Knowledge and importance of exclusive breastfeeding

“Breastfeeding is the most precious gift a mother can give her infant. When there is illness or malnutrition, it may be a lifesaving gift; when there is poverty, it may be the only gift.” – Ruth Lawrence, M.D.

1.1 Background of research

Exclusive breastfeeding starts from a new born to the age of six months. It is an ideal and incomparable to any infant formulas created for them recently. As it has been known that breastfeed contains the perfect food for a newborn which has immunization to diseases, easy to digest and at the perfect temperature to be fed to infants. Breast milk is the natural first food for babies which provides all the energy and nutrient that the infant needs for the first months of life.

The first breastfeed milk is known as the colostrums which can only be found in breast milk that contains all best nutrients for the new born babies. Colostrums contain antibodies that protect the baby from bacteria and viruses in the early age. It helps to increase the baby’s intelligence and growth and strengthen the close bond between mother and the baby ( Gartner et al. 1997). It strongly proven that breastfeed is the best food for a baby that no other food has the same nutrients values.

Pregnant mothers should have the knowledge and awareness of the benefits of breastfeeding to newborn infants. This study is to find out how much the awareness and knowledge of 30 pregnant women in the antenatal and postnatal wards through questionnaires. They should be aware of the benefits of breast milk to infants and to their own health.

Many women make infant feeding decisions before delivery and before any contact with healthcare professionals. Although health promotions campaigns are influential in educating women about breastfeeding, they often do not dissuade women from formula feeding once the decisions has been made. Antenatal preparations of pregnant women for breastfeeding rises awareness of the importance of breastfeeding, empower them with practical knowledge and skill in breastfeeding techniques, and prepare them for possible difficulties.

Though many campaigns and seminars were done nationally to educate the public, yet the rate of exclusive breastfeeding is still to the unsatisfactory level. The rate of exclusive breastfeeding in Malaysia has been decreased from 92% ( in 1950’s) to 78% (in 1970’s) but there was a slight of increment in the early year of 1975( Da Vanzo, 1991) although for only less than 10%. Report done by the World Alliance for Breastfeeding Action (WABA, 2005) , showed that millions of babies fell sick every year as they were not breastfeed. The World Health Organization (WHO, 2002) estimated that more than 1.5 million babies died yearly may be avoided if the babies were given exclusive breastfeed, from birth to six months and continuously until the age of two years old.

Malaysia has been doing a lot of promotions and activities lately to give the knowledge and importance of exclusive breastfeeding through activities such as World breastfeed week and Baby friendly Hospital.

1.1 Problem of statement

Breast feeding have multiple benefit to the mother and child but there are still postnatal mother that are not confident and not interest to breast feed their baby. This problem might be due to lack of knowledge on information sources regarding breastfeeding. This research is done to elevate the knowledge between antenatal and postnatal mothers in this hospital.

Breastfeeding offers irrefutable and long-lasting health benefits for both mother and baby, which are supported by a comprehensive scientific research. Many research and evidence base has been conducted and proven that the benefits of breastfeeding are undeniable.

Ministry of Health has set and implements various strategy in promoting exclusive breastfeeding. One of the strategy is the ‘Baby Friendly Hospital Initiative’ on 1993.The aim is neither than to develop an environment that support mother to breastfeed their baby, create a policy that control exclusive breastfeeding. On Mac 1998, Malaysia had been announced as the 3rd country in the world which all the government hospital has been given the ‘Baby Friendly Hospital’ status.

Over time, the percentages of births to subgroups with higher rates of breastfeeding–particularly Malays and more highly educated women–have increased. However, there is also evidence of changes in rates of breastfeeding within these subgroups. Many Malaysian infants have a total duration of breastfeeding (including with supplementation) considerably shorter than WHO recommended six months of exclusive breastfeeding.

The national breastfeeding policy has been revised in 2006, according to WHO all mothers are encouraged to breastfeed their babies exclusively from birth until 6 months of age and thereafter to continue until their child is 2 years old. Complementary foods should introduce when the baby is 6 month old.’

1.2 Hypothesis

The postnatal mothers have a higher level of exclusive breastfeeding knowledge compared to the antenatal mothers.

1.3 Significance Of Study

The benefits of breast milk is undeniable, manufacturer are trying to create a milk that are at least having similar benefits and nutritional value as the breast milk, yet no strong research study has been conducted to prove it.

