|BRIEF RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 1 | Page : 81-85
Intention toward optimal breastfeeding among expecting mothers in Angul district of Odisha, India
Deepanjali Behera1, Anil Kumar Kuttappan Pillai2
1 Centre for Health and Social Sciences, School of Health System Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
2 Professor, Centre for Health and Social Sciences, School of Health System Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
|Date of Web Publication||23-Feb-2016|
Plot No - 3, Gayatri Nagar, Dhenkanal, Odisha - 759001
Source of Support: None, Conflict of Interest: None
| Abstract|| |
This paper aims to assess the prenatal breastfeeding intention and its predictors in Odisha, a state in India. Data were collected from 218 rural pregnant women of Angul district of Odisha, India in 2012. About 33% of the women lacked the intention to exclusively breastfeed their babies for 6 months. Prelacteal feeding was intended by one-third of the women while 61.5% of the women intended to feed water during the first 6 months of birth. Women of an older age [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.09-1.55], with more education (OR = 1.14; 95% CI = 1.08-1.32), belonging to lower castes [other backward caste (OBC)-OR = 21.33; 95% CI = 4.29-106.0, scheduled caste (SC)-OR = 22.77; 95% CI = 2.47-199.1, scheduled tribe (ST)-OR = 26.16; 95% CI = 4.10-174.8), and lesser number of living sons (OR = 0.59; 95% CI = 0.22-0.94) were more likely to have a higher intention for optimal breastfeeding than those of a lower age, with less education, belonging to a higher caste, and with more number of living sons. Awareness generation programs need to be strengthened to educate pregnant women with appropriate and recommended breastfeeding guidelines to establish optimal breastfeeding practices.
Keywords: Intention, optimal breastfeeding, Odisha, pregnant women, sociodemographic correlates
|How to cite this article:|
Behera D, Pillai AK. Intention toward optimal breastfeeding among expecting mothers in Angul district of Odisha, India. Indian J Public Health 2016;60:81-5
|How to cite this URL:|
Behera D, Pillai AK. Intention toward optimal breastfeeding among expecting mothers in Angul district of Odisha, India. Indian J Public Health [serial online] 2016 [cited 2019 Sep 17];60:81-5. Available from: http://www.ijph.in/text.asp?2016/60/1/81/177350
India is the country with the highest number of underweight children and around one-third of under-five deaths in the world.  Inadequate and suboptimal infant and young child feeding practices are the key determinants of malnutrition, out of which breastfeeding is deemed as the most important component in the early period of life. India has not yet achieved universal infant and child feeding practices as recommended by the Infant and Young Child Feeding (IYCF) guidelines of the World Health Organization (WHO).  Only 24.5% Indian children initiate breastfeeding within 1 h and 46.4% get exclusive breastfeeding for 6 months. 
The state of Odisha has one of the highest infant mortality rates (65 per 1,000 live births) in India.  Although breastfeeding is a universal practice in Odisha, incorrect and inadequate infant and child feeding practices account for the high vulnerability of Odia children toward morbidity and mortality.  Only around half of the infants aged 0-5 months (54.3%) receive exclusive breastfeeding and only 63.2% receive the mother's milk within 1 h of birth.  Approximately 42% children in Odisha are fed with something other than breast milk during the first 3 days after birth. 
The existing literature identifies numerous determinants of breastfeeding behavior among mothers. However, psychosocial factors such as breastfeeding intention have been explored less extensively. Previous research conducted in different parts of the world suggests breastfeeding intention as an important determinant of optimal breastfeeding practice. ,, More specifically, it is emphasized that prenatal breastfeeding intention has a strong influence on the initiation and duration of breastfeeding. , Although many studies have been conducted on the breastfeeding intention of women in the developed world and other parts of developing countries, ,,,, limited information is available from India, especially from Odisha. This paper examines the level of breastfeeding intention and its sociodemographic correlates among rural pregnant mothers of Odisha.
The study was conducted in rural areas of Angul district of Odisha, India due to its lower optimal breastfeeding rates than other districts.  Only about 47% of the children were breastfed within 1 h of birth, which was considerably lower than the state average of 63%. The colostrum feeding rate (84.2%) was also lesser than Odisha state average of 87.1%. 
The study was designed as a cross-sectional survey between March 2012 and June 2012 among the rural pregnant women of Angul district. The sample was selected using multistage sampling method. Out of four subdivisions of Angul district, one subdivision was selected by simple random sampling. There were three community health centers (CHCs) under that subdivision. One subcenter under each CHC was randomly selected. After that, from the antenatal care (ANC) register of the three selected subcenters, a list of 283 registered pregnant women was collected and all of them were selected for the study. Of them, 65 women could not be reached and the remaining 218 registered pregnant women were interviewed.
