Abstract:
A community based follow-up study in four socioeconomically different groups in
Lahore, Pakistan was conducted consisting of a rural area, a peri-urban slum, an urban slum and
an upper middle class group. A total sample of 150 expectant mothers from three areas was
selected. Scheduled interviews were conducted at 4 points in time; from eighth month of
pregnancy up to the complete end of breastfeeding whenever it occurred during the infant’s first
two years of life. All mothers were breastfeeding at the time of interview within one month after
childbirth. Majority of the upper middle class mothers breastfed their infants partially and
terminated breastfeeding within six months which is significantly different from the other
groups. For prolonged breastfeeding significant contributing psychological factors were maternal
own personal experience of breastfeeding right from the beginning as a pleasant, natural and
enjoyable process even when initial infant feeding method and housing standard were taken into
account. A significant positive relationship was found between maternal temperament
dimensions (traits) “Accepting” and “Responsible” with initial feeding pattern for longer
duration. The results of the study also suggested that not only the demographic variables and
psychological factors but some maternal temperament dimensions also play an important role in
the process of decision making regarding the initial feeding pattern and its sustenance for longer
duration as well. The role and attitude of health care service provider is also very important in
decision making about the initiation of breastfeeding and its longer duration. A cross sectional
study was conducted on 30 women who delivered a normal healthy child in the Gynecological
ward of a government hospital which caters 30% of general population and more than 80% of
the Government Servants in the area. Information about the mode of infant feeding and about the
reinforcement provided by experts for a particular mode of feeding to the mothers was obtained
through a structured interview from women. 30 Medical Doctors including Gynecologists and
Pediatricians of the same hospital were also interviewed to find out their years of practical
experience their knowledge about importance of breastfeeding and their perspective and type of
technical support provided to pregnant women at the time of antenatal, natal and post-natal
visits. Results of the study supported and complemented the findings of the longitudinal study.
Gynecologists and Pediatricians perspective indicated that mothers from low socio economic2
groups, have family support and tradition of breastfeeding within their families and
are
comparatively more religious, or/and were aware about benefits of breastfeeding were the ones
who breastfeed their babies. At the time of interview 80% of the mothers in our sample were
breastfeeding either exclusively or mixed feeding (Breast and formula milk) and 20% were
feeding formula milk through bottle. Reasons given by mothers for adopting a particular mode
for feeding their babies indicated that several maternal and social factors including health service
provider’s responses dictate mother’s feeding choice. In establishment of initial feeding pattern
all the factors related significantly are poor living conditions, low socioeconomic status,
maternal breastfeeding satisfaction, her previous positive breastfeeding experience, a positive
family support, with temperamental traits like responsible, reflective, accepting, impulsive
irritable & withdrawing temperament, act as a stimulant in this regard. Mothers who adopted
almost exclusive breastfeeding pattern right from the beginning, lived in poor housing conditions
with poor socioeconomic status but had a good previous breastfeeding experience, had
breastfeeding satisfaction and enjoyed a good family support in this regard, possessed Casual but
Critical temperament, breastfed for a longer duration. The results also suggest that there is a need
for formal and informal education of expectant mothers and health service providers in this
regard. Breastfeeding and its management can be encouraged through “Behavior Change
Communication” and follow up support of health care system.