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mother’s bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 – 600 extra calories a day in producing milk. The composition of breast milk depends on how long the baby nurses.

“Research shows that the milk and energy content of breast milk actually decreases after the first year. Breast milk adapts to a toddler’s developing system, providing exactly the right amount of nutrition at exactly the right time. In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of a mother’s milk provide these percentages of the following minimum daily requirements:

Energy 29% Folate 76% Protein 43% Vitamin B12 94% Calcium 36% Vitamin C 60%10 Vitamin A 75% .

1.4 Research Objective

1.4.1 General Objective

The aim of this study is to identify all antenatal and postnatal mothers have the confidence and knowledge to exclusive breastfeeding.

1.4.2 Specific Objectives

1.3.2.1 To examine the knowledge of antenatal and postnatal mothers towards exclusive breastfeeding

1.3.2.2 To educate antenatal and postnatal mothers with exclusive breastfeeding knowledge and understandings.

1.5 Significant of Project

1.5.1 The importance of this study is to find out the difference knowledge level between antenatal and postnatal mothers on exclusive breastfeeding.

1.5.2 This study needs to assess the knowledge level of the antenatal and postnatal mothers after informations, campaign and educations given by health care staff and to show the teaching techniques by them are effective.

1.5.3. The is to esure that it will increase the knowledge and improvements to induviduals involvements in exclusive breastfeeding

1.6 Scope of Project

1.6.1 The study sample is limited to antenatal mothers who was come for screening in labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward.

1.6.2 Antenatal mother who was not delivered baby from 30 January to 30 Mac 2011

1.7 Definition

1.7.1 Assessment

Assessment is a process that follows a continuous cycle of improvement based upon measurable goals, involving data collection, organization and interpretation leading to planning and integration.

1.7.2 Knowledge

Knowledge is the awareness and understanding of facts, truths or information gained in the form of experience or learning. Knowledge is an appreciation of the possession of interconnected details.

1.7.3 Exclusive breastfeeding

Exclusive breastfeeding defined as no food or liquid other than breast milk , not even water, is given to the infant from birth until six months of age.

1.7.4 Antenatal mother

Occurring or present before birth; during pregnancy

1.7.5 Postnatal mother

post meaning “after” and natalis meaning “of birth”- is the period beginning immediately after the birth of a child and extending for about six weeks.

CHAPTER 2 LITERATURE REVIEW

2.0 Introduction

Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3-4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register quoted by Kramer MS , Kakumar R.( Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada)

Mothers often are uninformed about the health benefits of any amount of breastfeeding, their ability to continue breastfeeding while employed, and the convenience and cost differential of breastfeeding as compared to formula feeding. “Although there is a tendency in the literature to stress the time-intensive nature of breastfeeding, in fact it may require less time and attention than bottle-feeding” (Barber-Madden, 1990).

First, the promotion of breastfeeding without practical help and knowledge which led to many frustrated, unsuccessful breastfeeding attempts with subsequent backlash.

Second, a much shorter hospital stay which does not provide adequate time for mother’s milk to come in or for appropriate education and support. In Australia in 1993, a country which is known for its support of breastfeeding, the average hospital stay for vaginal delivery was still 5 to 7 days, and for C-section, 7 to 10 days. Australia also has the foresight to send home health visitors once the mother is discharged to offer further assistance and support.

Third, the continued increase of women in the workplace, many times by necessity and not by choice, has influenced the incidence and duration of breastfeeding. A non supportive work environment makes breastfeeding difficult at best.

Finally, the decline of breastfeeding has been assisted by the ambivalence of some health care professionals. This ambivalence is based on the lack of familiarity with current breastfeeding research, reliance on formula company nutritional information, and the very well meaning issue of not wanting to push breastfeeding because it might make the Mom who chooses artificial feeding feel guilty.

“Despite these initiatives, only 14.5 per cent babies were exclusively breastfed below six months in 2006,” . “In addition, only 19.3 per cent babies were exclusively breastfed below four months.” Jaafar,2008

Compared with the findings of the National Health and Morbidity Survey 2 (1996), there was a significant decline of 9.7 % in the prevalence of exclusive breastfeeding below four months and a concurrent rise in the prevalence of babies who were predominantly breastfed but given additional water.

