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EXCLUSIVE BREASTFEEDING PRACTICES AMONG URBAN WORKING MOTHERS: A CASE STUDY OF LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Exclusive breastfeeding (EBF) refers to the act of feeding an infant with breast milk solely during the first six months of infant life, without any other liquids or solids added traditionally is one of the most affordable child survival and child developmental intercessions in the scientific community. The World Health Organization (WHO) and UNICEF suggest EBF to all infants up to six months after which they initiate breastfeeding with complementary foods up to two years and more. There is always some evidence that exclusive breastfeeding lowers infant mortality caused by diarrhoea by 65 per cent, respiratory illnesses caused by 50 per cent, and better cognitive progress, spotting obesity, and health results in both the child and the mother (WHO, 2021).
EBF rates in the world are still significantly lower than the targets and only 44 percent of infants under six months exclusively breastfed in the world as of 2021. The Nigeria Demographic and Health Survey (NDHS) 2019 estimates the national EBF rates to be around 29% in Nigeria, which is a continuing issue of public health challenge. Although EBF rates are slightly higher in rural, the urban setting has its own barriers unique and increasingly reported which impede the long-term practice of breastfeeding. The high rates of urbanization experienced in Nigeria coupled with increasing numbers of women entering the formal labor market has developed structural conditions that hinder EBF among working mothers.
The state of Lagos, the commercial capital of Nigeria and the most populous state of its approximately 16 million inhabitants, is the epitome of the conflict between economic participation and the continuation of breastfeeding. Urban Lagos is defined by a mass, diverse formal labor force of women, working in the banking, retail, manufacturing, hospitality and the public sector. In a research study among bankers in the Mainland Local Government Area, Lagos, it was determined that although the majority of female workers expressed positive attitudes towards EBF, poor provision of workplace breastfeeding support lack of lactation rooms, inflexible working hours and poor maternity leave was among the major impediments to continued EBF practice (Ogbo et al., 2018). Another peri-urban Lagos study in 2022 found similar socioeconomic pressures, absence of spouse support, and physical demands of breastfeeding to be significant predictors of EBF abandonment (Sokan-Adeaga et al., 2022).
The Baby-Friendly Workplace Initiative in Nigeria and the maternity leave in the Nigerian Labour Act (12 weeks to formal sector employees) offer a legal framework in terms of support of breastfeeding. Nevertheless, these protections are weakly enforced and the informal and semi-formal sector which puts most urban Nigerian women to work is mostly not covered by these protections. The systematic review of obstacles to EBF in Nigeria (2021) found that the most common barriers in any setting were wrong perceptions, low spousal support, and socioeconomic barriers (Adeleke et al., 2021). Such aspects are especially pronounced in urban Lagos where working mothers have to find a balance between career, family, and breastfeeding.
1.2 Statement of the Problem
Although there is overwhelming evidence of its health benefits, the level of exclusive breastfeeding among working mothers in urban areas is dismal in Lagos. Return to work has been the most frequent identified reason why Nigerian working mothers abdicate breastfeeding prior to the recommended six months as one study found return to work as one of the barriers reported by up to 61% of the respondents. However, the interaction between workplace conditions, the social support structures, policies of employers and maternal knowledge that young working mothers in Lagos apply to quit EBF has not been fully researched.
The repercussions of insufficient EBF are severe: the infants are at risk to develop diarrhoea and respiratory illness more often, formula feeding is more expensive and puts a strain on the household budgets, and the babies miss out on immunological and developmental advantages. Since Lagos is a trendsetter in urban development in Nigeria, the results of this environment can guide national policies on breastfeeding in the workplace and population health. The absence of an extensive, more up-to-date research on EBF practices among urban working mothers in Lagos is a substantial gap that this study aims to fill.
1.3 Aim of the Study
To assess exclusive breastfeeding practices and their determinants among urban working mothers in Lagos State, Nigeria.
Specific Objectives
- To determine the prevalence of exclusive breastfeeding among working mothers in urban Lagos.
- To assess the knowledge and attitudes of urban working mothers regarding exclusive breastfeeding.
- To identify workplace-related barriers to exclusive breastfeeding practice in the study area.
- To evaluate the influence of spousal and family support on EBF practice among working mothers.
- To examine the relationship between employer breastfeeding support policies and EBF continuation rates.
