European Journal of Cardiovascular Medicine

Breastfeeding is critical for infant health, providing essential nutrients and immunological protection. Until the child is at least two years old, the World Health Organization (WHO) advises exclusive breastfeeding (EBF) for the first six months of life, followed by continuing breastfeeding and supplementary eating.1 By lowering the risk of several cancers and promoting postpartum recovery, EBF improves maternal health while also dramatically reducing the risk of infections and chronic disorders in newborns.

 
Kerala's EBF rate decreased from 69.8% in 2012–13 to 55.5% in 2019–21, against the 63.7%  national average.2 The best breastfeeding practices are hampered by a number of issues, even in Kerala, which has good literacy and health indices.3 These include cultural misconceptions about breastfeeding, a lack of knowledge about its advantages, and insufficient support for working women4 . Although the majority of mothers were aware of the nutritional advantages of breastfeeding, many encountered obstacles such as misunderstandings regarding proper technique and a lack of confidence in starting to nurse right away after giving birth.5

This cross-sectional study aims to assess the awareness and practices of breastfeeding among mothers of children aged 6 months to 2 years attending a taluk hospital in Kannur district. Understanding local practices and barriers will provide valuable insights for healthcare providers and policymakers to design targeted interventions that align with WHO guidelines. By addressing these challenges, we can improve breastfeeding rates and overall maternal and child health outcomes in the region.

Aims and Objectives

To study the awareness and practices of breast feeding among mothers of children between the age of 6 months and 2 years attending Taluk Hospital

MATERIALS AND METHODS

Study Design and setting: This is a cross-sectional study conducted at the Taluk Hospital, Pazhayangadi, located in Kannur district, Kerala.

Study Period: The study was conducted from June 2024 to September 2024       

Study Population: The study targeted mothers of children aged between 6 months and 2 years who visited the Taluk Hospital, Pazhayangadi, during the study period.

Sampling: Purposive sampling was used to select participants. This method involves selecting individuals based on specific characteristics  and their relevance to the study.

Data Collection: Data were collected directly using a pre-tested semi structured questionnaire designed to capture details on mothers’ awareness and practices regarding breastfeeding. The questionnaire included sections on demographic details, knowledge about breastfeeding benefits, breastfeeding techniques, and challenges faced. Scoring system was used to assess knowledge and practices of breast feeding

Data Analysis: Collected data was entered in MS excel sheet and analysed using SPSS software. Descriptive statistics were used to summarize the levels of awareness and breastfeeding practices among participants. Results were presented as frequencies and percentages for categorical variables.

Ethical Considerations: Ethical approval was obtained from the institutional ethics committee. Informed consent was taken from each participant before data collection, ensuring confidentiality and voluntary participation.

Socio-Demographic Details

The study included 200 women with children aged 6 months to 2 years who sought treatment at the Taluk hospital in Pazhayangadi. The majority of mothers identified as Hindu (62%). In terms of age, most were between 26-30 years (34%) and 18-25 years (33%), indicating a younger demographic. Regarding education, higher rates of exclusive breastfeeding were associated with mothers who had completed secondary and tertiary education. The socio-economic status (SES) of mothers also impacted breastfeeding practices, with Class 1 exhibiting the highest exclusive breastfeeding rates (67.35%) and Class 4 showing lower rates (38.46%). Interestingly, mothers in Class 5 reported 100% exclusive breastfeeding, likely influenced by cultural norms or limited access to alternatives. The majority of mothers were multipara (57%), and most had normal deliveries (76%), with only 22% undergoing caesarean sections and 2% having instrumental deliveries.

Knowledge of Breastfeeding

Mothers demonstrated a high level of awareness about breastfeeding (Table no.1). Almost all (98.5%) were knowledgeable about the recommended feeding frequency in the first month, and 86.5% understood the benefits of colostrum. Most mothers (82.2%) recognized the importance of exclusive breastfeeding for the first six months, while 91% knew when to introduce complementary feeding. However, there were significant gaps in knowledge related to expressed breast milk; only 30.6% had satisfactory knowledge, with 40.5% familiar with expressing techniques and a mere 8.5% aware of proper storage guidelines. Awareness of lactational amenorrhea was low, with only 39% adequately informed about its use as natural contraception. The primary source of information about breastfeeding for 78% of mothers was healthcare professionals. Despite high levels of awareness regarding breastfeeding benefits, the gaps in knowledge about expressed breast milk and lactational amenorrhea indicate a need for enhanced educational interventions.

