Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.

+,, 2 +3

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Factors Influencing Initiation of Breast Feeding among PostPartum Mothers in a Teaching Hospital of Osun State, Nigeria.
B. -. A.i/ade"0N,#h.1,23A4N%.+ )lade.i 5.) "0N, 5Sc%.2 6.A.)yedele"0N,5.6d, 23A4N%.3 A7oo #.) "0N,05,5Sc%4 5a8inde).9"0N,05,5Sc%& +,2,4:& -ado8e A8intola ;ni<ersity of =echnology, )g/o7oso. 4ollege of Health Sciences, 1e$art7ent of Nursing, )sun State, Nigeria. 3. 1e$art7ent of Nursing, 2aculty of Basic 5edical Sciences, ;ni<ersity of Jos, Jos, #lateau State. 4orres$ondence =o>-1r. B. -. A.i/ade, 67ail /adelawal?yahoo.co7 -A;=64H, )S)@B), 4A) #. ). B)( ++2 , )sog/o, )sun State, Nigeria. !stract INT"O#$%TION&- Breastfeeding is well recogniBed as the /est food source for infants. It has /een ad<ocated as a cost effecti<e 7eans of i7$ro<ing the childCs health, 7otherCs health and 7other - infant /onding. =he study was carried out to deter7ine the factors that influence the initiation of /reast feeding a7ong $ost $artu7 7others in a teaching hos$ital of )sun State, Nigeria. M'THO#& - A descri$ti<e cross sectional research design was used, with 3+, res$ondents selected rando7ly. 1ata were collected using a self-designed Duestionnaire. =he data were analyBed using statistical $roduct and ser<ice solutions window <ersion 2+. SiE research hy$otheses were set and analyBed while only one research Duestions was answered. "'S$(T& 0esults showed that 7aternal age was the only factor found to influence /reast feeding initiation. 5a.ority of res$ondents lac8 adeDuate understanding of the factors that are 7a.or $redictors of /reast feeding initiation. %ON%($SION&- It was concluded that 7others should /e gi<en health infor7ation on factors that can influence initiation of )e*+ords&2actors influencing, Initiation, #ost $artu7 7others, /reast feeding. INT"O#$%TION =here is a uni<ersal consensus a/out the funda7ental i7$ortance of /reastfeeding of childrenCs adeDuate growth and de<elo$7ent and for their $hysical and 7ental health. Breastfeeding, $articularly eEclusi<e /reastfeeding, and a$$ro$riate co7$le7entary feeding $ractices are uni<ersally acce$ted as essential ele7ents for the satisfactory growth and de<elo$7ent of infants as well as for $re<ention of child-hood illness. =his has cul7inated in a $u/lication /y the 3orld Health )rganiBation "3H)% reco77ending that infants u$ to F 7onths of age should /e eEclusi<ely /reastfed"+%. Infant 5ortality 0ate "I50% is regarded as an i7$ortant sensiti<e indicator of health status of a co77unity. It reflects the effecti<eness of inter<entions for i7$ro<ing 7aternal and child health"2%. 5a.or $art of Infant 5ortality 0ate is contri/uted /y a neonatal 7ortality rate. It has /een said that & G infant deaths occurs within the neonatal $eriod3,4,&.. 6Eclusi<e /reast-feeding is the 7ost natural and scientific way of feeding infants in the first F 7onths of lifeF. Breast feeding can contri/ute to the reduction of 7ortality and 7or/idity,. Benefits of /reast-feeding li8e a decrease in the incidence, se<erity of infectious diseases such as diarrhea, res$iratory tract infections, otitis 7edia and urinary tract infection, decreased incidence of ty$es + and 2 dia/etes 7ellitus, o<erweight, o/esity and asth7a were re$orted!. =oo early introduction of /reast 7il8 su/stitutes and too late introduction of se7i-solid co7$le7entary feeds are co77on and are res$onsi/le for ra$id increase in the $re<alence of under nutrition /etween F H 24 7onths'. So7e studies re<eal factors $ositi<ely associated with eEclusi<e /reastfeeding, such as higher 7aternal educational le<el, gestational age greater than 3, wee8s, 7others with $re<ious eE$erience of /reastfeeding+ . =here are also studies that relate factors leading to interru$tion of eEclusi<e /reastfeeding such as low fa7ily inco7e, low 7aternal age, $ri7 $arity and 7others returning to wor8. Se<eral studies intended to define deter7inant <aria/les in the success or failure of /reastfeeding which could ease the $lanning of $ro7otional strategies+2,+3. It was esta/lished that socio-de7ogra$hic <aria/les li8e 7aternal education, $aternal education and socioecono7ic status ha<e $ositi<e association for influencing decision on eEclusi<e /reast feeding+4. Nu7/er of antenatal <isits ta8en, older 7aternal age+& and low /irth weight+F re$orted $ositi<e i7$act on /reast-feeding initiation. Association was found /etween /reastfeeding $attern and <aria/les, classically considered as su$$orti<e for /reastfeeding such as three or 7ore antenatal <isits, /reastfeeding ad<ice recei<ing during antenatal <isits, during $ost natal <isits deli<ery inter<al 24 7onths or 7ore, and /irth weight 2& g7s or 7ore+4. So7e researchers+& in their study did not find any association /etween /reastfeeding ad<ice recei<ed during antenatal and deli<ery inter<als. If was o/ser<ed that there are a lots of new /orn that did not get /reastfeeding at /irth due to so7e 7aternal $ro/le7s li8e $arity, education and wor8ing status+F. A younger 7aternal age

