Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, and the Conceptual Frameworks
2.2. Study Setting and Population
2.3. Data Collection, Tools, and Procedure
2.4. Data Management and Analysis
2.5. Ethical Considerations
3. Results
3.1. Sociodemographic Status and Obstetric History
3.2. Characteristics of Children
3.3. Emergent Themes
3.3.1. Child and Maternal Benefits of BF
- ▪
- BF promotes child growth and development.
“I could even see that when the child was put on the weighing scale, the child was picking up weight because I checked the clinic card. Whenever I bring the child up for weighing, I would look at it each month and could see increases at that time I was only breastfeeding that one. I could see that the child is growing)”.(FGD 3, Participant 4)
“Breastfeeding is important, it make the child to grow well, be healthy, and to have a good weight”.(IDI. Participant 3)
- ▪
- BF offers protection against childhood illnesses
“I can say that most mothers breastfeed their children because breastfeeding children don’t get sick often, they grow well, actually they only come to the clinic for weight monitoring and not because the child is sick”.(IDI, Participant 7)
The practice of breastfeeding is good, because it protects the infants from illness..., and yes breastfeeding is good”.(FGD 2, Participant 1)
“Ok, with this breast milk, my child did not have this funny diarrhoea. She was ok and all that, but the minute she stopped breast milk and when I gave her formula, she had diarrhoea”.(IDI, Participant 5)
- ▪
- BF promotes mother-baby bonding
“I had that thing that I want my child and I to bond and that she can feel that I am her mother, so when I put her on the breast, she could feel that I am her mother”. I enjoyed breastfeeding, it pained me that I had to stop you see, I enjoy that there is this connection we have, when I breastfeed my child, it is just nice, like looking at the child while breastfeeding it’s just yes, it is nice”.(IDI, Participant 9)
“I am happy about breastfeeding my child because even the child looks at, touches me, and knows that this one is my mother. She/he feels the love from me because during breastfeeding I brush the child”.(IDI, Participant 2)
“It is not something that you are forced to do; it is out of love of it, yes. I think it creates a bond between you and the child when you breastfeed”.(IDI, Participant 8)
“I just feel that breastfeeding is important, it is important it keeps the bond between the mother and the child, and your child will be depending on the mother….(IDI, Participant 10)
- ▪
- BF is economical and convenient
“If you are not working like me, you won’t be stressing out about milk formula running out after two months or two weeks that you don’t have the money to buy it and all that there won’t be that”.(IDI, Participant 6)
- ▪
- BF promotes maternal mental wellbeing
“I was happy that I could communicate with the child, we would look at each other in the eyes during breastfeeding, I could see that that child is all good and not sick, it means it is nice to breastfeed”.(IDI, Participant 7)
“I feel happy always, because breastfeeding is in my blood, I love it, I enjoy it, I feel really good about it even when I am breastfeeding my mind is just free, I am not thinking of problems, my concentration would be on the child”.(IDI, Participant 6)
- ▪
- Child spacing
“Breastfeeding can delay the next pregnancy”.(IDI, Participant 9)
3.3.2. Fears and Distress of the Effect of EBF
- ▪
- Fears of harming the baby.
“I did not trust what the nurses said. Nurses said the child would not be infected because they have educated us that HIV can be transmitted through blood. I stopped breastfeeding because I was scared that the child would be infected with HIV”. She further said “I stopped breastfeeding the child because I was scared, my breast was cracked, it looked like it was cut, like blood was coming out.(IDI, Participant 9)
- ▪
- Belief that the baby is not getting enough milk.
“Breast milk is water and water does not satisfy…, it is just that it is coloured, and is milk. Alone it will never satisfy the baby. You will always need to also feed the child solid food on a side.”(FGD 1, Participant 2)
“Because these children do not get satisfied with breast milk and the more the child cries the more you become stressed and when you are stressed yet on the other hand you are breastfeeding, you just end up causing the child some tension”, said one mother.(IDI, Participant 4)
Another mother said, “At home, my mother decided that it was better that I give my child food so that we can see whether he is crying or if the baby wanted food”.(FGD 3, Participant 5)
- ▪
- Fears of effect of EBF on body image.
“What I can say is that I won’t breast pump again because I think it’s making my breasts to sag, because breast pumping every day is like breastfeeding, you do know right that when women breastfeed, the breasts sag, on top of that you still breast pump”.(FGD 3, Participant 4)
Another mother said, “My breasts are no longer the same size, I breastfeed on only one breast and my body shape is no longer the same”.(FGD 1, Participant 3)
“It was not comfortable, losing weight and looking thin. But due to exclusive breastfeeding a person looks at you as if you are sick with HIV”.(IDI, Participant 11)
“Isn’t it that some boyfriends do not like breastfeeding mothers. Let us say maybe he says let us meet and you then come with your leaking breast, they do not like that, some do not like that, some would even end the relationship because of that”.(IDI, Participant 7)
3.3.3. Cultural Beliefs Influencing EBF
- ▪
- Personal beliefs.
“I think it is a personal decision to decide whether it is good to give breast milk only or if you want to give both.” (IDI, Participant 11). Another one said, “I think it’s a belief thing…, older people believe in cultural practices…, it is a belief thing, because they believe that when you breastfeed and give solids food at the same time, the child would be well, healthy, and grow well”.(FGD 3, Participant 6)
- ▪
- Cultural and societal norms
One mother said, “As for me yes I choose to breastfeed because my mother breastfed me, so I just want to follow the way of the breast and breastfeed my child”.(IDI, Participant 10)
- ▪
- BF in public spaces
“No, I do not have a problem because I cover my breast. They have taught us that each time when you are breastfeeding you must cover the breast because the breast must be respected; yes, the public must not see your breast, so I do cover up”(IDI, Participant 6)
“There was a time I breastfed my baby in a train, the baby pressed and squeezed breast milk and it spread out to the other guy, some people would not like it. Many people will not enjoy watching our sagged breasts, some say it is disgusting, so I think having a private room where you can breastfeed your baby is nice”.(IDI, Participant 10)
“At home we don’t have those beliefs that maybe you don’t breastfeed the child in front of a man, or you don’t take out the breast, things like that, isn’t it that when I breastfeed her, I can take a blanket to cover”.(IDI, Participant 5)
- ▪
- Traditional beliefs influencing EBF.
One mother said, “just after I was discharged from the hospital maybe after two weeks of discharge when the child cried too much and would not stop crying, I took the child to the healer who made a cut [razor cuts on ibala, birth mark] and then gave me imbiza [traditional medicine] for the child to drink”.(IDI, Participant 9)
“When the child is passing out loose stools, they call it inyoni, so they make razor cut around the umbilicus and put the traditional medicine and also the child is given traditional medicine to drink”.(FGD 2, Participant 3)
“I don’t give anything traditional; I give only Western medicine for such things as in case the child might absorb the bad spirits, I use the Western ones like stapes drupels you see” (IDI, Participant 6). The other mother said, “As for us at home, we don’t use cultural medicine, so actually when you get a baby, you must just breastfeed, otherwise you just buy medicines like Phillips Gripe water, if the baby is having a troubled tummy, Bascopan, you give those”.(FGD 1, Participant 4)
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Categories/Mean ± SD | n | % |
---|---|---|---|
Age | 27 ± 6 | ||
≤30 years | 21 | 70 | |
>30 years | 9 | 30 | |
Marital status | Single | 25 | 83 |
Married | 2 | 7 | |
Cohabiting | 3 | 10 | |
Education level | Primary | 10 | 33 |
Completed 12th Grade | 18 | 60 | |
Tertiary | 2 | 7 | |
Employment status | Employed | 8 | 27 |
Unemployed | 22 | 73 | |
Household family income/month | <R2000 ($122.92) | 21 | 70 |
R2001–R5000 ($123.16–307.70) | 8 | 27 | |
>R5000 ($307.70) | 1 | 3 | |
Pregnancy planned | No | 20 | 67 |
Yes | 10 | 33 | |
Attended ANC | No | 4 | 13 |
Yes | 26 | 87 | |
Time attended ANC | ≤3 months | 14 | 47 |
>3 months | 12 | 40 | |
Never attended | 4 | 13 | |
Maternal HIV status | Positive | 12 | 40 |
Negative | 18 | 60 | |
Delivery mode | Normal | 21 | 70 |
Caesarean section | 9 | 30 | |
Number of pregnancies | 1 | 6 | 20 |
2 | 9 | 30 | |
≥3 | 15 | 50 | |
Parity | 1 | 8 | 27 |
2 | 8 | 27 | |
≥3 | 14 | 46 |
Variables | Categories/Mean ± SD | n | % |
---|---|---|---|
Child sex | 9 ± 7 | ||
Boy | 20 | 67 | |
Girl | 10 | 33 | |
Child age | <1 year | 21 | 70 |
>1 year | 9 | 30 | |
Childbirth order | Last | 23 | 77 |
Only | 7 | 23 | |
Child HIV status | Negative | 30 | 100 |
Positive | 0 | 0 |
Main Themes | Sub Themes |
---|---|
Child and maternal benefits of BF | BF promotes child growth and development |
BF offers protection against illness | |
BF promotes mother-baby bonding | |
BF is economical and convenient | |
BF promotes maternal mental wellbeing | |
Child spacing | |
Fears and distress of the effect of EBF | Fear of harming the baby |
Belief that the baby is not getting enough milk | |
Fear of the effect of EBF on body image | |
Cultural beliefs influencing EBF | Personal practice |
Cultural and societal norms | |
BF in public spaces | |
Traditional beliefs |
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Modjadji, P.; Seabela, E.S.; Ntuli, B.; Madiba, S. Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa. Int. J. Environ. Res. Public Health 2023, 20, 1513. https://doi.org/10.3390/ijerph20021513
Modjadji P, Seabela ES, Ntuli B, Madiba S. Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa. International Journal of Environmental Research and Public Health. 2023; 20(2):1513. https://doi.org/10.3390/ijerph20021513
Chicago/Turabian StyleModjadji, Perpetua, Ethel Sekori Seabela, Busisiwe Ntuli, and Sphiwe Madiba. 2023. "Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa" International Journal of Environmental Research and Public Health 20, no. 2: 1513. https://doi.org/10.3390/ijerph20021513