Investigating the Disjoint Between Education and Health Policy for Infant Feeding Among Teenage Mothers in South Africa: A Qualitative Study

2020 ◽  
Author(s):  
Virginia Zweigenthal ◽  
Anna Strebel ◽  
Joanne Corrigall ◽  
Jo Hunter-Adams
Keyword(s):  
South Africa ◽  
Health Policy ◽  
Infant Feeding ◽  
Breast Feeding ◽  
Adolescent Mothers ◽  
World Health ◽  
Return To School ◽  
Policy Makers ◽  
Education And Health ◽  
Breast Feed

Abstract BackgroundMany low-and-middle-income countries, including South Africa (SA), have high rates of teenage pregnancy. Following the World Health Organisation recommendations, SA health policy on infant feeding promotes exclusive breast-feeding until six months of age, with gradual weaning. At the same time, SA’s education department, in the interest of learners, promotes teenagers’ return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. MethodsThis article explores practice among policy makers and implementers in the education and health sectors in Cape Town, SA. We interviewed health and education officials, managers and policy makers, as well as school principals and nursing staff, who manage adolescent mothers and their babies. ResultsParticipants expressed discomfort at pregnant learners remaining in school late in pregnancy. There was uncertainty about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breast-feeding was not common. While health professionals highlighted the benefits of extended breast-feeding for infants and mothers, there was recognition of the potential conflict between the need for the mother to return to school and the recommendation for longer breast-feeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. ConclusionsOur findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breast-feeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage in intersectoral work to focus on systems that facilitate the interests of both the mother and infant – some exclusive infant feeding together with a supported return to school for the teen mother.

scholarly journals Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jo Hunter-Adams ◽  
Anna Strebel ◽  
Joanne Corrigall ◽  
Virginia Zweigenthal
Keyword(s):  
South Africa ◽  
Health Policy ◽  
Infant Feeding ◽  
Adolescent Mothers ◽  
Adolescent Mother ◽  
World Health ◽  
Return To School ◽  
Education And Health ◽  
Early Return ◽  
Breast Feed

Abstract Background Many low-and-middle-income countries, including South Africa, have high rates of teenage pregnancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staff who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results Informants from both sectors expressed discomfort at pregnant learners remaining in school late in pregnancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefits of extended breastfeeding for infants and mothers, they recognised the potential conflict between the need for the mother to return to school and the recommendation for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions Our findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother.

Breast Versus Bottle: Correlates of Adolescent Mothers' Infant-Feeding Practices

PEDIATRICS ◽  
1987 ◽  
Vol 79 (5) ◽  
pp. 689-695
Author(s):  
Alain Joffe ◽  
Susan M. Radius
Keyword(s):  
Infant Feeding ◽  
Breast Feeding ◽  
Adolescent Mothers ◽  
Personal Experience ◽  
Total Sample ◽  
Social Environments ◽  
Pregnant Adolescents ◽  
Feeding Method ◽  
Breast Feed ◽  
Breast Fed

Since the 1970s, breast-feeding as the preferred method of infant feeding has increased in overall popularity. However, certain populations, particularly poor, young, black, and less-educated women, have been slow to adopt this method. This prospective study was undertaken to identify factors relating to the choice of infant-feeding method among inner-city adolescents. Two hundred fifty-four pregnant adolescents completed a questionnaire supplying information regarding attitudes toward and knowledge about breast-feeding, social support, personal experience, and other variables hypothesized to correlate with their choice of infant-feeding method. Of the total sample, 17% said they were "probably" or "definitely" going to breast-feed their babies. Analyses revealed adolescents most likely to intend to breast-feed were those who perceived more benefits to breast-feeding, who desired more knowledge about it, who were themselves breast-fed, who reported supportive social environments, and who perceived relatively fewer barriers to breast-feeding their infants. Specific interventions based upon these findings are proposed. We conclude that adolescent mothers are interested in breast-feeding their babies and that interventions are feasible to increase breast-feeding within this population.

Factors Associated with the Choice and Duration of Infant-Feeding Practice

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 603-614 ◽  
Author(s):  
Artemis P. Simopoulos ◽  
Gilman D. Grave
Keyword(s):  
Infant Feeding ◽  
Breast Feeding ◽  
Infant Health ◽  
Collaborative Study ◽  
World Health ◽  
Feeding Practice ◽  
Economic Factors ◽  
Member States ◽  
Factors Associated ◽  
Breast Feed