'

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

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es$ecially under the age of +! years is thought to /e related to a significantly shorter duration of actual of intended /reast-feeding. )lder 7others, ty$ically wo7en o<er the age of 3 years are re$orted to /e 7ore li8ely to initiate /reastfeeding, and to this act for a longer $eriod of ti7e+,. #re<ious findings suggest that young age and low inco7e ha<e a negati<e i7$act on the successful outco7es of /reastfeeding+,. 5aternal education was $ositi<ely associated with the duration of /reast-feeding. Non- s7o8ing 7others were 7ore li8ely to /reastfeed linger than s7o8er2 . Ne<ertheless, it is always $rudent to consider that as an eating ha/it, /reastfeeding is intrinsically related to social cultural and traditional $attern of a gi<en $o$ulation. =his fact .ustifies need for regional studies that allows 7ore efficient action in regard to 7easures for inter<ention, /ased on 8nowledge of local reality. =herefore, the o/.ecti<e of this study was to assess factors influencing initiation of /reast feeding in new/orn infants in a State ;ni<ersity =eaching hos$ital in Nigeria. Theoretical Frame ,or-& - 2or =his Study =heory of #lanned Beha<ior was ado$ted. =he theory of $lanned /eha<ior "=#B% $ro<ides a fra7e - wor8 for <isualiBing /y which $sycho-/io-social factors can influencing /reast feeding initiation. According to the =#B, /eha<ior is a function of intention to $erfor7 the /eha<ior "e.g. $lanned duration of /reast feeding%. In addition to attitude and $ercei<ed control, the =#B $ostulates a lin8 /etween /eliefs of those who $ro<ide social su$$ort. So7e authors+, in their research wor8s disco<ered there was no relationshi$ /etween 7arital status and /reastfeeding $ractice a7ong $ost-$artu7 wo7en. It was eDually o/ser<ed that 7aternal education was not associated with /reast feeding initiation. 5orrow,@uerero, Shults et al+,. o$ined that there was no relationshi$ /etween 7arital status and /reast feeding $ractice, eDually there was no relationshi$ /etween 7aternal educational le<el and /reast feeding initiation. "esearch .uestion& - 3hat is the le<el of 8nowledge of 7other on initiation of Breast feeding in infantsI "esearch H*potheses&- for the $ur$ose of this research siE null hy$otheses were set and tested at . & le<el of significance and they were>"+% =here is no significant relationshi$ /etween age of the 7other and the initiation of /reastfeeding at $ost $artu7 "2% =here is no significant relationshi$ /etween 7arital status of res$ondents and the initiation of /reast feeding of $ost-$artu7. "3% =here is no significant relationshi$ /etween the 7aternal educational le<el and /reast-feeding initiation at $ost-$artu7. "4% =here is no significant relationshi$ /etween 7aternal e7$loy7ent status and /reastfeeding initiation at $ost $artu7. "&% =here is no significant relationshi$ /etween nu7/er of children and initiation of /reastfeeding at $ost-$artu7. "F% =here is no significant relationshi$ /etween the $sychological state of 7others and the initiation of /reast feeding at $ost $artu7. M'THO#O(O/0 "esearch Setting>- -ado8e A8intola ;ni<ersity of =echnology =eaching Hos$ital, )sog/o, )sun State is one of the tertiary health institutions in )sun State concerned with /oth curati<e and $alliati<e health care deli<ery, research and education of health students. It was located in A.egunle /ehind Idi - Se8e of )lorunda -ocal @o<ern7ent of )sun State 4a$ital, )sog/o. =he institution is owned /y /oth )yo and )sun State go<ern7ents. It ca7e into eEistence /y an edict that was gaBette in +'', and was a7ended in +''' /y the )sun State 7ilitary ad7inistration of -=. 4ol. Anthony )/i. =he hos$ital is co7$rised of se<eral units and wards, such as the accident and e7ergency, antenatal unit, $ost-natal unit, fe7ale and 7ale 7edical wards, fe7ale and 7ale surgical wards, $ediatric 7edical and surgical wards, eye, ear, nose and throat unit, /urns unit, intensi<e care unit, ortho$edics ward, 7ental healthA$sychiatric unit, s$ecial /a/y care unit, HI*AAI1S unit, etc. 2or the $ur$ose of this research, the infant welfare and $ost-natal unit were used. =he yearly attendance of $atients in the two units was $ut at +&+, /y the 7edical record. #esign of the Stud*&- =his study was carried out using a cross H sectional descri$ti<e design a7ong 3+, 7others that were selected consecuti<ely for a $eriod of four "4% 7onths "January H A$ril, 2 +3%. =hey were 7others who deli<ered at -=H or /rought their children to the infantsC welfare clinic. "esearch Population& - =he $o$ulations used for the study were lactating 7others whose /a/ies were within + day to F wee8s. Inclusion criteria> - "+% 5others who deli<ered at the la/or ward of -=H and initiated /reastfeeding within 3 7inutes of deli<ery. "2% 5others that /rought their children to the infant welfare clinic with the childrenCs age not 7ore than F wee8s. 6Eclusion 4riteria> - "+% 5others with health $ro/le7 $ost natally.

