CHALLENGES OF EXCLUSIVE BREASTFEEDING AMONG WORKING CLASS

MOTHERS IN AWKA SOUTH L.G.A.

NNAEMEZIE, NKIRU ONYINYECHUKWU1, ONYEBUCHI OGECHI STELLA2, MACHIE,

KENECHUKWU UCHENNA3, IFEDIORA, UCHENNA LOVETH 4

1234,
DEPARTMENT OF HUMAN KINETICS AND HEALTH EDUCATION, NNAMDI AZIKIWE
UNIVERSITY, AWKA ANAMBRA STATE NIGERIA.

ABSTRACT

Exclusive breastfeeding is an act that requires a lot of patients and while practicing exclusive

breastfeeding in Awka South Local Government Area of Anambra. Mother faced with a lot of

challenges. Therefore, this study tried to determine the various challenges experienced by

working class mothers in practicing exclusive breastfeeding. Three research questions guided

the study. The design of the study was a descriptive survey research design; the area of the study

was Anambra State, Awka south precisely. The study consisted of 205 working class Mothers,

who are Traders, Teachers, Bankers and unskilled labourers. The instrument for data collection

is a researcher developed questionnaire titled Challenges of Exclusive feeding among Working

Class Mothers Questionnaire. The method of data analysis was the use of frequencies and

percentage of responses. The result of the study indicated that lack of self confidence, lack basic

skills; limited duration of maternity leave and work problem during lactation was one of the

major challenges. Based on the findings, it was recommended that mothers should be

encouraged and sensitized to know the importance of exclusive breastfeeding, and extension of

maternity period is also important to enable them attend to their babies.

(KEYWORDS: CHALLENGES, EXCLUSIVE BREASTFEEDING, WORKING CLASS, MOTHERS)

Introduction

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and
development of infants; it is also an integrate part of the reproductive process with important

implications for the health of mothers. As a global public health recommendation, infants should

be exclusively breastfed for the first six months of life to achieve optimal growth, development

and health. Therefore, to meet their evolving nutritional requirements, infants should receive

nutritionally adequate and safe complementary foods while breastfeeding continues for up to two

years of age or beyond. All this shows the importance of exclusive breastfeeding to Both Mother

and child. According to world health organization (WHO) (2021), exclusive breastfeeding is

defined as no other food or drink, not even water, except breast milk (including milk expressed

or from a wet nurse) for six months of life, but allows the infant to receive ORS, drops and

syrups (Vitamins, minerals and medicines). Web MD (2021) breastfeeding is when you feed

baby breast milk, usually directly from the breast. It’s also called nursing. Making the decision to

breastfeed is a personal matter. It’s also one that’s likely to draw opinions from friends and

family.

Breastfeeding is one of the most effective ways to ensure child health and survival. However,

nearly two out of three infants are not exclusively breastfed for the recommended six months.

Breast milk is the ideal food for infants. It is safe, clean and contains antibodies which helps

protect against many common childhood illnesses. Breast milk provide all the energy and

nutrients that the infant needs for the first months of life, and it contains to provide up to half or

more of a child’s nutritional needs during the second year of life. Women who breast feed also

have a reduced risk of breast and ovarian cancers (WHO, 2021). Proper feeding of infants and

young children can increase their chances of survival. It can also promote optimal growth and

development, especially in the critical window from birth to two years of age. Ideally, infants

should be breastfed within one hour of birth, breastfed, exclusively for the first six months of life
and continue to be breastfed to two years of age and beyond. Starting at six months,

breastfeeding should be combined with safe, age –appropriate feeding of solid, semi-solid and

soft foods. (UNICEF, 2019).

According to WHO (2018), an estimated 78 million babies or three in five are not breastfed

within the first hour of life putting them at higher risk of death and disease and making them less

likely to continue breastfeeding and some of these babies are born in low and middle income

countries. Also new born who breastfeed in the first hour of life, are significantly more likely to

survive. Even a delay of a few hours after birth could pose life-threatening ring consequences.

