year in low-and middle-income countries (6). As mentioned earlier, continued breastfeeding is an important part of tradition among Haitians (8); however, tradition can also be a barrier to optimal exclusive breastfeeding practices, with prelacteal feeds and early introduction of complementary foods being frequently reported (12,30). Therefore, the association between early introduction of complementary food and beverages and good continued breastfeeding practices is to be expected in our study population.…”

“…The A3PN project used a community mobilization approach to improve families' knowledge, attitudes, and practices related to breastfeeding, nutrition, hygiene, and gender equity, and to improve families' access to financial resources, food, and essential perinatal and health services. The activities included mothers' support groups, community presentations, collective kitchens, mobile health clinics, home visits, home gardening initiatives, and solidarity funds (11)(12)(13).…”