CHAPTER ONE

1.0 INTRODUCTION

Breastfeeding is defined as the process of feeding the infant or the baby using the mother’s milk through the

expressed breast milk, or direct nipple-baby mouth contact. Breast milk is usually categorized into two types;

colostrum, and mature milk (Robinson et al., 2018). Colostrum is the yellowish and sticky milk produced

initially from the mother’s breast from the 37th week of gestation to approximately seven days post-delivery.

Mature milk is the whitish milk effectively produced after the 10th day post-delivery (Couto et al., 2020).

Exclusive breastfeeding (EBF) is defined as giving breast milk only to the infant, without any additional food or

drink, not even water in the first six months of life, with the exception of mineral supplements, vitamins, or

medicines (WHO.WHA Global Nutrition Targets 2025, Hossain et al., 2018).

EBF is an important public health strategy for improving children’s and mother’s health by reducing child

morbidity and mortality and helping to control healthcare costs in society (Al-Binali, 2012). Additionally, EBF is

one of the major strategies which help the most widely known and effective intervention for preventing early

childhood deaths. Every year, optimal breastfeeding practices can prevent about 1.4 million deaths worldwide

among children under five (Sinshaw et al., 2015). Beyond the benefits that breastfeeding confers to the mother-

child relationship, breastfeeding lowers the incidence of many childhood illnesses, such as middle infections,

pneumonia, sudden infant death syndrome, diabetes mellitus, malocclusion, and diarrhea (Holtzman et al., 2018,

Ogbo et al., 2018). Also, breastfeeding supports healthy brain development and is associated with higher

performance on intelligence tests among children and adolescents (UNICEF 2018, Victora et al., 2015). In

mothers, breastfeeding has been shown to decrease the frequency of hemorrhage, postpartum depression, breast

cancer, ovarian and endometrial cancer, as well as facilitating weight loss (Holtzman et al., 2018). The lactation

amenorrhea method is an important choice for postpartum family planning (Idris et al., 2015).
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The World Health Assembly (WHA) has set a global target in order to increase the rate of EBF for infants aged

0–6 months up to at least 50% in 2012–2025 ( WHO.WHA Global Nutrition Targets 2025) . The World

Health Organization (WHO) and the United Nation Children’s Fund (UNICEF) recommend initiation of

breastfeeding within the first hour after birth; exclusively breastfeed for the first six months of age and

continuation of breastfeeding for up to two years of age or beyond in addition to adequate complementary foods

(UNICEF 2018, Idris et al., 2015).

In spite of these recommendations, it has been documented over the years that the practice of exclusive

breastfeeding has not been adopted universally, most mothers embrace the idea but fail to breastfeed exclusively

few weeks after giving birth to their baby. A lot of factors ranging from cultural, social and economic conditions

have been identified as possible hindrances to an effective practice of exclusive breastfeeding (Tampah-Naah &

Kumi-Kyereme 2013, Fosu-Brefo & Arthur 2015).

Adherence to these guidelines varies globally, only 38% of infants are exclusively breastfed for the first six

months of life (WHO.WHA Global Nutrition Targets 2025, Hawley et al., 2015). High-income countries

such as the United States (19%), United Kingdom (1%), and Australia (15%) (Skouteri et al., 2014), have shorter

breastfeeding duration than do low-income and middle-income countries. However, even in low-income and

middle-income countries, only 37% of infants younger than six months are exclusively breastfed (Victora et al.,

2016). According to recent papers in the sub-Saharan Africa region, only 53.5% of infants in east African

countries were EBF for six months (Issaka et al., 2017), which is way below the WHO target of 90% (Jahanpour

et al., 2018). In addition, a study conducted in Tanzania reported that more than 91% of mothers received

healthcare in the antenatal period. However, only 39% of pregnant women and 25% of postpartum mothers

reported having received breastfeeding counseling (Maonga et al., 2016), and many women perceived that the

quantity of mothers’ breast milk is low for a child’s growth. The mothers perceived that the child is thirsty and
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they need to introduce herbal medicine for cultural purposes was among the important factors for early mixed

feeding (Maonga et al., 2016; Setegn et al., 2012; Mututho et al., 2017). The secondary analysis of WHO Global

reported that barriers of breastfeeding in low-income countries include cultural beliefs, education, and access to

healthcare (Takahashi et al., 2017). Mothers’ good knowledge and positive attitude play key roles in the process

of breastfeeding (Hamze et al., 2019).

The prevalence of exclusive breastfeeding rates at 6 months of age was 17% in Nigeria in 2014. A national

survey done in Nigeria in 2008 showed that exclusive breastfeeding rates still remain very low at 13% (Onah,

Ebeneche & Ezechukwu, 2014). The success of EBF has been attributed to several factors such as provision of

accurate information, support to breastfeeding mothers and perception (beliefs and attitude) of mothers,

(Wambach & Edegbai, 2005). Under-five mortality rate in Nigeria is as high as 183 per 1000 children and infant

mortality rate in the rural areas. Nigeria has been found to be exceptionally higher in areas with poor hygiene

and poor sanitation, among other factors (WHO, 2012).

The worldwide practice of exclusive breastfeeding is influenced by several factors including the maternal

knowledge (awareness), and perception. This study will help look into the maternal awareness and perception on

exclusive breastfeeding as a contraceptive method, and its benefits at large.

1.2 STATEMENT OF THE PROBLEM

Breastfeeding is the most natural method for humans to feed their children, and it is the primary source of

nutrients for the first few months of life (Robinson et al., 2018). Breastfeeding exclusively for six (6) months is

the most effective infant nutrition approach and should be maintained even if the kid consumes additional meals

after that (Couto et al., 2020).

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Recent powerful "Exclusive Breastfeeding" advocacy campaigns have raised breastfeeding awareness

significantly. Hospitals and other medical facilities are best equipped to educate expecting and nursing women

on the benefits of exclusive breastfeeding as well as the steps to take to make it a reality. (Wang and Cao, 2019).

Despite this, most women are unaware that exclusive breastfeeding may be used as a means of birth prevention.

As a result, I want to research pregnant women visiting the prenatal clinic at Primary Health Care, Mando and

Hayin Banki understanding and impression of exclusive breastfeeding as a birth control approach. Following the

survey that was done in 2017 by the National Demographic and Health Survey (NDHS), the use of Exclusive

Breastfeeding as a birth control method is generally low, adding up to only 5% (Johnson, 2017), despite the

widespread of knowledge of Exclusive breastfeeding globally, of about 97%. A few women use the Lactational

Amenorrhea Method (LAM), which is disheartening given that 97% of mothers exclusively breastfeed their

infants for sustenance. The fact that the rate of exclusive breastfeeding decreased from 17% in 2003 to 13% in

2008 further aggravates the problem (Johnson, 2017). The main issue is why mothers do not use exclusive

nursing as contraception despite its many health benefits. The study aims at elucidating the significant influence

of awareness and perception of Exclusive Breastfeeding as a birth control method among the mothers attending

the antenatal clinics.

One of the most crucial places for the general public to learn about women's reproductive health is antenatal

classes, both traditional and online. The importance of prenatal classes has been demonstrated in several studies,

and most women agree. Some women, particularly those who live in rural regions, might not have access to

these seminars, nevertheless. Most rural women have been unable to attend antenatal classes due to obstacles

such a lack of transportation and, for others, a lack of understanding of their significance. Also, few women in

rural regions are aware that exclusively nursing can be used as a form of pregnancy control (Omole et al., 2023).

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The study's goal, therefore, is to find out how pregnant women who attend prenatal in Primary Health Cares,

Mando and Hayin Banki, feel about using exclusive breastfeeding as a means of pregnancy prevention.

1.3 OBJECTIVES OF THE STUDY

The objectives of this study are:

1. To examine the level of awareness among pregnant women attending antenatal clinic at Primary Health Cares,

Mando and Hayin Banki on exclusive breastfeeding as a birth control method.

