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Impact of Exclusive Breastfeeding Promotion on Exclusive Breastfeeding Practices among Nursing Mothers in Nigeria

Abstract

Exclusive breastfeeding is a critical maternal and child health practice that provides infants with essential nutrients, supports immune protection, promotes healthy growth and development, and contributes to the prevention of childhood infections and undernutrition. Despite its recognized benefits, adherence to exclusive breastfeeding recommendations among nursing mothers in Nigeria remains affected by factors such as inadequate breastfeeding knowledge, cultural beliefs, family influences, maternal employment, workplace demands, limited maternity support, misconceptions about breast milk sufficiency, and inadequate access to breastfeeding counselling and support services. Exclusive breastfeeding promotion provides an opportunity to improve mothers' knowledge, confidence, and ability to initiate and sustain exclusive breastfeeding through antenatal education, postnatal counselling, community outreach, health-worker support, mothers' support groups, and workplace or community interventions. Against this background, this study investigates the impact of exclusive breastfeeding promotion on exclusive breastfeeding practices among nursing mothers in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how mothers' perceptions of the benefits of exclusive breastfeeding, perceived barriers, perceived susceptibility of infants to illness, and cues to action may influence breastfeeding decisions and practices. Social Cognitive Theory emphasizes the roles of knowledge, self-efficacy, observational learning, social support, and environmental factors in shaping breastfeeding behaviour. The Social Ecological Model recognizes the influence of individual, family, workplace, community, cultural, socioeconomic, and healthcare-system factors on breastfeeding practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how exclusive breastfeeding promotion may influence exclusive breastfeeding practices among nursing mothers in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise nursing mothers with infants aged approximately 0 to 6 months residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, primary healthcare centres, maternal and child health facilities, and eligible nursing mothers. Exclusive breastfeeding promotion will be measured using indicators such as exposure to breastfeeding education, antenatal breastfeeding counselling, postnatal breastfeeding support, early breastfeeding initiation education, education on exclusive breastfeeding for the first six months, breastfeeding technique demonstrations, counselling on breast milk sufficiency, management of common breastfeeding difficulties, support from healthcare workers, peer-support groups, family education, workplace breastfeeding support, breastfeeding promotion materials, and follow-up counselling. Exclusive breastfeeding practices will be assessed using indicators such as initiation of breastfeeding within the recommended period after birth, feeding infants only breast milk for the first six months where applicable, avoidance of water and other liquids or foods during the exclusive breastfeeding period, breastfeeding frequency, appropriate breastfeeding technique, continued breastfeeding, and mothers' reported adherence to recommended exclusive breastfeeding practices. Data will be collected using structured questionnaires, maternal interviews, infant feeding history, 24-hour feeding recall, breastfeeding practice assessment forms, maternal and child health records where available, and programme records. Descriptive statistics will be used to summarize mothers' demographic and obstetric characteristics, exposure to breastfeeding promotion, breastfeeding knowledge, and exclusive breastfeeding practices. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of exclusive breastfeeding promotion on exclusive breastfeeding practices. Where appropriate, exclusive breastfeeding practices before and after implementation of breastfeeding promotion activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that exclusive breastfeeding promotion has a significant positive impact on exclusive breastfeeding practices among nursing mothers in Nigeria. Mothers who receive systematic breastfeeding promotion are expected to demonstrate better adherence to recommended exclusive breastfeeding practices than mothers without similar exposure. Breastfeeding promotion may improve mothers' knowledge, confidence, self-efficacy, and practical skills regarding breastfeeding initiation, positioning and attachment, breast milk sufficiency, management of common breastfeeding difficulties, and continuation of exclusive breastfeeding. Antenatal and postnatal counselling may reinforce appropriate practices and provide mothers with opportunities to address misconceptions and receive professional support. Family and peer support may further encourage mothers to sustain exclusive breastfeeding, while workplace breastfeeding support may be particularly important for employed mothers. Conversely, maternal employment, inadequate maternity leave, unsupportive workplace environments, cultural beliefs, family pressure, misconceptions about breast milk sufficiency, breastfeeding difficulties, maternal workload, and limited access to trained breastfeeding counsellors may reduce the effectiveness of exclusive breastfeeding promotion. The study therefore expects comprehensive, culturally appropriate, and sustained breastfeeding promotion to contribute significantly to improved exclusive breastfeeding practices among nursing mothers in Nigeria. The study is expected to contribute to the literature on exclusive breastfeeding promotion, breastfeeding practices, maternal and child health, infant feeding, nutrition, health education, community health, 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, primary healthcare centres, hospitals, maternal and child health programmes, nurses, midwives, nutritionists, lactation counsellors, community health workers, employers, mothers' support organizations, development partners, and policymakers regarding strategies for improving breastfeeding practices. The study will also provide evidence-based recommendations for strengthening antenatal and postnatal breastfeeding counselling, expanding community-based breastfeeding promotion, increasing access to trained breastfeeding support personnel, strengthening mothers' peer-support programmes, improving family and workplace support, addressing cultural and socioeconomic barriers, and integrating sustained exclusive breastfeeding promotion into appropriate maternal and child health programmes across Nigeria.

Keywords: Exclusive breastfeeding promotion, exclusive breastfeeding practices, nursing mothers, breastfeeding support, infant feeding, maternal and child health, breastfeeding education, lactation support, child nutrition, community health, Nigeria, public health.