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Effect of Hospital Breastfeeding Support Services on Breastfeeding Initiation among Mothers in Nigerian Hospitals

Abstract

Breastfeeding initiation is an important component of maternal and child health because early breastfeeding provides essential nutrients, supports newborn immunity, promotes mother-infant bonding, and contributes to healthy growth and development. Despite the recognized benefits of breastfeeding, some mothers in Nigeria may experience difficulties initiating breastfeeding because of inadequate breastfeeding knowledge, delayed initiation after delivery, maternal fatigue, pain, perceived insufficient milk supply, cultural practices, limited family support, caesarean delivery, newborn health conditions, and inadequate professional assistance. Hospital breastfeeding support services provide opportunities for mothers to receive practical guidance, counselling, breastfeeding education, positioning and attachment assistance, and support with common breastfeeding difficulties during the immediate postnatal period. Effective hospital-based breastfeeding support may improve mothers' confidence and ability to initiate breastfeeding successfully. Against this background, this study investigates the effect of hospital breastfeeding support services on breastfeeding initiation among mothers in Nigerian hospitals. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Donabedian Model of Healthcare Quality. The Health Belief Model explains how mothers' perceptions of the benefits of breastfeeding, perceived barriers, perceived confidence, and cues to action may influence their decision to initiate breastfeeding. Social Cognitive Theory emphasizes the roles of knowledge, observational learning, self-efficacy, social support, and healthcare environments in shaping breastfeeding behaviour. The Donabedian Model explains healthcare quality through structure, process, and outcome, with hospital breastfeeding support services representing important structural and process components and breastfeeding initiation serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how hospital breastfeeding support services may influence breastfeeding initiation among mothers in Nigerian hospitals. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise postpartum mothers who give birth in selected public and private hospitals in Nigeria. A multistage sampling technique will be used to select states, local government areas, hospitals, maternity units, and eligible mothers. Hospital breastfeeding support services will be assessed using indicators such as availability of trained breastfeeding counsellors, breastfeeding education, individual counselling, practical assistance with positioning and attachment, skin-to-skin support, early postnatal breastfeeding guidance, rooming-in practices, support for mothers after caesarean delivery, assistance with breastfeeding difficulties, newborn feeding assessment, lactation support materials, follow-up counselling, staff availability, and hospital policies supporting breastfeeding. Breastfeeding initiation will be assessed using indicators such as whether breastfeeding was initiated, time from birth to first breastfeeding, initiation within the recommended early postnatal period, provision of colostrum, exclusive breastfeeding intention, successful latch, frequency of breastfeeding during the initial postnatal period, and mothers' confidence in breastfeeding. Data will be collected using structured questionnaires, maternal interviews, hospital maternity records, newborn feeding records, breastfeeding-support documentation, and direct observation where appropriate. Descriptive statistics will be used to summarize mothers' demographic and obstetric characteristics, exposure to breastfeeding support services, and breastfeeding initiation patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of hospital breastfeeding support services on breastfeeding initiation. Where a quasi-experimental design is adopted, breastfeeding initiation among mothers receiving structured breastfeeding support may be compared with initiation among mothers receiving routine postnatal care. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that effective hospital breastfeeding support services have a significant positive effect on breastfeeding initiation among mothers in Nigerian hospitals. Mothers who receive timely breastfeeding education, individualized counselling, practical assistance with positioning and attachment, and continuous support during the immediate postnatal period are expected to have a higher likelihood of initiating breastfeeding early and successfully than mothers who receive limited breastfeeding assistance. Practical support may improve maternal confidence, reduce anxiety about breastfeeding difficulties, and help mothers overcome common problems associated with breastfeeding initiation. Skin-to-skin contact, rooming-in, and appropriate assistance after caesarean delivery may further facilitate early breastfeeding. However, inadequate numbers of trained breastfeeding counsellors, heavy workloads among healthcare workers, limited hospital resources, cultural beliefs, maternal complications, newborn illness, and inconsistent implementation of breastfeeding-support practices may reduce effectiveness. The study therefore expects accessible, timely, skilled, and mother-centred hospital breastfeeding support services to contribute significantly to improved breastfeeding initiation among mothers in Nigerian hospitals. The study is expected to contribute to the literature on hospital breastfeeding support, breastfeeding initiation, maternal and newborn health, lactation support, postnatal care, infant feeding, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospital management boards, maternity hospitals, midwives, nurses, doctors, lactation consultants, maternal and child health professionals, development partners, and policymakers regarding strategies for strengthening breastfeeding support in healthcare facilities. The study will also provide evidence-based recommendations for training healthcare workers in breastfeeding counselling, increasing access to skilled lactation support, strengthening early postnatal breastfeeding assistance, improving skin-to-skin and rooming-in practices, supporting mothers after caesarean delivery, developing standardized hospital breastfeeding-support protocols, monitoring breastfeeding initiation, and integrating breastfeeding support into routine maternity and postnatal care services across Nigerian hospitals.

Keywords: Hospital breastfeeding support services, breastfeeding initiation, breastfeeding support, lactation counselling, maternal health, newborn health, infant feeding, postnatal care, skin-to-skin contact, Nigeria, public health.