Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands.
Human Nutrition and Dietetics department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Int Breastfeed J. 2020 Apr 17;15(1):29. doi: 10.1186/s13006-020-00275-y.
Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0-1 month to 81% among those aged 4-5 months. Little is known about what influences mothers' breastfeeding practices. This study aimed to gain insights into expectant mothers' prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child's life in Muhanga District, Rwanda.
This qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.
Of the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers' concerns over their infants' health, mothers' heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers' awareness of EBF's advantages, confidence in their breastfeeding ability, and support from health professionals and family members.
Despite participants' intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.
世界卫生组织提倡婴儿在出生后的头 6 个月内应进行纯母乳喂养。然而，在卢旺达，0-1 月龄婴儿的纯母乳喂养率为 94%，而 4-5 月龄婴儿的纯母乳喂养率则降至 81%。目前，人们对于影响母亲母乳喂养行为的因素知之甚少。本研究旨在深入了解孕妇在产前对母乳喂养的意图、潜在原因、产后实际做法，以及在卢旺达穆汉加地区促进或阻碍婴儿在出生后头 6 个月内进行纯母乳喂养的因素。
本研究采用定性纵向设计，于 2016 年 12 月至 2017 年 10 月期间进行，作为一项更大研究的一部分，在两个农村医疗中心招募了 39 名在最后三个月内接受产前检查的孕妇。在怀孕期间、产后第一周以及产后 4 个月和 6 个月时对这些孕妇进行访谈，以探讨其意图、实际做法、关键转折点以及促进或阻碍因素。访谈内容进行了录音、逐字记录并进行了主题分析。
在 39 名参与者中，有 38 名孕妇打算在产后第一小时内进行母乳喂养，有 32 名孕妇打算在头 6 个月内进行纯母乳喂养。实际上，有 34 名孕妇在产后第一小时内开始母乳喂养，有 12 名孕妇在头 6 个月内进行纯母乳喂养。阻碍因素包括认为母乳不足、来自家庭成员的压力、过去的经验、对婴儿健康的担忧、母亲工作量大、贫困和粮食不安全。促进早期开始和纯母乳喂养的因素包括母亲对纯母乳喂养优势的认识、对母乳喂养能力的信心、以及来自卫生专业人员和家庭成员的支持。
尽管参与者对母乳喂养有意图，但意图与实际做法之间存在差距。个人、群体和社会层面的各种障碍阻碍了妇女在头 6 个月内进行纯母乳喂养。母乳喂养促进干预措施应考虑为母乳喂养的母亲提供支持和技能培训，以应对母乳不足的问题，并识别婴儿饥饿的真正迹象。此外，还应针对重要的有影响力的家庭和社区成员进行干预，以支持母亲进行母乳喂养。也不应忽视解决贫困导致的粮食不安全问题的干预措施。
