chapter ii edited jeff

7/28/2019 Chapter II Edited Jeff

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CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter presents related literature and studies which have bearing and

relevance to the problem under study. This chapter provides the necessary background

carrying out the present investigation.

Breast Milk

According to the American Academy of Pediatrics (2007), breast milk is made from

nutrients in the mother's bloodstream and bodily stores. Breast milk has just the right

amount of fat, sugar, water, and protein that is needed for a baby's growth and

development. Because breastfeeding uses an average of 500 calories a day, it helps

the mother lose weight after giving birth. The composition of breast milk changes

depending on how long the baby nurses at each session, as well as on the age of the

child. The quality of a mother's breast milk may be compromised by smoking, alcoholic

beverages, caffeinated drinks, marijuana, methamphetamine, heroin, and methadone.

Tobacco smoking by mothers is not a contraindication to breastfeeding. In addition, the

AAP states that while breastfeeding mothers should avoid the use of alcoholic

beverages, an occasional celebratory single, small alcoholic drink is acceptable, but

breastfeeding should be avoided for 2 hours after the drink.

Lawrence (2008) pointed out that breast milk contains a unique composition of

nutrition especially made for the human infant. The amount of protein changes after the

childs needs, among other things it contains cholesterol and taurine that is important for


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the infant. Breast milk also holds a lot of antibodies against gastrointestinal and

respiratory diseases.

History of Breastfeeding

Nathoo, Tasnim, Ostry, and Aleck (2009) noted the history of breastfeeding. In

the Egyptian, Greek and Roman empires, women usually fed only their own children.

However, breastfeeding began to be seen as something too common to be done by

royalty, and wet nurses were employed to breastfeed the children of the royal families.

This was extended over the ages, particularly in Western Europe, where noble women

often made use of wet nurses. But lower class women breastfed their infants and used

a wet nurse only if they were unable to feed their own infant. Attempts were made in

15th century Europe to use cow or goat milk, but these attempts were not successful. In

the 18th century, flour or cereal mixed with broth was introduced as substitutes for

breastfeeding, but this did not have a favorable outcome either.

During the early 1900's breastfeeding started to be viewed negatively by Western

societies, especially in Canada and the USA. These societies considered it a low class

and uncultured practice, viewing it with a certain degree of disgust.. This coincided with

the appearance of improved infant formulas in the mid 19th century and its increased

use, which accelerated after World War II. From the 1960s onwards, breastfeeding

experienced a revival which continues to the 2000s, though negative attitudes towards

the practice were still entrenched up to 1990s.

Breastfeeding Benefits

American Academy of Pediatrics (AAP) (2005), stated the compelling benefits of

breastfeeding for infants, mothers, families, and our society, continue to be well


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supported by increasing amounts of scientific evidence. USDHHS, Office on Womens

Health ( 2006), said that infants not exclusively breastfed for six months are more likely

to develop a wide range of infectious diseases including ear infections, diarrhea,

respiratory illnesses, and have more hospitalizations. Because breastfed infants

typically require less sick visits, prescriptions, and hospital admissions, lower-income

families can benefit greatly from the cost savings associated with breastfeeding.

Lawrence (2008) study shown that children who have been exclusively breastfed,

when the infant only receives breast milk and no additional food or drink, including

water, for at least 4 months have a lower risk of develop allergy such as asthma and

eczema. Breastfeeding also has psychological benefits for the woman and the infant

and help the woman to recover after the partum. The profits of breastfeeding do not only

last for as long as breastfeeding is continued. For both the mother and the child there

are many long-term benefits. Lower rates of overweight and type-2 diabetes have been

shown among breastfed children.

Women who have breastfed have been shown to have a decreased risk of

cancer in breast and ovaries (WHO, 2008).