2. To find out the perceptions and experiences of the pregnant women regarding the use of exclusive

breastfeeding as a birth control method.

3. To examine the factors influencing maternal awareness and perception of exclusive breastfeeding as a birth

control method among pregnant women attending antenatal clinics at Primary Health Cares, Mando and Hayin

Banki.

4. To proffer solutions on ways to educate mothers on the need of exclusive breastfeeding as a way of

controlling birth.

1.4 RESEARCH QUESTIONS

This study aims at addressing the following four questions:

1. What is the level of awareness of pregnant women attending antenatal clinic at Primary Health Cares, Mando

and Hayin Banki towards exclusive breastfeeding as a birth control method?

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2. What are the perceptions and experiences of pregnant mothers regarding the use of exclusive breastfeeding as

a birth control method?

3. What are the factors influencing maternal awareness and perception of exclusive breastfeeding as a birth

control method among pregnant women attending antenatal Clinics at Primary Health Cares, Mando and Hayin

Banki?

4. What are the ways to educate pregnant mothers on exclusive breastfeeding towards birth control as a method?

1.5 SIGNIFICANCE OF THE STUDY

i. This research will help the health sector considerably by demonstrating the value of prenatal education.

ii. The findings of this study will also have implications for pregnant women by highlighting the value of

exclusive breastfeeding, prenatal education, and family planning.

iii. In addition to being useful for future research and reference, the results from this study will be used by the

Nigerian government to formulate policies to support exclusive breastfeeding.

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 CHAPTER TWO: LITERATURE REVIEW

2.0 INTRODUCTION

This literature review examines previous research conducted on three key objectives related to exclusive

breastfeeding: maternal awareness, maternal perception, and exclusive breastfeeding as a birth control method.

By synthesizing existing studies, this chapter aims to shed light on the current knowledge and understanding

surrounding these topics. Additionally, it explores the theoretical framework that underpins the research,

providing a theoretical lens through which to analyze the findings. Furthermore, the conceptual framework

highlighting the interrelationships between the objectives, guiding the exploration of their interconnectedness, is

also addressed in this chapter.

2.1 CONCEPTUAL REVIEW

A conceptual framework is developed to provide clear links between the dependent and independent variables as

they relate to each other in this research. The relationship between exclusive breastfeeding and birth control has

been diagrammatically presented in this conceptual framework.

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Intervening Variables

1. MATERNAL AWARENESS
2. MATERNAL PERCEPTION

EXCLUSIVE BIRTH
BREASTFEEDING CONTROL
Independent variables Dependent variables

2.1.2 GENERAL ISSUES ABOUT BREASTFEEDING

According to WHO’s Convention on the Rights of a Child (2016), every infant born into this world has a right to

food and nutrition, however, only few children meet their nutritional requirements appropriate for their age. Poor

nutrition is responsible for almost half of child mortalities in the world. Per WHO fact sheets (2016) on infant

and young child feeding, malnutrition accounts for 2.7 million infant mortalities yearly and more than 800,000

infants are likely to survive annually if all children aged 0-23 months are breastfed adequately.

2.1.2.1 BREAST MILK – COMPOSITION, NUTRITIONAL VALUE AND STORAGE

Breast milk is a natural food and nourishment for newborns; it forms the main source of nutrients, energy and

vitality for an infant. It is considered as the most convenient and safest means of feeding an infant because it is

ready made, at the right temperature and usually available when needed (AAP 2012, UNICEF 2013).

Additionally, breast milk contains antibodies needed for protection of the newborn, hence a perfect food for

8
babies (Munblit et al. 2017). The quantity, quality and production of breast milk varies to meet the nutritional

and fluid needs of an infant; it is evident that mother’s poor feeding habits, high intake of caffeine and other

products can affect the production and quality of breast milk (Ballard & Morrow 2013).

A yellowish, sticky milk called colostrum produced during the latter part of pregnancy through to delivery; is

highly recommended by WHO to be given to babies within the initial hours following delivery. Colostrum is

very definite in volume, appearance and composition, it contains an elevated level of immunologic components

like secretory immunoglobulin A (IgA), lactoferrin, leukocytes and epidermal growth factor for development.

After the first days of postpartum, this process of breast milk (colostrum) transformation continues into a

transition milk, which lasts for eight to twenty days until it transforms into a mature milk. Each stage of breast

milk composition contains nutrients, which are needed for the nourishment and growth of a baby (Mondker et al.

2009, Ballard & Morrow 2013, Munblit et al. 2017).

Hormones within the human body enhance the growth of breast milk duct; progesterone, estrogen, prolactin and

others promote lactation before birth. However, the level of hormones reduces to enable the flow of milk.

Nutrients contained in human breast milk include water, protein, fats, carbohydrates, minerals and vitamins

(Ballard & Morrow 2013, Infant Nutrition Council 2016). Each nutrient in breastmilk plays a role in nourishing

the baby, a breastfed child is protected against diseases through a chain of biomedical reactions which enable

enzymes, hormones and immunologic substances to protect the baby against diseases while enhancing the

survival of the newborn (Ballard & Morrow 2013, UNICEF 2015).

For safety and preservation of nutrients in breastmilk, breast milk can be stored at a room temperature (no more

than 25-degree Celsius) for a maximum period of six hours, and for a maximum of four hours at a hot

temperature of 30 to 38 degrees Celsius. It can also be stored at a temperature of 4 degrees in the refrigerator to

be used within 72 hours or stored in a freezer at -20 degrees to be used within a duration of up to six months

(Canadian Agency for Drugs and Technologies in Health 2016, Igumbor et al. 2000.). To ensure safety,
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refreezing or reheating of expressed breast milk is not recommended. A study by Peters et al in 2016 reported

that even though freezing is a safe method of storing breast milk, it reduces the immunological components in

the expressed breastmilk.

2.1.2.2 BREASTFEEDING RECOMMENDATION

Breastfeeding is an act of lactation whereby a baby is fed from a female breast, it can be done directly by putting

the baby to the mother’s breast or indirectly by expressing the milk using breast pump and giving it to baby

through bottle feed (WHO 2017). Health care agencies advocate an early initiation of breastfeeding during which

infants should be fed on demand unless for exceptional reasons (Fosu-Brefo & Arthur 2015). It is very necessary

to feed directly from the breast to avoid the transfer of contaminants to baby, however busy or working mothers

can express breast milk for use in future ensuring that breast milk is kept clean and stored depending on the

length of time intended for its use.

Exclusive breastfeeding is defined by UNICEF (2015) as an act of feeding whereby “infant receives only breast

milk (includes breast milk which has been expressed or from a wet nurse) and nothing else except for Oral

Rehydration Salt (ORS), medicines, vitamins and minerals”. UNICEF and WHO (2016) recommend that babies

should be given only breast milk for the first six months of their lives, after which breastfeeding should be

continued in addition to appropriate complementary food until the baby is 24 months old. Although

breastfeeding for six months is a desirable goal, breastfeeding in general is a very important exercise.

HIV/AIDS is a prevalent issue in Ghana. In 2015, the Joint United Nations Programme on HIV/AIDS

(UNAIDS) reported that 270,000 people were living with HIV/AIDS of which 19000 were children aged 0 to 14

years. Due to improved research about the effectiveness of exclusive breastfeeding; WHO recommends that with

continuous intake of antiretroviral drugs during pregnancy, after birth and during breastfeeding, an HIV- infected

mother can breastfeed her baby. In such condition, the baby should be breastfed exclusively for six months after

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which there should be a continual feed in addition to complementary food till twelve months (WHO 2010). This

practice is likely to reduce the risk of mother-child infection by 42% (Siegfried 2011, White et al. 2014).