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

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"2% 5others with children with health $ro/le7s. Sample Si1e #etermination& - =he $re<ious year clinic attendant was used to deter7ine the sa7$le siBe. 9a7ane calculation 7ethod was e7$loyed. It states thus n J N + K N "e% 2 where n J Sa7$le SiBe J I N J #o$ulation SiBe J +&+, e J -e<el of $recisionJ . & =herefore, n J +&+, + K +&+," . &%2 n J 3+F.& =he sa7$le siBe nJ 3+,. Sample and Sampling Techni2ue - Si7$le rando7 =echniDue was used to select the res$ondent at the $ost natal ward and infant welfare clinic /etween January and A$ril, 2 +3, until the reDuired sa7$le siBe of 3+, was attained. "esearch Instrument& 0esearcher self- designed instru7ent was used for the research. =he instru7ent was di<ided into 3 sections "A - 4%. Section LAM was on the de7ogra$hic infor7ation, and consisted of F ite7sN Section LBM was on 8nowledge of 7others a/out the initiation of /reastfeeding, it consisted of F ite7s while the last $art of the instru7ent L4M was on factors influencing initiation of /reastfeeding, and it consisted of , ite7s. Ps*chometric Properties of Instrument& =his in<ol<ed the <alidity and relia/ility of the instru7ent. =he face <alidity and content <alidity of the instru7ent were carried out /y showing the instru7ent to @ynecologists and the eE$erts in the field of 5aternal and 4hild Health 4are. =hey confir7ed the face <alidity and content <alidity of the instru7ent. =hose ite7s that were /elie<ed to /e a7/iguous and not rele<ant to the study were .ettisoned. 0elia/ility of the instru7ent was deter7ined through $re-test a7ong 2 $ost-natal 7others in State Hos$ital, Asu/iaro, )sog/o. =he cron/atchCs coefficient yielded .,!&. =his de$icted ,'G relia/ility, which 7eans the instru7ent, could /e used for the study. Procedure for #ata %ollection - =he instru7ent designed for the research was ad7inistered to the res$ondents ha<ing selected the7 through the issuance of nu7/ers. =he researcher assistants who had /een trained in the transliteration of the ite7s on the instru7ent ad7inistered the instru7ent to the rando7ly selected res$ondents at each clinic for the infant welfare and at the $ost-natal ward. 6ach res$ondent was allowed to s$end /etween + and +& 7inutes in answering the ite7s on the instru7ent and sa7e was collected here and there. Method of #ata nal*sis& 1ata collected were <alidated and analyBed using the statistical $roduct and $ro/le7 solutions "S#SS% <ersion 2+. =he only research Duestion was answered using freDuency and $ercentages while the null hy$otheses were analyBed and tested using the chi-sDuare "E2% analysis. 'thical %onsideration& =he research instru7ent was re<iewed /y the ethical co77ittee of -=H and necessary for7s were filled after which the a$$ro<al was gi<en to conduct the research. =he res$ondents were gi<en an infor7ed consent to sign. =hey were 7ade to realiBe that filling of the instru7ent was free and they would not /e re$ri7anded if they refused to answer the instru7ent. "'S$(TS A total of 3+, Duestionnaires were ad7inistered to the 7others that deli<ered at -=H and those that /rought their /a/y to infantsC welfare clinic of the hos$ital for i77uniBation. =he age distri/ution of the res$ondents "ta/le +% showed that 7ore than half of the 7others &+G were within 2F-33 years of age, 2'G were within +!-2& years of age while +4G were within 34 and 4+ years of age, and FG were a/o<e 42 years of age. ! G of the res$ondents were 7arried, FG of res$ondents were single, 3G di<orced, and the re7aining 3G were widows. In ter7 of the educational le<el of res$ondents, 44G of res$ondents were graduates of higher institutions, 3FG had only secondary education certificates while +4G had $ri7ary school education, and FG had no for7al education. 0egarding the ethnicity of the res$ondents, 7a.ority of the7 were 9oru/a 23F",4G%. =he eE$lanation for this was that the hos$ital is situated in South 3est of Nigeria which is $redo7inantly occu$ied /y 9oru/a. 2+G of res$ondents were Ig/os while the re7aining 4G "+4% res$ondents were Hausa. =he e7$loy7ent status of the res$ondents ta/le + showed that 43G were e7$loyed /y go<ern7ent, 3+G e7$loyed the7sel<es, in<ol<ed $etit trading, !G "24% of the res$ondents were students while +!G"&,% were not e7$loyed at all. )n the /asis of the nu7/er of children "ta/le +%, F G "+' % had either one"+% or two "2% children, 33G of the res$ondents had either three "3% or four"4% children while .ust ,G had either fi<e "&% or 7ore than fi<e children. 4oncerning the 8nowledge of 7others a/out the initiation of /reastfeeding. 5a.ority of the res$ondents !,G dis$layed good 8nowledge of /reastfeeding initiation when they agreed that /reast feeding initiation occurs when the child is $ut to the /reast /etween 7inute to thirty 7inutes after /irth "=a/le 2%. =hey eDually agreed