World Health Organization recommendations

The World Health Organization (WHO) (2010) recommends that all infants shall

breastfeed exclusively for six months and together with The United Nations Childrens

Fund, UNICEF, WHO has launched Baby-friendly hospitals which are obliged to

promote breastfeeding and work with Ten steps to successful breastfeeding. Ten

steps to successful breastfeeding includes recommendations to healthcare givers,

information to the pregnant woman and support to the post partum woman. All steps


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support breastfeeding as the superior infant feeding method. WHO reclaims that

governments all over the world have the responsibility to protect families from formula

advertising by the Intern

National Code of Marketing of Breast milk Substitutes. Moreover, the

governments shall see to that the women have the access to skilled support for initiating

and sustaining exclusive breastfeeding for six months and healthcare professionals

should be able to give effective feeding counseling.

Millennium Development Goals

Millennium Development Goals (MDG) (2012) highlighted that reaching the MDG

on reducing child mortality will require universal coverage with key effective, affordable

interventions: care for newborns and their mothers; infant and young child feeding;

vaccines; prevention and case management of pneumonia, diarrhea and sepsis;

malaria control; and prevention and care of HIV/AIDS. In countries with high mortality,

these interventions could reduce the number of deaths by more than half.

Every day approximately 940 adolescents and women worldwide die due to

complications from pregnancy or childbirth. This recent data shows a decline in

maternal mortality from the previously stated statistic of 1500 women dying daily, which

had been considered unchanging for years. This is good news showing that priority

given to sexual and reproductive health can have significant impact. However, there

remain large discrepancies in maternal mortality rates throughout the world. More than

50% of the deaths occur in only six countries and the prevalence of HIV and AIDS has

had a significant impact on maternal mortality rates in some countries. Adolescents

aged 15 through 19 are twice as likely to die during pregnancy or child birth as those


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over age 20; and girls under age 15 are five times more likely to die. Many unsafe

abortions among adolescent girls, at least 2.5 million every year, are the result of

unintended pregnancies and the inability to access to reproductive health information

and services. Unsafe abortion significantly contributes to high rates of maternal

morbidity (including short-term and long-term effects of disease, injury, impairment or

disability) and mortality rates, particularly in developing countries.

Adolescent Mothers Breastfeeding

According to Ruth (2009), breastfeeding is a particular challenge for young

mothers, who often consider breastfeeding to be too confining of their movements and

too demanding of their time. So it is your task to help maintain a realistic perspective

that supports the young mother in making a decision that she is comfortable with and

can successfully carry out. Help her achieve her identity and minimize role confusion as

she negotiates between her personal development needs and her role as a mother.

One way you can do this is by emphasizing that she is the only one who can mother

her baby when she breastfeeds. Offer her a different perspective; rather than seeing

breastfeeding as keeping her tied down, explain that she is doing something important

that no one else can take over. Emphasizing that breastfeeding is convenient and is

rewarding to the mother. Provide breastfeeding guidance from the moment of delivery

by giving practical suggestions to maximize the mothers success and confidence.

According to Lawrence (2008), several factors have been identified as having a

significant impact on a mothers decision to initiate or continue breastfeeding. These

include the attitudes of healthcare providers; the mothers support network that may

include fathers/partners, family members, and/or friends; hospital practices such as


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providing infant formula to newborns; a mothers personal experience; and workplace

environment.

Mothers typically know that breastfeeding is the best way to feed their infants.

However, mothers may not know about the personal health benefits associated with

breastfeeding. Some mothers are challenged with combining breastfeeding and other

competing demands and may focus on the barriers to breastfeeding rather than the

benefits. Exploring both the benefits and barriers is an effective way to counsel a new

mother. Research has shown that the common barriers to breastfeeding are

embarrassment, lack of social support, lack of time, and competing demands on the

mother. Embarrassment is the primary barrier for women of all backgrounds and in all

regions of the country. Strategies to address embarrassment include teaching mothers

how to breastfeed discretely, providing the opportunity to discuss mothers concerns,

and reassuring mothers they are doing something good for their infant. Lack of social

support has a major influence on the decision to breastfeed and on the duration of

breastfeeding. Family and friends are often not aware of the importance of

breastfeeding and how to be involved in the care and nurturing of a breastfed infant.