2.1.2.3 BENEFITS

It is inarguably true that breastfeeding has a positive impact in the lives of both baby and mother. Breast milk is

easy to digest, contains the right proportion of nutrient such as carbohydrates, fatty acids, water and protein

necessary for baby’s growth and development. Exclusive breastfeeding is a very necessary and important

practice recommended to mother and child during the first six months of the baby’s life due to its numerous

benefits. This practice serves as a growth- monitoring tool which not only support the growth and development

of an infant but also monitor the weight as well. During the first year of childhood development, breastfed babies

are leaner and healthier than formula fed babies (Ziegler 2006, Gale et al. 2012).

Global health departments advocate the practice of exclusively breastfeeding at the initial stages of an infant’s

life since it helps stimulate and enhance the development of the mouth and jaws cells in babies and ensures the

growth of major organs in newborns. It aids in brain development and enhances the intellectual capacity of the

child. This feeding practice helps build the immune system and protects the baby against diseases (Dieterich et

al. 2013). There is a heightened proof that exclusive breastfeeding reduces the risk of gastrointestinal infections

in children (Szajewska 2012). There is usually an elevated risk of diarrhea among children who are partially

breastfed or not giving breastmilk.

Practicing exclusive breastfeeding within an hour after birth protects new babies from infection and death.

Breastfeeding a baby helps reduce fevers, which occur after child immunization (AAP 2012, NHMRC 2012,

WHO/UNICEF 2017.). Under 5 mortality rates per every 1000 births in Ghana as of 2015 was 61.6% (World

Bank Group 2016). When exclusive breastfeeding is practiced effectively, it can prevent 13% of under 5

mortalities since it minimizes the severity of infectious diseases (UNICEF 2016). Practicing exclusive

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breastfeeding is not only beneficial to infants but nursing mothers too. Results from a cohort study conducted by

Saxton and colleagues in 2015 proved that the risk of postpartum hemorrhage can be lowered through the

practice of breastfeeding. Continual breastfeeding postpones the menstrual cycle of a lactating mother hence

reducing the risk of pregnancy (Gebreselassie et al. 2008). It protects mother from the risk of type 2 diabetes,

breast, uterine and ovarian cancers. Breastfeeding helps control post-natal depression in mothers (Swarna 2009).

In emergency situations, such as of food shortage or an outbreak of a water borne disease, breastfeeding serves

as the most cost-effective means of meeting the nutritional requirement of infants and a life-saver. Exclusive

breastfeeding is an effective means of minimizing child malnutrition, it provides food security for infants in

deprived and poor communities, hence highly recommended in low and middle-income countries (UNICEF

2015, WHO 2016, Nkrumah 2017).

In addition, breastfeeding increases the connection and love between mother and child. Skin to skin contact

create warmth, closure and help reduces neonatal deaths. Nevertheless, fathers are encouraged to support

mothers during the period of breastfeeding. Supportive fathers also win a stronger bond with their infants as well

through bottle-feeding and spending quality time with baby (Anderzén-Carlsson et al. 2014.). There are

numerous advantages of breast milk over formula milk. Formula milk given to babies as a breast milk alternative

is expensive and poses a lot of risk to an infant’s life especially in developing countries. This form of feeding is

quite challenging since it needs to be measured adequately, mixed well with clean water at the right temperature

for the baby, while ensuring that feeding bottles are kept clean; failure to perform this practice right can lead to

contamination and

diarrhea. In the developing countries, the contamination risk during formula feed is high and challenging (Mead

2008, UNICEF 2015.).

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2.1.3 MATERNAL AWARENESS ON EXCLUSIVE BREASTFEEDING

Maternal Awareness on the exclusive breastfeeding, and its recommendation for a period of six completed

months, acts as an independent positive predictor of breastfeeding initiation and duration. In a study to examine

the level of awareness of pregnant and lactating mothers on exclusive breastfeeding, Dukuzumuremyi et al.,

(2020) did a systematic review of peer-reviewed literature from the online databases. According to the study's

findings, mothers with a high degree of awareness about the benefits of exclusive breastfeeding know that only

breast milk, especially in the first six months after delivery, is essential for a baby's nourishment

(Dukuzumuremyi et al., 2020). From this study, it is clear that awareness is an important factor influencing the

prevalence of exclusive breastfeeding. It is evident that most mothers in this study had knowledge deficit on the

duration of feeding, dangers of bottle-feeding, and the benefits of breastfeeding to both the mother and the baby.

The study recommended that the maternal knowledge gaps on exclusive breastfeeding, should be placed into

consideration in the subsequent researches.

According to Elyas et al., (2017), Exclusive breastfeeding is defined as the process whereby the infant is given

the breast milk by the mother or a wet nurse. This can also be given through expressing the nipple to the mouth

of the infant to give the breast milk (Elyas et al., 2017). From this study, Elyas et al., (2017) highlights that the

infant should not be given any liquids or solids, with an exception of drops and syrups of medicines, minerals,

supplements, or vitamins. This follows the fact that breastfeeding is the natural source of food serving for a

complete nutrition for the infant during the first six months of life. Breast milk contains all the necessary

nutritional supplements needed for growth and development of the infant, provided in all bioavailable forms.

From this study which was conducted in Ethiopia, it is shown that the prevalence of exclusive breastfeeding in

Ethiopia is low. The main reason for this may be due to limited information and awareness on the benefits

associated with Exclusive Breastfeeding for these mothers (Elyas et al., 2017). This study recommended that

adequate information should be imparted to the mothers on the basis of Exclusive breastfeeding, while also
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highlighting some of the factors which are likely to influence the practice of Exclusive Breastfeeding.

2.1.4 MATERNAL PERCEPTION ON EXCLUSIVE BREASTFEEDING

Maternal perception on exclusive breastfeeding is another major factor influencing the practice of exclusive

breastfeeding as recommended. The perception is built especially when the mothers are provided with the right

and adequate information on the benefits of exclusive breastfeeding during the antenatal clinic visits (Kamath et

al., 2016).

Based on the research by Mututho et al., (2017) the perception of the mother on the milk production has a major

impact on the practice of exclusive breastfeeding. This study cites maternal perception on insufficient milk

production as the major reason that engineered the introduction of complementary food for infants (Mututho et

al., 2017). The insufficient breast milk production is also projected as the main factor influencing early

breastfeeding cessation for most of the mothers. The study also showed a strong connection between maternal

perception of the impacts of exclusive breastfeeding on mother’s health, physical appearance, and ability to

engage in other, and premature exclusive breastfeeding cessation. Similarly, a study by Masaba et al., (2021) on

factors influencing the exclusive breastfeeding practice recommendation of WHO, recorded that the maternal

perception of insufficient breast milk production, has been attributed to poor practices of exclusive breastfeeding

(Masaba et al., 2021). More efforts should therefore be directed to addressing these beliefs, so as to effectively

promote exclusive breastfeeding practices.

2.1.5 FACTORS INFLUENCING MATERNAL AWARENESS AND PERCEPTION OF EXCLUSIVE

BREASTFEEDING AS A BIRTH CONTROL METHOD

According to Kimani‐ Murage et al. (2014), factors influencing the actualization of WHO breastfeeding

recommendations in poor urban settings in Kenya included a lack of knowledge about breastfeeding benefits,

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inadequate support from family and healthcare providers, misconceptions about breastfeeding, and challenges in

the work environment. The study emphasized the importance of breastfeeding counseling and support in

promoting exclusive breastfeeding practices. The study highlights the importance of addressing these factors to

promote optimal breastfeeding practices in urban poor settings.

In a study to explore the factors influencing the maternal decision on exclusive breastfeeding, Hamilton (2020)

found that these factors included personal beliefs and attitudes towards breastfeeding, social and cultural norms,

maternal employment, access to support networks, and the influence of healthcare providers. The study

highlighted the need to address these factors to support and promote exclusive breastfeeding among women. The

findings suggest that maternal decision-making is complex and influenced by multiple interrelated factors.

Understanding these factors is crucial for developing effective interventions and support systems to promote

optimal infant feeding practices.

