Title: Early Initiation of Breastfeeding in Ghana: Barriers and Facilitators Charlotte Tawiah-Agyemang1, Zelee Hill2, Alessandra Bazzano2, Karen Edmond1, 2, Betty Kirkwood2 1 Kintampo Health Research Centre, Ghana. 2 London School of Hygiene and Tropical
1Early Initiation of Breastfeeding in Ghana
Barriers and Facilitators Charlotte
Tawiah-Agyemang1, Zelee Hill2, Alessandra
Bazzano2, Karen Edmond1, 2, Betty Kirkwood2 1
Kintampo Health Research Centre, Ghana. 2 London
School of Hygiene and Tropical Medicine
- 1. Introduction
- There has been little change in neonatal
mortality in developing countries1,2 and feasible
home-based interventions are urgently needed. - A recent Ghanaian study found 30 of infants did
not initiate breastfeeding on the day of birth
and that these infants had a 2 times higher risk
of neonatal death than those who initiated on day
one3. - Programs targeting early infant feeding could
have a significant impact on neonatal mortality
but designing effective interventions requires
understanding the barriers and facilitators for
early breastfeeding.
3. Sample Characteristics
References 1. Lawn J. Cousens S, Zupan J. 4
million neonatal deaths When? Where? Why? Lancet
2005 Published online Mar 3 2005. 2. Save the
children. State of the world's newborns 2001. A
report from Saving Newborn Lives. Washington DC
Save The Children, 20011-49 3.Karen M Edmond,
Charles Zandoh, Maria A Quigley,
SeebaAmenga-Etego, Seth Owusu-Agyei, Betty R
Kirkwood. Paper in press in Pediatrics Delayed
breastfeeding initiation increases risk of
neonatal mortality.
- 4. Results
- 15/21 women who initiated late reported that they
did not have enough breast milk (see box 1)
saying that there was no point, or that it was
unfair, to give a child an empty breast. - Beliefs about first milk were mixed. A belief
that it was harmful sometimes resulted in delayed
feeding as women waited for the good milk to
come, however, some women squeezed the milk out
and fed on day one. - Other reasons for late initiation were that the
baby did not cry (indicating it was not hungry)
or because the mother or baby needed rest after a
long or difficult birth - Babies who were breastfed on day two were given
nothing at all or water and those breastfed
later, a variety of liquids including water,
evaporated milk, bead or shea butter dissolved
in water, coconut water or Milo (malted chocolate
drink). - Advice was an important reason for early
initiation and was most often given at a health
facility by the midwife. This is reflected by the
fact that only 3/21 women who initiated late gave
birth at a health facility compared with
18/31women who initiated early. - Advice on initiation was occasionally given at
ANC (attended by all but two women) or by family
and friends. This was usually to first time
mothers. - Some women (mostly from the Bono tribes) had
beliefs that encouraged early initiation such as
giving the baby the breast to pull to encourage
milk to come.
Study area
- I dont give the first breast milk to the baby.
I gave the breast milk to the baby the next day
after birth when the first milk has mixed with
the second breast milk. - I start feeding when the baby begins to cry.
- It took a long time for me to push the baby out
and the child was weak and slept the whole day. - The nurse brought me the baby and told me to
start breastfeeding, I wanted to have some rest
but she insistedthere was no milk as I could not
feel anything coming out when the baby was
sucking. I told the nurse but she said I should
put it in its mouth and through that the milk
will come - I didnt get any advice because I was old enough
to know what to do with my baby. - There is no breast milk but you have to give the
breast to him to suck the red one and the proper
one will come.
- 2. The study
- Aim Explore why women initiate breastfeeding
early or late, who gives advice about initiation
and what food or fluids are given when initiation
is late. - Study site Kintampo district is predominantly
rural, with little electrification, one hospital
and seven health posts. The district is part of
the ObaapaVitA Vitamin A and maternal mortality
trial area. - Data Collection
- Women who had given birth in the last two months
were identified from the ObaapaVitA surveillance
system. - Qualitative case histories were collected from 52
women selected to capture a range of initiation
timing and factors associated with timing. - Information collected included a description of
when, what and why infants were first fed and
where women got advice about feeding. - Fieldnotes were taken during the interview and
converted to fairnotes manual coding and content
analysis was then conducted. -
Box 1 What does not having enough milk mean?
No milk at all I didnt give breast milk
because there was none in my breast- I squeezed
and realized that nothing at all was coming out
The breast was flat and nothing came out of
it No milk sometimes means no white milk I
had no milk in my breast I squeezed and nothing
came out when probed about first milk, I did
have a little red milk at birth but I squeezed it
out because it isnt good for the child The
breast milk was coming but it wasnt thick and
the breast was very light
- 5. Conclusions/implications
- Having no, or the wrong kind of milk, is the main
reason breastfeeding was not initiated within the
first day of life. - Women are willing to change their initiation
behaviour if given advice and some women have
beliefs that facilitate early initiation. - Currently advice is mainly provided by midwives
at the time of birth, but many women deliver at
home and do not receive any advice. Most women
attended antenatal clinics during pregnancy,
which may offer a good educational channel.