Skin-to skin contact along with sucking at the breast stimulates the mother’s production of breast

milk, including colostrums, also called the baby’s first vaccine which is extremely rich in

nutrients and antibodies. Breastfeeding rates within the first hour after birth are highest in eastern

and southern Africa (6%) and lowest in East Asia and the pacific (32%). Nigeria demographic

and health survey (NDHS) (2018) released a report stating that only 29 percent of children are

exclusively breastfed from age zero to six months, learning a deficit of 73 percent, being denied

the right and by extension denied the right to survival. NDHS (2018) further stated EBF among

children age 0-5 months has increased since 2013, from 17 percent to 29 percents. This

development in Africa’s most population nations denies millions of such children the benefits of

breast milk, an unnecessary and unacceptable phenomenon that should be vigorously

campaigned against.

Virtually all mothers can breastfed, provided they have accurate information and the support of

their families, the health care system and the society at large, however, pressure from family

members and friends to give water, other liquids herbal concoctions and other forms of milk in

addition to breast milk prevents them from exclusively breastfeeding their babies colostrums
which is the yellow custard like milk produced in the first few days after birth is described as the

infants first immunization because it is very rich in substances that fight in fections protecting

infants from potentially deadly diseases. Furthermore, breast milk is the ideal food for babies and

infants as it contains nutrients in the right quantity, given them all the nourishment, they need to

survive and thrive.

Breast milk is easily digestible and well absorbed. Besides, it is safe and contains antibodies that

help protect infants from common childhood illnesses, such as respiratory tract infections

diarrhoea and pneumonia, which are the two primary cause of child mortality worldwide.

Exclusive breastfeeding can also reduce the risk of coaliac disease and chances of developing

type II diabetes, asthma and other allergic problems. Breastfeeding also prevents obesity in

childhood and adulthood, as well as diet related chronic diseases, such as hypertension and

cancers. In addition, breastfed infants are known to show better on intelligence tests, when

compared with infant formula- fed babies. Breast milk is readily available and affordable, which

helps to ensure that infants get adequate nutrition at all times and at very little cost, and at the

right temperature. As a result, the death of children under the age of five could be prevented with

increased breastfeeding and the incidence of certain disease among babies would significantly

reduce. (The Guardian, 2021).

According to Nigeria Demographic and Health Survey (2018), child mortality accounts for 52%

of all under-five deaths. The child mortality rate is 69% deaths per 1,000 children surviving to

age 12 months, while the overall under-five mortality rate is 132 deaths per 1,000 live births.

Fifty one percents of all deaths among children under age five in Nigeria take place before a

child’s first birthday, with 30% occurring during the first month of life, on the part of the mother,

early initiation of breast milk helps to first-track expulsion of the placenta while breast feeding
helps burn extra calories and helps the mother lose pregnancy weight faster. It releases the

hormone, which helps the uterus to return to its per-pregnancy size and may reduce uterine

bleeding after birth. Also, the community reaps a lot of benefits when mothers practice

breastfeeding because breastfed babies are healthy babies and healthy babies make a healthy

nation as cases of and severity of childhood illnesses are reduced, thereby improving child

survival. This would turn lead to huge reduction in national expenditure because the county will

spend less on the importation of formula and curative health care for children.

Also government needs to create policies that would favour nursing mothers. They can borrow a

leaf from Lagos and Kaduna States that have adopted six months maternity leave to enable

mothers to have enough time to rest from the stress they go through during labour and also the

time to feed their babies. Breastfeeding practices, including initiation and duration are

influenced by multiple inter woman factors among these factors, decisions regarding in low –

income counties are influenced by maternal age, education, employment, parity, place of

delivery, family pressure and cultural values. According to first cry parenting (2021) the

importance of exclusive breastfeeding can never be understated. It minimizes the infections and

diseases and also beneficial for the mother. Exclusive breastfeeding is one of the best ways to

minimize the chances of a baby getting diarrhea, allergies, pneumonia and suffering from

malnutrition, the addition of any other food will considerably increase the risks of the same. Also

because of the importance of exclusive breastfeeding, working mothers can also express breast

milk which can remain good for up to ten hours at now temperature and approximately three day

in the fridge (since the baby is only given breast milk, the frequency depends on the baby)

feeding should be done as per the baby’s demand. This means that one will be feeding your baby

your baby at least 8 to 12 times a day. It is also advisable for the mother to read and learn about
potential problems with breastfeeding. According to Abigail et al, (2016), some of the challenges

of practicing EBF include; cracked or sore nipples, breast engorgement, sufficient breast milk

production, disapproval and discomfort of breastfeeding in public, insufficient breastfeeding

supports from society and healthcare providers, short maternity leave periods and difficulties

associated with combing breastfeed and other maternal responsibilities and emotional stress.

