Breastfeeding provides unmatched health benefits for babies and mothers. It is the clinical gold standard for infant feeding and nutrition, with breast milk uniquely tailored to meet the health needs of a growing baby [1].

Exclusive breastfeeding is the practice of giving the baby nothing but breast milk, with the exception of liquid medication or vitamin/mineral supplements. Breast milk is the best food for infants during the first six months of life because it contains all the essential elements, including vitamins and minerals. WHO advises that newborns should only be breastfed for the first six months of life in order to ensure optimal growth, development and health [2-4].

One of the main causes of poor health outcomes in children, especially in developing countries, has been documented to be inadequate breast-feeding practices and attitudes. However, in developing nations with high levels of poverty, which are characterized by a high burden of disease, insufficient access to clean water and inadequate sanitation, the promotion and acceptance of practices, such as exclusive breastfeeding, are especially crucial [5-7].

Breastfeeding is considered to be a traditional practice in India and it is believed that it comes ‘naturally’ to Indian mothers. The factors that influence initiation, maintenance and duration of breastfeeding are social and cultural traditions, infant maturity at birth, degree of commitment and literacy of the mother and level of modernity [8].

In spite of convincing evidence of the benefits of breastfeeding, breast feeding rates are less than satisfactory in Himachal Pradesh, which need to be identified and addressed. While, a number of studies have assessed knowledge of breastfeeding in different parts of the India; such studies are limited among postnatal mothers in rural areas of District Kangra. Thus, the present study was developed to examine the knowledge towards breast feeding among postnatal mothers attending Primary Health Center, Dhanot of District Kangra, Himachal Pradesh.

Objectives of the Study

To evaluate the knowledge towards breast feeding among postnatal mothers attending Primary Health Center Dhanot of District Kangra, Himachal Pradesh.

Research Methodology:

• Research Approach-Descriptive

• Research Design-Hospital based cross-sectional survey design

• Setting of the study-OPD in Primary Health Center, Dhanot of District Kangra, Himachal Pradesh

• Study duration- between January 2022-March 2022

• Study population-Post Natal Mothers came to OPD and having children aged less than one year

• Sample size-400 Post Natal Mothers assuming 50% mothers have adequate knowledge regarding Breast feeding, 5% absolute error, 95% confidence level and 5% non-response rate

• Sampling Technique-convenience Sampling technique

• Sampling criteria-first five post-natal mothers who came to OPD and having children aged less than one year were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained

• Inclusive Criteria‐Post natal mothers who were willing to participate in the study

• Exclusion Criteria: Post natal mothers who were not willing to participate in the study

Description of Tool

Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Checkup and many more.

Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as:

>80%(16-20)=very good, 60-79%(12-15) =Good, 41-

59% ( 8-11)=Fair, <40% (< 8)=poor

Validity of tool = by the experts in this field

Data collection by under the guidance of supervisors and Post natal mothers were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time.

Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

Present study was developed to evaluate the knowledge towards breast feeding among postnatal mothers’ attending Primary Health Center, Dhanot of District Kangra, Himachal Pradesh. A total of 400 Post Natal Mothers Post Natal Mothers came to OPD and having children aged less than one year were selected after  explaining the  purpose  of the  study.

Table 1: Socio demographic characteristics of the participants

Among the total mothers, maximum 201(50.25%) were having age between 26-30 years, educated up to Matric & Senior Secondary 165(41.25%), Hindu 376(94%), housewife 304(76%), Multigravida 278 (69.5%) and delivered in government hospitals 268(67%) (Table 1 and 2).

In the Table 3 16% (64) postnatal mothers had very good knowledge (16-20 marks) towards breast feeding, 64% (256) having good knowledge (12-15 marks), 19% (76) having fair knowledge (8-11 marks) and 1% (4) having poor knowledge (<8 marks).

Mothers’ good knowledge and positive attitude play key roles in the process of breastfeeding [9]. Breast feeding has multiple benefit to the mother and child but there is still postnatal mother that are not confident and not interest to breast feed their baby. This problem might be due to lack of knowledge on information sources regarding breastfeeding [10].

