Addressing Challenges to Immediate and Exclusive Breastfeeding in the First Months of Life – Findings From Egypt

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: Maternal perceptions of insufficient breastmilk is a major barrier to immediate and exclusive breastfeeding, yet limited evidence and guidance exists on how to address this issue in newborn health programming. The United States Agency for International Development (USAID)-funded Maternal and Child Health Integrated Program (MCHIP) implemented Smart Project, with a focus on improving newborn health and the nutritional status of children less than two years of age. A doubling in stunting prevalence in Lower Egypt between 2005 and 2008 prompted a research study, as part of the MCHIP program, to examine infant and young child feeding practices within the context of stunting in children less than 2 years of age. Commonly held perceptions, beliefs and practices which hinder immediate and exclusive breastfeeding were examined in order to generate guidance for strengthening newborn health programming in this area.

Methods: Implementation research was conducted in Upper and Lower Egypt in February-April 2013 among women who participated in the MCHIP/Smart project. Qualitative data collection consisted of in-depth interviews with 150 women, with children 0-23 months of age. Mothers discussed perceptions and cultural norms surrounding breastfeeding practices and problems experienced during breastfeeding, as well as early introduction of certain foods and liquids.

Results: In the first few days of life, most mothers provide herbal drinks to sooth children’s crying. Following these prelacteal feeds, most mothers continue to provide herbal drinks and introduce foods in the initial months of life, as a response to perceptions that breastmilk is lacking in quality and/or quantity. Provider advice regarding how mothers can address insufficient breastmilk was inadequate and encouraged mixed feeding, which was supported by some grandmothers and fathers.

Conclusions: Community-based strategies and messages to dispel misperceptions regarding breastmilk insufficiency by mothers, health workers and family members can strengthen immediate and exclusive breastfeeding in newborn health programs.