ATTITUDE OF WORKING MOTHERS TOWARD EXCLUSIVE BREASTFEEDING

IN OKPANAM, DELTA STATE

CHAPTER ONE: BACKGROUND OF THE STUDY
Breastfeeding according to "Wikipedia" is the action of feeding a baby with milk from the breast. It's
the process by which human breast milk is fed to a child. Breast milk may be from the breast or may be
expressed by hand and fed to the infant.
Breastfeeding according to American Academy of Pediatrics (2022) has been recommended as the
sole source of nutrition for babies about 6 months old and can be continued and can be continued for as long
as both mother and baby desire it.
Breastfeeding is one of the most effective ways to ensure child health and survival. However, nearly 2
out of 3 infants are not exclusively breastfed for the recommended 6months {a rate that has not improved in
2 decades} - WHO (2023).
Breastfeeding is the ideal food for Infants because it is safe, clean and contains antibodies which help
protect against many common childhood illnesses. Breastfed children perform better on intelligence test,
they are less likely to be overweight or obese and less prone to diabetes later in life and women who
breastfeed have reduced risk of ovarian and breast cancers.
According to WHO, Exclusive breastfeeding is defined as the practice whereby an infant receives only
breast milk from the mother or a wet nurse or expressed breast milk and no other liquid or solids, with the
exception of drops or syrups consisting of vitamins, mineral supplements and medicines. Moreover, WHO
recommends exclusive breastfeeding for 6months, with introduction of foods and continued breastfeeding
thereafter - International Journal of Pediatrics (vol. 2017).
Within the period of exclusive breastfeeding (1st - 6th months of life);
1. No other drink or food except breast milk
2. Practice is in response to baby's demand
3. New born baby must be put to breast within 1st minutes of life
4. Baby must be breast fed for at least 6-14 times in 24 hours which entails night feeding
5. No pacifiers or dummies are given to the baby
6. More than 6 feeds in 24hours for more than 60 minutes sucking time
 7. Duration should be approximately 6 months & beyond.
Breastfeeding has been linked to higher IQ scores in later childhood in some studies. There is also close
bonding between mother and child due to skin touching, eye contact etc. Which help the baby feel secure; to
the mother, breastfeeding burns extra calories, so it can help loose pregnancy weight faster. It releases the
hormone oxytocin, which helps the uterus to return to its pre-pregnancy size and may reduce uterine
bleeding after birth. It also lowers the mother's risk.
A working mother can be described as a woman with the ability to combine a career with the added
responsibility of raising a child born. Webmed (2022)
Approximately 18,000 children globally still die every day and if current trend continues, some 60million
children under age 5 will die between 2017 and 2030 and half of them will be newborns. International
Journal of Pediatrics (vol. 2019).
Among Infants born in 2019, data shows that most (83.2%) started out receiving some bread milk and
(78.6%) were receiving any bread milk at 2 month while at 6 months, (55.8%) of Infants received any breast
milk and (24.9%) received breast milk exclusively. CDC report card. (2020).
The breastfeeding rate in Delta State has remained low at 25% compliance despite efforts to encourage
exclusive breastfeeding practices among nursing mothers. The state Government then highlighted at a
media event geld in Asaba, for the 2022 world breastfeeding week the theme "step up for breastfeeding;
educate and support" (Omon Julius Onabu- Sept. 2022).
Some misconceptions that are held by mothers about exclusive breastfeeding include:
Mother's perception that grandmothers did not practice exclusive breastfeeding but their children grew well
and gestures of baby suggested their readiness to start eating.
 Most women belief that breast milk is watery in nature and doesn't satisfy infants.
 The perception that health worker do not also practice exclusive breastfeeding
 The believe that male babies may not be satisfied when they solely feed on breast milk.
Some factors that influence exclusive breastfeeding among working class mothers according to a
research conducted on the south west part of Nigeria in the scientific research Journal (vol. VIII,
2020) includes:
  Social barriers such as working outside the home, length of maternity or maternity leave,
embarrassment of breastfeeding in public etc.
 Economic circumstances
 Maternal age and Family influences etc.