All data were collected in the local "Odia" language through face-to-face interview using the pretested structured interview schedule. The interview schedule was reviewed by two public health experts, two medical doctors, and two nurses to ensure content validity. This study proposal was approved by the Board of Research Studies at the School of Health System Studies, Tata Institute of Social Sciences (TISS), Mumbai, Maharashtra, India. Written informed consent was taken from all respondents with assurance of complete anonymity and confidentiality.
The outcome variable was breastfeeding intention among pregnant women while the predictor variables included sociodemographic variables. The outcome variable was measured using a set of seven questions and the responses of each question were coded 1-2. A score of 2 was denoted as positive or optimal intention toward breastfeeding while a score of 1 was given to suboptimal responses such as negative intention or if unsure. The reliability for the breastfeeding intention scale was calculated through Cronbach's alpha statistic of 0.78. After calculating the total score for breastfeeding intention (range: 7-14), it was further categorized as low intention, moderate intention, and high intention. Low intention was defined as positive intention for only one or no question out of the total seven items (total score: 8 or less), moderate intention as positive intention for two to four questions (total score: 9-11), and high intention as positive intention for five or more questions (total score: 12-14).
The data were coded, entered, and analyzed through Statistical Package for the Social Sciences (SPSS) computer software (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0., Chicago). Multinomial logistic regression was performed to identify sociodemographic correlates of optimal breastfeeding intention. The dependent variable intention of breastfeeding was included as a categorical variable with low, moderate, and high categories. Odds ratios (ORs) and confidence intervals (CIs) were calculated for each association while two-tailed statistical significance was reported at P < 0.05 level.
The age of the respondents ranged 18-35 years (mean age: 23.6 years). Most of the women were in their second (40.4%) or third (39%) trimester of pregnancy. One-fourth of the total women were illiterate and 43.6% were experiencing their first pregnancy. The median per capita monthly income was ₹1,277 with one-third of the respondents earning below ₹950 per capita per month. Most of the respondents were living in joint families (78.9%) with their parents-in-law (76.1%). Other backward caste (OBC) women were a major proportion (39.9%) in the sample followed by 30.3% scheduled caste (SC) women, 15.6% general caste women, and 14.2% scheduled tribe (ST) women.
All respondents stated that they intended to breastfeed their forthcoming baby. However, about 33% of the women lacked the intention to exclusively breastfeed for 6 months. Approximately one-third women (33%) intended prelacteal feeding while 61.5% intended to give water to their babies during the exclusive breastfeeding period [Table 1]. Majority of the respondents (44.5%) showed a moderate level of intention while about 30% of the women had a low intention for optimal breastfeeding.
The results of multinomial regression analysis demonstrated that the odds of having a high intention increased by 30% and that of moderate intention increased by 17% as compared to low intention for every 1 unit increase in age [Table 2]. In addition, there was approximately 14% increase in the chances of having high intention and 9% increase in having moderate intention as compared to low intention with every 1 additional year of education. However, women with a higher number of living sons were found to have lesser intention (OR = 0.59; 95% CI = 0.22-0.94) for optimal breastfeeding. Lower caste women such as OBC women, SC women, and ST women had about 21 times, 22 times, and 26 times, respectively, more chances of having a high intention for optimal breastfeeding than upper caste women.
|Table 2: Results of multinomial logistic regression for breastfeeding intention|
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This study revealed the introductory findings about rural Odia women's intention toward breastfeeding during the prenatal stage while a majority of the past studies in India emphasized the breastfeeding practices. ,,,,, It also examined the seven important components of optimal breastfeeding intention among rural Odia mothers, which has been scarcely examined in the past.
The present study findings established that there is a strong intention to breastfeed among all women. However, the intention toward exclusive breastfeeding for 6 months was inadequate in the region. About two-third women intended to exclusively breastfeed their child for 6 months, which was higher than the national level figure of 46.4% as illustrated by the third round of National Family Health Survey (NFHS-3).  However, this study demonstrated that a much higher proportion of women (61.5%) possessed a strong intention to feed water to their babies during the first 6 months and about 33% of the pregnant mothers showed a positive intention toward prelacteal feeding with something other than mother's milk after birth. This implicitly illustrated that exclusive breastfeeding practice as recommended by WHO was not correctly understood by the mothers. This also suggested that long years of awareness generation initiatives have not been able to spread the correct information to the targeted mass. Further, women's intentions for colostrum feeding and breastfeeding initiation within 1 h of birth are yet to achieve a universal level in the study area. However, these rates were much higher than the corresponding figures of breastfeeding practice in Angul district during the last round of NFHS-III. 