Analysis of the breastfeeding pattern showed generally that exclusive breastfeeding rates were high in the first two months but dropped rapidly after the age of two to three months .It was also found after the age of two months, more than half of the breastfed babies were supplemented with infant formula and given other foods like commercial baby foods or home-cooked baby food while 20 percent of breastfed infants were supplemented with plain water.Few factors that contribute to early discontinuation of breastfeeding as follow :

2.1 Cultural Beliefs And Myths Of Breast Feeding

The cultural beliefs, myths and ignorance have to be blame for the country’s poor breastfeeding performance.

The myths that breastfed babies need water in addition to breast milk are wide spread in the country. Lack of knowledge and skill of mothers on when to start complementary food and how to maintain breastfeeding are other prohibitive factors,” Complementary food, including water, should ONLY be introduced after the age of six months

2.2 Lacks Of Benefit And Facility

Other factors according to Jaafar ( 2008 ) are the lack of benefits and facilities to promote and facilitate breastfeeding practices amongst women who also make up some half of the country’s working population. These include the absence of longer maternity leave, the lack of flexible working hours and missing childcare centers at work places.

Breastfeeding patterns in Malaysia suggest that inadequate maternity leave may in fact be denying babies their right to mother’s milk, and one of the reasons why only 1 in 7 infants were exclusively breastfed for the first six months of life in 2006. (Nadchatram ( 2008 )

According to Ministry of Health analysis of national breastfeeding data, exclusive breastfeeding rates in the country were high in the first two months but dropped rapidly after two or three months, roughly the period when maternity leave ends and working mothers return to paid employment.Â

In Malaysia, women are entitled to 8 weeks (60 days) paid maternity leave, 6 weeks short of the recommended 14 weeks by the International Labour Organisation’s Maternity Protection Convention 2000 (No. 183). Malaysia is not a signatory of the Convention.

2.4 Not Enough Milk

Hussain (2003) has revealed that other factor for early discontinuation of exclusive breast feeding is not enough milk .In his study,54% of the sample express that this is one of the reason. The reason for not having enough milk might be highly influenced by the mother’s emotional and psychological well-being.

Low levels of stress, healthy nutrition, plenty of fluid intake, emotional support and nipple stimulation through baby’s sucking are all important contributors to breastfeeding success. However, living circumstances often don’t allow perfect breastfeeding conditions: another child in the family, the death of a loved one, money worries etc. all add to an increase in stress levels.

Other factors such as breast surgery can contribute to low amounts of breast milk. It has also been found that more women who gave birth by caesarean section

Encountered breastfeeding problems, this may have various reasons such as the initial separation between mother and baby or the physical pain as a result of the surgery which ultimately affects the mother’s ability to enjoy the breastfeeding experience.

Chen ( 2006 ),conclude in his research that breastfeeding-friendly policies can significantly affect breastfeeding behaviors. However, an unfavorable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women’s work “productive role” and family “reproductive role” be respected and accommodated by society.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life. The length of maternity leave is positively associated with the duration of breastfeeding The International Labour Organization (ILO) recommends a period of maternity leave of not less than 14 week. However, the typical maternity leave in many Asian and Middle Eastern countries falls below these levels, only offering less than 12 weeks paid leave. In Taiwan, most companies provide only eight weeks of maternity leave.

A national survey in 2005 showed that the rate of exclusive breastfeeding in Taiwan at one month postpartum was only 22.3%, and dropped to 16.7% at three month. To bring Taiwan in line with WHO guidelines, effective worksite strategies needed to be implemented to encourage new mothers to breastfeed in the workplace.

2.5 Levels of Influence and the Breastfeeding Decision

2.5.1 Health Professionals’ Roles

Multiple studies indicate that health professionals’ support of breastfeeding is important in increasing breastfeeding rates (Lawrence, 1993, Winikoff & Baer, 1980; Winikoff, Laukaran, Myers, & Stone, 1986, 1987). Health professionals have made important promotion contributions, yet many health professionals who provide care to pregnant women and infants do not demonstrate explicit support of breastfeeding; nor do they have adequate knowledge about breastfeeding. In an American Academy of Pediatrician’s study, only 65 percent of pediatricians recommended exclusive breastfeeding for the first month and only 37 percent recommended breastfeeding continue for the first year (Schanler, O’Connor, & Lawrence, 1999).