Despite all the efforts put in place to make exclusive breastfeeding practicable, many still do not practice
exclusive breastfeeding while some do. This is why the researcher considers the research on "Attitude of
working mothers towards exclusive breastfeeding in Okpanam, Delta State".

STATEMENT OF PROBLEM
Most babies in Okpanam Delta State often come down with opportunistic disease such as diarrhea
which is suspected to be as a result of inadequate breastfeeding from their mothers who claim to breastfeed
adequately, therefore the researcher wants to determine the" Attitude of working mothers towards
exclusive breastfeeding in Okpanam Delta State".

OBJECTIVES OF THE STUDY

1. To determine the knowledge of working mothers towards exclusive breastfeeding in Okpanam, Delta
State.
2. To determine the Attitude of working mothers towards exclusive breastfeeding in Okpanam, Delta
State
3. To identify the factors affecting exclusive breastfeeding among working mothers in Okpanam, Delta
State.
4. To enlighten working mothers in Okpanam, Delta State on the importance of Exclusive breastfeeding.

SIGNIFICANCE OF STUDY
At the end of this study, the result obtained should:
  Help improve the attitude of working mothers towards exclusive breastfeeding in Okpanam, Delta
State
 Enable the health workers (Nurse/midwives) give proper health education to mothers on the
importance of exclusive breastfeeding.
 Help working mothers to know the benefits of practicing exclusive breastfeeding.
 Help increase the acceptance rate of exclusive breastfeeding among working mothers in Okpanam,
Delta State.

RESEARCH QUESTIONS
1. What is the attitude of working mothers towards exclusive breastfeeding?
2. What are the challenges of working mothers in the practice of exclusive breastfeeding?
3. What are the benefits and how can exclusive breastfeeding be improved among working mothers.

SCOPE OF THE STUDY

The study is centered on working mothers in Okpanam, Delta State, Nigeria.

DEFINITION OF TERMS
Attitude: A settled way of thinking or feeling about exclusive breastfeeding of working mothers in
Okpanam, Delta State
Working mothers: These are mothers that are employed in either private or Government establishment
and working for about 6-8 hours daily and are breastfeeding their babies.
Breastfeeding: This means the action of feeding a baby with milk from the breast.
Exclusive breastfeeding: Use of only breast milk to feed an infant from the 1st-6th months of life without
Introducing supplements such as water of formula feed

CHAPTER TWO: LITERATURE REVIEW

INTRODUCTION
This chapter focuses on the reviewed materials that are relevant to this topic and is discussed thus:

2.1. BRIEF ANATOMY OF THE BREAST:

The breast is a secretory gland. They are rudimentary at birth, develop to adult form at puberty and
become fully secretory during pregnancy and pueperium. Each breast is covered by skin and is situated at
each side of the sternum. It has a central protuberance which is known as the "nipple" (a sensitive tissue
which is pigmented) which has 16-20 small orifices which are the openings of the lactiferous ducts.
The breast is hemispherical in shape; it has an axillary tail of spense extending to the axilla. The breast
extends from the second rib to the 6th rib, with the nipple at the level of the 4th rib. The breast contains 16-
20 lobes in the glandular tissues which are separated from each other by bands of fibrous tissue. Each lobe is
composed of glands (alveoli) and ducts. The alveoli are lined by milk secreting cells. The alveolus sends the
produced milk into the lactiferous tubule where it's transported to the ampulla through the lactiferous ducts
to be stored. These lactiferous ducts open onto the nipple.
The breast has blood supply from the internal mammary artery, external mammary artery and the
intercostal arteries. Venus drainage is from corresponding veins. Anatomy and physiology applied to
obstetrics -third edition (pg.1-3).
 A B
(A) Shows the microscopic structure of the female breast. (B) Shows the gross structure of the female breast