Mothers should be encouraged to talk with their family and friends about breastfeeding

and to invite them to attend prenatal classes to learn more about breastfeeding. Time

and competing demands are a reality of life and new mothers can benefit from

information on how breastfeeding can be successfully combined with other

commitments in their busy lives.

Statistics

According to Tucker, Wilson, and Samandari (2011), in the United States, just

over half of mothers under age 20 initiate breastfeeding. Furthermore, adolescents who


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do initiate breastfeeding tend to breastfeed for shorter durations than older mothers.

According to the National Immunization Survey, between 2004 and 2008 only 19% of

teens continued to breastfeed at six months postpartum, compared with 34% of mothers

ages 20-29 and 49% of women 30 and older.

Several factors may explain the lower levels of breastfeeding among teen

mothers. Given their age, teen mothers are more likely than older mothers to be single

and to have lower levels of education and income--characteristics that are negatively

associated with breastfeeding. Additional factors that may contribute to lower

breastfeeding rates among teens include returning to school, unease with the act of

breastfeeding, and embarrassment about breastfeeding in public. A lack of confidence

in their ability to breastfeed and reticence to ask for help may be other barriers that

pertain especially to teens.

Current understanding of breastfeeding among adolescents has several

limitations, however. Because national statistics group together mothers younger than

20, we do not have population-based data on the breastfeeding practices specific to

younger school-age adolescents. In addition, most studies of adolescent breastfeeding

are composed of hospital-based convenience samples of urban White and African

American teens. As a result, available data focus primarily on breastfeeding intentions

and decisions to initiate, and few studies examine breastfeeding experiences after

hospital discharge. Furthermore, there is little information about breastfeeding

experiences among Hispanic adolescents or among adolescents from rural areas in the

United States.


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According to Burks Aw (2010) that in the Philippines, the Implementing Rules

and Regulations of the Milk Code requires that breastfeeding be encouraged for babies

up to the age of 2 years old or beyond. Under the same code, it is prohibited to

advertise infant formula or breast milk substitutes intended for infants and young

children 24 months old and below. In practice, however, a 2008 WHO survey found that

on average, mothers in the Philippines breastfed their babies until 14 months of age,

with breastfeeding extending up to 17 months on average in rural areas. Almost fifty-

eight percent of mothers surveyed around the nation were still breastfeeding their

babies when the babies were a year old, and 34.2% of mothers were still breastfeeding

when their babies were 2 years old.

In 2012, it was reported that legislation had been introduced which would narrow

down the application of the Milk Code (reducing the period recommending against

artificial baby foods for babies from 0 to 36 months to 0 to six months only), would lift

the restriction on donations of artificial milk products in emergency situations

(encouraging mothers who suffer from disabilities to shift to milk substitutes instead of

encouraging them to continue breastfeeding assisted by support persons), would

change the legally mandated lactation break period for breastfeeding mothers from paid

to unpaid status, and would remove the prohibition against milk companies giving away

free samples of artificial milk products in the health care system.

Confidence and self-efficacy

According to Sjgren (2008), a woman who feels confident in her ability to

breastfeed, to produce breast milk and who are motivated to breastfeed are more likely

to have a longer duration of breastfeeding. When a woman worries about her ability to


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breastfeed she can more easily loose her confidence and stop breastfeeding. The

perceived ability influences the thoughts and actions of the individual and is therefore

shown to be a predictor for her health behavior, writes Dennis (2000) in her article about

self-efficacy. Dennis found that a high level of self-efficacy in breastfeeding leads to

choosing, performing and maintaining breastfeeding as infant feeding method.