Many women do not initiate breastfeeding because they know they will be returning to full-time employment that will entail separation from the baby. Perhaps they believe that they will not be able to continue breastfeeding once they return to work, and they adopt an attitude of “Why start something I will not be able to continue?” (Fein & Roe, 1998). Furthermore, women who return to full-time work wean their infants earlier than other women. It has been found, however, that expecting to work part-time following the birth of a baby did not affect initiation of breastfeeding. Part-time work of four or fewer hours a day did not affect duration of breastfeeding. Part-time work for more than four hours per day affected duration of breastfeeding less than full-time work (Fein & Roe, 1998).

Because of economic necessity and the need for other benefits such as health insurance, many women cannot afford to work less than fulltime. When possible, however, delaying separation from the infant and reducing the amount of time mother and infant are separated during the infant’s first six months increases the likelihood that breastfeeding will be successful (Stuart-Macadam & Dettwyler, 1995).

In a qualitative study carried out by MacLaughlin and Strelnick (1984), many women suggested it would be helpful to receive breast-feeding information about combining breast-feeding with working and to have open discussions of the topic with other mothers. A survey of 567 women who breastfed while employed outside the home showed that the most significant difficulty was “role overload,” a result of the multiple demands to which they were responding. This aspect does not differ markedly from what is found for non-breastfeeding, working mothers (Auerbach & Guss, 1984).

About 60 per cent from 451 mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies’ birth. The mother’s age, education or parity, did not affect the rate of breastfeeding.

Low birth weight, especially birth weight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottle feeding compared with newborns who had been delivered normally, discharged early, and nursed at home.

Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birth weight (Shiva , 2003 )

2.6 Advantages of breast milk to babies

Breast milk is best for newborn baby, and the benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients baby needs in the first six months of life, breast milk is packed with disease-fighting substances that protect baby from illness.

American Academy of Pediatrics recommends exclusive breastfeeding for the first six months (although any amount of breastfeeding is beneficial). And scientific studies have shown that breastfeeding is good for mothers health, too. Numerous studies from around the world have shown that stomach viruses, lower respiratory illnesses, ear infections, and meningitis occur less often in breastfed babies and are less severe when they do happen. Exclusive breastfeeding (meaning no solid food, formula, or water) for at least six months seems to offer the most protection.

A study by the National Institute of Environmental Health Sciences showed that children who are breastfed have a 20 percent lower risk of dying between the ages of 28 days and 1 year than children who weren’t breastfed, with longer breastfeeding associated with lower risk.

The main immune factor at work here is a substance called secretor immunoglobulin A (IgA) that’s present in large amounts in colostrums, the first milk mother’s body produces for the baby. (Secretors IgA is present in lower concentrations in mature breast milk.) The substance guards against invading germs by forming a protective layer on the mucous membranes in the baby’s intestines, nose, and throat.

2.7 Advantages to breastfeed mothers

A study of more than 33,000 Danish women who had given birth between 1999 and 2002 evaluated the effect of breastfeeding on maternal weight at 6 and 18 months postpartum compared to reported pre pregnancy weight. The authors calculated that a Danish woman with normal or obese pre pregnancy weight who gained 11-12 kg during the pregnancy and exclusively breastfed her infant for 6 months would be back to her pre pregnancy weight by then. At 18 months postpartum, women who exclusively breastfed for 6 months and continued breastfeeding until their infant was 12 months of age had the lowest probability of retaining 5 or more kg of weight no matter how much weight they gained during the pregnancy (Baker, 2008)

2.8 Conceptual framework

The research conceptual framework will be carried out as shown in the flow chart below.

INTERGRATED WARD

HOSPITAL TUANKU AMPUAN NAJIHAH

POSTNATAL MOTHERS

ANTENATAL MOTHERS

QUESTIONAIRE

RESULT

ANTENATAL MOTHERS

POSTNATAL MOTHERS

CHAPTER 3 RESEARCH METHODOLOGY

3.0 Introduction

In this chapter the researcher will discuss the main aspect of the research methodology in detail. There are five aspects that consist of the research design, population, sampling and methods, study instruments, collection of data and limitation of study.