A diagram showing
the cross section of the female breast
 2.2. BRIEF HISTORY OF EXCLUSIVE BREASTFEEDING
Breastfeeding is a normal process of a woman feeding an infant with breast milk who has not yet began
to walk or talk. The milk is produced from the mammary gland of female mammal and passes directly from
the nipple to the baby's mouth.
Exclusive breastfeeding is as old as man throughout history; breastfeeding was a norm with only a small
number of infants not breastfed for varieties of reasons. In the early years of the human species there was
no other food for women to feed their infants and so mother alone with other lactating females would have
no choice but to breastfeed their babies.
This brought about the practice of exclusive breastfeeding.

2.3. 10 STEPS TO SUCCESSFUL BREASTFEEDING

The baby friendly which was initiated by WHO & UNICEF in 1991 to encourage hospitals to promote
breastfeeding was centered around ten (10) steps which was being implemented in about 16,000 hospitals
in 171 countries. (Valences and savage, 2009).
The ten steps include:
 Have a written breastfeeding policy that is routinely communicated to all health care staffs
 Train all health care staffs in skills necessary to implement this policy
 Inform all mothers about the benefits and management of breastfeeding.
 Help mothers initiate breastfeeding within half an hour of birth
 Show mothers how to breastfeed and maintain lactation even if they should be separated from their
infants.
 Give new born infants no food or drink other than breast milk unless medically indicated
 Practice rooming-in allow mothers and infants to remain together 24hours a day
 Encourage breastfeeding on demand
 Give no artificial treats or pacifier (dummies) to breast feeding infants
 Foster the establishment of breastfeeding support groups and refer mothers to them.
 2.4. KNOWLEDGE OF WORKING MOTHERS TOWARD EXCLUSIVE BREASTFEEDING
Working mothers are aware of the fact that breast milk in comparison with any other available milk in
the market cannot be contested, as the nutritional and immunological properties of breast milk outweighs
other milk.
In some context by Sherima et, al (2007) exclusive breastfeeding is considered dangerous by people of
due early days as they feel that the baby has an obligatory requirement for supplementary water to quench
its thirst and promote its normal development and herbal tea which serves as food and medicine.
A number of studies have addressed breastfeeding in different part of the world in respect of relevant
Statistics, factors influencing breastfeeding and practice towards breastfeeding. Female school teachers
compromise half the female workforce - 250,854 teachers out of 504,340 female employees and they exert a
tremendous socializing influence on upcoming generation. Disseminating of breastfeeding knowledge to this
population should have a striking impact on child health in the country in the short to medium term, as well
as in the more distant future, since teachers are best suited to pass on correct attitudes to the mothers of
tomorrow. Rhishan kaamal (2011).
There are marked increase in breastfeeding exclusively in recent times due to numerous strategies and
international Initiative supporting breastfeeding. Emphasis was on superiority and social acceptance of
formula as mothers viewed breastfeeding as old fashioned. The reduction in breastfeeding rate was blamed
on some physicians who chose to market formula for companies producing them as most mothers go for
what the doctor says.

2.5. ATTITUDE AND PRACTICE OF WORKING MOTHERS TOWARD EXCLUSIVE BREASTFEEDING

Evidently, most establishments rarely provided places where nursing mothers could have her infant
breastfed while at work. In line with this assertion, Ekanem et al. (2012), Haroon et al. (2013), and Rollins
and Doherty (2019) maintained that hardly would you find organizations that believed it was economically
meaningful to grant their female employees a six-month maternity leave that the World Health Organization
recommended promoting exclusive breastfeeding of an infant during the first six month of birth.
It is indicated that women’s empowerment is an important element for a better breastfeeding practice,
and one of the significant contributors to achieving this globally is women’s employment. But despite this,
studies globally show that it contrarily contributes to poor breastfeeding practice where the prevalence of
breastfeeding among employed mothers is lower than that of unemployed mothers due to various work-
related factors.
Women’s attitude and intentions towards exclusive breastfeeding are affected by different factors at the
individual, group, and society level where women employment summed up with the condition of working
environment like the length of maternity leave are some of the repeatedly mentioned factors affecting
breastfeeding. Ashimka M. et al (2014)
Mothers in this study expressed that effectiveness at work becomes possible when they have the support
of their boss and colleagues which is in agreement with the West Sumatera report that showed working
mothers need their superior’s assistant to sustain work and exclusively breastfeed, Sari Y et al, (2015).
Mothers complained that it is impossible to breastfeed during shift work without daycare service indicating
the need for a Child Care Centre. Sousan E.A.V (2017)