Confidence and self-efficacy

A woman who feels confident in her ability to breastfeed, to produce breast milk

and who are motivated to breastfeed are more likely to have a longer duration of

breastfeeding. When a woman worries about her ability to breastfeed she can more

easily loose her confidence and stop breastfeeding (Sjgren, 2008). The perceived

ability influences the thoughts and actions of the individual and is therefore shown to be

a predictor for her health behavior, writes Dennis (2000) in her article about self-

efficacy. Dennis found that a high level of self-efficacy in breastfeeding leads to

choosing, performing and maintaining breastfeeding as infant feeding method.

The Breastfeeding Self-efficacy Scale (BSES) has been developed by Dennis

and Faux (1999) in Canada, with the objective to receive a predictor for breastfeeding

initiation and duration. The results from assessing the scale showed that participants

who rates their self-efficacy higher, more often exclusively breastfeed. A later study by

Dennis (2003), also conducted in Canada, showed that the rates on the BSES have no

correlation with demographic factors such as maternal age, education and income. In

the BSES the woman answers questions about whether she chooses to breastfeed,

how much effort she will provide in this task, how her thought pattern looks and how she

will respond to difficulties. The answers to these questions show her confidence and


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thereby can her breastfeeding duration be predicted (Dennis, 2000). According to

Dennis and Faux the scale helps healthcare professional to identify mothers in risk of

early discontinuing of breastfeeding and the healthcare professionals are thereby able

to perform interventions. The predictive validity of the BSES has been further tested in a

methodological study carried out in Australia by Creedy et al. (2003). This study

supported the results of earlier studies that have indicated that BSES is a good

predictor of infant feeding method. Creedy et al. (2003) suggested that a higher score

on the BSES would be 140 and higher, and a lower score 130 and lower, but declared

that more evaluation are needed. A study, conducted in Australia by Blyth et al. (2004)

with the aim to investigate the influence of antenatal variables on breastfeeding

outcome, used the BSES for exploring the confidence of the mothers in breastfeeding.

The results indicated that most of the mothers felt confident in breastfeeding. Further

the results revealed that the BSES score, also here, had a significant relation with

breastfeeding duration and level. In Thailand, a study conducted by Bergstrm and Zyto

(2009), also used the BSES for measuring mothers confidence in breastfeeding. The

aim of the study was to investigate the attitude and confidence of breastfeeding mothers

and showed that the Thai mothers had a good confidence in breastfeeding and a

positive attitude to it.

A study conducted in Sweden by Ekstrm, Widstrm and Nissen, (2007) had the

objective to describe breastfeeding support and confidence in relation to breastfeeding

duration. The results showed that one week after childbirth, first time mothers rated their

confidence lower than mothers who had given birth before. The authors also showed a

relation between the mothers confidence and her social support. An influence on


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breastfeeding from grandmothers were shown, which brought Ekstrm et al. (2008) to

the conclusion that healhcare professionals should include grandmothers who are

positive to breastfeeding when supporting mothers.

Vicarious experience

Vicarious experience involves observing others performing activities and

comparing oneself to them. This source of information can have a powerful impact on

perceived self-efficacy especially in the absence of previous experience. Dennis (2002)

concluded that the effect of observational learning is contingent on the attributes

performed. Role modeling occurs when a woman watches breastfeeding or reads or

hears about it. Friedman, (2008) gave an example that if the mother is watching great

numbers of women successfully breastfeed their children in public places is role

modeling and habituation that increases emotional comfort and more likely to choose

and succeed at breastfeeding. According to Bandura (2009), this source of information

usually provides weaker efficacy judgments than performance accomplishments, yet

has the potential to provide important information.

Verbal persuasion

Through verbal persuasion, one is led through suggestion into increasing ones

beliefs in ones capability. Bandura (2009), discussed that verbal persuasion must be

realistic to contribute to ones beliefs about successful performance, and is only

influential as the recipients confidence in the person issuing the information.