Therefore, the present study aimed at evaluating the knowledge regarding breastfeeding among post-natal women with children less than one year of age. 

Table 2: Responses of the participants to various statements

Table 3: Knowledge towards breast feeding among postnatal mothers’

Maximum =20 Minimum=7

Table 4: NFHS-5 data on Breast Feeding in Himachal Pradesh

To our best knowledge, this was the first study in this area of District Kangra. Although, the present study demonstrated good knowledge among mothers but still there was room for improvement as there is a significant gap in knowledge.

Government of India standards for Infant and Young Child Feeding (IYCF) state that breastfeeding should start as soon as possible after birth, preferably within an hour. The World Health Organization (WHO) advises continuing breastfeeding until the child is 2 years old or older [11].

In terms of the child's health, nutrition and development as well as the mother's health, breastfeeding has both immediate and significant long-term effects. An infant's mortality and morbidity from diarrhoea, respiratory and other infections, otitis media, necrotizing enterocolitis and sudden infant death syndrome are reduced when nursing is practiced properly (SIDS). It is also well known that nursing helps mothers’ space out their pregnancies by encouraging lactation amenorrhea and lowering the risk of breast and ovarian cancer [12,13].

Although more than 80% of neonates receive breast milk in nearly all countries, only about half begin breastfeeding within the first hour of life and rates of exclusive breastfeeding are well below 50% in most of the countries. NFHS 5 data on breast feeding in Himachal Pradesh showed that there was increase in breastfeeding within one hour of birth from 41.1% to 45.1%. Also, there was rise in exclusive breast-feeding rate from 67.2% to 69.9 % (Table 4) [14].

Optimal breastfeeding practices are potentially one of the top interventions for reducing under-five mortality and are essential for the achievement of many of the newly launched Sustainable Development Goals by 2030, as it can help to improve child and maternal health, nutrition, economy, intelligence and human capital, while reducing inequalities. Suboptimal breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0.49% of the world gross national income [15,16].

The finding of present study indicates that post natal mothers should be made aware about the importance of breastfeeding practices.

Limitations

Due to the present study's cross-sectional design, participants' postpartum status, children under one-year olds and small sample size, it was challenging to generalize the results. Future studies should concentrate on qualitative investigations with a larger sample size, such as focus groups, to uncover the obstacles to promoting breastfeeding among postnatal women.

Nevertheless, despite these drawbacks, the results of the current study may be useful to policymakers and health professionals in developing interventions to support breast-feeding practices.

The present study showed that the mothers had a good understanding of breast feeding but yet there was room for improvement since there is a large gap in the breastfeeding knowledge. The promotion of breastfeeding can be bolstered further by a number of community initiatives. In order to encourage breastfeeding, we also advise stepping up public health Information, Education and Communication (IEC) programmes.

During their antenatal follow-up visits, healthcare professionals should educate all women on breastfeeding, especially those with low educational attainment and no prior breastfeeding experience. It is important to find ways to remove these obstacles, especially for working women.

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11. Operational Guidelines of IYCF. IMA India, www.ima-india.org/windata/Operational-Guidelines.pdf. Accessed 15 June 2022.

12. Stuebe, A. "The risks of not breastfeeding for mothers and infants." Review of Obstetrics and Gynecology, vol. 2, no. 4, 2009, pp. 222–231.

13. BPNI. "Breastfeeding in the 21st century: epidemiology and mechanisms." BPNI, www. bpni. org/ Article/ Breastfeeding -in -the -21^st -century - epidemiology- mechanisms .pdf. Accessed 16 June 2022.

14. National Family Health Survey‐5. "Himachal Pradesh fact sheet." RCHIIPS, www. rchiips. org/ nfhs/ NFHS- 5_ FCTS/ Himachal_ Pradesh.pdf. Accessed 19 June 2022.

15. World Health Organization. "Global target 2025 discussion paper: extension to 2030 targets." WHO, www. who. int/ nutrition/ global- target- 2025/ discussion- paper-extension- targets- 2030.pdf. Accessed 17 June 2022.

16. UNICEF. State of the World’s Children 2019. www.unicef.org/media/60806/file/SOWC-2019.pdf. Accessed 17 June 2022.