2.6. FACTORS AFFECTING THE ATTITUDE OF WORKING MOTHERS TOWARDS EXCLUSIVE

BREASTFEEDING
Cases of infant mortality rate in Nigeria have been reported to be relatively high, pegged at over one
tenth per 1,000 births (Ekanem, Ekanem, Asuquo, & Eyo, 2012). The practice of exclusive breastfeeding in
Nigeria has been topical. Most studies have concentrated in experiences and attitudinal responses to the
practice by nursing mothers Ekanem et al (2012).
According to a research carried out by Sousan E.A.V. (2017) most mothers face difficulty while continuing
breastfeeding, emotional and physical challenges are more intensely experienced by mothers who have
none of the supporting conditions. Mothers experienced emotional stress like guilt and feeling sinful for not
breastfeeding well.
Difficulties related to lack of facilities like refrigerator are expressed by mothers who have none of the
supporting conditions which are concordant with the Malaysian study that pointed out the importance of
facilities for maintaining breastfeeding among employed mothers. Amin RM et al (2011).
Mothers have raised their concern concerning the decrement of female employment recruitment
because of the impact of six months maternity leave on the operation of organizations; which is supported
by a report of a backward slide of mother’s careers, reduced post-birth wages, reduced job opportunities
and job uncertainties of women after return to work. Frehiwot W et al (2014)
Several factors have been found to be associated with EBF, in developed countries; social class, level of
education, employment status, living with partner, lack of parental support, parity, Al-sahab B et al, (2010).
Similarly, in developing countries, socio-demographic factors like maternal age, residency, employment,
religious and cultural practices, living arrangement, antenatal care practices, home delivery, professional
assistance at birth were associated with suboptimal breastfeeding practices, Mgongo M et al, (2012).