2.1.5.1 ATTITUDE

Society and individuals have a two-way relationship, while individuals make up a society, society influences the

lives of individuals. Society shapes up the attitudes and behaviors of the individuals (Hossain & Ali 2014).

Traditions, norms, lifestyles and shared values such as culture, religion, education, economics and politics

influence the quality of life and individual choices (UNESCO 2010).

2.1.5.2 CULTURAL INFLUENCE

The Ghanaian society is highly imbedded with various culturally oriented perceptions. These are among the

leading factors, which influence a mother’s decision to breastfeed exclusively (FosuBrefo & Arthur 2015). One

paramount feature is a common myth that babies do not get enough nutrients from breast milk hence the need to

add other food substitutes such as porridge and other soft food. This popular perception is likely to influence the

15
attitude of most lactating mothers in the choice to breastfeeding exclusively. Due to the warm climatic

conditions in Ghana, there is the believe that babies need water in addition to breast milk which tend to interfere

with the rationale behind the decision to exclusively breastfeed (Zhang et al. 2015, Mensah et al. 2017).

Contrary, results from another study conducted in Atwima Nwabiagya District of Ghana showed evidence of

cultural approval of exclusive breastfeeding (Ayawine & Ae-Ngibise 2015). This shows the effect of cultural

diversity and dynamism within a given society and how they impact an individual’s behavior.

2.1.5.3 RELIGIOUS INFLUENCE

Religiosity is an important concept in the lives of people, it is well represented in the less developed and

developing countries hence the role played by religious leaders in harnessing a behavior either positive or

negative cannot go unnoticed (Pew Research Center 2008, Page et al. 2009, Aldashev & Platteau 2014).

Religious leaders are usually accorded much respect within the society, they mainly play the role of an advocate,

educator, promotor, healer, counselor and much more (Nicklas 2011, Lumpkins et al. 2013). Studies conducted

in the role of religiosity in health behavioral choices have shown an association between religion and health

(Shaikh 2006, Burdette 2012). A study conducted by Burdette in 2012 proved an association between church

attendance and the perception about breastfeeding. The role played by church leaders in advocating the

importance of breastfeeding was identified as the force behind the high prevalence in breastfeeding since it

ignites a positive attitude towards breastfeeding. Likewise, a study by Shaikh in 2006 reported that Islamic

religion supports breastfeeding and recognizes it as a natural and divine responsibility of a mother to her child.

This positive reinforcement influences mother’s attitude towards breastfeeding.

2.1.5.4 PERSONAL MOTIVATION AND CONFIDENCE

According to the English Oxford Living Dictionary, “Self-motivation is one’s own enthusiasm or willingness to

achieve a goal without any external pressure”. It is the force that drives an individual to embark on an activity
16
aimed at reaching a goal. Self-motivation promotes confidence in an individual’s action, confidence in one’s

ability to perform a task and promotes the inner will to do more (Benabou & Tirole 2001). Although majority of

mothers breastfeed their child during their infant life, the decision to attain an optimum breastfeeding target is

highly influenced by an intrinsic desire to breastfeed. Having adequate knowledge about the importance of

breastmilk, making initial breastfeeding plans, self-efficacy and anxiety heightens the confidence of a lactating

mother (O`Brien et al. 2008). Mothers who exhibited positive energy and attitude towards breastfeeding are most

likely to decide to breastfeed their infants for a lengthy period and are more

likely to breastfeed exclusively (Glassman et al. 2014, Minas & Ganga-Limando 2016). A study by Mogre et al.

(2016) revealed that 92.6 % of mothers who participated in the study had a positive attitude towards exclusive

breastfeeding.

2.2 THEORETICAL FRAMEWORK OF HEALTH BELIEF MODEL (HBM)

The health belief model is a psychological framework for investigating and encouraging health services, such as

exclusive breastfeeding and birth control (Ghanbarnejad et al., 2022). The concept presupposes that people's

beliefs and attitudes are important determinants of their behaviours connected to their health (Ghanbarnejad et

al., 2022). According to this theory, differences in uptake behavior may be explained by beliefs about the

following sets of variables when signals to actions are present:

Perceived susceptibility- If someone perceives that the health issue, that is, birth control is personally relevant,

they are likely to practice the control methods (Ghanbarnejad et al., 2022). This is expected among women who

are aware of the vulnerability to become pregnant after delivery.

Perceived severity- Even when one recognizes personal susceptibility of being pregnant after delivery, action

will not occur unless an individual perceives the severity of having a shorter Inter-Pregnancy Interval.

17
Perceived benefits- Refers to patients’ belief that a given treatment will cure an illness or help to prevent it

(Ghanbarnejad et al., 2022). Women are likely to embrace exclusive breastfeeding if they are aware of its

benefits, which are to be used primarily as Lactational Amenorrhea Method of contraception, as it increases the

inter-pregnancy interval.

Perceived barriers- refer to the negative aspects of health-oriented actions which serve as barriers to action

(Ghanbarnejad et al., 2022). Barriers of practicing exclusive breastfeeding among mothers could be lack of

adequate knowledge on the benefits of Exclusive Breastfeeding, and the maternal perception on the practice.

Most mothers perceive that Exclusive Breastfeeding interferes with their aesthetic body shapes.

Perceived cost- Refers to complexity, duration and accessibility of treatment. The working-class mothers are

unlikely to practice exclusive breastfeeding because of inadequate time. It becomes so challenging for them to

balance the office work and breastfeeding, thus most of them use supplementary feeding methods for their

babies. Motivation- Includes the desire to comply with the treatment (Ghanbarnejad et al., 2022). Women who

are ignorant about the contraceptive and other benefits of exclusive breastfeeding, are likely to be less motivated

to practice exclusive breastfeeding.

2.3 EMPIRICAL REVIEW

Omole et al., (2023) carried out a study to examine the awareness and perception of exclusive breastfeeding as a

birth control method among pregnant women attending antenatal clinics in rural communities. One hundred and

sixty-six pregnant women attending antenatal care in six public health facilities in Surulere local government

area of Oyo State were used in this study. A questionnaire with five sections was administered and collected

from them. However, only 154 were valid due to irregular, incomplete and inappropriate responses to some

questionnaires. These 154 questionnaires were validated and analysed using SPSS. The study revealed that

27.92% of the respondents were between the age categories of 25-30 years. Majority of the respondents
18
(83.12%) are married. Most of the respondents (92.86%) did not go beyond secondary school. This shows that a

vast majority of the respondents are not well educated. It can be seen that 47.20% and 29.87%, of the

respondents are traders and farmers respectively. However, it was discovered that the awareness on exclusive

breastfeeding as a method of birth control is high among pregnant women attending antenatal clinic in rural

communities but its practice is low. This may be due to the misconceptions that individuals still have about

various forms of contraception, and education on these methods may be what is needed to dispel myths and

explain the truths or facts underlying these various forms of contraception.

Chinenye-Julius et al., (2021) conducted a study to examined the level of knowledge and perception of exclusive

breastfeeding among pregnant women in Ikorodu, Lagos State. Convenience sampling method was used in

selecting 174 respondents from the two selected private hospitals in Ikorodu, Lagos. The instrument for the study

was a questionnaire which was well-structured and data obtained from the questionnaire was coded and then

inputted into the computer. Statistical Package for Social Sciences (SPSS) version 21.0 was used for this

analysis. Inferential statistics such as logistic regression and Pearson’s correlation test were also used to check

for association. The level of significance used was 0.05. The result of the study revealed that most (39.1%) of the

respondents were between the ages of 25-29 years. Majority (69.5%) of the respondents were married and most

(42%) of the respondents had tertiary education. Respondents’ level of knowledge measured on a 14- point

rating scale showed that the respondents scored a mean of 5.22±2.28 which translated to a level of knowledge

prevalence of 37.3%. Respondents’ perception measured on a 108-point rating showed that they scored a mean

of 66.23±8.12 translated to perception prevalence of 61%. It was concluded that younger mothers practiced

exclusive breastfeeding, while older mothers practiced non-exclusive breastfeeding of their babies. Mothers with

a higher level of education practiced exclusive breastfeeding, while mothers with low or no educational

attainment practiced non-exclusive breastfeeding of their babies.

