Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng

Abstract

Despite the well-documented health benefits of breastfeeding and recommendations by the Department of Health for women to exclusively breastfeed for approximately the first six months of life and continuation beyond one year, a large percentage of South African women do not breastfeed their infants, or only do so for a short period of time. No national South African statistics are available but figures emerging from the attendance of mothers at a baby clinic on the West Rand in Gauteng indicated the following: 64% of the mothers breastfeed up to six weeks, after which the figure rapidly declines to less than 20% at three months (Truter 2007). Several studies have assessed the attitudes of health care personnel towards breastfeeding, but little is known of the type of information given to breastfeeding mothers by private medical practitioners who are the frontline of contact with clients and who may convey information that either promotes or discourages breastfeeding. The following question was thus formulated: With regard to breastfeeding, what are the constraints to breastfeeding in private practice? Therefore, in order to understand the constraints to breastfeeding, the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy, to describe the management of breastfeeding in the consulting rooms of private medical practitioners, and to describe women’s experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the first six weeks. Purposive convenient sampling, as described by Babbie and Mouton (2002:166), was used in both phases of the study. All participants chose a gynaecologist as the primary care giver and delivered in various private hospitals in Johannesburg. Data were collected by means of an anonymous questionnaire, compiled from national and international literature, as well as personal interviews. Data from the questionnaires were analysed by hand. Descriptive statistics were applied. The interviews were analysed according to the descriptive analysis suggested by Tesch (in Creswell, 1994:155). Themes that emerged were clustered and coded. A co-coder, experienced in the field of qualitative research, assisted with the analysis of the transcripts of the interviews. A literature control was conducted to validate the findings. Ethical considerations were based on the DENOSA Ethical Standards for Nurse Researchers (1998:2.3.2–2.3.4). Themes and sub-themes were identified. Opsomming Ten spyte van die goed gedokumenteerde gesondheidsvoordele van borsvoeding en die aanbevelings van die Departement van Gesondheid dat vroue vir ongeveer die eerste ses weke tot een jaar uitsluitlik moet borsvoed, word gevind dat 'n groot aantal Suid-Afrikaanse vroue hul babas nie borsvoed nie, of slegs vir 'n kort tydperk borsvoed. Geen nasionale Suid-Afrikaanse statistiek is beskikbaar nie, maar 64% van moeders wat 'n babakliniek besoek het op die Wes Rand in Gauteng borsvoed steeds op ses weke, waarna die aantal borsvoedende moeders verminder tot minder as 20% op drie maande (Truter 2007). Verskeie studies het die houding van gesondheidspersoneel ten opsigte van borsvoeding bepaal, maar min is bekend oor die tipe inligting wat deur die mediese praktisyn aangebied word. Hierdie praktisyn het eerstehandse kontak met die kliente en mag inligting aanbied wat borsvoeding kan bevorder of belemmer. Die volgende vraag is dus geformuleer: Met betrekking tot borsvoeding, wat is die beperkinge in privaat praktyk? Die doel van hierdie studie was om vas te stel watter borsvoedinginligting deur gesondheidspersoneel in privaatpraktyk aan swanger vroue oorgedra word. Die doelwitte van die studie was om die aanbevelings om te borsvoed te bepaal, om die behandeling en sorg in die spreekkamer van die geneesheer te beraam, en om die vroue se belewenisse van borsvoeding in privaat hospitale te ondersoek. In Fase 1 van die studie het die populasie bestaan uit alle moeders wat 'n ondersteuningsgroep by 'n privaat nageboortekliniek bygewoon het. In Fase 2 was die populasie alle moeders wat 'n ondersteuningsgroep bygewoon het en 'n babakliniek besoek het. Die steekproef het bestaan uit alle primigravidae wat borsvoed of probeer het om te borsvoed gedurende die eerste ses weke. Doelgerigte gerieflikheidssteekproefneming, soos beskryf deur Babbie and Mouton (2002:166), is in albei fases van die studie gebruik. Alle deelnemers het 'n ginekoloog as primêre sorggewer gebruik en het in verskillende Johannesburgse hospitale gekraam. Data is deur middel van anonieme vraelyste, saamgestel uit nasionale en internasionale literatuur, ingesamel sowel as deur middel van persoonlike onderhoude. Data vanaf die vraelyste is deur die navorser ontleed en beskrywende statistiek is toegepas. Die onderhoude is ontleed volgens die beskrywende analise voorgestel deur Tesch (in Creswell, 1994:155). Temas is saamgevoeg en gekodeer.'n Mede-kodeerder was behulpsaam met die ontleding van die transkripsies van die onderhoude. Literatuur is aangewend as kontrole om die bevindinge te valideer. Etiese oorwegings is gebaseer op die DENOSA Etiese Standaarde vir Verpleegnavorsers (1998:2.3.2–2.3.4). Temas en subtemas is geïdentifiseer.

Keywords

• breastfeeding
• Gauteng province
• South Africa
• paediatric nutrition
• postnatal care