Research Article

Why Women Stop Breast Feeding Under 6 Month of Baby Age in Occupied Palestine?

Neveen Shalalfa^1*, Shatha Wajeeh² and Baraa Wajeeh³

¹Department of family medicine, Palestine polytechnic university, Palestinian Territory, Occupied, Hebron, P.O.Box 6, Palestine

²School of medicine, Palestine polytechnic university, Palestinian Territory, Occupied, Hebron, P.O.Box 6, Palestine

³Department of obstetrics and gynecology ,ministry of health, Palestinian Territory, Occupied, Hebron, P.O.Box 6, Palestine

Submission: March 04, 2023; Published: March 06, 2024

*Corresponding author: Neveen Shalalfa, Department of family medicine, Palestine polytechnic university, Palestinian Territory, Occupied, Hebron, P.O.Box 6, Palestine

How to cite this article: Neveen S, Shatha W, Baraa W. Why Women Stop Breast Feeding Under 6 Month of Baby Age in Occupied Palestine?. Acad J Ped Neonatol 2024; 13(4): 555924. 10.19080/AJPN.2024.13.555924

Abstract

Aim of the Study: To explore the reasons why Palestinian mothers stop breastfeeding(BF) before six months of baby age.

Methods: A cross-sectional study was conducted in Hebron/ Palestine that included mothers of all 420 live singleton newborns in the period between ( January 1, 2022, and July 31, 2022 ) in the main hospital . Mothers who did not initiate breastfeeding or continued to breastfeed, either exclusively or with supplementation, were excluded beyond the first six months of life. The information about BF status at 6 months of baby age and reasons for stopping BF was collected by public health doctors and midwives through face-to-face interviews when women visit the clinic for 6-month baby vaccination and family planning consult.

Results: Of all the 420 participant mothers, 300 stopped breastfeeding completely before six months of baby age, among them, only 281 gave an obvious reason for stopping breastfeeding because of scanty milk production, child weaning him/herself, show that returning to work is the main cause, fatigue, and painful nipples were and mother preference .

Conclusion: This study highlights the reasons why women stop breastfeeding completely before six months. The results may help in identifying interventions for prolonged breastfeeding periods.

Keywords: Breastfeeding; Weaning; Lactation

Abbreviations: BF: Breast Feeding; UNICEF: United International Children Emergency Fund; WHO: World Health Organization; GCC: Gulf Cooperation Council

Introduction

Breast milk is very important for infants and mothers, it has established health, psychological, environmental, and other benefits, including cognitive development, and lowering the risk of infections, cancers, and diabetes in children and mothers [1], it is also considered to be the optimal food that enhances the growth and development of the infants [1,2]. Breastfeeding (BF) should be continued for at least 6 months according to the Canadian Infant Feeding Joint Working Group [3-5]. Despite that many mothers choose to stop breastfeeding before 6 months of age for many reasons such as insufficient milk supply, infant self-weaning, return to studying, school or work and many other issues that related to the obstetrical and neonatal factors, infant age, lifestyle, mother’s education, parity, level of income, stress factors and smoking [6-9]. BF contributes to the good health of mothers and babies as some research demonstrates [10] and so, the World Health Organization (WHO) and international bodies like United International Children Emergency Fund (UNICEF) set several guidelines that recommend and support mothers to breastfeed their babies for the first 6 months of age [11,12].

Across-sectional studies showed that there is a decrease in BF rate from 89% in the second month, to 78% in the 6th month of babies’ age [13]. And according to the Gulf Cooperation Council (GCC) of Arab countries, the challenges of BF were; lack of education and policy support, inadequate training of mothers of health workers, marketing formula, returning to work, scanty milk production, sickness and diseases, and pregnancy [14]. As a part of the global efforts to promote BF, Palestinian hospitals try all the time to be Baby-Friendly Hospitals that support and educate mothers about BF to overcome these challenges. In this study, we will explore the reasons for stopping breastfeeding in Palestine.