3.1 Study design

The study uses a descriptive and quantitative method. The researcher will distributes the questionnaires to the respondents as the main instrument to collect data for the study. The collection and the analysis of data is done in two weeks.

3.2 Population and sample

The population is all antenatal mothers who will be come for screening in the labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward in Hospital Tuanku Ampuan Najihah.

3.3 Study subject

All 15 antenatal mothers who will come for screening in integrated ward from 30 January to 30 Mac 2011 and 15 postnatal mothers discharge from labour room during the study period.

.

3.4 Sample size calculation

The sample size will be calculated so that the study has the capability to detect clinically importance difference as statistically significant. The sample size also will be calculated to estimate effect with stated precision. Only 30 cases will be selected as the sample.

3.5 Study participants

3.5.1 Inclusion criteria

All antenatal mothers who are conceiving their second child and above that warded from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward.

3.5.2 Exclusion criteria

All antenatal mothers who are conceiving their first baby from 30 January to 30 Mac 2011 was not included in this study.

3.6 Data collection procedures

3.6.1 This study will be using questionnaires that will be given to the

antenatal and postnatal mothers before and after the campaign.

3.6.2 Permission to carry out the study will be obtained from the Hospital Director and the Chief Matron. An inform consent will also being obtained from the respondents

( Appendix II / Lampiran II).

3.6.3 Self Administered Questionnaire (SAQ)

Self Administered Questionnaire will be used to determine the medical personal knowledge as shown in Appendix III / Lampiran III.

3.7 Sampling methodology

Sampling refers to ‘the process of selecting a portion of the population to represent the entire population’ (Polit & Hungler, 1999). In this study only 30 participants will be selected among the antenatal and postnatal mothers in HTAN from January till March in the year of study. The study was done with pilot test 10 antenatal and postnatal mother and the cronbach’s alpha= 0.732

3.7.1 Statistical analysis

The result of this study was based on the responses from 30 of the antenatal and postnatal mothers. The independent variables identified namely were designation. The data was analyzed and presented in percentage.

3.7.2 Research tools

Data was collected by using structured questionnaire. See Appendix III and Appendix IV.

3.8 Expected results

Antenatal mothers have the knowledge and understanding of the importance in exclusive breastfeeding.

Antenatal mothers will be making decisions on exclusive breastfeeding before delivery.

CHAPTER 4 RESEARCH RESULTS

4.0 Introduction

In this chapter the collected data is analysed from the questionnaires given to the respondents. The demographic factors usually tested as it is often used as the inference study as it is easy to get and easily analysed the effect (Jack Fiorito et el 2007) . The first part is a demographic data about the respondents for example race, age , education level and their exclusive breastfeeding knowledge.

4.1 Characteristics of demographic respondents

Section A

Table 1 : Ethnic :- Antenatal mothers

Antenatal mothers

Post natal mothers

Ethnic

Number of respondents

Percentage

Number of respondents

Percentage

Total number

Malay

73.3 %

86.7 %

Chinese

6.7 %

–

Indian

20.0 %

13.3%

Referring to the table above, majority of the respondents are from the Malay ethnic which gives 73.3% for the antenatal mothers while the postnatal respondents gives 86.7%. The second higher percentage of ethnic comes from the Indians that give 20 %for the antenatal mothers and the postnatal mothers contributes 13.3 %.

The least is the Chinese that gives only 6.7% that is only one respondent for the antenatal but none for the postnatal mothers.. As usual majority of the respondents are the Malays as most of them preferred to give birth in government hospitals comparing to the Chinese who prefer going to the private hospitals.

Table 2 : Age of the respondents

Age range

Number of respondents

for both ante and postnatal mothers

Percentage

20 -25 years old

9 30.0%

26 – 30 years old

12 40.0 %

31 – 35 years old

6 20.0 %

36 – 40 years old

3 10.0%

The age range for this study is done to get a better view to the majority of the ante and postnatal mothers involved. As shown in the table above the age range between 26 to 30 years of the antenatal and postnatal mothers gives the majority which contributes 40.0 %. The least comes from the age range of 36 to 40 years that gives only 10% which only 3 respondents involved.

