Breastfeeding trends in Yerevan: Relationship between maternal knowledge and breastfeeding practices

Abstract

Background: The positive health benefits from exclusive breastfeeding are well documented. Starting from 1993, with support from UNICEF and USAID, the Ministry of Health of Armenia initiated a new nationwide program called State Program on Breastfeeding. State programs were initiated in maternity hospitals as part of the Baby Friendly Hospital Initiative (BFHI). From 1993 to 1997 the rate of exclusive breastfeeding in Armenia increased from 0.7% to 20%. According to the Armenia Demographic and Health Surveys, exclusive breastfeeding increased from 30% to 33% from 2000 to 2005. Study Aim: This study assessed the current levels of breastfeeding, feeding practices and their influence on breastfeeding, and maternal knowledge about breastfeeding. The findings were compared with the survey outcomes conducted in 1997. Methodology: The analytical cross-sectional telephone survey was conducted with 135 mothers of children aged 0-6 months served by nine health facilities located in different districts of Yerevan. Infants were randomly chosen according to systematic random sampling and then their mothers were contacted for interviews. The study adapted the instrument used in1997. Results: Approximately17.0% of mothers reported about prelacteal feeding, 6.0% of these babies received prelacteal feeding by bottle, 77.0% reported that they were explained the benefits of correct positioning and attachment, 74.8% of mothers reported about being informed on demand feeding. About 91.9% of the study participants reported that their babies stayed with them in the same room. Only 2.9% of the study participants reported that they never breastfed their children because of health condition. About 46.7% mothers reported about bottle feeding with a nipple. According to mothers' reports the mean age of giving infants other food than breastmilk was about 4 month. Although the majority of mothers breastfed their children, they substituted their milk with water, tea, fruit juices, bananas, porridge, and infant formula earlier than recommended. According to WHO indicators, the rate of exclusive breastfeeding for up to 6 months was 23% and for up to 4 months 44.4%. The multiple regression analysis revealed significant associations between exclusive breastfeeding and stress as the main reason of insufficient breastmilk (OR=9.28, 95%CI=2.1-40.8), the need of giving water to a newborn baby besides being breastfed (OR=19.4, 95%CI=2.5-151.8) and infant’s age (R=0.974, 95%CI=0.96-0.99). Conclusion and Recommendations: Although the percent of exclusive breastfeeding increased since 1997, it is still less than ideal. Some of the hospital practices also need improvement. Maternal knowledge related to breastfeeding was less than 50%. Maternal knowledge was identified as strong predictor of exclusive breastfeeding among the mothers, but their knowledge level needs to improve significantly. The following two recommendations emerge from these findings and the existing literature: 1. The health system should better educate pregnant women and new mothers about exclusive breastfeeding. 2. The MOH should improve the implementation of the Ten Steps to Successful Breastfeeding Policy in order to ensure appropriate post-partum care practices.