|Year : 2014 | Volume
| Issue : 2 | Page : 77-80
Determinants of initiation of breast feeding among lactating women in Sub-Himalayan region
Ankush Kaushal, Sunil Kumar Raina, Vishav Chander Sharma, Ashok Bhardwaj
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
|Date of Web Publication||18-Sep-2014|
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh - 176 001
Source of Support: None, Conflict of Interest: None
Introduction: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. Aim: To determine factors influencing early initiation of breastfeeding. Materials and Methods: The Multiple Indicator Cluster Survey (MICS) technique with 30 clusters proposed by the World Health Organization (WHO) was used for the purpose of this study. Results: All (100%) children, whose fathers were middle pass, were put on breast feed within one hour, where as only 66.6% of children of post graduate fathers were put on breast feed within one hour. Conclusions: Poor-feeding practices are present across all socioeconomic groups and there is no significant difference to suggest the importance of one single factor.
Keywords: Breast feeding, Determinants, Initiation, Sub-Himalayan
|How to cite this article:|
Kaushal A, Raina SK, Sharma VC, Bhardwaj A. Determinants of initiation of breast feeding among lactating women in Sub-Himalayan region. J Med Soc 2014;28:77-80
|How to cite this URL:|
Kaushal A, Raina SK, Sharma VC, Bhardwaj A. Determinants of initiation of breast feeding among lactating women in Sub-Himalayan region. J Med Soc [serial online] 2014 [cited 2022 May 27];28:77-80. Available from: https://www.jmedsoc.org/text.asp?2014/28/2/77/141082
| Introduction|| |
Breastfeeding has been going on since mammals existed on earth.  Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. Breastfeeding practices play an important role in reducing child mortality and morbidity.  It is evident that even the most sophisticated and carefully adapted feeding formulae can never replicate human milk, as human milk has anti-infective properties, and is a 'live' fluid, which cannot be mimicked in an artificial formula. An adequate supply of human breast milk is known to satisfy virtually all the nutritional needs of an infant at least for the first six months of life. Breast milk, and especially colostrums, in the long term, prevents atherosclerosis, hypertension, and obesity; it also prevents allergy to non-specific proteins and develops immunity. Breastfeeding has a vital child-spacing effect, which is especially important in developing countries where the awareness, acceptability and availability of modern family planning methods are very low. 
The beneficial effects of breastfeeding depend on breastfeeding initiation, its duration, and the age at which the breast-fed child is weaned. Breastfeeding practices vary among different regions and communities. In India, breastfeeding in rural areas appears to be shaped by the beliefs of a community, which are further influenced by social, cultural, and economic factors. 
The present study was conducted to find out breastfeeding practices and the pattern of breastfeeding in rural areas of District Kangra (Himachal Pradesh). The differential study included the type of family, income of family, education of parents, occupation of parents, delivery conducted by, place and type of delivery.
| Materials and Methods|| |
Kangra district is situated in the eastern part of the Himachal Pradesh. It is located within the 30 ° 22' 40" to 33 ° 12' 40" north latitude and 75 ° 45' 55" to 79 ° 04' 20" east longitude. Kangra district occupies an area of 5739 square kilometers.
The study was conducted in Shahpur block of Kangra district. Shahpur happens to be the rural training facility for undergraduate and internship program under department of community medicine of our college. The population of Shahpur is 1,38,362 as per 2001 census.  The study population consisted of mothers whose baby was less than one week of age. Around 4000 children spread across all villages of Shahpur and less than one week of age were considered eligible for inclusion in this study. Infants with specific feeding problems (cleft lip and palate), thus requiring infant formula or bottle feeding, were excluded from the study. The Multiple Indicator Cluster Surveys (MICSs) technique with 30 clusters proposed by the World Health Organization (WHO), is a standard method for rapid assessment of coverage evaluation.  The 30-cluster technique is a sampling design primarily used to estimate immunization coverage to within ±10 percentage points of the true proportion, with 95% confidence. Before the sampling begins, the population was divided into a complete set of non-overlapping subpopulations with a defined geographic (villages). These subpopulations are called clusters. After this, 30 of these clusters are sampled with probability proportionate to the size (PPS) of the population in the cluster. MICS are a survey program developed by the United Nations Children's Fund to provide internationally comparable, statistically rigorous data on the situation of children and women.  The first round of surveys (MICS1) were carried out in over 60 countries, in 1995, in response to the World Summit for Children. The MICS use a defined strategy for studying health-related indictors in different age groups. The questionnaire intended to capture indicators regarding under 5-year-old children is administered to mothers of children. It was this methodology that was used for the assessment of initiation of breastfeeding. The 30 clusters were selected on the basis of systematic random sampling from the probability of the cluster selection based on the population size of the cluster. To satisfy the objective of studying multiple indicators, among these, study of households in four different quadrants of the village with at least one children aged less than a week in each quadrant was also considered.