Encouragements and evaluations from influential others such as lactation consultants,

health professionals, peer counselors, and family members can be particularly

beneficial to breastfeeding women. According to Dennis, (2000) a womans self-efficacy


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is bolstered when attention is provided to the successful or improved aspects of

breastfeeding performances.

Physiological responses

Bandura (2009) pointed out that physiological status involves ones interpretation

of physical signs of arousal. Arousal is a result of the degree of perceived match

between coping capabilities and task demands. So, how one perceives these signs of

arousal determines the effect on performance and is affected by ones efficacy

judgment. Emotional comfort is necessary for learning to take place. This area for

breastfeeding mothers is of importance because increased anxiety has a direct effect on

the milk ejection reflex and can decrease maternal milk supply.

Breastfeeding Initiation

Promotion of early initiation of breastfeeding has the potential to make a major

contribution to the achievement of the child survival millennium development goal; 16%

of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if

breastfeeding started within the first hour. Breastfeeding-promotion programs should

emphasize early initiation as well as exclusive breastfeeding. This has particular

relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but

most women already exclusively or predominantly breastfeed their infants.

According to Alive & Thrive (2009), despite of the breastfeeding benefits, many

women delay initiation of breastfeeding. Only 39 percent of newborns in developing

countries are put to the breast within one hour of birth. Establishing good breastfeeding

practices in the first days is critical to the health of the infant and to breastfeeding

success. Initiating breastfeeding is easiest and most successful when a mother is


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physically and psychologically prepared for birth and breastfeeding and when she is

informed, supported, and confident of her ability to care for her newborn. The following

actions can increase rates of early initiation of breastfeeding: Identify the practices,

beliefs, concerns, and constraints to early and exclusive breastfeeding and address

them through appropriate messages and changes in delivery and postpartum

procedures; counsel women during antenatal care on early initiation and exclusive

breastfeeding; upgrade the skills of trained attendants to support early and exclusive

breastfeeding; make skin-to-skin contact and initiation of breastfeeding the first routine

after delivery; practice the "Ten Steps to Successful Breastfeeding" in maternity

services; praise the mother for giving colostrum, provide ongoing encouragement, and

assist with positioning and attachment.

Edmond et al (2006) concluded that breastfeeding was initiated within the first

day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were

exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold

higher in children given milk-based fluids or solids in addition to breast milk. There was

a marked dose response of increasing risk of neonatal mortality with increasing delay in

initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was

associated with a 2.4-fold increase in risk. The size of this effect was similar when the

model was refitted excluding infants at high risk of death (unwell on the day of birth,

congenital abnormalities, premature, unwell at the time of interview) or when deaths

during the first week (days 27) were excluded.

Exclusive Breastfeeding


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According to World health Organization (2007), exclusive breastfeeding to six

months of age has been one of the primary aims of nutrition and public health programs

across the world. One of the Millennium Development Goal of WHO was to reduce child

mortalityby two-thirds, between 1990 and 2015, the under-five mortality rate.6.9 millionChildren under five died in 2011. Almost 75% of all child deaths are attributable to just

six conditions: neonatal causes, pneumonia, diarrhea, malaria, measles, and HIV/AIDS.

The aim is to further cut child mortality by two thirds by 2015 from the 1990 level.

UNICEF (2013) said that as a global goal for optimal maternal and child health

and nutrition, all women should be enabled to practice exclusive breastfeeding and all

infants should be fed exclusively on breast milk from birth to 4-6 months of age.

Thereafter, children should continue to be breastfed, while receiving appropriate and

adequate complementary foods, for up to two years of age or beyond. This child-feeding

ideal is to be achieved by creating an appropriate environment of awareness and

support so that women can breastfeed in this manner. CDC's Division of Nutrition,

Physical Activity, and Obesity (DNPAO, 2009) is committed to increasing breastfeeding

rates throughout the United States and to promoting and supporting optimal

breastfeeding practices toward the ultimate goal of improving the public's health.

Jun Pisco (2012) wrote in his article that the several international organizations

hailed the Philippines for the significant increase in exclusive breastfeeding rates.

Recent figures released by the Food and Nutrition Research Institute showed that

exclusive breastfeeding rates have risen from 36 per cent in 2008 to 47 per cent in

2011. At the same time, there are still substantial disparities in exclusive breastfeeding

rates within the Philippines. Data from the recent Family Health Survey (FHS) in 2011


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showed that exclusive breastfeeding rates in some areas are as low as 27 per cent.

Further efforts will be needed to increase the exclusive breastfeeding to be truly at the

universal level, which will have a significant impact on the nutritional status of children in

the Philippines. Exclusive breastfeeding is the best way to provide babies with the

nutrients they need during the first six months of life, and means giving the baby no

additional liquids or solid food - not even water.

Predominant or mixed breastfeeding means feeding breast milk along with infant

formula, baby food and even water, depending on the age of the child. Babies feed

differently with artificial nipples than from a breast. With the breast, the infant's tongue

massages the milk out rather than sucking, and the nipple does not go as far into the

mouth; with an artificial nipple, an infant must suck harder and the milk may come in

more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier)

before the baby is used to feeding from its mother can result in the infant preferring the

bottle to the breast. Some mothers supplement feed with a small syringe or flexible cup

to reduce the risk of artificial nipple preference.

Planned breastfeeding and Decision to Breastfeed

Although breastfeeding is beneficial to infant and mother, other factors are

involved in the decision to breastfeed. In a study by Persad and Mensinger (2007),

breastfeeding intent strongly correlated with breastfeeding initiation, indicating that

women who decide to breastfeed during early pregnancy are likely to initiate lactation

after birth. Brodribb, Fallon, Hegney, and OBrien (2007) reported that the women in

their study decided whether or not to breastfeed before or in early pregnancy, and their

decisions were based on baby- or mother-centered factors. The baby-centered factor


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most frequently reported was concern for infant health. Mother-centered factors

included either a preference to bottle-feed for convenience or a dislike of breastfeeding

because of the reasons that included inconvenience, social barriers, or work-related

barriers (Brodribb et al., 2007). Sociocultural, environmental, and personal factors are

influential in a womans decision to breastfeed. If a woman perceives breastfeeding is

the social norm, she may be more inclined to breastfeed.

Throughout the literature, a recurring factor that influences a womans decision to

breastfeed is the presence of a support system, whether it is personal or professional

(Johnston & Esposito, 2007; Persad & Mensinger, 2007; Taveras, 2003). In fact,

support systems may be a greater influence than socioeconomic status; if a woman

views breastfeeding positively, and has support from her partner, she will be more likely

to breastfeed (Persad & Mensinger, 2007). Additionally, the presence of professional

support strongly correlates with both breastfeeding initiation (Persad & Mensinger,

2007) and increased duration of breastfeeding (Taveras et al., 2003). Professional

support may include support from postpartum nurses during early hospitalization,

lactation consultants, physicians (Johnston & Esposito, 2007), and clinicians, such as

pediatricians and community lactation consultants outside the hospital (Taveras et al.,

2003). Health-care workers during the immediate postpartum period, especially nurses

and lactation consultants, play an integral role in assisting the mother to initiate

breastfeeding. Education formally presented through individualized, interactional

techniques rather than independent and informal means (such as pamphlets or other

reading materials) usually yields better results (McInnes & Chambers, 2008; Persad &

Mensinger, 2007; Swanson & Power, 2005). Clinicians who are in contact with the


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mother and infant can affect the duration of breastfeeding by providing positive support,

problem solving, and continued patient education. Because of the influence they have, it

is important that clinicians have adequate knowledge and skills for educating and

supporting women to increase the duration of breastfeeding (Taveras et al., 2003).

A recurring factor that influences a womans decision to breastfeed is the

presence of a support system, whether it is personal or professional.

