This article is included in the Datta Meghe Institute of Higher Education and Research collection.
lactating women, Early initiation of breastfeeding (FIBF), Exclusive Breast Feeding (EBF), breastfeeding techniques, complementary feeding practices (CF), Infant and Young Child Feeding (IYCF), National Family Health Survey(NFHS), Myths Related Breast Milk.
The registration of the study is in process in the clinical trial registration of India with this reference no. REF/2023/06/068537.
The World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) advise exclusively nursing a baby during the first six months of life, starting with the initial hour after delivery and discontinuing it at age two or later.1 To grow and develop properly, a child must have adequate nourishment throughout the first 1,000 days of life. The “critical window” for promoting the best possible growth, health, and cognitive development is from birth to age two.2 The UNICEF East Asia and Pacific Regional Office have developed a supplement nutrition strategy. The study demonstrates that four system that may be involved to influence predictors of complementary feeding, including caregiver’s attitude, sociocultural perceptions, and knowledge are important factors in the efficacy of feeding practices. Food, health, social protection, and water, sanitation and hygiene (WASH) are the perspectives that affects predictors influence.3
According to 16 states and Union Territories that reported an increase, the NFHS-5 data indicates that exclusive breastfeeding is improving. These states include Goa, Gujarat, Assam, Bihar, Maharashtra, Daman & Diu, Telangana, Dadra & Nagar Haveli, Himachal Pradesh, Mizoram, Kerala, Ladakh, Karnataka, Lakshadweep, Meghalaya, and West Bengal. World Breastfeeding Week is commemorated annually from August 1 to August 7.4 WHO reports that 170 nations attend to support, promote, and encourage breastfeeding.4 During complementary feedings, children are more likely to be undernourished. Good nutritional value should be consumed on time, so that the development (physical and mental) of the child is good. In infants older than six months, intake of low-nutrient and energy-deficient foods may lead to some form of nutritional deficiency and retardation of the child’s development.5,6
Children’s feeding habits have mainly progressed, except for the percentage of children under three years old who were breastfed within an hour of delivery, which has remained stable since NFHS-4. The rate of exclusively breastfed children under six months has improved significantly, from 55% in NFHS-4 to 64% in NFHS-5.7 Although exclusive breastfeeding has increased in India, early breastfeeding initiation remains critical. As per the data, breastfeeding within one hour reduces neonatal mortality by 22.3%.8 The National Guidelines on Infant and Young Child Feeding Practice (IYCFI) emphasize the significance of critical nursing starting or exclusive breastfeeding practices. For the first time in India, the Planning Commission included breastfeeding and complementary feeding targets in the National Nutrition Goals for the Tenth Five-Year Plan (2002-2007). The Ministry of Health and Family Welfare launched MAA (Mothers’ Absolute Affection) in 2016 to promote elite breastfeeding practices and to create awareness and strengthen breastfeeding support programs in public health facilities to create an atmosphere that supports breastfeeding. However, the fifth round of national family health survey’s findings show that the new program has made no substantial progress.9,10
According to the World Health Organisation, the first six months of a child’s life need to be spent breastfeeding. To practice exclusive breastfeeding, mothers’ knowledge and a healthy attitude are essential.11 This study evaluates the methods for early initiation and breastfeeding. Compared to exclusively breastfed infants, those who are not have a roughly six-fold increased risk of dying from an infectious disease in the first month of life.12,13 Non-breastfed babies had a four times higher mortality rate between 2 and 3 months. All neonates should only receive breast milk for nutrition. Additionally, it improves sensory and cognitive development and is one of the most economical strategies to lower newborn morbidity and death from illnesses, including diarrhea, respiratory diseases, and others.4
Children that have early skin-to-skin contact with their mothers interact with them more and cry less. Additionally, it improves the mother-child bond, reduces newborn hypothermia, and lessens the mother’s risk of postpartum hemorrhage, a major contributor to maternal death. Assume that we are unable to enhance this important indication, then all the advantages mentioned above would be jeopardized, and we might not make the best use of a crucial and cost-effective program to reduce newborn, infant, and maternal morbidity and death.9,14
• begin nursing an hour after birth
• Newborns should only be breastfed for the first six months to provide the best possible growth, development, and health. Infants should continue breastfeeding while eating safe, nutritionally adequate supplements to meet their changing dietary needs.