Breast-feeding makes a unique, fundamental contribution to the health and nutrition of infants. The World Health Organization International Code of Marketing of Breastmilk Substitutes is designed to encourage, promote, and protect breast-feeding in all WHO member states. The Code acknowledges that a number of social and economic factors affect the decisions of women to breast-feed and that breast-feeding has declined. Member states have been urged, therefore, to develop appropriate social support systems to overcome and adjust for factors associated with breastmilk substitutes. Although the Code does not so state, these factors are not fully understood. The reasons for unsuccessful breast-feeding and early termination are important concerns. So far only vague and rudimentary answers have been identified, eg, "the milk dried up"49 or "lack of satisfaction."7 The decision-making process involved in early weaning has yet to be carefully analyzed. Certainly, biologic variables are involved, such as maternal nutritional status, maternal nutrient intake, and volume and quality of milk produced. These factors have not been well studied, and they are presumably influenced by psychological, social, cultural, and economic factors. Vahlquist,55 writing in the introduction to the WHO Collaborative Study on Breast-Feeding, noted, "Whereas, up to the 1960's it had been widely held that the decline in breast-feeding was a `fact of modern life,' this premise began to be increasingly questioned, and it was wondered whether the trend was really irreversible." The stakes in reversing the trend are great, as breast-feeding is the safest, most economical way to promote infant health and sound nutrition. Since then, the literature on the determinants of infant-feeding choice has grown rapidly.

Trends in Breast-Feeding

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 591-602
Author(s):  
Gerry E. Hendershot
Keyword(s):  
Infant Feeding ◽  
Breast Feeding ◽  
Market Research ◽  
The United States ◽  
Upward Trend ◽  
Disadvantaged Women ◽  
Breast Feed ◽  
Statistical Studies ◽  
Low Levels ◽  
Short Section

Starting from very high levels in the 1940s, breast-feeding declined steadily to low levels in the early 1970s, and then began an upward trend which has apparently continued until the present (Fig. 1). In the 1940s, breast-feeding was more common among disadvantaged women. The subsequent decline was also more rapid among the disadvantaged, however, so that by the early 1970s, disadvantaged women were considerably less likely than others to breast-feed. Because the increase since the early 1970s has not been so pronounced among the disadvantaged, they continue to have relatively low levels of breast-feeding. The causes of these trends and differentials are not well understood. These are the principal conclusions drawn from a review of statistical studies of trends and differentials in breast-feeding in the United States. The studies included national health surveys conducted by the federal government, market research surveys conducted by infant formula manufacturers, and infant feeding surveys conducted by medical researchers. The studies differed markedly in their methods—a fact that affects their validity, reliability, and comparability. The first section of this paper discusses these data sources and their limitations. The next two sections discuss the downward trend in breast-feeding from the 1940s to the early 1970s, and the upward trend since. Each of these sections examines demographic differences in these trends. A short section that addresses possible causes of the trends and differentials follows those two sections. SOURCES AND LIMITATIONS OF THE DATA The principal sources of data on trends and differentials in breast-feeding are national fertility surveys, market research surveys, and special purpose infant-feeding surveys.

scholarly journals Adolescent mothers’ utilisation of reproductive health services in the Gauteng province of the republic of South Africa

Curationis ◽  
2000 ◽  
Vol 23 (3) ◽  
Author(s):  
VJ Ehlers ◽  
T Maja ◽  
E Sellers ◽  
M Gololo
Keyword(s):  
South Africa ◽  
Reproductive Health ◽  
Adolescent Mothers ◽  
Termination Of Pregnancy ◽  
World Health ◽  
Reproductive Health Services ◽  
Gauteng Province ◽  
Emergency Contraceptive ◽  
The Republic ◽  
Health Organization

A financial grant was received from the World Health Organization (WHO) during 1998 to establish whether adolescent mothers (aged 19 or younger at the birth of their babies) utilized contraceptive, emergency contraceptive and termination of pregnancy (TOP) services in the Republic of South Africa (RSA). This report refers to data obtained from 111 questionnaires completed by dolescent mothers between January 2000 and May 2000 in the Gauteng Province; 61 in the Pretoria and 50 in the Garankuwa areas, and excluding the 12 completed questionnaires used foi pretesting the research instrument. The biographic data of the 111 adolescent mothers indicated that the minority were married, employed or earned sufficient income to care for themselves and their babies. However, the minority used contraceptives prior to conception, none used emergency contraceptives or termination of pregnancy (TOP) services. The minority attended ante-natal clinics five or more times during their pregnancies, and a negligible number indicated that they had ever been treated for sexually transmitted diseases (STDs). These findings indicate that the 111 adolescent mothers in Gauteng who participated in this survey did not make optimum use of the available reproductive health (RH) care services. Education about sex, pregnancy and contraceptives should commence at the age of 10, but no later than the age of 12 as the majority of respondents did not have the necessary knowledge to make informed decisions about their futures. The accessibility of contraceptive, emergency contraceptive and TOP services for adolescents should be investigated in specific areas and attempts made to enhance such accessi- bility. This might necessitate offering these services over weeker| ds or during evenings when school girls could attend without fear of meeting their mothers, aunts or teachers at these clinics.