1.4 Research Questions
- What is the prevalence of exclusive breastfeeding among urban working mothers in Lagos?
- What is the level of knowledge and attitude of working mothers toward exclusive breastfeeding?
- What workplace-related factors serve as barriers to EBF among working mothers in Lagos?
- How does spousal and family support influence EBF practice?
- Is there an association between employer breastfeeding support policies and EBF continuation?
1.5 Research Hypotheses
- H₀: There is no significant association between return to work and early cessation of exclusive breastfeeding among urban working mothers in Lagos.
- H₁: There is a significant association between return to work and early cessation of exclusive breastfeeding among urban working mothers in Lagos.
- H₀: Workplace availability of lactation facilities does not significantly influence EBF practice.
- H₁: Workplace availability of lactation facilities significantly influences EBF practice.
1.6 Scope of the Study
The target population to be used in this study will be mothers who are currently working in the formal and semi-formal sector within urban Lagos to be more precise in Lagos Island, Ikeja and Surulere Local Government Areas with infants aged between 6-24 months old. These variables are of interest: EBF prevalence, knowledge and attitudes about EBF, EBF policies at the workplace, maternity leave and lactation and spousal support and sociodemographic factors. The research will take place in the 2024-2025 school year.
1.7 Significance of the Study.
This research has a lot of implications to various stakeholders. To the Lagos State Government and Federal Ministry of Labour and Employment, the findings will be used to offer evidence that will empower the Baby-Friendly Workplace policies, in particular, the informal sector. The research identifies the business and population health argument in employers in Lagos to adopt lactation-supportive workplaces. Evidence will help healthcare workers in Lagos, such as nurses and lactation consultants to conduct targeted counselling of working mothers during the antenatal and postnatal services. To development partners and NGOs engaged in infant and young child feeding (IYCF) work, the study offers an up-to-date, urban specific evidence base, to inform programming in the largest city in Nigeria. At the scholarly level the research fills a gap in urban-based EBF studies in West Africa and provides comparative data to cross-national analyses of working mothers on the breastfeeding experience.
1.8 Operational Definition of Terms
- Exclusive breastfeeding (EBF): Feeding an infant only breast milk including expressed breast milk without any other liquids, solids, or infant formula, for the first six months of life, as defined by the WHO.
- Urban working mother: A woman currently engaged in paid employment formal or semi-formal residing in an urban area of Lagos and who has delivered a child within the preceding two years.
- Breastfeeding support: Tangible and intangible assistance provided to a breastfeeding mother, including spousal encouragement, family involvement, employer-provided lactation breaks, and access to lactation facilities.
- EBF cessation: The complete discontinuation of breastfeeding or introduction of complementary foods or formula before the infant reaches six months of age.
- Lactation facility: A designated private space in the workplace for mothers to express or directly breastfeed their infants.
References
Adeleke, O. A., Adesanya, O. A., Bamidele, J. O., & Aluko, O. O. (2021). Barriers to exclusive breastfeeding practice among rural and urban mothers in Nigeria: A systematic review. African Journal of Reproductive Health, 25(4), 109-120.
National Population Commission (NPC) [Nigeria] & ICF International. (2019). Nigeria Demographic and Health Survey 2018. NPC and ICF International.
Ogbo, F. A., Dhami, M. V., Uchenna, F., Osuagwu, U. L., Agho, K. E., Ezeh, O. K., & Page, A. (2018). Prevalence and determinants of complementary feeding practices among children aged 6-23 months in Nigeria: Evidence from the 2013 Nigeria Demographic and Health Survey. Nutrients, 10(6), 679.
Sokan-Adeaga, M. A., Sokan-Adeaga, A. A., Sokan-Adeaga, E. D., Osibogun, A., & Edris, H. (2022). Predictors of exclusive breastfeeding practice among nursing mothers attending a health care facility in a peri-urban setting in Lagos State, Nigeria. African Health Sciences, 22(2), 588-598. https://doi.org/10.4314/ahs.v22i2.63
Ugboaja, J. O., Berthrand, N. O., Igwegbe, A. O., & Obi-Nwosu, A. L. (2013). Barriers to postnatal care and exclusive breastfeeding among urban women in southeastern Nigeria. Nigerian Medical Journal, 54(1), 45-50. https://doi.org/10.4103/0300-1652.108895
World Health Organization. (2021). Infant and young child feeding: Key facts. WHO. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding