CHAPTER ONE

INTRODUCTION
1.1 Background to the Study
Over the years, breastfeeding has been a universal means of feeding infants and a common

feature of all cultures since the survival of mankind. It is a phenomenon that is deeply rooted in

the tradition of human culture. Although, breastfeeding practices have fluctuated over the years,

it is widely regarded as an unequalled way of providing ideal nutrition for the healthy growth and

development of infants (World Health Organization, 2016). Breast milk is mostly referred to as

nature‘s most precious gift to the newborn and the ideal food for the human infant of which an

equivalent is yet to be developed by the scientific community despite tremendous advances in

science and technology (Nanthini & Jeganathan, 2018). There are several methods of infant

feeding, prior to the discovery and recommendation of exclusive breastfeeding. Mixed feeding

has been a common practice, where infants received breast milk and other food or liquids and

predominant feeding, where infants receive breast milk as a predominant source of nourishment

and also receive water and water-based drinks or liquids (WHO, 2019).

Exclusive breastfeeding means only breast milk is allowed with the exception of medicine,

vitamin syrup and oral rehydration solution for the first six months of life to achieve optimal

growth, development and health. Thereafter, infants should receive nutritionally adequate and

safe complementary foods (WHO, 2016). Complementary feeding means infants can receive

breast milk, expressed milk or milk from a wet nurse, as well as solid or semi-solid foods,

liquids, formula milk, which begins from 6 months and continuing to breastfeed for up to two

years or more (United nations children‘s funds, 2019). This has been one of the primary aims of

nutrition and public health programmes across the world with the aim of improving infant and

child morbidity and mortality and also to improve maternal health. Exclusive breastfeeding is
internationally the most preferred way of feeding infants during the first six months of their lives,

and it is recognized as being one of the most natural and best forms of preventive medicine

(WHO, 2016). During the first few days after delivery, colostrum, known as the first fluid that

comes from the breast immediately after birth, is produced and should be fed to the new-born,

while awaiting the production of regular breast milk (Makena, 2018). It is yellowish in colour,

contains high proteinand anti-bodies and often described as the first form of immunization

because it is an important source of nutrition and antibody protection for a newborn child.

Therefore, it is recommended that infants should be put on the breast immediately or within one

hour after birth, which enables the stimulation of breast milk production (WHO, 2015).

Although, the composition of breast milk varies according to factors such as maternal nutritional

status, genetic makeup, maternal dietary habits, and so on, it contains nutrients, anti-bodies, and

properties important for growth and development, which makes it a uniquely perfect food for

babies with nutrient in the right proportion and ready in the right temperature (Riordan, 2017).

Breast milk is the most complete form of nutrition because it has the right amount of fat, sugar,

water, and protein which most babies find easier to digest than formula (United nations

international children‘s Emergency Fund, 2018).The water content of breast milk consumed by

an exclusively breastfed baby meets the water requirements for infants and provides a

considerable margin of safety because breast milk contains 10% solids and 90% water

(Lawrence and Lawrence, 2018).

The mother also benefits from exclusive breastfeeding by experiencing increased production of

hormones that are responsible for uterine contraction, prevention of postpartum haemorrhage and

maternal mortality
The overall exclusive breastfeeding rate worldwide is not satisfactory considering the policy

responses established for improving infant and young child feeding practices. One of such

responses is the Baby Friendly Hospital Initiative (BFHI) launched in 1991 to encourage

exclusive breastfeeding for the first six months of life and continued breastfeeding for at least

one year of life. The initiative has been launched in at least 152 countries worldwide and in

several parts of Nigeria (UNICEF and WHO, 2019). Although, considerable improvements have

been made in some regions, the prevalence of exclusive breastfeeding remains far too low

especially in many areas of the developing world which is far below the widely accepted 90%

universal coverage target of the international recommendation (Cai, Wardlaw, & Brwon, 2016).

This implies that there is a great deal of low or non-compliance worldwide. For this reason, the

World Health Organization aims to increase the global rate to at least 50% by the year 2025

(UNICEF, 2019).

Exclusive breastfeeding for the first six months has the capability to prevent 13% of all under

five deaths in developing countries (UNICEF, 2014). However, infant and child mortality

remains disturbingly high in Africa and other developing countries, despite the significant

Exclusive breastfeeding protects children from a myriad of illnesses, increases IQ, promotes a

strong bond between mother and infant and also decreases a mothers’ risk of breast cancers,

among others (WHO, 2017). Yet, only two in five babies worldwide are exclusively breastfed for

the first six months of life (UNICEF, 2015). Globally, the overall rate of exclusive breastfeeding

for infants under six months of age is 40%, and this is evident that the practice rate is still very

low (UNICEF, 2017).

1.2 Statement of the Research Problem

Despite the well-documented benefits of exclusive breastfeeding (EBF) for both infants and
mothers, its practice remains suboptimal, especially among working-class mothers. The World

Health Organization (WHO) and UNICEF recommend exclusive breastfeeding for the first six

months of life as a vital intervention to reduce infant morbidity and mortality, enhance child

growth and development, and improve maternal health. However, many mothers face challenges

in adhering to this recommendation due to personal, social, cultural, and occupational factors. In

Nigeria, while awareness of breastfeeding is generally high, the actual practice of exclusive

breastfeeding remains relatively low, particularly among employed mothers who often struggle

to balance work demands with the needs of their infants.

Working-class mothers are uniquely affected by issues such as short maternity leave, lack of

workplace support for breastfeeding, inadequate knowledge, and limited access to breastfeeding-

friendly environments. These factors often compel them to introduce infant formula or

complementary feeding earlier than recommended, thereby undermining the practice of

exclusive breastfeeding. In Minna, the capital of Niger State, the situation is no different. Many

mothers who attend primary health care centres receive antenatal and postnatal education, yet the

extent to which this translates into practical adherence to exclusive breastfeeding

recommendations remains unclear. This raises critical questions about the effectiveness of

current awareness strategies and the real-life challenges faced by working mothers in practicing

exclusive breastfeeding .

