Birth Weight, Birth Size and Exclusive Breastfeeding in Ghana

Abstract

Despite the widespread advocacy for exclusive breastfeeding, and associated health, social and economic benefits, there is a low prevalence of exclusive breastfeeding in both developed and developing countries. Whilst several studies have been conducted on exclusive breastfeeding, few of such studies have linked birth weight and birth size independently with exclusive breastfeeding. Given that there is limited data on birth weight, birth size is often used as a proxy for birth weight. However, there is an inconclusive discussion on the relationship between birth weight and birth size. The extent to which the perception of the mother on the size of the infant (perceived birth size) or actual measurement (birth weight) influence exclusive breastfeeding is not known. In addition, there is limited information on the experiences of health workers and mothers on exclusive breastfeeding. To understand this phenomenon, the study examined the relationship between birth weight and birth size and their influence on exclusive breastfeeding. Furthermore, the study examined experiences of exclusive and non-exclusive breastfeeding mothers and health workers. A mixed research method approach was used to achieve the objectives of this study. Quantitative data was taken from the 2014 Ghana Demographic and Health Survey while the qualitative method used an in-depth interview involving sixteen exclusive and non-exclusive breastfeeding mothers and four health workers. A binary logistic regression was used to examine the influence of birth weight and birth size on exclusive breastfeeding whilst the qualitative data was analysed thematically. The results of the study showed that exclusive breastfeeding prevalence is 54.8%. The majority (85%) of the infants were of normal birth weight. About 52% of the infants were perceived by their mothers to be of small birth size. On maternal characteristics, about two-thirds of the mothers had secondary education, married with at least one child and slightly more than one-third were Akan. Also, the findings showed that there was a low or weak relationship between birth weight and birth size. Exclusive breastfeeding was significantly predicted by birth weight, birth size and other factors such as the age of the child, household wealth quintile, ethnicity, and religion. The results of the qualitative analysis showed that mothers relied on birth weight rather than birth size to practice exclusive breastfeeding. Furthermore, the decision of the mothers to practice exclusive breastfeeding was also based on information received at the health facilities, type of work engaged in, and advertisement. Both health workers and mothers expressed that exclusive breastfeeding served as a family planning method, makes children healthy and is very economical. Some of the challenges faced by exclusive breastfeeding mothers include pressure from family members, dizziness and breast sag. Mothers indicated that discontinuation of exclusive breastfeeding was due to insufficient flow of breast milk. Also, mothers eat healthy food and breastfeed when needed to manage exclusive breastfeeding. In addition, counselling and monitoring mothers, maternity leave and advertisement were identified by health workers as ways of improving exclusive breastfeeding practice. The study concludes that both birth weight and birth size were significant predictors of exclusive breastfeeding. However, validation of the relationship between birth weight and birth size showed a low relationship. In the qualitative analysis, the results showed that mothers rely more on the birth weight of infants rather than the perceived birth size to practice exclusive breastfeeding. Health talk at the health facilities is very essential towards the practice of exclusive breastfeeding. Due to the limited data on birth weight, this study recommends that health workers should be sensitised to record birth weight of infants at birth especially for deliveries occurring outside the health facilities as well as encouraging mothers to keep their health records book. Furthermore, maternity leave should be extended from three months to at least six months to help working mothers to complete exclusive breastfeeding practice.