++

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

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that initiation of /reastfeeding allows for i77ediate s8in to s8in contact /etween the new /orn /a/y and the 7other, '+G /elie<ed that it encourages s8in contact, while !G sees no reason for early s8in contact. '+G of res$ondent agreed that initiation of /reast 7il8 would afford the /a/y to /e gi<en colostru7s that contains anti/iotics that $re<ents the /a/y fro7 infection "ta/le 2%, 'FG of res$ondents agreed that initiation of /reastfeeding encourages early /onding /etween the 7other and the /a/y, while 4G did not su$$ort this assertion "see ta/le 2%. )n factors influencing initiation of /reast feeding, ta/le 3 showed that FFG "+!,% of res$ondents agreed that $sychological state of the 7other could influence the initiation of /reast feeding, closely followed /y the age at 7arriage which accounted for &!G"+F&% 6ducational le<el of the 7other carried 4,G"+33%, 67$loy7ent status of the 7other accounted for 43G"+22% while 7arital status accounted for 32G"'2% and nu7/er of children was the least factor that would influence initiation of /reast feeding a7ong 7others "ta/le 3%. In testing the hy$otheses + to F, hy$otheses +-& showed no significant relationshi$ a7ong the <aria/les analyBed /ut hy$otheses F showed that there was a significant relationshi$ /etween $sychological states of 7others and the initiation of /reastfeeding "ta/le 4%. =he result in ta/le 4 with reference to hy$othesis + showed that &!G of the res$ondents agreed that age at 7arriage could influence the initiation of /reastfeeding, 42G of res$ondents did not see age at 7arriage as factor that can influence /reast-feeding. =o <alidate whether to or not to re.ect the null hy$othesis that there is no significant relationshi$ /etween age at 7arriage and initiation of /reast-feeding, chisDuare"E2% analysis was carried out. =he calculated chi-sDuare " .&4% was /elow the critical <alue of . & significant le<el "3.!4%, suggesting that differences in res$onses were not statistically different fro7 one another. )n 7arital status, 32G of the res$ondents agreed that it influences the initiation of /reastfeeding while F!G did not agree, =he calculated <alue of chi-sDuare for the res$onses of the res$ondents was &&.!, which is greater than the critical <alue of the . & significant le<el "3.!4%N the null hy$othesis could not /e re.ected "ta/le 3%. #IS%$SSION OF FIN#IN/S =his study was /ased on factors influencing initiation of /reastfeeding a7ong the $ost-$artu7 7others attending -ado8e A8intola ;ni<ersity =eaching Hos$ital. 3+, Duestionnaires were distri/uted a7ong 7others in the $ost-natal ward and lactating 7others attending the infant welfare clinic. All the Duestionnaires were retrie<ed and analyBed. =he analysis re<ealed that slightly 7ore than half of the res$ondents &+G were within the age /rac8et of 2F H 33 years. 