Health Education in the Border Corridor

1991 ◽  
Vol 13 (2) ◽  
pp. 26-29
Author(s):  
Hope Isaacs
Keyword(s):  
Infant Feeding ◽  
Breast Feeding ◽  
Health Care Professionals ◽  
Infant Health ◽  
Positive Impact ◽  
The United States ◽  
World Health ◽  
Mexico Border ◽  
Health Organization ◽  
United States Mexico

Despite closely maintained familial connections and cultural traditions, the Hispanic population spanning the United States-Mexico border has diverged sharply from its traditional infant feeding practices. Successive reports document a trend away from the long-established cultural pattern of breast-feeding among Hispanic mothers. At the same time, World Health Organization reports have stimulated greater awareness among health care professionals of the positive impact of breast-feeding on infant health rates in Third World countries. This paper describes a multistage project undertaken by a binational team of nursing professionals and an anthropologist. Project goals were to research, design, and implement a mode of intervention which would encourage better management of infant feeding and which could be clinically applied on both the Mexican and U.S. sides of the international border.

Executive Summary

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 579-583
Keyword(s):  
Developing Countries ◽  
Breast Milk ◽  
Infant Feeding ◽  
Breast Feeding ◽  
Maternal Employment ◽  
The United States ◽  
Attitudinal Factors ◽  
Rate Of Increase ◽  
Breast Feed ◽  
Breast Fed

Domestic Although the rate of breast-feeding is increasing in the United States, it appears that the rate of increase has been much slower among less well educated and economically disadvantaged women. Relatively little is known about the behavioral and attitudinal factors that affect the decisions to breast-feed or to stop if already breast-feeding. Breast-feeding does appear to decrease an infant's risk of gastrointestinal infection and otitis media. The effect of method of infant feeding on risk of other infections and allergic illness is less certain. International The rate of breast-feeding in developing countries appears to have declined, especially among urban women. Although some sociodemographic correlates of infant-feeding choice have been examined, little is known about the behavioral and attitudinal factors that influence choice and duration of infant-feeding practices. Milk insufficiency, maternal employment, and pregnancy frequently are given as reasons for terminating breast-feeding. Rates of gastrointestinal illness are lower among breast-fed infants and when such illness is an important cause of death, infant mortality from this cause appears to be reduced. A randomized clinical trial carried out among high-risk infants found a significantly lower rate of infections among those given breast milk than those fed with infant formula. The evidence of the effect of breast-feeding on respiratory tract and other infections from other studies was less clear. Direct comparison of the growth of predominately breast-fed v artificially fed infants in the same populations from developing countries generally show faster growth for the breast-fed infants for the first 6 months of life. After 6 months, severe growth faltering occurs regardless of the method of feeding. In communities where the nutritional adequacy of supplementary foods is poor, breast milk is an extremely important, high-quality food during the second half of infancy and beyond.

scholarly journals Maternal perspectives on infant feeding practices in Soweto, South Africa

2020 ◽  
pp. 1-13
Author(s):  
Stephanie V Wrottesley ◽  
Alessandra Prioreschi ◽  
Wiedaad Slemming ◽  
Emmanuel Cohen ◽  
Cindy-Lee Dennis ◽  
...  
Keyword(s):  
South Africa ◽  
Infant Feeding ◽  
Breast Feeding ◽  
Feeding Practices ◽  
African Women ◽  
Infant Feeding Practices ◽  
Eating Behaviours ◽  
Group Discussions ◽  
Exclusive Breast Feeding ◽  
South African Women

Abstract Objective: To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers’ perspective what influences feeding practices. Design: Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis. Setting: Soweto, South Africa. Participants: Nineteen mothers were stratified into three FGD according to their baby’s age as follows: 0–6-month-olds, 7–14-month-olds and 15–24-month-olds. Four mothers from each FGD then attended an IDI. Results: Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and ‘junk’ food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers’ beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers’ feeding practices; however, their advice often contradicted that of health professionals. Conclusions: In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding.

scholarly journals Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward

2012 ◽  
Vol 12 (52) ◽  
pp. 6274-6290
Author(s):  
C Sagoe-Moses ◽  
◽  
K Mwinga ◽  
P Habimana ◽  
ID Toure ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Health Workers ◽  
National Level ◽  
Scale Up ◽  
World Health ◽  
Child Health Services ◽  
Feeding Practice ◽  
Policy Makers ◽  
Hiv Exposed ◽  
The Way

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feeding guidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World Health Organization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them.

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