19
The study by AlGhamdi (2020) investigated the maternal factors that influence exclusive breastfeeding practices

during the first six months of infant life in the Sudair and Al Zulfi areas of Saudi Arabia. The study utilized a

cross-sectional design and collected data through structured interviews with 500 mothers who had infants aged 6

to 12 months. The findings revealed that maternal factors influencing exclusive breastfeeding practices in the

Sudair and Al Zulfi areas of Saudi Arabia included maternal age, education, occupation, parity, and knowledge

about breastfeeding. Younger, more educated, and unemployed mothers were more likely to engage in exclusive

breastfeeding, along with mothers with higher knowledge about breastfeeding and its benefits. The study

emphasizes the need for targeted interventions that address these factors to enhance exclusive breastfeeding rates

in the Saudi Arabian context.

In a study to examine the perception and practices of exclusive breastfeeding, Kamath et al., (2016) conducted a

cross-sectional study of 188 mothers, using a well-structured questionnaire. This study showed that the more the

mothers are informed of the benefits of exclusive breastfeeding, the more they practice it. More emphasis should

therefore, be made on providing quality education to the mothers during their antenatal clinic visits, as a way of

boosting their perception on exclusive breastfeeding. This is the most probable way to boost the practice of

exclusive breastfeeding.

According to the community-based cross-sectional study conducted by Jama et al., (2020) in Burao district in

Somaliland, where 464 mothers were directly interviewed, it was realized that the prevalence of Exclusive

breastfeeding was very low, accumulating to only 20.47%. This study also unveiled that Exclusive breastfeeding

is influenced by several factors including; having a female infant, lack of formal education, monthly income,

lack of family support, especially from the husband, and availability of maternal education on exclusive

breastfeeding during antenatal visits (Jama et al., 2020). This study recommended promotion of formal education

for women based on the exclusive breastfeeding, enhancing husband’s engagement, encouraging the mother to

have antenatal care follow-ups, and provision of exclusive breastfeeding counselling to the mother during
20
antenatal clinic visits. The study also projected a need to have exclusive breastfeeding prevalence to reach 50%

globally by 2025, from the then 40%. The basis of this study was the dominant low exclusive breastfeeding

practices, recorded especially in the developing countries.

In a study to examine and describe exclusive breastfeeding practices in the rural settings, especially the coastal

regions of Tanzania, Kazaura, (2016) conducted a cross-sectional study, involving 342 mothers with children

aged between 6-23 months (Kazaura, 2016). From this study, up to 30% of the mothers reported having

breastfed their infants exclusively for up to at least six months. Those who reported not practicing complete

exclusive breastfeeding, complained of insufficient milk production as the main reason. The study reported that

the rate of exclusive breastfeeding in the rural areas, as seen in the coastal regions of Tanzania, is still very low.

This is influenced by lack of proper and quality maternal education on the benefits of exclusive breastfeeding. It

is recommended therefore, that the programs to promote exclusive breastfeeding in rural areas, should be

prioritized, emphasizing a multifactorial consideration.

21
 CHAPTER THREE

METHODOLOGY

3.1 Research Design

For this investigation, the researcher employed a survey research design. This is so because a sampling of

people's thoughts and points of view is part of the study's design. Dillman, Smyth, and Christian (2014)

explained that survey design is a meticulous process of constructing and organizing questionnaires to gather

information systematically from a sample of individuals. It is a crucial component of empirical research,

providing a structured means to collect data, measure variables, and draw meaningful conclusions. Surveys offer

an efficient means to collect data from a large number of participants in a relatively short time. This scalability

makes surveys cost-effective compared to other data collection methods, such as interviews or experiments. This

study looked at how pregnant women who attended antenatal clinics in rural areas felt about using exclusive

breastfeeding as a means of birth prevention.

3.2 Research Setting

The study was conducted in two primary healthcare centres in Kaduna North LGA – PHC Mando and Hayin

Banki. Mando Kaduna is located on latitudes (100 and 200N) and longitudes (70 and 450E) and altitude of 632m

and above sea levelin the Northern Guinea Savanna of Nigeria (GPS, 2019).

22
 Figure 1: Study area Mando, Kaduna

Hayin Banki a suburb of Kaduna metropolis (Figure 1), is located in Kaduna North Local Government area

and lies between coordinates Latitude: 10° 33' 12" N. Longitude: 7° 26' 29" E. Lat/Long and elevation of 631

meters above sea level. (Garba and Abiola, 2022).

23
 Figure 2: Study area Hayin Banki, Kaduna
From a personal point of view, the population of Mando and Hayin Banki is diverse, with a mix of ethnic groups

and religions represented. The both are a rapidly growing community, with new residents moving in from other

parts of Kaduna State and Nigeria. The population of Mando and Hayin Banki is mostly rural, with many

residents living in small villages and farming communities.

The majority of the population that uses the primary health care system in Mando and Hayin Banki is made up of

women and children. The use of primary health care services in Mando and Hayin Banki is highest among

women of childbearing age and young children. The population that uses the primary health care system in

Mando and Hayin Banki is made up of people from all socio-economic backgrounds. Both primary health cares

are used by people of all religions and ethnic groups. Overall, the primary health care system in Mando and

Hayin Banki serve a diverse population with a wide range of needs.

24
3.3 Target population

The target population of the research comprises of 122 and 97 pregnant women attending antenatal at Primary

Health Cares, Mando and Hayin Banki respectively between the months of July and September 2024, which

gives a total of 219 pregnant women.

3.4 Sampling size determination

A study sample is only a selective segment of the population from which conclusions are drawn. Essentially, it

is the part of a whole that best represents the total and exhibits characteristics that are similar to those of the

whole. Sample size, a critical component of research design, refers to the number of participants or

observations included in a study. Determining an appropriate sample size is a delicate balance, aiming to

provide sufficient statistical power for meaningful conclusions while considering practical constraints

(Creswell & Creswell, 2017).

This study adopts the Taro Yamane’s formula arriving at sample size. The method is depicting as follows. n =

N / (1+N(e)2)

Where:

n signifies the sample size

N signifies the population under study

e signifies the margin error

n = 219 / (1+219(0.05)2)

n = 219 / (1+219(0.0025))

25
n = 219 / (1+0.5475)

n = 219 / 1.5475

n = 142

122
Sample size for Mando = x 142 = 79
219

97
Sample size for Hanyi Banki = x 142 = 63
219

Therefore, total sample size = 79 + 63

= 142 respondents

3.5 Sampling technique

The non-probability sampling technique, specifically purposive sampling, was employed for this study.

Purposive sampling, a non-probability sampling technique, involves deliberately selecting participants based on

specific characteristics or criteria relevant to the research objectives. This method is particularly advantageous

when the researcher seeks in-depth understanding, expertise, or unique perspectives related to the study's focus.

By intentionally selecting participants who possess the targeted qualities, researchers ensure a nuanced

understanding of the phenomenon under investigation (Creswell & Creswell, 2017).

The study inclusion criteria were participants attending antenatal clinics in the primary healthcare centres while

the exclusion criteria were women who were within the primary healthcare environment but not pregnant.

3.6 Instrument for Data Collection

26
In this study, the research tool used was a questionnaire. The survey that was available to the participants

included several questions in it. The questionnaire was divided into five sections; the first sought demographic or

personal information from respondents, followed by the respondents’ level of knowledge and awareness of

pregnant women on exclusive breastfeeding, the third section sought the perceptions and experiences of pregnant

women in rural communities towards exclusive breastfeeding as a birth control method, factors influencing

maternal awareness and perception of exclusive breastfeeding as a birth control and the ways to educate pregnant

mothers on exclusive breastfeeding towards birth control as a method in rural communities in line with the

objectives of the study were also included in respective sections. Participants have to tick the appropriate box in

the column to respond.