Race may also be a factor in initiation and duration of breastfeeding. Chin et al.

(2008) found that, among the participants in their study, women of non-White racial

backgrounds had lower initiation rates than White women. Additionally, the duration of

breastfeeding among non-White women was shorter than among White women. Black

women had both lower initiation and duration rates than White women regardless of

other demographic and socioeconomic variables. Although several possible

explanations may explain this disparity, one reason is thought to be the early

introduction of solid foods as a cultural norm (Chin et al., 2008). Conversely, Black

women in the United Kingdom who recently immigrated from either the Caribbean or

Africa were more likely to breastfeed at 3 months postpartum than White women (Kelly

et al., 2006). The same was true of Indian and Bangladeshi mothers at 3 months, with

the highest rate of breastfeeding in Black Caribbean women (Kelly et al., 2006).

Women of higher educational status also have higher rates of breastfeeding. In

the study by Chin et al. (2008), women who graduated from high school were 70% more

likely to breastfeed than those who did not; women who attended college were four

times more likely to breastfeed than women who graduated from high school. A


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relationship between race and education could not be determined. In a national study of

Canadian mothers, Chalmers et al. (2009) found women who were educated, older, had

incomes above the low-income cutoff level, and had vaginal births were most likely to

breastfeed.

Marital status also affects breastfeeding initiation and duration. Compared to

unmarried women, married women have higher rates of breastfeeding, especially

among Black women. Married Black women are twice as likely to breastfeed as

unmarried Black women (Chin et al., 2008; Thulier & Mercer, 2009).

Synthesis

Breastfeeding is a global issue for communities and governments that affect both

women and their infants on many levels. Despite identifying factors that influence the

initiation of breastfeeding and the importance of breastfeeding to both mother and

infant, there continues to be sub-optimal exclusive breastfeeding in both developing and

developed countries. National and international researchers, as well as governing

bodies, have outlined guidelines that support and promote breastfeeding, strongly

advocating breastfeeding as being the best practice by which to feed infants.

Research shows the advantages to infants, mothers, families, and society from

breastfeeding and the use of human milk for infant feeding. These include health,

nutritional, immunologic, developmental, psychological, social, economic, and

environmental benefits. It has been observed that there is an important relationship

between successful breastfeeding by the first-time mother and guidance and


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encouragement on the part of health care professionals before and after the birth of the

child.

Although the health benefits of breastfeeding are well documented and initiation

rates have increased over the past 20 years, most mothers wean before the

recommended 6-months postpartum because of perceived difficulties with breastfeeding

rather than due to maternal choice. Women least likely to breastfeed are those who are

young, have a low income, belong to an ethnic minority, are unsupported, and are

employed full-time, decided to breastfeed during or late in pregnancy, have negative

attitudes toward breastfeeding, and have low confidence in their ability to breastfeed.

Support from the mother's partner or a nonprofessional greatly increases the likelihood

of positive breastfeeding behaviors. Health care professionals can be a negative source

of support if their lack of knowledge results in inaccurate or inconsistent advice.

Furthermore, a number of hospital routines are potentially detrimental to breastfeeding.

Although professional interventions that enhance the usual care mothers receive

increase breastfeeding duration to 2 months, these supportive strategies have limited

long-term effects. Peer support interventions also promote positive breastfeeding

behaviors and should be considered.

The studies of American Association of Pediatric (AAP)(2007), Lawrence

(2008), World Health Organization (2010), and Millenium Development Goals (2012) all

stated that infants should be exclusively breastfeed for six months and according to

them breastfeeding lowers the risk of different diseases like asthma, diarrhea, and

respiratory illness. .


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According to Ruth (2007), and Lawrence (2008)

Therefore, researchers concluded that promotion and prolonging breastfeeding

should positively modify the womans breastfeeding intention, her social support and her

breastfeeding confidence.

chapter ii edited jeff

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