Table 3 ; Education Level

Academic level

Number of respondents

Percentage

Non- schooling

1 3.3 %

Primary school

2 6.7%

Secondary school

17 56.7%

College/ University

10 33.3%

As shown in the above table, the majority of the educational level comes from the secondary school level which contributes 56.7 % from all the respondents. This shows that this group of respondents have the great trust in the government hospital so does the college/ university level respondents that gives 33.3% of all.

Table 4 : Occupation

Occupation

Number of respondents

Percentage

Housewife

17 56.7 %

Self employed

4 13.3 %

Government servant

5 16.7%

Private sector

4 13.3%

Referring to the above table, the housewife is the majority respondents in this study that carries 56.7% which is more than half of the respondents involved. The government servants contributes 16.7% while the self employed and the private sectors employees give the same percentage of 13.3% each.

Table 5. : Exclusive breastfeeding prior knowledge

YES

Number Of respondents

Percentage

83.3%

16.7 %

Referring to Table 5, 83.3% of the respondents have the prior knowledge of exclusive breastfeeding which means that they had the experience and knowledge to breastfeeding. Five respondents, contributing 16.7% had no knowledge of exclusive breastfeeding.

Table 6 : Number of child

Number of child

(conceiving/ give birth)

Number of respondents

Percentage

40%

36.7%

10%

6.6%

As shown in the table above , 12 respondents conceiving or giving birth to their second child that gives 40% of the study. 36.7% conceive or give birth to their third child, 10% or 3 respondents conceive or give birth to their 4th child and 6.6% contributed by respondents who conceive or give birth to their 5th and 6th child.

SECTION B

Knowledge on exclusive breastfeeding

Question number

1 YES

Percentage

NO

Percentage

Antenatal

80%

20%

Postnatal

100%

–

Table 7.0

As shown in table 7.0, 100% of the postnatal mothers understand and experiencing exclusive breastfeeding, while 80% of the antenatal mothers have already knew about it. Only 20% had no idea of exclusive breastfeeding.

Question number

2 YES

Percentage

NO

Percentage

Antenatal

93.3%

6.7%

Postnatal

100%

–

Table 7.1

Referring to Table 7.1, all 15 postnatal mothers or 100% of them, breast feed their child as soon as birth or within half an hour or an hour after birth. 93.3% of the antenatal mothers do give breast milk to their earlier child birth. Only one antenatal mother had never given the previous child.

Question number

3 YES

Percentage

NO

Percentage

Antenatal

13.4%

86.6%

Postnatal

–

100%

Table 7.2

As shown in Table 7.2, 100% or all the 15 postnatal mothers did not give breast milk alternately with baby formula milk, while the antenatal mothers,13 of them or 86.6% also did not give formula milk. Only 2 or 13.4 % antenatal mothers did give their child formula milk alternately with breast milk.

Question number

4 YES

Percentage

NO

Percentage

Antenatal

100%

–

Postnatal

100%

–

Table 7.3

The data shown in Table 7.3, shows that both the ante and postnatal mothers do give their new born babies breast feed as frequently and unrestrictedly.

Question number

5 YES

Percentage

NO

Percentage

Antenatal

13.3%

86.6%

Postnatal

–

100%

Table 7.9

Table 7.9 shows 100% of the both ante and postnatal mothers believe that breast feeding help a lot in attaching the strong bond of love between mother and baby.

Crosstabulation between Overall score and Postnatal or Antenatal mothers

Count

AntePost

Total

Antenatal

Postnatal

Good

Poor

Total

Chi-Square Tests

Value

Asymp. Sig. (2-sided)

Exact Sig. (2-sided)

Exact Sig. (1-sided)

Pearson Chi-Square

9.130a

.003

Continuity Correctionb

6.708

.010

Likelihood Ratio

11.869

.001

Fisher’s Exact Test

.006

.003

Linear-by-Linear Association

8.826

.003

N of Valid Cases

a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 3.50.

b. Computed only for a 2×2 table

Null hypothesis : There is no relationship between Overall Knowledge level Breast feeding and Antenal or Postnatal mothers.

Alternative Hypothesis : There is relationship between Overall Knowledge level Breast feeding and Antenal or Postnatal mothers.

P value is 0.003 hence there is relationship between the Overall Knowledge level Breast feeding and Occupation.

Score where the respondents have a score of 91% is considered good ; While anything below that is considered poor.