3.7 Validity of instrument

Face and content validity of the questionnaire was done by the project supervisor from the department of nursing

in Nigerian Airforce College of Nursing Sciences (NAFCONS) and all necessary corrections were made before

the instruments was administered to the respondent.

3.8 Reliability of the instrument

The data was gathered through a validation approach in which items or questions were gathered from medical

practitioners and persons with knowledge on the subject. The Pearson Correlation Coefficient was used to

evaluate the instrument's dependability. The study instrument was reasonably reliable, as evidenced by its co-

efficient value of 0.68. According to Omole (2023), a suitable dependability ranges from 0.67 to 0.87.

3.9 Method of Data Collection

The researcher used questionnaire method to obtain pertinent and relevant information from the respondents

based on the objectives of the research study. Copies of the questionnaires were handed out directly to

27
respondents by self-administration after seeking the consent of the respondents. The questionnaires were

returned upon completion by respondents for analysis of the result. The reason for self-administering was to

meet with respondents personally and address areas of doubts and complexities. On the other hand,

questionnaires were interpreted for uneducated respondents and those who are not confident enough to fill out

the questionnaires.

3.10 Method of data analysis

A simple percentage method was used to analyze data collected from the respondents using tables for percentage

presentation and a brief interpretation. Data collected via the questionnaire are tabled in serial order and

presented using percentages. A description of the presented data was written in prose form before analysis. This

was done to ease understanding for proper analysis.

3.11 Ethical Consideration

The Department's Project Committee gave its approval to the study. The process of data collection for the study

was guided by the social sciences research ethics: confidentiality, anonymity, non- maleficence to participants,

beneficence, voluntariness, and translation of protocol to local language for easy communication. There was no

bias in selection of study participants and respondents were treated with dignity and respect. Participant also had

the right to withdraw from the research anytime they are not comfortable with the process.

28
 CHAPTER FOUR

PRESENTATION OF DATA AND ANALYSIS

This chapter presents the summary and analysis of the primary data utilised for the study in line with the four

research questions formulated to guide the study.

A total of eighty (142) questionnaires were administered and retrieved from the respondents. The same

number of questionnaires were validated for the analysis.

Table 1. Demographic distribution of

respondents
Demographic information Frequency Percentage
(n) (%)
Age (in years)
Below 20 36 25.35
20-24 60 42.25
25-30 39 27.46
31-35 7 4.93
Above 35 0 0
Marital Status
Single 17 11.97
Married 121 85.21
29
 Separated 0 0
Widowed 4 2.82
Level of Education
None 45 31.69
Primary 54 38.03
Secondary 32 22.54
Tertiary 11 7.75
Occupation
Housewife 58 40.85
Farming 41 28.87
Trading 34 23.94
Civil servant 9 6.34
Number of Children
None 15 10.56
1 22 15.49
2 34 23.94
3 45 31.69
4 and above 26 18.31
Primary Healthcare
Mando 79 55.63
Hayin Banki 63 44.37

The results for the demographic distribution of the respondents as presented in Table 1 above revealed that

42.11% of the respondents were between the ages of 20 and 24years, 27.63% of the respondents were between

the age categories of 25-30 years, 5.26% of the respondents were between the ages of 31 and 35, none of the

respondents was older than 35 and the least age category (below 20years) made up 25% of the respondents.

Majority of the respondents (85.53%) were married. Only 30.26 of the respondents completed secondary

school. However, with a primary school completion of 38.18%, it can be said that majority of the respondents

are literates. It can be seen that 40.79% of the respondents were housewives while those that were farmers,

traders and civil servants constituted 28.95%, 23.65% and 6.58% respectively. In the same vein, the

classification of the respondents according to their communities revealed that 71.05% of the respondents are

from Mando while 28.95% are from Hayin Banki.

Research question 1

What is the level of awareness of pregnant women attending antenatal clinic at Primary Health Cares, Mando

and Hayin Banki towards exclusive breastfeeding as a birth control method?

30
Table 2. Respondents’ level of knowledge and awareness on
exclusive breastfeeding
Variable Frequency Percentage
(n) (%)
Have you heard of exclusive breastfeeding?
Yes 107 75.35
No 35 24.65
What do you understand by exclusive breastfeeding
Feeding the baby with breast milk and water only 26 18.31
Feeding the baby with breast milk only 82 57.75
Feeding the baby with breast milk, pap and water 17 11.97
Feeding the baby with breast milk, formula and water 15 10.56
Feeding the baby with breast milk, water and soft food like 2 1.41
indomie
When should a baby be breastfed?
Morning, afternoon and night 22 15.49
On demand 86 60.56
Only when crying 30 21.13
At night 4 2.82
Discarding of the first milk or colostrum is the best
practice?
Yes 88 61.97
No 54 38.03
Breast milk alone is enough for an infant during the first 6
months of life?
Yes 97 68.31
No 45 31.69
Is exclusive breastfeeding cost effective?
Yes 103 72.54
No 39 27.46
Are you going to practice exclusive breastfeeding?
Yes 92 64.79
No 50 35.21

31
 Are you aware that exclusive breastfeeding can delay the
return of your menstrual periods after child birth?
Yes 103 72.54
No 39 27.46

Table 2 above presents the analysis on the level of knowledge of pregnant women on exclusive breastfeeding.

It was shown that 57 of the respondents representing 75% have heard of exclusive breastfeeding. Out of the 76

valid questionnaires, 44 of the respondents representing 57.89% knew the correct meaning of exclusive

breastfeeding while 46 (60.53%) of the respondents believed that a baby should be breastfed on demand. It

was also shown in the analysis that 47 (61.84%) of the respondents agreed with discarding the first milk or

colostrum as the best practice to do. Majority (68.42%) of the respondents believed that breast milk alone is

enough for an infant during their first 6 months of life. A yet greater majority (72.37%) of the respondents

believed that breastfeeding is cost effective, and more than half (64.47%) of the respondents agreed to practice

exclusive breastfeeding.

Research question 2
What are the perceptions and experiences of pregnant mothers regarding the use of exclusive breastfeeding as

a birth control method?

Table 3. Respondent’s perceptions and experiences on the practice of

exclusive breastfeeding
Variable Frequency Percentage
(n) (%)
Have you used exclusive breastfeeding as a method of birth control?
Never used 110 77.46
Used exclusive breast feeding 32 22.54
If you have never used exclusive breastfeeding as a method of birth
control, why haven’t you?
I’m yet to have my first baby 15 13.64
Inconvenience 11 10
Health issues 4 3.64
Lack of support 8 7.27
Lack of knowledge about its effectiveness 35 31.82
Desire to become pregnant again 37 33.64

32
 Other 0 0
If you have used exclusive breastfeeding as a method of birth control,
select your experience.
Very satisfied 11 34.38
Somewhat satisfied 2 6.25
Neither satisfied nor Dissatisfied 6 18.75
Satisfied 13 40.63
If you have stopped using exclusive breastfeeding as a method of birth
control, select your reason(s).
Inconvenience 8 25
Health issues 2 6.25
Lack of support 8 25
Method not effective for birth control 5 15.63
Desire to get pregnant again 9 28.13
Other 0 0

According to Table 3, on the perceptions and experiences of the respondents on the practice of exclusive

breastfeeding, majority of the respondents (77.63%) have never practiced exclusive breastfeeding despite the

high majority awareness of 75% recorded in table 2. Of this same category of respondents who have never

practiced exclusive breastfeeding, 33.90% responded that they desired to get pregnant again, 32.20% have not

yet practiced exclusive breastfeeding as a result of lack of knowledge of its effectiveness, 13.56% are yet to have

their first babies while 10.17%, 6.78% and 3.39% gave reasons of inconvenience, lack of support and health

issues respectively. Of the remaining 17 who have practiced exclusive breastfeeding, a combined response of

35.29% and 41.18% showed a general satisfaction level of 76.47%. also, all of these categories of respondents

answered to the question on reasons for stopping exclusive breastfeeding as a method of birth control. The

reasons were spread among 29.41% who desired to be pregnant again, 25.53% who gave reasons for

inconvenience and lack of support, while 17.65% and 5.88% of respondents accounted for method not effective

for birth control and health issues respectively. From the foregoing, it is obvious that lack of practice of

exclusive breastfeeding among the rural mothers is majorly not on grounds of ignorance but a combined result of

other factors put together as presented.