0esults of the study showed that 7a.ority of the res$ondents were 7arried "! G%. It was also disco<ered that 44G were highly educated while the 7a.ority of the res$ondents were 9oru/as. According to ta/le ', &!G of the res$ondents agreed that 7aternal age was a significant $redictor for the initiation of /reastfeedingF, + ,++,+2,+4. 32G of the res$ondents agreed that 7arital status was a significant $redictor for the initiation of /reastfeeding while F!G /elie<ed that 7arital status could not $redict the initiation of /reast feeding+', 2 . 4,G of the res$ondents agreed that the 7other educational le<el could influence the initiation of /reast feeding+ , ++, +&, +F. 43G of the res$ondents agreed that 7aternal e7$loy7ent had an influence on the initiation of /reast feeding+4, +F. FFG of res$ondents agreed to the assu7$tion that the $sychological state of the 7others could influence the initiation of /reast feeding+4, +F. #resent study alerts us that in s$ite of $re<alent $ractice of /reast feeding, $ro7oting and strengthening re$roducti<e and child health ser<ices were of $ara7ount i7$ortance, since unsatisfactory /eha<ior, regarding eEclusi<e /reast feeding is still o/ser<ed. Implication for Nursing Practice. Breast feeding is of eEtre7e i7$ortance for safe guarding the health and welfare of the growing infant and this $ractice 7ust /e $reser<ed, $rotected and $ro<ided /y all 7eans. =raining of health wor8ers in $ri7ary care setting on need for a$$ro$riate and ti7ely counseling of antenatal 7others on /reast feeding 7ust /e stressed. =he Duality of 8nowledge and su$$ort has a crucial role in the success of /reast feeding $ro7otion. =he findings of this study a$$ear to ha<e so7e <alue to $rofessional 7idwi<es. Since the rates of /reast feeding are consistently lower than desired. It see7s li8ely that Nurse-5idwi<es would address this $ro/le7 /y designing inter<entions and educational $rogra7s to teach the /enefits and reco77endations of /reast feeding. ;nderstanding which de7ogra$hic factors $redict /reast feeding in early $ost $artu7 $eriod is useful when designing these $rogra7s to ensure that li7ited resources are directed to grou$s that 7ight /e a7ena/le to change for eEa7$le, this study indicates that younger single wo7en with a high school le<el education are less li8ely to /reast feed than are older 7arried college educated wo7en. Industrial nurses could also /enefit fro7 the findings of current study when wor8ing with large cor$orations and co7$anies /y trying to influence $olicy change for eEa7$le, the literature clearly $ro<es that /reast feeding is the healthiest o$tion for /oth 7other and child, resulting in less illness for /a/ies, which in turn causes less of a financial drain on insurance 7onies and less ti7e off wor8 for 7others. =he current study indicates that wo7en who return to $aid e7$loy7ent are less li8ely to /reastfeed, and are therefore not