The chi square was answer for my hypothesis that there is a connection between the antenatal mothers and postnatal mothers. The postnatal mothers are doing much better than the antenatal mothers.

Overall the data shows that there are some rooms of improvement for antenatal mothers in certain field as identified as above. The position for breastfeeding should be corrected in antenatal mothers and also the misconception use of alternative formula milk should be rectified.

CHAPTER 5 DISCUSSION AND CONCLUSION

4.1 Introduction

In this chapter, the researcher collected all the analysed data from the previous chapter for discussion and the conclusion. A good discussion comes from the way it was elaborated that gives the result of the research something that can be accepted and proven to have integrity. The discussion in this chapter will be based on the demographic data, the knowledge and the effectiveness of exclusive breastfeeding among the post and antenatal mothers. This is also to see whether the objectives of this research related to the knowledge given to the antenatal mothers after giving birth and the postnatal mothers do carried out the knowledge they get to their new born babies. The questionnaire made is to ensure that the objectives of the researcher were achieved or not. Besides that, the researcher will discuss of any suggestions and implications that could be used from the results of this research.

4.2 Discussion.

This study is to educate ante and postnatal mothers the importance of exclusive breast feeding to their new born babies. Data collected and analysed in previous chapter shows that the respondents of the study are from the three major ethnic in Malaysia. However, the Malays are the majority of 24 out of 30 respondents for the study, 5 respondents or 33.3% are Indians and only one respondent from the Chinese.( refer Table 1)

As the researcher carried out the study and give age range of the respondents, majority contributed by mothers of the ante and postnatal is in the range of 20-25 years old which contributed 63.3% of the overall age range. This shows that young mothers are willing to give their cooperation to ensure this study is carried out as planned earlier. Most of the respondents, though are housewives (56.7%) are educated to the secondary school level with the same percentage as the housewives (refer Table 3 & 4). This shows that they are literate and able to answer the questionnaire with integrity to ensure the results gained from them are valid to this research.

In the demographic results of the respondents ,in Table 5, showing that 25 respondents or 83.3% (refer table 5) had their prior knowledge of exclusive breast feeding. This helps the researcher to achieve the objective of the study easier as 40% of them (refer table 6) give birth to their second child that shows they had the experience in breast feeding from their previous pregnancies or after birth. The number of mothers that had been giving exclusive breast feeding for the 1st and 2nd child has been increasing lately as the sign that mothers are aware of the best nutrients for them. The data in table 6 also shows that mothers that give birth to their 3rd child is 36.7% .

As referring to the data from questionnaire on knowledge of exclusive breast feeding,100% of the postnatal mothers and 80 % of the antenatal mothers have the knowledge and experience in exclusive breast feeding.(refer table 7.0). At this stage , young mothers breast feed their new born as they are aware of the best nutrients comes from breast milk. Lozoff, et el (1977) quote that after weeks of delivery, the new born babies need 4 – 16 breast feed daily. As mothers to new born babies, breast feed helps them to save their money and time yet able to give their child the best food they could ever get at the early age. The awareness of the both ante and postnatal on the knowledge of exclusive breastfeeding because mothers get the knowledge through their monthly check-ups where they are exposed to the correct techniques of breast feeding.

The respondents from the postnatal mothers, give their newborn breastfeed as early as half an hour or an hour after birth which carries 100% and the antenatal mothers contributes 93.3% (refer Table 7.1). This shows that the respondents knew that breast milk is the best food for their new born babies. The data shows that the postnatal are exposed to many input or information and had breastfeed experience comparing to the antenatal mothers. However the antenatal mothers should be prepared mentally and physically from their early pregnancy. Mentally they are prepared about breastfeeding so as to build up their confidence and motivation in within them while physically , demonstration is done using doll and role play or even in reality to the postnatal respondents.

Related to the Table 7.1, data shows in Table 7.2 refers to the knowledge and understanding of the postnatal mothers on exclusive breastfeeding gives them 100% of the respondents did not want to feed their babies alternately with other baby formulas. The antenatal mothers , however only 86.6% do agree that they do not need to feed their babies with baby formulas and 13.4% still had less knowledge to the goodness of breast milk. In enhancing the knowledge of exclusive breast feeding to the antenatal mothers information and promotion should be done through medias and in health clinics and hospitals.