1.3 Objectives of the Study

The objectives of the study is to:
i. Assess the level of awareness of exclusive breastfeeding among working-class mothers

attending selected primary health care centres in Minna.

ii. Examine the attitudes of working-class mothers towards exclusive breastfeeding in the
selected primary health care centres.

iii. Evaluate the practices of exclusive breastfeeding among working class mothers in the

study area

iv. Identify the factors militating the practice and of exclusive breastfeeding among

working-class mothers in selected primary health care centres in Minna.

1.4 Research Questions

The following research questions were asked to guide the study:

i. What is the level of awareness on exclusive breastfeeding among working-class mothers

in selected primary health care centres in Minna?
ii. What are the attitudes of working-class mothers towards exclusive breastfeeding in the
study area?
iii. What are the breastfeeding practices of working-class mothers with respect to exclusive
breastfeeding in the selected area?
iv. What are the factors militating the practice of exclusive breastfeeding among workng-
class mothers in the selected health centres?

1.5 Significance of the Study

The study serves as an eye opener, especially to the women population who are ignorant of the

benefits of exclusive breastfeeding. It also serves as a tool for educating women on newborn

feeding practices and to enable every woman to develop a positive attitude towards exclusive

breastfeeding . The study motivates health professionals and health care providers on the need to

intensify and widen their scope of counselling services to expectant mothers for proper education

on exclusive breastfeeding. The study was able to elicit information that unveiled challenges

faced by women in their bid to practice exclusive breastfeeding so that necessary actions can be

taken to prevent and overcome such challenges. The study also emphasized the need for

communities, government and the society as a whole to create a favourable conducive

environment and space for mothers to practice exclusive breastfeeding without undue influence

from social network, such as peers, elderly females, mother in-law, and so on. As past strategies

did not consider the social norms linked to the practice and, therefore, did not address those who

influence and enforce the current practice. Hence, the study will aid the ministry of health and

other organizations concerned with infant and young child feeding in determining the type of

interventions to design in order to improve maternal and child health. The study also contributes

to the growing body of scientific knowledge and will also add to existing literature on the subject

of exclusive breastfeeding.

1.6 Scope of the Study

This study is specifically focused on assessing the awareness and practice of exclusive

breastfeeding among working-class mothers in selected Primary Health Care (PHC) centres in

Minna, Niger State. It aims to determine the extent of knowledge these mothers have about

exclusive breastfeeding, their attitudes toward it, and the behavioral patterns they exhibit in

relation to the practice. The research seeks to understand whether the knowledge acquired by

these mothers is being translated into proper breastfeeding practices, especially within the

recommended six months of exclusive breastfeeding as advised by the World Health

Organization (WHO) and UNICEF.

The scope is limited to working-class mothers who attend selected PHC centres in Minna. This

focus is due to the increasing rate of female participation in the workforce, which may

significantly influence their ability to practice exclusive breastfeeding. By concentrating on this

specific demographic, the study intends to uncover the unique challenges and barriers working

mothers face in adhering to optimal breastfeeding practices, including workplace policies,

maternity leave, availability of breastfeeding-friendly environments, and support systems. These

insights are important in understanding how employment may interfere with or support exclusive

breastfeeding efforts.

Furthermore, the study is restricted to mothers with infants aged 0–6 months, as this period is the

recommended duration for exclusive breastfeeding. It does not cover stay-at-home mothers or

those receiving care from private or tertiary health institutions. The geographical scope is limited

to Minna metropolis to make data collection more practical and to provide context-specific

recommendations. Findings from this study will provide valuable information for health

practitioners, policymakers, and stakeholders to develop strategies that support exclusive

breastfeeding among working mothers, ultimately improving child health outcomes in Niger

State and similar settings.

1.7 Operational definition of terms

i. Exclusive Breastfeeding (EBF): Feeding an infant only breast milk (no water, formula,

or other liquids/solids) for the first six months of life, with the exception of oral

rehydration salts, drops, or syrups (vitamins, minerals, medicines).

ii. Awareness: The state or level of consciousness and understanding a mother has

regarding exclusive breastfeeding and its benefits.

iii. Practice: The actual application or implementation of exclusive breastfeeding by

mothers in real-life settings.

iv. Working-Class Mothers: Women who are employed in either the formal or informal

sectors and are actively engaged in earning a living, while also raising children.

v. Primary Health Care Centres (PHCs): Government-approved health facilities that

provide basic health services, including maternal and child care, at the community level.

vi. Attitude: A mother’s mental and emotional stance or perception towards exclusive
 breastfeeding, which can influence her decision to practice it.

vii. Behaviour:The actions or reactions of mothers in response to the idea or practice of

exclusive breastfeeding, including consistency, duration, and adherence.

viii. Infant Nutrition: The dietary needs and feeding practices that promote optimal health

and development in infants from birth to one year.

ix. Malnutrition: A condition that occurs when a child's diet does not provide adequate

nutrients for growth and development, often preventable through exclusive breastfeeding.

x. Lactation: The physiological process of producing and secreting milk from a mother’s

breast, usually in response to childbirth.

xi. Complementary Feeding: The introduction of solid or semi-solid foods alongside breast

milk, typically after the infant reaches six months of age.

xii. Health Education: The process of informing and educating mothers about health

practices, including the benefits and techniques of exclusive breastfeeding.

xiii. Maternal Health: The health of women during pregnancy, childbirth, and the

postpartum period, which can influence breastfeeding choices and outcomes.