• Mother’s milk should be given to the child for at least two years.
According to the WHO, nursing also has advantages for mothers. It is a natural way of preventing pregnancy that offers ninety-eight percent defence in the first six months after birth.15
Rationale: UNICEF and WHO recommends exclusive nursing during the first six months of a baby’s life, beginning the hour after delivery. Regular breastfeeding for the first six months boosts sensory and cognitive development, protects the infant from illness, and lowers the neonatal death rate. The kid is quite active in the first hour after birth, and if they are maintained on the mother’s breast at that time, bonding is made easier since the taste of the fluid there is similar to that of the amniotic fluid in the womb.15 Breast milk is prevalent in many areas of the world and is frequently associated with family practices, cultural norms, hospital rules, and procedures not founded on scientific proof. The mother’s “first milk” is an immunity booster and an essential source of nutrition, some households or older family members give the infant certain liquids and foods, such as formula milk, honey, or sugar syrup, and throw away the first breast milk. These procedures can cause a baby’s first essential interaction with its mother to be delayed.13,14
This paper assesses the knowledge, attitude, and practices of IYCF with the parameter of socio-demographic area, knowledge regarding feeding techniques, early initiation, and complementary feeding practices of lactating mothers aged between 20-35 years. Women were excluded if they were unwilling to participate, or had untreated HIV, cancer, psychosis, active tuberculosis, had a complicated delivery, the baby required NICU and neonatal resuscitation admission in the immediate post-delivery period, or had a gross congenital anomaly. Data will be collected through self-made Odk survey responses, and M.S. Excel will be used for analysis. The study aim is to evaluate people’s understanding, attitudes, and usage of IYCF practices.
This research is similar to that of Bhalamwala et al. which assessed dietary patterns of children aged 6 months-3 years in urban slums of Arvi Naka. The objective was to assess the mother’s practices on pre-lactate feed, colostrum, exclusive breastfeeding, duration of breastfeeding, importance, and methods of weaning. Notable findings of this study were the lack of knowledge about breastfeeding and early initiation and malpractices regarding breastfeeding and weaning in slum areas.6
In a subsequent study, Bhatt et al. evaluates the mothers who give birth at tertiary care facilities about their knowledge, attitudes, and practices towards the early commencement of breastfeeding. Designed to offer suggestions for actions to support early breastfeeding, the study came to the conclusion that targeted and well-coordinated breastfeeding policies and interventions by health workers, busting pre-lactate feed myths, and promoting EIBF can improve early initiation of breastfeeding practices for all Indian mothers—increased early initiation of breastfeeding among working women.12
Prajapati et al. is the third study we looked at and used descriptive cross-sectional research to yamine nursing women in Mizan Aman City, Southwestern Ethiopia, to determine their knowledge, attitudes, and practices toward exclusive breastfeeding. Most moms were aware of EBF, it was revealed that they were supportive of EBF. The mothers’ perceptions of the sufficiency of EBF for six months and their awareness of the necessary length of EBF might have been greater.16
Kushwaha et al.’s study was conducted according to a survey on Initiation of Breastfeeding: Are Babies in India Getting the Best Start? It aimed to assess the level of knowledge about the initiation of breastfeeding. The study found that nearly half of the mothers believed breast milk was more nutritious, and mothers said feeding babies breast milk protected them from infection. And their point was that they started breastfeeding within 1 hour of birth. Most of the mothers agreed to give colostrum.17
A cross-sectional observational study will be conducted in Wardha District, Maharashtra from February 2023 to October 2023.
The study participants for this paper will be women in Wardha district aged 20-35 years who are lactating mothers. A convenience sampling method will be used for the study. The inclusion criteria will be lactating mothers between 20-35 years of age group.