The present study further illustrated that women's higher age and education had a strong influence on their intention for optimal breastfeeding. These findings are supported by past Indian studies conducted on breastfeeding practices. ,, In addition, there was a higher intention identified among backward caste women than among upper caste women, which is similar to the findings of a study about breastfeeding practices conducted in Andhra Pradesh, India.  This may be explained by the higher restrictive influence of cultural and traditional norms toward suboptimal breastfeeding among higher caste women. Furthermore, with an increase in the number of living sons, the women's intention for optimal breastfeeding was observed to be reducing. This highlighted the inclination for sons in Indian society. ,
The findings imply that there was a specifically low intention toward exclusive breastfeeding for 6 months, which was further reinforced by the high intentions for inadvisable behaviors such as prelacteal feeding after birth and feeding external water during the first 6 months. Therefore, breastfeeding awareness programs must focus on providing correct information about optimal breastfeeding guidelines in order to establish the right breastfeeding intentions among pregnant mothers. More efficient engagement of the health workforce in promoting optimal breastfeeding advice is deemed absolutely essential to promote good health and reduce mortality among children in Odisha, India.
The authors extend their sincere thanks to the field staff and officials of Angul District Health Office for their kind support during the data collection process. The authors would also like to thank all the respondents for their participation in this study.
Financial support and sponsorship
There was no funding support for this research.
Conflicts of interest
There are no conflicts of interest.
| References|| |
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06: India: Vol. 1. Mumbai: International Institute for Population Sciences (IIPS); 2007.
International Institute for Population Sciences (IIPS). District Level Household and Facility Survey (DLHS-3), 2007-08: India. Orissa: Mumbai: International Institute for Population Sciences (IIPS); 2010.
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), India, 2005-06. Orissa: Mumbai: International Institute for Population Sciences (IIPS); 2007.
Bai Y, Middlestadt SE, Peng CY, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact 2010;26:26-34.
Forster DA, McLachlan HL, Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. Int Breastfeed J 2006;1:18.
Shi L, Zhang J, Wang Y, Guyer B. Breastfeeding in rural China: Association between knowledge, attitudes, and practices. J Hum Lact 2008;24:377-85.
Digirolamo A, Thompson N, Martorell R, Fein S. Grummer-Strawn L. Intention or experience? Predictors of continued breastfeeding. Health Educ Behav 2005;32:208-26.
Swanson V, Power KG. Initiation and continuation of breastfeeding: Theory of planned behaviour. J Adv Nurs 2005;50:272-82.
Patil PS, Chowti JV. A study to assess the knowledge regarding breastfeeding in rural women. Indian J Matern Child Health 2012;14:2-9.
Meshram II, A L, K V, N V BG. Impact of feeding and breastfeeding practices on the nutritional status of infants in a district of Andhra Pradesh, India. Natl Med J India 2012;25:201-6.
Kishore MS, Kumar P, Aggarwal AK. Breastfeeding knowledge and practices amongst mothers in a rural population of north India: A community-based study. J Trop Pediatr 2009;55:183-8.
Mahmood SE, Srivastava A, Shrotiya VP, Mishra P. Infant feeding practices in the rural population of north India. J Family Community Med 2012;19:130-5.
Garg R, Deepti S, Padda A, Singh T. Breastfeeding knowledge and practices among rural women of Punjab, India: A community-based study. Breastfeed Med 2010;5:303-7.
Sinhababu A, Mukhopadhyay DK, Panja TK, Saren AB, Mandal NK, Biswas AB. Infant- and young child-feeding practices in Bankura District, West Bengal, India. J Health Popul Nutr 2010;28:249-9.
Population Council. Increasing Early and Exclusive Breastfeeding in Rural Uttar Pradesh: Implications for Behaviour Change Communication, Policy Brief No. 5. New Delhi, India: Population Council; 2010.
Leung TF, Tam WH, Hung EC, Fok TF, Wong GW. Sociodemographic and atopic factors affecting breastfeeding intention in Chinese mothers. J Paediatr Child Health 2003;39:460-4.
Mclnnes RJ, Love JG, Stone DH. Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women. BMC Public Health 2001;1:10.
Malhotra R, Noheria A, Amir O, Ackerson LK, Subramanian SV. Determinants of termination of breastfeeding within the first 2 years of life in India: Evidence from the National Family Health Survey-2. Matern Child Nutr 2008;4: 181-93.
Jayachandran S, Kuziemko I. Why do mothers breastfeed girls less than boys? Evidence and implications for child health in India. Q J Econ 2011;126:1485-538.
[Table 1], [Table 2]