+2

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

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$ro<iding their child the healthiest o$tion for infant feeding. If health educators are wor8ing with co7$anies trying to effect a $olicy change that allow 7ore fleEi/ility for wor8ing 7others to $u7$ /reast 7il8 during the wor8 day, this infor7ation $ro<ides a strong argu7ent for ado$tion of this $olicy, using data deri<ed fro7 a local sources, rather than national or international studies. Ta!les 3- #emographic #ata ge 4in *r5 +!-+& 2F H 33 34 H 44 O 42 Total 'ducational Status No for7al 6ducation #ri7ary School Secondary School Higher 6ducation Total 'mplo*ment Student Self-e7$loyed 67$loyed of @o<ern7ent ;ne7$loyed Total Marital Status Single 5arried Se$arated 1i<orced 3idow Total 'thnicit* 9oru/a Ig/o Hausa Total Num!er of %hildren +H2 3H4 O& Total

Fre2uenc* '2 +F3 43 +' 637 +' 43 +4 +4+ 637 24 + +3& &,

Percentage 2' &+ +4 F

F +4 3F 44

! 3+ 43 +!

+' 2&& 24 ++ ! 637 23F F! +4 637 Fre2uenc* +' + & 22 637

F ! 3 3

,4 2+ 4 Percentage F 33 ,

Ta!le 8 - )no+ledge of Mothers on the Initiation of Breast feeding. S9N IT'MS +. Breastfeeding should /e initiated within the first thirty 7inutes after the siEth of child. 2. S8in to s8in contact should /e done to ensure successful /reastfeeding initiation. 3. It is i7$ortant to gi<e the first 7il8 "colostru7s to the /a/y i77ediately he is /orn%. 4. =he /a/y should always /e $ut to /reast on de7and. &. A 7other is <ery li8ely to initiate /reastfeeding if she is ha$$y with the arri<al of the /a/y. F. Initiation of /reastfeeding allows for the esta/lish7ent of /uilding /etween the 7other and her /a/y.