The study was conducted for duration of three months from 1 st June 2011 to 31 st August 2011. This was a cross-sectional analytical study.
Before conducting interview, verbal consent was obtained from them.
The data collected was entered into MS Excel spreadsheet 2007. Mean standard deviation and proportions were calculated using MS Excel.
| Results|| |
In our study, majority of husbands (68.57%) of the lactating mothers were educated up to 10 or 10 + 2 levels. All (100%) children whose fathers were middle pass were put on breast feed within one hour, whereas only 66.6% of children of post graduate fathers were put on breastfeed within one hour. In all, 55% children of 10 pass fathers and 36.9% of 10 + 2 pass fathers were initiated breastfeeding within one hour. Breastfeeding was delayed beyond 24 hours in 33.3% children of postgraduate fathers and 15.47% of 10 + 2 fathers and 15% children of 10 pass fathers. No delay was seen in children, whom fathers were primary or middle pass.
There were 3.33% mothers, who were educated up to primary standard. Out of these mothers, 57.14% of mothers initiated breastfeeding within one hour and other 42.8% within one to four hours. In 2.85% postgraduate mothers, 50% mothers initiated breastfeeding within one hour. [Table 1] But, other 50% delayed beyond 24 hours of delivery. Majority of mothers (40%) were educated up to 10th, in which 59.5% initiated breastfeeding within one hour and 15.4% with one to four hours after delivery. There was also delay of more than 24 hours in 7.14% mothers who were 10 th pass. Total of 6.19% fathers of children were in government service, in which 46.15% initiated breastfeeding within one hour after delivery. Majority of fathers (37.61%) were skilled workers, out of which 74.6% initiated breastfeeding within one hour of delivery and 11.39% delayed breastfeeding more than 24 hours.
|Table 1: Distribution of lactating mothers according to education status and time of initiation of breastfeeding|
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Most of the lactating mothers in the present study were homemakers (61.4%), out of which 48.83% initiated breastfeeding within one hour of delivery and (21.7%) home maker mothers initiated breastfeeding within one to four hour of delivery. Total of 35.71% mothers were involved in agriculture, out of which 65.3% initiated breastfeeding within one hour of delivery and 14.6% delayed more than 24 hours. Total of 1.42% mothers were working in government job, and out of them 33.3% initiated breastfeeding within one hour and 66.6% within one to four hour of delivery.
Among the deliveries conducted by the Doctors, 52.6% women initiated breastfeeding within one hour of delivery [Table 2], whereas 50% of women delivered by trained dais, initiated breastfeeding within one hour. In 14.7% of deliveries conducted by doctors, breastfeeding was delayed more than 24 hours. In 32.54% of deliveries conducted by doctors breastfeeding was initiated after one hour. The table [Table 2] shows the difference in breastfeeding patterns depending on the place of delivery. Out of those who delivered at home, only 63.41% mothers initiated breastfeeding within one hour as compared to 51.80% mothers, who delivered in government hospitals. It is also seen that 100% women who delivered at private hospitals started breastfeeding within one hour. Total of 20.47% women started breast feeding within one to four hours of delivery, out of which 72.09 were those who delivered in government hospitals.