Variables are clearly defined for all outcomes, exposures, predictions, and impact modifiers.
A validated structured questionnaire will be created in ona.io (Odk questionnaire) format and used for the data collection. Face-to-face interviews will be conducted after filling out the consent form with a predesigned, standardized questionnaire regarding knowledge, attitude, and practices of IYCF. The data will be collected in Odk form. The participants will answer questions regarding knowledge of IYCF practices such as early initiation of breastfeeding, exclusive breastfeeding, and complimentary feeding practices. Knowledge of colostrum and its advantages will be assessed (Table 1).19
• MODULE 1 will include questions on socio-demographic background (A/C to Modified BG Prasad Socioeconomic Status Scale)
• MODULE 2 will include questions on knowledge regarding breastfeeding, early initiation (A/C to WHO & UNICEF IYCF Practices)
• MODULE 3 will include questions on myths related to breastfeeding
The sample size is 355 lactating women in Wardha District.
Estimate a proportion with absolute precision:
Alpha (α) – 0.05
Estimation error (p) – 0.64
Estimation error (d) – 0.05
The minimum sample size needed: 355
Numerous publications on early initiation and IYCF nursing practices have been read. The study “Prevalence and variables related with early beginning of breastfeeding among women in Moshi Municipality, Northern Tanzania,” and the NFHS-4 and NFHS-5 data of 5% prevalence in the study, 0.5 significance for the study, of which 355 respondents are necessary.18
Descriptive statistics will be used
Information will be collected and analyzed using the Open data kit and Microsoft Excel software. Descriptive statistics such as mean, frequency, and percentage of different parameters will be calculated. Association and correlation between early breastfeeding will be examined using a chi-square test.
There may be information bias in this research, such as some questions missed by the researchers, and recall bias, for example relating to when the mother fed the child for the first time.
Through our study, we wish to assess the following:
1. The percentage of women with knowledge of early initiation of breastfeeding.
2. Myths and misconceptions prevalent amongst the study participants regarding breastfeeding.
3. Percentage of women with knowledge of complementary feeding practices amongst the study population.
4. Association of socioeconomic status of the study population with IYCF practices.
Assess the percentage of women with knowledge of the early initiation of breastfeeding and the ability to complementary feed the child.
The results of this study should be interpreted in the context of several limitations. These include the study’s cross-sectional nature, the lack of information on breastfeeding practices, and the lack of indicators that align with WHO guidelines. Lastly, there were just a small number of demographic variables that could be used as control variables. This was due to some potential demographic variables being dominated by single categories. Future studies may benefit from the inclusion of additional control variables, including things such as social norms, cultural practices, and the inclusion of spouse data, which were not available in this study. Strengths include large sample size, randomization of sampling units, and the presence of a large-scale intervention.
Interpretation: This study examines the knowledge, attitudes, and practices of mothers regarding the early commencement of breastfeeding, exclusive breastfeeding, and breastfeeding methods. According to research, breastfeeding should begin as soon as possible since it lowers the death rates for newborns, infants, and children under five years old and is a public health priority. A newborn must receive colostrum as its first meal and avoid pre-lacteal feeds to start breastfeeding as soon as possible.
✓ Our study found that focused and well-coordinated breastfeeding policies and interventions by healthcare professionals, dispelling myths about breastfeeding, and promoting EIBF will increase the early start of nursing practices for all Indian mothers.
✓ This study will show the increased awareness for early initiation, exclusive breastfeeding, and complementary feeding.
✓ Understanding that breastfeeding promotes the bond between mother and child is helpful.
✓ Additionally, this research shows that breast milk is more essential for children than bottled or formulated milk.
✓ For making policies related to the promotion of early initiation and complementary feeding for 0 to 1 year of a child.
Ethical approval for this study (DMIHER (DU)/IEC/2023/646) was provided by the Ethical Committee of Datta Meghe Institute of Higher Education and Research (Deemed to be University) on 11/02/2023.
Informed written consent will be obtained from all study participants prior to starting the study.
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