THEROLE OF PSYCHO SOCIAL FACTORSINDE TERMINING THE INITIAL FEEDING PATTERN AND DURATION OF BREASTFEEDING

Abstract

A community based follow-up study in four socioeconomically different groups in Lahore, Pakistan was conducted consisting of a rural area, a peri-urban slum, an urban slum and an upper middle class group. A total sample of 150 expectant mothers from three areas was selected. Scheduled interviews were conducted at 4 points in time; from eighth month of pregnancy up to the complete end of breastfeeding whenever it occurred during the infant’s first two years of life. All mothers were breastfeeding at the time of interview within one month after childbirth. Majority of the upper middle class mothers breastfed their infants partially and terminated breastfeeding within six months which is significantly different from the other groups. For prolonged breastfeeding significant contributing psychological factors were maternal own personal experience of breastfeeding right from the beginning as a pleasant, natural and enjoyable process even when initial infant feeding method and housing standard were taken into account. A significant positive relationship was found between maternal temperament dimensions (traits) “Accepting” and “Responsible” with initial feeding pattern for longer duration. The results of the study also suggested that not only the demographic variables and psychological factors but some maternal temperament dimensions also play an important role in the process of decision making regarding the initial feeding pattern and its sustenance for longer duration as well. The role and attitude of health care service provider is also very important in decision making about the initiation of breastfeeding and its longer duration. A cross sectional study was conducted on 30 women who delivered a normal healthy child in the Gynecological ward of a government hospital which caters 30% of general population and more than 80% of the Government Servants in the area. Information about the mode of infant feeding and about the reinforcement provided by experts for a particular mode of feeding to the mothers was obtained through a structured interview from women. 30 Medical Doctors including Gynecologists and Pediatricians of the same hospital were also interviewed to find out their years of practical experience their knowledge about importance of breastfeeding and their perspective and type of technical support provided to pregnant women at the time of antenatal, natal and post-natal visits. Results of the study supported and complemented the findings of the longitudinal study. Gynecologists and Pediatricians perspective indicated that mothers from low socio economic2 groups, have family support and tradition of breastfeeding within their families and are comparatively more religious, or/and were aware about benefits of breastfeeding were the ones who breastfeed their babies. At the time of interview 80% of the mothers in our sample were breastfeeding either exclusively or mixed feeding (Breast and formula milk) and 20% were feeding formula milk through bottle. Reasons given by mothers for adopting a particular mode for feeding their babies indicated that several maternal and social factors including health service provider’s responses dictate mother’s feeding choice. In establishment of initial feeding pattern all the factors related significantly are poor living conditions, low socioeconomic status, maternal breastfeeding satisfaction, her previous positive breastfeeding experience, a positive family support, with temperamental traits like responsible, reflective, accepting, impulsive irritable & withdrawing temperament, act as a stimulant in this regard. Mothers who adopted almost exclusive breastfeeding pattern right from the beginning, lived in poor housing conditions with poor socioeconomic status but had a good previous breastfeeding experience, had breastfeeding satisfaction and enjoyed a good family support in this regard, possessed Casual but Critical temperament, breastfed for a longer duration. The results also suggest that there is a need for formal and informal education of expectant mothers and health service providers in this regard. Breastfeeding and its management can be encouraged through “Behavior Change Communication” and follow up support of health care system.