Practice of Breastfeeding

The breastfeeding practices of the mothers showed some areas of strength and opportunities for improvement. While 62% initiated breastfeeding within the recommended hour after birth, 38% delayed, often due to lack of support or maternal health issues. Approximately 55% of mothers exclusively breastfed for the first six months, while 45% introduced other feeds earlier. Despite this, 73% continued breastfeeding for up to two years, reflecting adherence to extended breastfeeding recommendations. Only 27% reported using artificial feeds prior to six months, indicating a positive trend in avoiding unnecessary supplementation. The most commonly introduced weaning food was Ragi (65%). Challenges such as insufficient breast milk (45%) and returning to work (35%) were cited as primary reasons for ceasing exclusive breastfeeding, highlighting the need for supportive measures to help mothers maintain breastfeeding practices.

Overall, while the study indicates a solid foundation of knowledge and adherence to breastfeeding practices among mothers, targeted educational efforts are needed, particularly in areas concerning expressed breast milk and the timing of breastfeeding initiation. Reasons given by mothers for giving artificial feeds in children less than 6 months are given in figure no.1.

Table no.1Distribution of mothers according to the knowledge and practices of breast feeding

Fig.no.1 Reasons given by mothers for giving artificial feeds in children less than 6 months

The findings of this study align with existing literature on breastfeeding knowledge and practices both in India and globally. In our study, 55% of mothers practiced exclusive breastfeeding for the recommended six months, comparable to a study at Elite College of Nursing, Thrissur, which found that 56% practiced colostrum feeding, though only 38% maintained exclusive breastfeeding for six months.6 Another study at AIIMS, New Delhi, reported even lower exclusive breastfeeding rates (21%), often due to concerns about insufficient breast milk, illustrating regional differences influenced by education, socioeconomic factors, and access to healthcare.7

In a similar study conducted in Kannur district, Kerala, 82.2% of antenatal mothers were aware of the need for exclusive breastfeeding, a finding close to our 85% awareness rate. However, early breastfeeding initiation within one hour post-delivery was significantly lower in the AIIMS study at 21% compared to our study's 62% rate, likely due to the impact of local awareness campaigns and healthcare access in rural Kerala.8

Internationally, variations in breastfeeding practices are often shaped by cultural, socioeconomic, and healthcare factors. In Calabar, Nigeria, for example, 80% of mothers were aware of exclusive breastfeeding, but actual practice was lower (61%), resembling the findings in our study. Similarly, a study from Nepal found high rates of colostrum feeding (87%) but lower adherence to early breastfeeding initiation within 30 minutes post-delivery (27%), emphasizing the need for global efforts to promote prompt breastfeeding initiation.9

A significant gap in our study was low awareness regarding expressed breast milk and lactational amenorrhea, which was also noted in other studies. In our sample, only 30.6% were aware of expressed breast milk, a finding consistent with research from Kannur Medical College (30.64%).10 This gap indicates the importance of reinforcing counseling and education programs, focusing on alternatives such as expressed milk when direct breastfeeding is not feasible, to enhance breastfeeding practices.

The study revealed that while awareness about breastfeeding is generally satisfactory among mothers, significant gaps remain regarding the handling of expressed breast milk and the use of lactational amenorrhea. The findings suggest that socio-economic factors and education levels influence breastfeeding practices, highlighting the need for targeted interventions. Continued education and support, particularly for mothers from lower socioeconomic backgrounds, could enhance breastfeeding practices and ultimately improve maternal and child health outcomes.

RECOMMENDATIONS

Promote community-based educational programs and peer support groups to address breastfeeding challenges, especially for mothers in lower socioeconomic groups. Train healthcare providers to offer consistent breastfeeding guidance and advocate for workplace policies supporting breastfeeding. Conduct follow-up studies to evaluate the long-term impact of these interventions on maternal and child health.

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2. National Family Health Survey (NFHS-5). 2019-21. Available from: http://rchiips.org/nfhs/NFHS-5_Factsheet.pdf
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