|Table 2: Delivery conducted by, place of delivery, type of delivery and breast feeding initiation|
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In all, 13.33% women delay breastfeeding until after 24 hours of delivery out of which 89.2% of the women delivered at government hospitals. Majority (64.4%) of lactating mothers who had normal delivery initiated breastfeeding within one hour. However, mothers (53.6%) who had undergone cesarean section for delivery, initiated breastfeeding after 24 hours.
| Discussion|| |
The study per se reflects on the poor state of breastfeeding across all socio-economic factors. Surprisingly, across the board although some differences in initiation of breastfeeding is seen across the various differential studies, but none of them is significantly associated with early initiation. Of the total 210 (54%) lactating mothers included in this study, 115 initiated breastfeeding within one hour. According to the National Family Health Survey (NFHS-3), the initiation of breastfeeding within one hour of birth is only 24.5%, which is very low compared to our study.  However, according to the District Level Household and Facility Survey (DLHS-3) about 40% mothers initiated breastfeeding within one.  This data shows the reflective of trends in initiation from 534 districts in India, which presents a slightly better picture than NFHS-3 data. In a study conducted in North West India, education and more so place of residence seemed to influence initiation of breastfeeding.  The data reveals that 58 percent initiated as late as 25-72 h compared to rural areas, wherein the majority (60%) initiated breastfeeding within first 24 h. Again, when a comparison was made for initiation of breastfeeding with regard to various social groups the differences were significant in that study in contrast to our study. It is seen that higher percentage of formally educated mothers and fathers at RS Pura recorded initiating breastfeeding in 0-6 h in the rural area (48% and 47% respectively) while in urban areas; however, the formally educated showed higher preference to start breastfeeding around 25-72 h.  The above discussed studies point to the fact that feeding practices have not shown a significant rise over the past two decades to be anywhere near universal coverage. ,, Several reasons that include aggressive promotion of baby foods by commercial interests, lack of support to women at family and work places, and inadequate skilled healthcare support.  All that shows how much work needs to done if meaningful rise of feeding practices is to be achieved.
| References|| |
|1.||Greiner T. History of breastfeeding, 04-Nov-2008. Available from: http://m.studentmidwife.net/educational-resources-35/midwifery-history-43/9364history-of-breastfeeding.html [Last accessed on 2013 Apr 07]. |
|2.||Madhu K, Chowdary S, Masthi R. Breast feeding practices and newborn care in rural areas: A descriptive cross-sectional study. Indian J Community Med 2009;34:243-6. |
|3.||Reddy S, Sunita. Breastfeeding - Practices, problems and prospects. J Fam Welf 1995;41:43-51. |
|4.||Himachal Pradesh - Census of India website. Available from: http://www.censusindia.gov.in [Last accessed on 2014 May 31]. |
|5.||Bennett S, Woods T, Liyanage WM, Smith DL. A simplified general method for cluster sample surveys of health in developing countries. World Health Stat Q 1991;44:98-106. Available from: http://www.ph.ucla.edu/epi/.../RScourse/whostatquarterly44_98_106_1991.pdf [Last accessed on 2014 May 31]. |
|6.||Multiple Indicator Cluster Survey (MICS). Statistics and monitoring. Unicef. Available from: www.unicef.org/statistics/index_24302.html [Last accessed on 2014 May 31]. |
|7.||International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005-06: India: Volume II. Mumbai: International Insitute of Population Sciences (IIPS). |
|8.||DLHS-3- District level household and Facility Survey. Available from: http://www.rchiips.org/PRCH-3.html [Last accessed on 2013 Apr 07]. |
|9.||Raina SK, Mengi V, Singh G. Determinants in initiation of breastfeeding among lactating women in block R. S. Pura of district Jammu (India). Ann Trop Med Public Health 2011;4:71-3. |
|10.||Breast Feeding Promotion Network of India. Dark cloud and silver lining. BPNI bulletin. 2012;36. Available online from : bpni.org/Bulletin/Bulletin_36.pdf. [Last accessed on 2013 Apr 07] |
[Table 1], [Table 2]