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Influence of Breastfeeding Education on Exclusive Breastfeeding Practices among Mothers of Infants in Nigeria

Abstract

Exclusive breastfeeding is an important maternal and child health practice because breast milk provides essential nutrients and immune protection during early infancy and can contribute to healthy growth, development, and protection against common childhood illnesses. Despite the recognized benefits of exclusive breastfeeding, some mothers may introduce water, formula, other liquids, or complementary foods before the recommended period because of inadequate breastfeeding knowledge, cultural beliefs, perceived insufficient milk supply, maternal employment demands, family influences, breastfeeding difficulties, and limited access to professional breastfeeding support. Breastfeeding education provides mothers with knowledge and practical skills relating to the benefits of exclusive breastfeeding, early initiation of breastfeeding, appropriate breastfeeding techniques, positioning and attachment, recognition of effective feeding, management of common breastfeeding difficulties, expression and safe storage of breast milk, maintenance of milk supply, and recommended timing for introducing complementary foods. Exclusive breastfeeding practices refer to feeding an infant only breast milk, apart from prescribed medicines, vitamins, minerals, or other medically indicated substances, during the recommended first six months of life. In Nigeria, inadequate access to breastfeeding education and support, misinformation, cultural practices, maternal employment, limited maternity protection, breastfeeding difficulties, and inconsistent counselling during antenatal and postnatal care may affect exclusive breastfeeding practices. Effective breastfeeding education may improve mothers' knowledge, confidence, practical skills, and adherence to recommended exclusive breastfeeding practices. Against this background, this study investigates the influence of breastfeeding education on exclusive breastfeeding practices among mothers of infants in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and the Theory of Planned Behaviour. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping breastfeeding behaviour. The Health Belief Model explains health-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding mothers' decisions regarding exclusive breastfeeding. The Theory of Planned Behaviour explains how attitudes, subjective norms, perceived behavioural control, and behavioural intentions influence mothers' breastfeeding practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how breastfeeding education may influence exclusive breastfeeding practices among mothers of infants in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from mothers of infants attending selected public and private healthcare facilities in Nigeria using a structured interviewer-administered questionnaire, breastfeeding knowledge assessment, and exclusive breastfeeding practices assessment tool. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, communities, and eligible mothers. Where feasible, selected mothers or groups will be assigned to intervention and comparison groups. Mothers in the intervention group will receive structured breastfeeding education covering the benefits of exclusive breastfeeding, early initiation, correct positioning and attachment, recognition of effective breastfeeding, management of common breastfeeding difficulties, expression and safe storage of breast milk, maintenance of milk supply, breastfeeding support, and the recommended timing for introducing complementary foods. Exclusive breastfeeding practices will be assessed using indicators such as initiation of breastfeeding, feeding the infant only breast milk during the recommended period, avoidance of unnecessary water and other liquids, appropriate management of breastfeeding difficulties, and timing of introduction of complementary foods. Where possible, infant feeding histories and relevant maternal and child health records will complement self-reported information. Descriptive statistics will be used to summarize mothers' sociodemographic and maternal characteristics, breastfeeding knowledge, exposure to breastfeeding education, and exclusive breastfeeding practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the influence of breastfeeding education on exclusive breastfeeding practices. Where appropriate, pre-intervention and post-intervention breastfeeding practice measures will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that breastfeeding education has a significant positive influence on exclusive breastfeeding practices among mothers of infants in Nigeria. Mothers exposed to structured breastfeeding education are expected to demonstrate improved knowledge and greater adherence to recommended exclusive breastfeeding practices. Education may improve mothers' understanding of the benefits of exclusive breastfeeding, correct breastfeeding techniques, management of common breastfeeding challenges, recognition of adequate infant feeding, and appropriate timing for introducing complementary foods. It may also increase mothers' confidence in breastfeeding and reduce misconceptions regarding breast milk sufficiency and the need to introduce water or other liquids during early infancy. However, education alone may not guarantee sustained exclusive breastfeeding because mothers may continue to face barriers such as maternal employment, inadequate maternity leave, limited breastfeeding facilities in workplaces, family and cultural influences, breastfeeding difficulties, perceived insufficient milk supply, and inadequate access to continued professional support. Consequently, breastfeeding education is expected to be most effective when supported by regular antenatal and postnatal counselling, skilled breastfeeding support, family involvement, maternity protection, supportive workplace policies, and accessible maternal and child health services. The study is expected to contribute to the literature on breastfeeding, maternal and child health, infant nutrition, health education, maternal healthcare, child survival, and public health in Nigeria by providing empirical evidence on the influence of breastfeeding education on exclusive breastfeeding practices among mothers of infants. 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, hospitals, primary healthcare facilities, maternal and child health programmes, nutrition programmes, healthcare professionals, community health workers, development partners, and policymakers regarding strategies for improving exclusive breastfeeding practices. The study will also provide evidence-based recommendations for strengthening breastfeeding education during antenatal and postnatal care, improving access to skilled lactation support, involving families in breastfeeding promotion, strengthening maternity protection, improving workplace breastfeeding support, and promoting sustained exclusive breastfeeding among mothers in Nigeria.

Keywords: Breastfeeding education, exclusive breastfeeding practices, mothers of infants, infant feeding, maternal and child health, breastfeeding support, infant nutrition, health education, child health, maternal health, public health, Nigeria.