Data collected and analysed in Table 7.3 shows that both ante and postnatal mothers do believe and supporting the fact that new born babies should be fed frequently and unrestrictedly. For both group of the ante and postnatal mothers have the knowledge that newborn babies need breast milk to grow healthily. Both groups contribute 100% to question 4 (refer Table 7.3) and they knew that the risk of the newborn babies getting diarrhoea is 20% compared to 40% to non exclusive breast

feeding babies. Through study done , Diaz et al(1995),majority of ante and postnatal mothers’ point of view shows that by breastfeeding the babies to their need and the high frequency of breastfeeding will increase the output of breast milk and hence will give optimum growth and have positive impact to the babies’ health.

Table 7.4 shows the data , 100% of postnatal mothers did not breastfeed their babies while lying and the antenatal mothers , 13.3% do lie down when breast feeding their babies while the rest, 86.6% did not. The data analysed shows that these mothers have other positions when breast feeding their newborn babies. Maybe through experience and knowledge gained, they are able to change positions due to the babies and mothers’ comfortably situations.

In this discussion, as data shown in Table 7.5, 100% of the postnatal and 93.3% of the antenatal mothers knew that the breast milk contains the best nutrients for their newborn babies. They knew that breast milk contain colostrums that is rich with antibodies which protects the babies from disease and the entire nutrient needed without the help of baby formulas. Study done, Dewan et al (2002) shows that mothers knew what is best for their babies and the techniques of breast feeding do help them to be comfortable with the ongoing breast feeding process and hence exclusive breastfeeding will be a success.

Study had done shows that by exclusive breastfeeding the ante and postnatal mothers believe that they could help to gap pregnancies. This believes is supported by the findings through questionnaire (100%) that both ante and postnatal agreed to (refer Table 7.6).They also believe in that exclusive breastfeeding could reduce the risk of uterine and breast cancer. Therefore as shown in table 7.7 both ante and postnatal proven that by giving 100% in the questionnaire answers.

Exclusive breastfeeding do help mothers to gap pregnancies and minimizing the risk of getting uterine and breast cancer. Through findings and study done, these results show that the increasing number of postnatal mothers starts their exclusive breastfeeding from the early hours of birth. However the antenatal mothers, a few of the respondents are still vague of the importance of exclusive breastfeeding to their newborn or to themselves. This is due to their less knowledge of exclusive breastfeeding to the newborn or to themselves. Hence , referring to Table 7.8, only 66.7% , of the antenatal mothers knew the correct position when breastfeeding their newborn comparing to the postnatal that contributes 100% of the correct position when breastfeeding their newborn. From the data given, the knowledge of the correct position when breastfeeding should be emphasised to the antenatal mother through practical using dolls. Here they will get the best view and experience before giving birth to their child.

The ante and postnatal mothers both feel that exclusive breastfeeding strengthen the love bond between the mothers and their babies. These are agreed in the findings where 100% for both groups is stated (refer Table 7.9). They could still feel the bond as the child grows though they had no more breast feed after two years of age.

This research can be further improved to not only see the level of the knowledge of the breastfeeding but the practicability and the technique of breastfeeding is effective. This is different from just accessing the knowledge of breast feeding. Knowledge is just one of the components but also attitude and behaviour plays a big role in breastfeeding.

RECOMENDATION OF STUDY

The consequence of this study will help the researcher to identify a suggestion based on the findings and discussion done. The researcher would like to suggest a research should be done longitudinally that is starting from the first week of conceiving until the baby born, age up to six months, continuing the research till the baby’s age up two years old. It is to get better and more detail results of whether exclusive breastfeeding proven to give the best benefits for the babies so as to the mothers.

CONCLUSIONS:

Hypothesis is accepted that the postnatal mothers have better knowledge than the antenatal mothers. Exclusive breastfeeding should starts from the beginning of antenatal period, so the knowledge and benefits of exclusive breastfeeding could be spread out not only to the family but to the communities too. This is to give them the moral support and confidence emotionally and physically. It also should be put to the responsibility to all Malaysian citizens towards protecting, encouraging and support to exclusive breast feeding for the sake of the children and future generations’ health.

This results also shows the effectiveness of teaching exclusive breastfeeding during pregnancy when the patient are mostly postnatal understand the benefit of breast feeding better than antenatal mothers

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