Exclusive breastfeeding: A Qualitative Study of Women in the Gambia

PhotosAs one of the eldest in a predominately male family, Sering A.L. Sosseh, BSc, MSc, HND says he grew up nurturing and feeding babies. Though it was a burden to him as a child, caring for infants and children flourished into a hobby and ultimately into his career goal.

While working as a public health officer and nurse under the Gambia’s Ministry of Health and Social Welfare, Sosseh says he was inspired by the officers of the Reproductive and Child Health Unit to study public and environmental health.

He is a recent graduate of National Yang-Ming University’s International Health Program in Taiwan where he says he gained “competencies in environmental assessment, designing and evaluating evidence-based policies geared towards creating healthy and conducive environments for infants and their mothers worldwide.”

Sosseh will present Exclusive breastfeeding: A Qualitative Study of Women in the Gambia at the upcoming International Breastfeeding Conference in Orlando, Fla.

“Our findings revealed that breastfeeding is a culturally cherished practice in the Gambia,” Sosseh reports. “However, in-spite of the common practice, the number of exclusively breastfed infants has been low for decades; despite its extensive promotion countrywide.”

Sosseh and his colleagues found that “the welfare of babies is perceived to be dependent on the types of foods mothers eat during breast-feeding.”

He reports that breastfeeding mothers in the Gambia refuse spicy, watery, green leafy and hot foods.

Challenges like weight loss, nipple inflammation and backache arise in breastfeeding women in the Gambia which sometimes discourages them from breastfeeding.

“The strong cultural belief that water is essential for infants’ survival and the practice of giving ‘charm water’ to infants are…barriers to exclusive breast-feeding,” Sosseh adds.

He concludes that “the promotion of exclusive breast-feeding is challenged by some complex and sensitive socio-cultural factors” and advises these be taken into consideration when promoting exclusive breastfeeding in developing countries like the Gambia.

Sosseh comments on other complex socio-cultural factors that influence infant feeding in the Gambia.

For instance, elders and husbands in the Gambia are highly influential in matters regarding infant feeding.

“On one hand, it is due to the structure of Gambian families; which is typically extended and patriarchal in nature and on the other hand, it is the influence of our entrenched cultural and religious beliefs,” Sosseh explains. “Unlike what prevails in other parts of the world- where women have the right to participate in decisions that affect their daily lives- women of child bearing age in the Gambia have limited opportunities for this kind of participation…”

Sosseh goes on, “It should be pointed out that this culture is not in any way close to changing because there are no intervention programs targeting these groups in the country.”

Current breastfeeding practices in the Gambia are also influenced by specific traditional beliefs and practices.

“For example, breast feeding mothers are advised to abstain from sex, because of the belief that sperm may contaminate breast milk and thus render it impure,” Sosseh explains.

He says that breastfeeding mothers are traditionally separated from their husbands for at least a year or two “to avail infants the opportunity to be adequately fed with pure breast milk.”

Moreover, many Gambians believe that breast size is a significant determinant of milk production, so women with smaller breasts are not always confident in their ability to produce milk for their babies.

“Finally, due to the preference of male over the female child, men are less likely to be breast feed longer than their female counterparts,” Sosseh explains. “Among others, it is believed that over exposing males to breast milk may compromise their physical strength or make them womanizers.”

Because breastfeeding is both culturally and religiously preferred in the Gambia, exclusive bottle-feeding is “almost negligible.”

“However, due to the rapid modernization, about 8 percent of women either express their breast milk in bottles to feed infants or use supplementary milks to feed their infants,” Sosseh says.

He adds that because the majority of Gambian women are informally employed or unemployed, they have the time to breastfeed their babies. Employed Gambian women are entitled to six months paid maternity leave.

Sosseh explains that the 2013 Gambia Demographic and Health Survey indicated that feeding children with bottles is linked to the income and educational status of households; children from rich households are more often fed with bottles than children from poor households.

Education also plays a role in infant feeding method with those who attain secondary education or higher more likely to practice bottle-feeding.

Among the mothers practicing bottle-feeding, the majority of them live in urban areas, while those in the countryside prefer using basins, cups and spoons, Sosseh says.

The 2013 Gambia Demographic and Health Survey (GDHS)– a nationwide study conducted by the Gambia Bureau of Statistics in collaboration with the Ministry of Health and Social Welfare and the National Population Secretariat Commission– is the latest national document with maternal and child health related data.

“It reported a considerable increase in [exclusive breastfeeding] from 33 percent in 2010 to 48 percent in 2013, thanks to the unrelenting efforts of the National Nutrition Agency,” Sosseh reports.

“Considering the dynamic socio-cultural beliefs and how they influence breast feeding practices…the exclusive breast feeding agenda is not a one-size-fit all subject, especially in settings like the Gambia where traditional beliefs are entrenched,” Sosseh comments.

He suggests further studies “explore how such beliefs can be negotiated, modified and integrated into current interventions geared towards the promotion of exclusive breast feeding.”
Register here for the opportunity to network with and learn more from Sosseh at the International Breastfeeding Conference held January 12-16, 2016.

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