a. FACTORS MILITATING AGAINST MATERNAL PRACTICE OF EXCLUSIVE BREASTFEEDING

Post natal care practices such as exclusive breastfeeding are critical to the wellbeing and growth of the
baby. It is a critical intervention in improving neonatal and infant’s health. Some factors which militate
against maternal practice of breastfeeding include:
 Religion: According to Ellison c, et al (2009), frequent service attendance is associated with increased
odds of exclusive breastfeeding initiation. There is a weaker association between attendance and
breastfeeding duration as some mothers may initiate breastfeeding but not sustain breastfeeding due
to frequent service attendance. Therefore there is a need to initiate church-based health programmes
to reach undeserved population. For the Muslim religion and how it affects breastfeeding;
breastfeeding in the Islamic religion is very important. In the Qur’an it is mentioned that the period of
breastfeeding is two years. Word of Allah “mothers shall suckle their children for two full years that is
for those who wants a perfect breastfeeding” (Surah al-Baqarah: 23).
 Cultural factors: the most common cultural belief that affects exclusive breastfeeding include that
women cannot have sex while breastfeeding as they believe that the ejaculated semen will go to the
breast and cause harm to the baby so they tend to stop breastfeeding earlier, thus belief is
accompanied with the fear that if they do not have sex with their husbands, they will have sex with
other women outside. Some cultures believes that if their women for some reason have to stay away
from their infant for long, the milk will go bad and no longer be good to feed the infant. While some
others believe that infants being given breastfeeding for six months will reject other food later. Some
 other cultures believe that when a baby starts crying too much they need to be given pap. All this and
more cultural beliefs affect the practice of exclusive breastfeeding. Institute de la statistique (2012)
 Occupation: there is a significant difference in the prevalence of exclusive breastfeeding practice
between employed mothers and unemployed mothers. Unemployed mothers are more likely to
breastfeed their children exclusively than employed mothers. Mothers themselves report multiple
barriers to breastfeeding once returning to work. Such as lack of flexibility in the work schedule to
allow for milk expression; lack f accommodations to express and/or store human milk; and concerns
about support from supervisors and colleagues. Havilland B, et al (2018).
 Age: studies on parents’ age at married shows that mothers who married at younger age are less likely
to breastfeed their children exclusively. A study by Andy Emmanuel shows that older maternal age is
associated with higher rates of exclusive breastfeeding. Emmanuel A. (2015). On the contrary it was
observed that young mothers practiced exclusive breastfeeding more compared to their older
counterparts, a higher proportion of those aged less than 30 years practiced exclusive breastfeeding
when compared with those aged 30 years and above. This may be due to the fact that majority of the
older mothers might have larger number of to care for and were distracted by their occupation, family
duties, school involvement, and previous knowledge and attitude that are hard to change. Akinyele I.O
(2012)
 Education: it has been observed that mother’s educational level is associated with effect exclusive
breastfeeding of infants as mother’s education is one of the most important factors in promoting a
healthy family life and good nutrition. It is believed that with higher education mothers are exposed to
adequate health information especially as regard importance of exclusive breastfeeding. Pena R,
(2000)
 Health condition: there are some medical conditions that affect the practice of exclusive
breastfeeding which includes mastitis, poor infant attachment, nipple damage, and fungal infection,
breast surgery, hepatitis or C infections, herpes simplex Virus, HIV. When mothers are infected with
chronic disease conditions such as herpes simplex virus (HSV), untreated brucellosis etc, and the
mother may be able to resume breastfeeding after consulting with a physician to determine when
their breast milk is safe for their infant. Mothers in this category should be provided with lactation to
 support to learn how to maintain milk production and feed their infants with pasteurized donor
human milk, previously expressed breast milk (if appropriate), or formula, while temporarily not
breastfeeding.
b. FACTORS THAT PREVENT INFANTS FROM EXCLUSIVE BREASTFEEDING
Infants born with birth defects can have a range of physical and developmental abnormalities, from
very mild to more severe. Breast milk is still important nutrition for these infants, and in fact may be
especially beneficial for infants with certain birth defects who are often at higher risk for developmental
delays and respiratory and other infections.
However, due to these infants’ physical and developmental differences, mothers may face some
challenges in establishing and maintaining breastfeeding. Several of the most common birth defects that can
affect infants’ ability to breastfeed include:
 Down syndrome: infants with down syndrome(trisomy 21) can have hypotonia (low muscle tone)
which can lead to abnormal or weakened control of the oropharyngeal structures, contributing to an
uncoordinated and/or weak suck, or difficulty swallowing, similar to those experienced by premature
infants.
 Cleft lip/ cleft palate: in infants under this category, the oral cavity may not be adequately separated
from the nasal cavity during feeding, which can make it difficult to create the suction needed to
breastfeed successfully. This may result in the infant getting tired easily while breastfeeding or
requiring a longer time to feed, other difficulties may include nasal regurgitation (milk comes out of
the nose) and aspiration (milk enters the airway) which can affect the growth and nutrition status of
the infant.
 Congenital heart defect: some infants born with this condition may not be able to feed at the breast
right after birth due to complications, such as hypoxia (low levels of oxygen in the blood). Once these
babies are stable breastfeeding is usually possible.
 Prematurity: preterm infants who are sufficiently not strong enough to have developed sucking and
swallowing reflexes are not fully developed, the baby may get tired before the feed is complete and
complimentary tube feeding may be necessary.
 Tongue tie: this is the attachment of the frenulum to the tip of the tongue. Where baby is unable to
extend his tongue over his lower gum, he is likely unable to draw the breast deeply into his mouth
which he needs to feed effectively. Centers for disease control and prevention (2021)

