Feeding infants (0-6 months)
Exclusive Breastfeeding during the first six months is an important part of the 1000 days of opportunity window for effective and efficient nutrition intervention. Breastfeeding provides ideal nutrition for infants and the first immunity against infectious diseases thus, lowering infant morbidity and mortality. Breastfeeding also contributes to maternal health by reducing the risk of breast and ovarian cancer, and by increasing the spacing between pregnancies. Additional advantages are social and economic benefits. Breastfeeding should be initiated during the first hour after birth.
Women should be enabled to practice exclusive breastfeeding the first six months of age and to breastfeed, while providing appropriate and adequate complementary foods, for up to two years of age or beyond. The quality and quantity of breastmilk is associated to maternal dietary intake.
A KAP survey conducted during 2021 showed some insight on the knowledge attitude and practice of women of fertile age in exclusive breast feeding.
The recommended length of time for exclusive breastfeeding by the Innocenti-Declaration is six months. The Eri-KAP survey showed that the percentage of care providers who know the recommended length of exclusive breastfeeding (Figure 3.23) was more than ninety percent (94.6%). A similar percentage of care providers residing in urban (94.2%) and rural (95.0%) knew the correct length of exclusive breastfeeding. Care providers from SKB (88.9%) were found to have the lowest knowledge on the recommended length of exclusive breastfeeding (Table 3.27).
Figure 3.23: Distribution of care providers’ knowledge on exclusive breastfeeding, Eri-KAP and MDD-W 2021
Benefits of Exclusive Breastfeeding
The knowledge of the caregivers on the benefits of exclusive breastfeeding is expected to increase the motivation of the caregiver to exclusive breastfeeding. Thus, this question aimed to enquire the knowledge of the caregivers on the importance of exclusive breast feeding. The health benefits to the child in association to exclusive breastfeeding was known to more than half (63.9%) of the care providers. Only 10.8% of care providers did not know the benefits of exclusive breastfeeding. Protection against diarrhoea, disease and other infections, and provision of all nutrients as benefits of exclusive breastfeeding was known by a similar percentage of respondents, 26.8% and 27.1% respectively (Figure 3.24).
Figure 1: Percentage distribution of care providers’ knowledge on benefits of exclusive breastfeeding, Eri-KAP and MDD-W 2021
Growing healthily as a benefit of exclusive breastfeeding was correctly perceived by 70.7% of care providers residing in the Zoba Maekel. Almost half (47.9%) of care providers from Semenawi Keih Bahri were familiar with the protective ability of exclusive breastfeeding against diarrhea and other infections (Table 3.28).
Ways of Maintaining Breast milk Supply
In regards to knowledge on maintaining breast milk supply, more than eighty percent (83.8%) mentioned drinking enough liquids as a way of maintaining breast milk supply. Exclusive breastfeeding on-demand as a way of maintaining breast milk was known to less than one-tenth (7.5%) of the caregivers, and only 0.9% thought of manual expression of breast milk to keep up a milk supply (Figure 3.25). None of households whose care providers aged from 18-24 knew the manual expression of breast milk as a measure to keep up milk supply. All care providers at adult education and a higher level of education were able to mention a way of maintaining breast milk supply.
Figure 3.25: Percentage distribution of care providers on way of maintaining the breast milk supply, Eri-KAP and MDD-W 2021
Having good nutrition as a way was correctly known to a three-quarter of care providers in Zoba Gash Barka (75.5%). Drinking enough liquids was correctly known to a similar proportion of respondents in urban (84.2%) and rural areas (83.5%). Percentage distribution of care providers on ways of maintaining breast milk production by demographic characteristics is shown in Table 3.29.
Knowledge regarding the Influence of Eating Fish on Breast Milk
The quantity and quality of breast milk production is affected by maternal dietary habits. Moreover, the omega fatty acid composition of breast milk is influenced by intake of Omega 3 fatty acids (29). Table 3.30 illustrates the proportion of care providers who knew the influence of eating fish on breast milk and what the influences are. One out of six (60.5%) of the care providers recognized the influence of eating fish on breast milk (Figure 3.26). Augmenting the nutritional contents of breast milk and increasing breast milk production as influences were suggested by 59.9% and 43.6% of the care providers respectively. The majority (72.5%) of households in which the care provider has a higher level of education was found to know the influence of eating fish on breast milk. Relatively higher percentages (74.3%) of care providers in Zoba Debubawi Keih Bahri were aware about the association of eating fish on breast milk as compared to the other Zobas. More than seventy percent of households with care providers aged 45 or above (71.2%), and a higher level of education (75.7%) identified the nutritional effect of eating fish on breast milk. Similar percentage of care providers in urban (43.0%) and rural areas (44.2%) also recognized the possible role eating fish on the quantity of breast milk production.
