Prevalence of exclusive breastfeeding and its determinants in first 6 months of life: A prospective study

Discussion

Exclusive breastfeeding is safe, economical and
emotionally satisfying means of feeding babies. In
countries where lactation support is available, six months
exclusive breastfeeding has improved substantially over
time.³ This study enabled to evaluate the rate of
exclusive breastfeeding and to determine factors
associated with cessation of exclusive breastfeeding
within first 6 months of life. In present study, the
prevalence rate of exclusive breastfeeding by 6 months
was 62%, compared to 46% at national level.¹³ Foo LL et
al ¹⁴ reported prevalence rate of 21% which is very low
compared to present study.

Present study showed no association between parental
education, and mother’s employment with exclusive
breastfeeding. It differs with Agampodi SB et al¹⁵ study
which associates influence of parental education and
women’s employment on breastfeeding practices. The
reason may be because of better health services
available under Integrated Management of Neonatal &
Childhood Illness (IMNCI). Several studies ^16,17
recommended implementation of IMNCI in India. Present
study showed no association between living conditions
and cultural habits of population with breastfeeding
practices during first 6 months of child birth in contrast
to Mascarenhas MLW et al⁹ study. After detailed analysis
by adjusted logistic regression, no significant association
was found with birth weight, while comparing another
study in which low birth weight was negatively associated
with initiation and continuation of exclusive
18
breastfeeding.

No association was found between breastfeeding pattern
and variables, classically considered as supportive for
breastfeeding such as number of antenatal visits,
mothers receiving postnatal breastfeeding advice,
previous breastfeeding duration in multiparous, start of
breastfeeding after birth, which was in accordance with
Caldeira AP et al.¹⁹ The possible justification for such
findings could be excellent execution of maternal and
infant care which includes promotion of breastfeeding in
health services especially after introduction of IMNCI
training in Gujarat state, an Indian modification of
Integrated Management of Childhood Illness (IMCI)
which promotes exclusive breastfeeding for first 6
months of life. Breastfeeding is a maternal option that
involves a complex interaction of socioeconomic,
cultural and psychological factors and many more.
However, as a socially recreated habit, the role of
reproductive and child health services in promoting of
breastfeeding should by no means be disregarded.

There is an intricate relation among the determinants of
successful breastfeeding practice, but present study did
not aim at discussing it deeply. Authors believe that
while defining breastfeeding pattern in a certain region,
it is of utmost importance that all intervening variables
be considered, allowing a thorough knowledge of
situation, and ensuing a greater potential for planning
and intervening.

Present study alerts us that in spite of prevalent practice
of breastfeeding, promoting and strengthening
reproductive and child health services is of paramount
importance, since unsatisfactory behavior, regarding
exclusive breastfeeding is still observed. Further studies
are necessary to correlate the interrelations among these
several variables and also other psychological and
anthropological questions (not considered in this study)
that are known to certainly interfere in breastfeeding
practice.

There were several limitations in this study. Main
clientele was from low socioeconomic strata attending a
tertiary care center and hence it may not be a
representative of the general population. Overestimation
of proportion of exclusive breastfed is possible due to
selection bias. Good numbers of subjects were from
urban area and they might have more exposure to the
facts of importance of breastfeeding.

Conclusion:

Exclusive breastfeeding prevalence rate found higher
than at national level indicating better feeding practices
in these part of India. Also, factors classically considered
as supportive for breastfeeding had shown no
association with breastfeeding pattern in present study,
needs promotion ^{20, 21} & improvement of maternal &
child health services.

Recommendations:

Impact assessment of IMNCI introduction should be
carried out to identify changes in knowledge, attitude
and practice regarding breastfeeding over a period of
time.

Acknowledgements:

We acknowledge the help provided by the nursing staff
at maternity unit of civil hospital, Rajkot and the
personnel involved for data collection.

Competing interests:

The authors declare that they have no competing
interests

Source of funding: None

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