33
 Research question 3

What are the factors influencing maternal awareness and perception of exclusive breastfeeding as a birth control

method among pregnant women attending antenatal Clinics at Primary Health Cares, Mando and Hayin Banki?

34
 Table 4. Factors Influencing Maternal Awareness of Exclusive
Breastfeeding.
Variable Frequency Percentage
(n) (%)
Have you heard health care provider discuss exclusive
breastfeeding as a birth control method during your antenatal
visits?
Yes 107 75.35
No 35 24.65
How important is it for health care providers to promote
exclusive breast feeding as a method of birth control?
Very important 110 77.46
Somewhat important 21 14.79
Not very important 11 7.75
Were there any cultural or social factors that have affected your
usage of exclusive breastfeeding as a birth control.
Culture does not support family planning 17 11.97
Influence from friends 7 4.93
Lack of knowledge about exclusive breastfeeding 36 25.35
Lack of support 11 7.75
Low income 9 6.34
My religion teaches against family planning 41 28.87
Unsupportive partner 21 14.79

Table 4 above presents the responses of the respondents on factors influencing maternal awareness

of exclusive breastfeeding. 75% of the respondents agreed that they have heard healthcare provider

discuss exclusive breastfeeding as a method of birth control during antenatal. A combined response

of 77.63% and 14.47% shows how important it is for healthcare providers to promote exclusive

breastfeeding as a method of birth control. On the other hand, religious belief (28.95%), lack of

knowledge (25%), cultural belief (11.84%) and unsupportive partner (14.47%) are major socio-

cultural factors affecting the usage of exclusive breastfeeding as a birth control method.

Research question 4

What are the ways to educate pregnant mothers on exclusive breastfeeding towards birth control as a

method?

35
 Table 5. Ways of Educating Pregnant Women on Exclusive
Breastfeeding.
Variable Frequency Percentage
(n) (%)
Your knowledge of exclusive breastfeeding came mostly from.
Family/friends 2 1.41
Health care providers 137 96.48
Media (radio, TV, Internet) 2 1.41
Others 0 0

According to Table 5 above, 96.49% of the respondents owed their knowledge of exclusive

breastfeeding to healthcare providers. This emphasizes the important role played by healthcare

providers in disseminating the knowledge of exclusive breastfeeding to rural pregnant mothers.

However, the media (radio, TV, internet) still hold great potential in the dissemination of the

knowledge of exclusive breastfeeding if properly harnessed.

36
 CHAPTER FIVE

5.0 Discussion of findings

The majority of respondents, according to the study's findings, were between the ages of 20 and 30

years old, which corresponds to the peak reproductive age for females in Nigeria as determined by

the 2008 National Demographic Health Survey (NDHS, 2009; Udigwe et al., 2022). Similar

findings were found in a study conducted by Chinenye-Julius et al. (2021) in Ikorodu among

pregnant women in which 39.1% of participants were between the ages of 25 and 29. The outcome

is also consistent with a study by Girish et al. (2013) among pregnant women in Kerala, where

69.4% of participants were between the ages of 18 and 30.

The vast majority of participants were aware of the significance of feeding the infant on demand.

According to a comparable survey, 54% of pregnant women were aware of demand feeding (Girish

et al., 2013). A combined 93.42% of the respondents did not go beyond secondary education. This

demonstrates that the vast majority of responses are not well formally educated. This is not

surprising since the study was conducted in rural areas where farming and petty trading are the two

main industries. This is similar to a previous study in Yobe state (Ajibuah et al., 2013) where 59%

of the participants had no formal education and only 24% had some form of formal education and

64% of the mothers are fulltime housewives.

The majority of respondents in this study have heard of exclusive breastfeeding. A study on

knowledge of exclusive breastfeeding by Agu and Agu, (2011) pointed out that most women had

good understanding of exclusive breastfeeding. In contrast, a study in Sokoto State found that only

31% of mothers there had sufficient knowledge of exclusive breastfeeding (Mogre et al., 2016).

The vast majority of participants in this study were aware of the significance of feeding the infant on

demand. This is consistent with the findings of De et al. (2016), who found that a large proportion of

women were aware of how to feed a baby on demand. Nonetheless, average percentages of pregnant
37
mothers who knew about feeding the baby on demand were found in the studies by Girish et al.

(2013) and Chinenye-Julius et al. (2021). Also, it was found in this survey that the majority of

respondents thought it was advisable to discard the first milk (colostrum). This can be a result of

cultural and traditional beliefs. Majority of those surveyed believed that exclusive breastfeeding

could delay the return of menstrual periods after child birth

A previous study conducted within Kaduna metropolis (Yakubu et al., 2023) showed that there was

high level of awareness and knowledge about exclusive breastfeeding practice among mothers and

this was attributed to the fact majority of the mothers had access to media. 78% of the participants

got information about exclusive breastfeeding from antenatal clinics. Also, 83% of them decided on

their own to practice exclusive breastfeeding. Similarly, in this present study, a larger percentage of

the participants (96.49%) got their message on exclusive breastfeeding from antenatal clinics,

though the media only accounted for 1.75% of source of enlightenment on exclusive breastfeeding.

In contrast, However, only 64.47% agreed on practicing exclusive breastfeeding. It is however

shocking that only 22.37% of the respondents have practiced exclusive breastfeeding despite a high

level of awareness of 75%. Another study conducted in Yobe State (Ajibuah et al., 2013) also

reveals similarly low level of practice where only 7.4% of mothers practiced exclusive

breastfeeding. The same study revealed that early initiation of breastfeeding was higher in urban

than rural communities which corroborates this present study which was also conducted in two rural

communities of Mando and Hayin Banki, Kaduna State. Meanwhile, the study conducted in Kaduna

metropolis as earlier mentioned showed a high level of practice. Also, Dhaka study of mothers

found that only a small minority of respondents exclusively breastfed their infants during the first

six months of life. This shows that there is a need to bridge the gap between knowledge and practice

of exclusive breastfeeding by mothers.

Finally, this survey reveals that the major barriers to the practice of exclusive breastfeeding were
38
majorly socio-cultural. This corroborates the study in Yobe State where it was gathered that social-

cultural beliefs play major roles in hindering exclusive breastfeeding.

5.1 Implication to nursing

Since research plays a major role in establishing the scientific basis for evidence-based nursing

practice, it is essential for the profession to question what is important and fundamental to its

advancement. The study also allowed the reflection on the need to intervene strategically with

regard to the promotion of exclusive breastfeeding, as it is still undervalued, given the advantages

inherent to it, and the work can be used by nurses as an incentive tool for mothers to try to reduce

precocious weaning.

This study shows that are many benefits for exclusive breastfeeding that must be explained to

parents so they may decide for themselves what is better for their child. Nurses must incorporate the

best available evidence into their practice and, depending on their experience, expertise, patients,

and resources, provide care of excellence.

5.2 Limitations of the study

This study has its own limitations. The first limitation of this study was only English articles were

considered and there may be other studies published in other languages. Also, this study has a small

sample size which is not an absolute representation of the entire population of mothers attending

antenatal in rural Primary Healthcare Centres in Nigeria, this therefore could affect generalization of

the findings of the study.

Other challenges encountered in the course of the study are:

Financial constraints: The researcher had problem of finance in terms of printing, photocopying

and browsing to get information.