2.7. Ways to improve exclusive breastfeeding

To encourage and support exclusive breastfeeding as a care giver there are key things that can be
done which include:
 Encourage breastfeeding frequently, day and night
 Advise the mother to allow the baby to feed for as long as he/she wants.
 Tell mother it is quite normal for a baby to feed up to eight times a day
 Advise all women to seek care if there breast becomes painful, swollen and red or if they feel ill
 Encourage continuous skin to skin contacts to help low birth weight babies keep warm And support
breastfeeding on demand
 Make sure mothers are aware of all the newborn danger signs and that they understand it is especially
important to take the low birth weight baby to the hospital if there is any need to be worried
 Explain to the mother the signs a baby will show when he/she needs to be fed (such as “rooting”
looking for the nipple or sucking of hand)
 Reassure the mother that breast milk has all that the baby needs so there would be no need to feed the
infant with any other drink or food not even water
 Help mother whenever she needs assistance especially first time or adolescent mothers or mothers
with other special needs
 Explain to the mother that she needs to let the baby finish from one breast and come off on its own
before offering the second breast.
 Encourage mother to start each feed with a different breast for example; if the left breast is used to
start one feed, at the next feeding start with the right breast.
 If there is need to express milk, show the mother how to do this and show her how to feed expressed
milk by cup
  Reassure the mother that her body can produce enough breast milk to meet her baby’s needs, when
her baby cries; it does not mean that she does not have enough breast milk. A baby who is demanding
more breast feeds may be growing
 Explain to a working mother that she can continue breastfeeding even if she has to go back to work or
school either by expressing milk or feeding more often when she’s at home
 Advise mother to come back to the health facility if baby is not feeding well of if she has any difficulty
with breastfeeding, sore nipples or painful breast. WHO (2013).

2.8. THEORETICAL FRAMEWORK

This research work is based on Abraham Maslow’s Hierarchy of needs theory. These needs are prioritized in
ascending order from the lowest to the highest human need. The theory states as follows:
1. Biological and physiological needs: this includes air, water, food, drink, shelter, warmth, sex, sleep
etc.
2. Safety needs: protection from elements, security, order, law, limits, stability etc.
3. Love and belonging needs: need to have a family, join work group, social group, affection etc.
4. Self esteem: achievement mastery, independence, status, dominance, prestige, managerial
responsibilities etc.
5. Self actualization needs: revealing personal potentials, self fulfillment; seeking personal growth and
peak experiences.
6. Aesthetic needs: appreciation and search for beauty, balance and form etc.
7. Cognitive needs: knowledge, meanings etc.
Maslow referred to additional aspects of “aesthetic” and “cognitive” needs; however, he did not add them to
the levels of hierarchy of needs. The first five needs are the basic before the last two needs

2.9. APPLICATION OF THE THEORY TO WORK

Maslow’s hierarchy of needs theory can be applied to the topic “attitude of working mothers towards
exclusive breastfeeding” in that the breast milk when exclusively given to an infant meets the Maslow’s
physiological and biological need (need for food).
 The infants physiological need (air, food, water) for survival are to be satisfied by the mother and
health care giver. Infants need safety as stated in the second level of Maslow’s hierarchy of need, the mother
is expected to provide the infant with safety and protection from infection and physical trauma. Babies need
love and affection to promote bonding with their mothers and this can be applied to third hierarchy of
Maslow’s need theory.
 CHAPTER THREE
RESEAARCH METHODOLOGY
INTRODUCTION
This chapter provides an outline used for this study. It consists of the following:
 Research design
 Study setting
 Target population
 Sample/sampling technique
 Instrument for data collection
 Validity of instrument
 Method of data collection
 Method of data analysis
 Ethical consideration