Some of the problems encountered by EBF mothers according Okolie, (2012), includes,

worry and stress of feeding at all times even at night (92%), having to breastfeed even in public

places (82%), fear that the baby might not be getting enough nutrients (71%), to trauma of

expressing breast milk (67%), fear of safety of expressed breast milk (68%) and a feeding that

the baby will dry up if not given water or other fluids (50%). Other factors identified were; work

place not conducive (91.6%), lack of adequate education at antenatal clinics (63%). Finally,

Exclusive breastfeeding has so many challenges which could be very difficult for mother to

practice EBF. But because of the importance of EBF to mother and child’s health, this study

wants to determine the challenges of EBF among working class mothers in Awka South L.G.A

of Anambra State.

Purpose of the Study

The main purpose of this study is to determine the challenges of exclusive breastfeeding among

working class mothers in Anambra state. Specifically, the study will determine

1. The challenges of exclusive breastfeeding among working class mother in Awka South

L.G.A Anambra State based on their occupation.

2. The challenges of exclusive breastfeeding among working class mother in Awka South

L.G.A Anambra State based on the sex of the infant.

 3. The challenges of exclusive breastfeeding among working class mother in Awka South

L.G.A Anambra State based on their education level.

Research Questions

The following research questions would guide the study;

1. What are the challenges of exclusive breastfeeding among working class mothers in

Awka South L.G.A Anambra State based on their occupation?

2. What are the challenges of exclusive breastfeeding among working class mothers in

Awka South L.G.A Anambra State based on the sex of the infant?

3. What are the challenges of exclusive breastfeeding among working class mothers in

Awka South L.G.A Anambra State based on their educational levels?

METHOD

The study made of descriptive survey research design. The area of the study is Anambra State,

Awka south in particular. Three research questions guided the study. The population consisted of

all the working class mothers in Awka South, L.G.A of Anambra state who is either Traders

Bankers, Teacher, Unskilled labourers. The sample of the study consisted of 205 working class

mothers in south Awka L.G.A of Anambra State. The study also made use of Accidental

sampling technique to get the mothers that answered the questionnaire. Only mothers who were

around at the immunization centers and Antenatal and post Antenatal unit were used for the

study. The instrument for data collection was a questionnaire which was developed by the

researcher titled Challenges of Exclusive Breastfeeding among Working Class Mother’s

Questionnaire (CEBWCMQ). Content and face validity of the instrument was established with

the help of three experts two from the Department of Human Kinetics and Health Education and
 one from the Department of Educational Foundations with emphasis on measurement and

evaluation, all from Nnamdi Azikiwe University, Awka. Reliability of the instrument was

established using Cronbach Alpha which yielded value of 0.76. The data collected in study was

analyzed using frequencies and percentages of the responses from the working class mothers.

Results

RESEARCH QUESTION 1: What are the challenges of exclusive breastfeeding among working

class mothers in Awka South L.G.A Anambra State based on their occupation?

TABLE 1: Responses on the challenges of exclusive breastfeeding by working class mothers

in Awka L.G.A.

S/N Challenges Traders Teachers Bankers Unskilled

F(%) F(%) F(%) labourer
1 lack of self confidence 5 (9.8) 10 (14.7) 2 (0.08) 21 (34.4)
2 Lack of basic skill 10 (19.6) 5 (7.3) 4 (0.16 15 (24.5)
3 limited duration for maternity leave 15 (29.4 25 (36.7) 10 (0.4) 5 (8.1)
4 work problem during lactation 15 (29.4) 15 (22.0) 7 (0.28) 10 (16.3)
5 Type of delivery 5 (9.8) 5 (7.3) 2 (0.08) 10 (16.3)
N = 205

Result in Table 1 revealed that (9.8%) of the working class mothers who are trader agreed that

lack of self confidence was a challenge in engaging in exclusive breastfeeding, (29.4%)

answered that limited duration for maternity leave was a challenge among the traders for

working class mothers who are Banker (36.7%), answered that limited maternity leave was a

challenge in engaging in exclusive breastfeeding Also (22.0%) agreed that working problems

during lactation is one of the problems encountered during exclusive breastfeeding. Among

working class mothers who are Bankers, (0.28%) answered working problems, (0.4%) answered

limited duration for maternity leave. For mothers who are unskilled labourer; (34.4%) answered
lack of self confidence; (24.5%) answered lack of basic skills; (16.3%) answered problems

during lactation as one of challenges of EBF.