0'S 2,F 2!, 2!, 2 2!2 3 3

: !, '+ '+ F3 !' 'F

NO 4+ 22 3 +++ 3& +4

: +3 , ' 3& ++ 4

TOT ( 3+, 3 ' 3+, 3++ 3+, 3+,

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Ta!le 6& Factors Influencing Initiation of Breast feeding S9N IT'MS Fre2uenc* +. Age at 5anage +F& 2. 5arital Status '2 3. 6ducational Status of 0es$ondents +33 4. Nu7/er of children F! &. #sychological State of 0es$ondents +!,

Percentage &! 32 4, 24 FF

;8 .&34 &&.! !.2 4 + 3.34 + .24F

NS S NS NS S

"'F'"'N%'S +. 3orld Health )rganisation. 6<idence for the ten ste$s to successful /reastfeeding. @ene<a> 3+ N +''!. 2. State of 3orldCs 4hildren. ;NI462 2 F. A<aila/le on htt$>AAwww.unicef.orgAindiaAhealth assessed +FA 3A+3. 3. 0ahl 5, =ane.a 1(, 5istra A, 5athur NB, Badhans. New/orn 4are #ractices in an ;r/an Slu7 of 1elhi. Indian J 5ed Sci. 2 FN F >& F-&+3. 4. 4unha AJ, -eite A5, 5achado 55. Breastfeeding and #aficier use in BraBil. Indian J #ediatr 2 &N ,2>2 '-2+2. &. Blac8 06, 5orris SS, Bryce J. 3here and why are + 7illion children dying e<ery yearI -ancet 2 3N 2 F-2234. F. 5acli8ar.una HB, Bana$ur7ah 40, Bana$ur7ath S, Pesaree N. Breastfeeding #ro/le7s in first siE 7onths of life in 0ural Parnata8a. India #ediatr 2 2N 3'>!F+-!F4. ,. Pu7ar 1, Agarwai N, Swa7i H5, Socio-1e7ogra$hic 4orrelates of Breast-feeding in ;r/an Slu7s of 4hendiga-th. Indian J7ed Sci 2 FN F >4F+-4FF. !. @artner -5, 5orton J, -awrence et al. Breastfeeding and the use of hu7an 7il8. #aediatrcis 2 &N ++&N 4'F-& F. '. 0a7achandran #. Breastfeeding $ractices in South Asia. Indian J 5ed. 0es. 2 4N ++'>+3-+&. + . A7yanne 3uthrich 0eggio. A thesis on de7ogra$hic factors in the early $ost$artu7 $eriod in ;tah 3o7en. ++. 4entres for 1isease 4ontrol and $re<ention htt$>AAwww. 4dc.go<A/reastfeedingA$dfABreastfeeding 0e$ort card assessed 4th 5ay, 2 +3. +2. Nadler 6. 0egion of 3aterloo #u/lic Health Infant feeding Sur<ey 2 FA ,. 0egion of Inlatorloo #u/lic Health 2 ,. 0etrie<ed fro7 www. Sciendges..co7 +4A 'A2 +3. +3. 0oss B. Nil8ilson, 2iorial B Scherl. #sychological Health. 5aternal attach7ent and attach7ent style is /reast and for7ula feeding 7others> a $reli7inary study. Journal of 0e$roducti<e and Infact #sychology, 24"+% &.www.digital conQ.edu. assessed 22A '.2 +3. +4. Sinclair S, Huston *, Shields P, Snellings. Breastfeeding #ractices in Northern )ntario. )ntario #erinatal and 4hild Health Sur<ey 2 3. www. #ediatrics digest 7o/ico7 Assessed +4A'A2 +2. +&. Swanson *, #ower P@. Initiation and Initiation and 4ontinuation of /reastfeeding> =heory of #lanned /eha<ior. htt$>AAwww.nc/i.nl7 assessed 4A +A2 +3. +F. A7ayatul.P, ;nla<anich =, =anthaya #hinet ). Breastfeeding @uide for 7edical $rofessional /oo8s google.co7. ngA/oo8s assessed +4A'A2 +2. +,. 5orrow A-, @uerrero 5-, Shutts J et al. 6fficacy of ho7e /ased $eer counseling to $ro7ote eEclusi<e /reastfeeding> a rando7iBed controlled www.nature. 4o7AJ#AJournal ,2+ ,43+. Assessed +4. 'A2 +2.

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