Figure 3.26: Distribution of care providers’ knowledge on the influence of eating fish on breast milk, Eri-KAP and MDD-W 2021
3.1.3.5 Attitude towards Exclusive Breast Feeding
When households were surveyed in regards to their attitude on excusive breast feeding for six months, only 1% believed that exclusive breast feeding was very disadvantageous or disadvantageous and 2.4% were not sure about their attitude towards exclusive breast feeding (Figure 3.27). Since the frequency and percentage of those who responded disadvantageous/very disadvantageous is very few, no further analysis/breakdown was performed.
The percentage distribution of care providers on attitude of breast feeding exclusively for six months by demographic characteristics is shown in Table 3.31.
Figure 3.27: Distribution of care providers’ attitude on exclusive breastfeeding for 6 months, Eri-KAP and MDD-W 2021
3.1.3.6 Perceived Barriers to Exclusive Breast Feeding
Concerning the perceived barriers to exclusive breast feeding, only 6.2% found exclusive breastfeeding for 6 months very difficult/difficult and 93.8% found so-so/ not difficult/Easy (Figure 3.28). Households with care providers aged 45 or above (17.7%), a higher level of education (14.2%) found breastfeeding more very difficult/difficult than their counterparts. Health problems (53.7%) followed by too much workload (31.3%) were the commonest perceived barriers.
Figure 3.28: Distribution of care providers’ perceived barriers to exclusive breastfeeding, Eri-KAP and MDD-W 2021
Health problems and too much work load constituted for 86.7% and 53.1% of households whose care providers belonged to the age group 45 or above and from 35 to 44 respectively. A relatively higher percentage of respondents (21.1%) in Zoba Maekel found exclusive breastfeeding for six months difficult because of pain in the breasts. Feeling tired during breastfeeding (29.7%) consequently making exclusive breastfeeding difficult was reported by the younger care providers whose age ranged from 18-24. When looking at the educational level in terms of the perceived barriers, 9.6% of households whose care providers were at a higher level of education believed they will not get enough sleep if they are to exclusively breast feed their baby (Table 3.32).
3.1.3.7 Practice of Introducing Liquids
Table 3.33 shows the percentage distribution of households with practice in regards to introducing liquids to a baby less than 6 months of age. Care providers, as shown in Figure 3.29, introduced the following liquids; plain water (26.5%), infant formula (15.3%), fresh animal milk (8.6%), powdered milk (4.3%), butter (2.4%), and other liquids (1.9%).
Figure 3.29: Distribution of care providers’ practice of introducing liquids for babies less than 6 months of age, Eri-KAP and MDD-W 2021
A relatively higher percentage of the introduction of liquids was seen in households in which the care providers were of older age (45 or above) and in those residing in rural areas in comparison to their counterparts. In addition to that, households in which the care providers were residing in Zoba Gash Barka (38.5%) tend to offer plain water more frequently than care providers residing in the other Zobas.
The practice of exclusive breastfeeding was assessed indirectly by asking if the care providers give any additional fluid to the infant before six months of age. By computing the number of caregivers who do not provide anything before the child is 6 months, the number of women who exclusively breastfeed was calculated to be 65.1%
3.1.3.8 Knowledge of when to Breast feed a Child
When care providers were asked how they know when to breastfeed their child, the majority (76.9%) said they know they have to breastfeed their child when he or she cries (Figure 3.30). Analysis of this knowledge parameter by demographic characteristics shows that households with care providers at a higher level of education (69.3%) were not in favor of the response “when a child cries”, while households in which care providers are residing in Zoba Gash Barka (85.1%) were in favor of breast feeding their child in response to his/her crying (Table 3.34).
Figure 3.30: Percentage distribution of care providers on when to breastfeed their children, Eri-KAP and MDD-W 2021
Knowing to breastfeed a child when he/she wakes up was addressed by 39.4% of respondents. More than half (53.5%) of households in which the care providers were at a higher level of education had the knowledge that a child is to be breastfed on his/her time. A comparatively higher percentage of a notion that a child is to be breastfed when mother’s breast milk starts to run was seen with residents of Zoba SKB (40.7%).