RESEARCH QUESTION 2: What are the challenges of exclusive breastfeeding among working

class mothers in Awka South L.G.A of Anambra State based on the sex of the infant?

Table 2: Responses of working class mothers based on the sex of the infant.

S/N CHALLENGES YES F (%) NO F (%)

6 Male children drinks breast a lot 150 (73.1) 55 (26.8)
7 Female children drink breast milk too much 55 (26.3) 150 (73.1)
8 Male children drinks breast in the night which is 115 (56.0) 90 (43.9)

discomforting.
9 You have to feed a lot to be able to breastfeed a male 125 (60.9) 80 (39.0)

child
10 You have to feed well to be able to breastfeed a 110 (53.6) 95 (46.3)

female child
N = 205

Table 2: Showed that out of 205 working class mothers, (73.1%) said that male children suck

breast a lot as one of the major challenges, also (56.0%) said yes to the fact that male children

suck breast in the night which is discomforting to them. 60.9% working class mothers said one

has to feed a lot to be able to breastfeed a male child. While (53.6%) said yes to the fact that one

also have feed well to breast a female child.

RESEARCH QUESTION 3: What are the challenges of exclusive breastfeeding among working

class mothers in Awka South L.G.A of Anambra State based on their Educational level?

Table 3: Responses of the challenges of exclusive breastfeeding among working class

mothers based on their Educational level.

 S/N Challenges Primary Edu. Secondary Tertiary
F (%) Edu. F (%) Edu.
11 lack of self confidence 6 (15) 10 (14.2) 25 (26.3)
12 Lack of basic skill 10 (25) 5 (7.1) 10 (10.5)
13 limited duration for maternity leave 4 (29.4) 20 (28.5) 25 (26.3)
14 work problem during lactation 10 (25) 20 (28.5) 27 (28.4)
15 Type of delivery 10 (25) 15 (21.4) 8 (8.42)
N = 205

Table 3: Showed that (25%) of working class mothers with primary education agreed that lack

of basic skill for breastfeeding is one of the challenges of EBF. (25%) agreed that work problem

during lactation is one of the challenges. For mothers who have secondary education (28.5%)

agreed that limited duration for maternity leave is one of the challenges ,(21. 4%) agreed that

type of delivery is one of the major challenge (14.2%) answered lack of self confidence as one of

the challenges. For working class mothers with tertiary education, (28.4%) said that work

problem during lactation is one of the major challenges, (26.3%) agreed that lack of self

confidence is a major challenge; (26.3%) also agreed that limited duration of maternity leave is

also one of the major problem.

Discussion of findings

The findings of the study showed that working class mother who are traders agreed that limited

duration of maternity leave is one of the challenges of EBF this is because, they have to return

back to their business which is unique to them quickly because the more or longer they stay with

the baby, they might suffer set back. These groups of mothers also agreed that work problem
during lactation because of the issue as stated above. Some of the working class mothers agreed

that lack of skill by some of these mothers is also a big challenge. Working class mothers, who

are teachers, also agreed that limited duration for maternity leave, working problem during

lactation and lack of self confidence were one of the challenges of EBF in Awka South L.G.A

among working class mothers. Working class mothers who are Banker also agreed that limited

number for maternity leave and work problem during lactation were one of the major challenges

of EBF among working class mothers. Working class mothers who are unskilled labourer

accepted that lack of self confidence, lack of basic skill and type of delivery were among the

challenges of exclusive breastfeeding among working class mothers in Awka South L.G.A of

Anambra State. Now looking at all their response it could be generalized that lack of self

confidence that not be able to breast at any point in time was agreed upon as a challenge

mothers might feel as harmed to breast fed their children in an open place because they are

working class mothers, limited duration for leave was the biggest challenges facing exclusive

breastfeeding among working class mothers because they must return back to whatever they are

doing after a short maternity leave period so not to lose their source of income. Working

problem during lactation was the second most challenge situation facing the working class

mothers because to work and attend to one’s baby at the same time is multitasking and some of

them might not be able to cope comfortably. Also type of delivery was also accepted because

mothers with normal delivery will return and be happy also immediately after delivery breast

feed their child but mothers that went through operation might not be able to breast immediate

and for a long time due to the pain from the delivery.

