Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

Abstract

Background:Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %.The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeedingmothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.Methods:This community-based mixed-methods study collected data within a prospective cohort study onsociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-ShortForm (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothersliving in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted.Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.Results:The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%).Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infantformula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statisticallysignificant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data,codes associated with barriers were more than enablers. The themes wereMothers’attributes (wellbeing,experiences and relationships)with the codemother’s stressthe strongest barrier,Mother’s knowledge, attitudesand practices of breastfeedingwith the codeconventional medicinesthe strongest barrier,Family environmentwith the codehome settingthe strongest barrier,Social environmentwithpublic spaces and placesa barrier and inBaby cuesthe codebaby stomach ailmentsthe barrier. Within these same themesmother’s positive emotions,benefits of breastfeeding,support in the home, access to information and services fromhealth professionalsandbaby’shealthwere strong enabling factors. Conclusions:Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in thequalitative data. The data suggests that mothers from low-income households would be better supported throughinterventions that address food insecurity; family relationships and those that build confidence in mothers andresilience in confronting difficult and hostile breastfeeding environments