39
Time factor: Time for carrying out the research was limited as the researcher had to combine going

for classes, doing of assignments and preparing for presentations with research process.

5.3 Summary

From the above discussion of findings, socio-demographic determinants, educational level,

occupation and level of support from partner among others emerged as key determinants of the

willingness of pregnant women to practice exclusive breastfeeding. Exclusive breastfeeding among

the population sample is suboptimal, compared to the current WHO recommendations. In addition,

there are relatively unfavorable levels of knowledge and a less positive attitude of exclusive

breastfeeding as compared to the FAO guidelines, in fact, the observed exclusive breastfeeding

practices among the pregnant women included in the sample were statistically found to be 22.37%,

which is absolutely below the FAO and WHO recommendations. The results of this study are

critically important, that as they are addressing the gap in the exclusive breastfeeding segment and

sensitively show evidence for areas where urgent interventions are needed. Moreover, these results

also inform concerned policymakers on areas where they can respond and integrate exclusive

breastfeeding programs within their community health system.

5.4 Conclusion

Only a small percentage of pregnant women who attend antenatal clinics in rural areas actually use

exclusive breastfeeding as a method of birth control. This may be largely the result of

misunderstandings that individuals still have about various forms of contraception, and education on

these methods may be what is needed to dispel myths and explain the truths or facts underlying

these various forms of contraception. Therefore, there is a need for aggressive, target-oriented

information dissemination using all of the available channels, particularly the mass media,

40
 community opinion leaders, religious leaders, husbands, mothers, relatives, health care

professionals, and everyone else involved in practices that promote contraception. Also, the

underlying barriers can be overcome through the necessary support from family members, health

care practitioners, government and all employers of labour. The goal here should be to dispel the

women's misconceptions and raise the bar for practise. In the end, this will result in the benefits of

contraception and lessen the complications that can arise from having numerous children, for both

the mother and the baby.

5.5 Recommendations

On the basis of the conclusions drawn, the following recommendations are made:

1) Since health education remains the most viable means of reaching mothers on the benefits

derived from exclusive breastfeeding, healthcare workers should intensify health education to

provide mothers with complete and current information on the methods of exclusive breastfeeding,

to increase their knowledge of benefits derived from exclusive breastfeeding of babies.

2) Special interventions should be made for older mothers with poor breastfeeding practices by

healthcare workers to encourage them to endure the task of breastfeeding, through health education

and nursing support to enable them to breastfeed exclusively.

3) Employers of labor should extend maternity leave for nursing mothers to 6 months to enable

them practice exclusive breastfeeding or establish day care centers within the working environment

to enable mothers’ breastfeed their babies more conveniently and adequately.

4) Other agents of information dissemination on exclusive breastfeeding, such as the mass media,

should be equally employed to promote rural pregnant women awareness of the benefits practice.

5.6 Suggestions for further studies

1. Appraisal of Nursing Mothers’ Knowledge and Practice of Exclusive Breastfeeding in

41
 Yobe State, Nigeria. Published by Ajibuah BJ in the Journal of Biology, Agriculture and

Healthcare 2013; 3 (20): 75-81.

2. Yakubu MI, Odesanya RU, Abbas MY, Lawal BK. Exclusive breastfeeding knowledge and

practice among nursing mothers in selected healthcare facilities in Kaduna Metropolis,

Nigeria. Published by Yakubu et al., in the Journal of African Health Sci. 2023;23(2):682-

93.

APPENDIX

Nigerian Airforce College of Nursing,

Mando,
Kaduna State.

Dear Resondent,

I am a nursing student of Nigerian Airforce College of Nursing, Mando, Kaduna carrying out a

research on “Awareness and Perception on Exclusive Breastfeeding as a Birth Control Method Among

Pregnant Women Attending Antenatal Clinic in Rural Communities: Case Study of Primary

Healthcares, Mando and Hayin Banki”.

You are kindly requested to provide answers to the questions below, which would be used strictly for

research purposes only, and your response would be treated confidentially.

42
Thanks very much for your anticipated cooperation.

Yours faithfully,

Thomas Glory
21/GNS/167

AWARENESS AND PERCEPTION ON EXCLUSIVE BREASTFEEDING AS A BIRTH

CONTROL METHOD AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC

IN RURAL COMMUNITIES: CASE STUDY OF PRIMARY HEALTHCARES, MANDO AND

HAYIN BANKI

QUESTIONNAIRE

Instruction: tick your choice in the spaces provided

SECTION A: Demographic data.

1. Age.

Below 20 ( ) 20-24 ( ) 25-30 ( ) 32-35 ( ) 36 and above ( )

2. Marital status.

Single ( ) Married ( ) Separated ( ) Widowed ( )

3. Level of education.

43
None ( ) primary ( ) Secondary ( ) Tertiary ( )

4. Occupation.

House wife ( ) Farming ( ) Trading ( ) Civil servant ( ) Others ( )

5. Number of children.

None ( ) 1 ( ) 2 ( ) 3 ( ) 4 and above ( ).

6. Primary health care.

Mando ( ) Hayin Banki ( )

SECTION B: Level of Awareness of Exclusive Breastfeeding.

7. Have you ever heard of exclusive breastfeeding?

Yes ( ) No ( )

8. What do you understand by exclusive breastfeeding?

Feeding the baby with breast milk and water only ( )

Feeding the baby with breast milk only ( )

Feeding the baby with breast milk, pap and water ( )

Feeding the baby with breast milk, formula and water ( )

Feeding the baby with breast milk, water and soft food like indomie ( )

9. When should a baby be breastfed?

Morning, afternoon and night ( ) On demand ( ) Only when crying ( ) at night ( )

10. Discarding of the first milk or colostrum is the best practice?

Yes ( ) No ( ).

11. Breast milk alone is enough for an infant during the first six months of life?

Yes ( ) No ( ).

12. Is exclusive breastfeeding cost effective?

44
Yes ( ) No ( ).

13. Are you going to practice exclusive breast feeding?

Yes ( ) No ( ).

14. Are you aware that exclusive breastfeeding can delay the return of your menstrual periods

after child birth? Yes ( ) No ( )

SECTION C: Perceptions and Experiences.

15. Have you used exclusive breastfeeding as a method of birth control?

Never used ( ) Used exclusive breast feeding ( )

16. If you have never used exclusive breastfeeding as a method of birth control, why haven’t

you?

I’m yet to have my first baby ( ) Inconvenience ( ) Health issues ( )

Lack of support ( ) Lack of knowledge about its effectiveness ( )

Desire to become pregnant again ( ) Other ( )

17. If you have used exclusive breastfeeding as a method of birth control, select your experience.

Very satisfied ( ) Somewhat satisfied ( ) Neither satisfied nor Dissatisfied ( ) Satisfied ( )

18. If you have stopped using exclusive breastfeeding as a method of birth control, select your

reason(s).

Inconvenience ( ) Health issues ( ) Lack of support ( ) Method not effective for birth control ( )

Desire to get pregnant again ( ) Other ( ).

SECTION D: Factors Influencing Maternal Awareness.

19. Have you heard health care provider discuss exclusive breastfeeding as a birth control

method during your antenatal visits?

Yes ( ) No ( ).

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20. How important is it for health care providers to promote exclusive breast feeding as a

method of birth control?

Very important ( ) Somewhat important ( ) Not very important ( ).

21. Were there any cultural or social factors that have affected your usage of exclusive

breastfeeding as a birth control. Tick as appropriate.

Culture does not support family planning ( ) Influence from friends ( )

Lack of knowledge about exclusive breastfeeding ( ) Lack of support ( )

Low income ( ) My religion teaches against family planning ( )

Unsupportive partner ( ).

SECTION E: Ways of Educating Pregnant Women on Exclusive Breastfeeding.

22. Your knowledge of exclusive breastfeeding came mostly from.

Family/friends ( ) Health care providers ( ) Media (radio, TV, Internet) ( )

Others ( ).

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