The findings revealed that all most all the mothers agreed that male children drink breast a lot

because they tend to get hungry very fast some mothers might not be able to allow their child cry
for a long time because of shortage of breast milk their by given them other food type and

stopping exclusive breastfeeding. A good number of working class mothers disagreed with the

fact that female children drink breast milk a lot and when this happen they might want to take

other type of food that is not only breast milk. They feel that when they do not want to drink

breast, they will start to lose weight so to avoid this kind of situation other food items are quickly

introduced to them. Some working class mothers agreed that male children ask for breast milk a

lot at night thereby, tasking them to remain awake for a longtime at night making them very

weak in the morning to go to work. If such be the situation some of them might turn to other

food item in order to allow them get enough sleep at night. Also many working class mothers

agreed that they have to feed a lot before they can be able to feed a male child. This in return

affect their appearance making them grow fat and out of shape. They agreed that too much food

makes them look less attractive among their peer in the work place. So in order to avoid all this

situation, they do not feed well and end up not being able to undergo exclusive breasting. Just

like male children also a good number of woman also agreed that one has to feed properly to be

able to feed a female child. In generally it is assumed they do not want to eat a lot because of

their physical appearance and this situation greatly affects as exclusive breast feeding of infant.

The findings revealed that working class mothers with primary education agreed that lack of

basic skills, working problem during lactation and type of delivery were one of the challenges

faced by working class mothers during exclusive breastfeeding. Working class mother who have

secondary education agreed that lack of self confidence, limited duration of maternity leave,

working problem during lactation and type of delivery were a serious challenges facing exclusive

breastfeeding among working class mothers. Working class mothers who had tertiary education
also agreed that lack of self confidence, working problem during lactation limited duration for

maternity leave and lack of basic skills were the major challenges of exclusive breastfeeding

among working class mothers. In general, work problem during lactation was the major

challenge for mothers based on the educational level because working and with all the various

challenges that comes from a women’s work place could affect the woman’s could affect them

not being able to breastfeed.

Conclusion

Based on the findings of the study, the following conclusions were made;

Working class mothers who are Traders agreed with lack of basic skills, limited duration for

maternity leave and work problem during lactation were the challenges they face. Working class

mothers who are Teachers agreed that lack of self confidence, limited duration of maternity leave

and work problem during lactation were the challenges they face. Working class mother who are

Banker agreed that limited duration for maternity leave and work problem during lactation were

the major challenges they face. Working class mothers who are unskilled labourer had lack

skills, lack of self confidence, working problem during lactation and type of delivery as the

challenges they faced in engaging in exclusive breastfeeding. But generally, the most

experienced challenges among them is limited duration for maternity leave and work problem

during lactation. They also agreed that female children do not drink a lot of breast milk. The

working class mothers also agreed that male children requires a lot of breast milk at night which

they see as discomforting to them and their work. For working class mothers who had primary

education, lack of basic skill, work problem during lactation and type of delivery were their

major challenge. Working class mothers who had secondary education had lack of self
confidence, limited duration for maternity leave, work problem during lactation and type of

delivery as their major challenges. Working class Mother with Tertiary Education had lack of

self confidence, lack of basic skills, limited duration for maternity leave and work problem

during lactation as one of their major problem.

Recommendations

The following recommendations were made based on the findings and conclusion of the study.

1. There is need for more sensitization of mothers on the importance of exclusive

breastfeeding.

2. There is need to train mothers especially working class mothers on the basic skills of

exclusive breastfeeding.

3. More maternity period should be given to working class mothers to enable them

attending to their young babies.

4. People working with a nursing mother in the office, market or any where should try not

to over bounding them with activities.

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