Methods

A cross-sectional study was conducted in Hebron/ Palestine that included mothers of all live singleton newborns in the period between (January 1, 2022, and July 31, 2022). Mothers who did not initiate breastfeeding or who continued to breastfeed, either exclusively or with supplementation beyond the first six months of life were excluded. The information about BF status at 6 months of baby age and reasons for stopping BF was collected from all women enrolled in the study by public health doctors and midwives through face-to-face interviews when women visit the clinics for baby vaccination and family planning consult . Written consent was taken from all the participants .

Results

Study findings revealed that the mean age of mothers was 31 years, a majority had at least a bachelor’s degree (60.7%), The family income average was (2000)shekel which was about (650)$ . Of all women who gave birth to a live singleton infant between January 1, 2022, and July 31, 2022, 420 women initiated breastfeeding and were breastfeeding at discharge from the hospital, and 300 women stopped breastfeeding completely before the baby was six months of age. Among those who were known to have weaned by six months, 281 answered about the study and were included. Of these 281 women, (30%) stopped breastfeeding because of scanty milk production, (28.8%) child weaning him/herself, (24.8%) show that returning to work is the main cause, fatigue and painful nipples (8.4%), and medical advice and mother preference (4%) (Table 1).

Discussion

There are many factors associated with stopping breastfeeding before the 6 months of baby age as decreased, milk production, lack of training, and short maternity leave time which was discussed in the Behzadifar et al, 2019 systemic review [15]. Insufficient milk production comes from low mother knowledge about lactation and addressed crying as the main sign of hunger, so giving milk formula as the best solution [16]. Women were more likely to cite “fatigue with breastfeeding” as a reason for cessation (18%) in Palestine and (18.9%) in the Brown Canadian study [17]. Pain also was a major challenge proven by Ghana mothers [18]. Effective early training on the best way of lactation helps in increasing milk production and decreasing the pain and is crucial to avoid early baby weaning [19]. Some babies refuse breast milk as babies weaning him/her-self, this agrees with a systematic review study done by Zimmerman and his colleagues which confirmed that babies might prefer the bottles and reject breast milk [20].

The maternal choice for BF cessation in our study was following a secondary data analysis done by Michigan State University that highlighted some psychological distress issues [21]. Moreover, a cross-sectional survey done in Canada revealed that there is a strong mother’s intention for short duration of breastfeeding [22]. Breast milk is still the ideal food for infants [23]. Although the literature indicates that milk formula supplementation is negatively associated with breastfeeding duration it is not obvious which occurs first, whether breastfeeding problems lead to milk formula usage, or supplementation of milk formula occurs first that leading to breastfeeding problems [24].

Limitations of this Study

The inability to generalize the results across all over Palestine. We will conduct further studies with larger sample sizes in the future.

Conclusion and Recommendations

It is recommended that all Palestinian mothers should be trained in BF. The health care provider should improve mothers’ confidence in the ability to breastfeed and enhance their knowledge of the importance of lactation before 6 months of baby age. Secondly, Policymakers also should implement guidelines in hospitals and clinics to overcome the challenges and barriers of exclusively breastfeeding until 6 months of baby age in addition to prolonged maternity leave.

Declarations

Ethics Approval and Consent to Participate

All procedures performed in this study have been performed following the Declaration of Helsinki. The study was approved by the Institutional Review Board of the Palestine polytechnic university and ministry of health . All subjects involved in the study were invited to participate voluntarily and signed an informed consent. All Participants were interviewed in a private clinic, where they were informed that their information would be used solely for research purposes and that their confidentiality would be guaranteed.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Author Contribution

Neveen shalalfa designed and conducted the study. Neveen shalalfa , Baraa Wajeeh shatha , Alqadi ,Eman and Lina provided materials and collected the data. Ibrahem alheeh analyzed the data. Neveen shalalfa and Shatha wrote and drafted the manuscript . All authors reviewed the manuscript.

Acknowledgements

We thank the Palestinian Ministry of Health and the head of Primary Health Care directorates in the West Bank for the help and contribution they have given us in facilitating our study. We thank the study participants for their efforts and time contributing to the study.

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