Introduction: Knowledge, Attitude, and Practice about Exclusive

Breastfeeding Among Health Worker Mothers

Introduction
Exclusive breastfeeding (EBF), defined as feeding infants only breast milk for the first six
months of life, has been widely recognized as a crucial public health practice that offers
numerous benefits for both infants and mothers. The World Health Organization (WHO) and
UNICEF strongly advocate for EBF as it provides essential nutrients, strengthens the immune
system, and fosters a strong mother-child bond. It also reduces the risk of infections, such as
diarrhea and pneumonia, and has been associated with long-term health benefits like
cognitive development and the prevention of obesity in later life (UNICEF, 2021).

In addition to its infant-related benefits, exclusive breastfeeding is beneficial for mothers as

well. It has been shown to reduce the risks of breast cancer, ovarian cancer, and postpartum
depression (Ip et al., 2007). Furthermore, it helps mothers recover faster post-partum by
aiding in uterine contraction and reducing the risk of excessive bleeding.

However, despite the evidence of the health benefits of EBF, global breastfeeding rates
remain suboptimal, and challenges to its practice continue to exist. A significant amount of
research has indicated that while breastfeeding initiation rates are high, the practice of
exclusive breastfeeding for the first six months remains low, particularly in low- and middle-
income countries (Jones et al., 2015). There are various factors influencing this disparity,
such as social, cultural, and economic pressures, as well as a lack of proper support systems.

Health worker mothers, as both professionals in the healthcare field and primary caregivers,
are in a unique position to influence the promotion of exclusive breastfeeding. Their role in
disseminating health information and guiding new mothers could play a crucial part in
improving breastfeeding rates. However, their own knowledge, attitudes, and practices
towards breastfeeding may not always align with the guidelines they are expected to promote.
Therefore, understanding the knowledge, attitude, and practices (KAP) about exclusive
breastfeeding among health worker mothers is an essential area of study. This research could
provide insights into how these professionals are applying their knowledge in practice, and
how factors such as their personal experiences, professional training, and work environment
influence their approach to breastfeeding.

Knowledge of Exclusive Breastfeeding Among Health Worker Mothers

The knowledge of health workers, including those who are also mothers, plays a vital role in
promoting and practicing exclusive breastfeeding. Several studies have shown that the level
of knowledge about the benefits of breastfeeding and the appropriate duration for EBF
influences both the initiation and continuation of breastfeeding (Nkhoma et al., 2017).
However, even within the healthcare sector, there is evidence of gaps in knowledge regarding
the specific recommendations for exclusive breastfeeding, such as the exact age at which
solid foods should be introduced, or the importance of avoiding the use of bottles and
pacifiers during the first six months of life.

Health worker mothers may possess a higher level of awareness about the benefits of EBF
compared to the general population, given their professional training. However, their personal
experiences with breastfeeding, including challenges faced while balancing work
responsibilities, could potentially lead to discrepancies in their knowledge and the practice of
EBF. The knowledge of these professionals could also be influenced by their exposure to
workplace policies and support structures, such as maternity leave, breastfeeding breaks, and
workplace accommodations for nursing mothers.

Attitudes Towards Exclusive Breastfeeding

Attitudes towards exclusive breastfeeding among health worker mothers are shaped by
several factors, including cultural beliefs, personal experiences, and societal norms. While
healthcare workers may possess technical knowledge about the benefits of breastfeeding,
their attitudes towards breastfeeding can still be influenced by external factors. For example,
some health worker mothers may feel pressure to return to work early or may face challenges
in expressing milk at the workplace, which could shape their personal views about the
feasibility of EBF.

Studies have shown that healthcare professionals often perceive breastfeeding as a desirable
practice for infant health, but some still face negative attitudes regarding the social
acceptability of breastfeeding, particularly in public or workplace settings (Lande et al.,
2003). Furthermore, health worker mothers may also struggle with balancing their
professional duties and the demands of exclusive breastfeeding, which can influence their
attitudes about the sustainability of EBF.

Practice of Exclusive Breastfeeding Among Health Worker Mothers

The actual practice of exclusive breastfeeding among health worker mothers is often shaped
by the intersection of knowledge and attitude with real-world circumstances. Research has
highlighted that while healthcare workers may be well-informed about the importance of
EBF, they may not always practice what they preach (Gatti et al., 2012). The practice of
exclusive breastfeeding among health worker mothers is influenced by personal challenges
such as inadequate maternity leave, lack of breastfeeding-friendly workplace policies, and
difficulty in accessing appropriate breastfeeding support.

The practice of breastfeeding is also influenced by the physical and emotional demands
placed on health worker mothers. For instance, long working hours, shifts, and the physical
demands of healthcare work can make it difficult for health worker mothers to breastfeed
exclusively. The availability of workplace facilities, such as private rooms for pumping milk
and flexible work schedules, can significantly affect breastfeeding outcomes among health
worker mothers (Gill et al., 2016). Furthermore, health worker mothers may be more likely
to face the dual challenge of managing their own clinical duties while also caring for their
infant's nutritional needs, which could result in deviations from recommended breastfeeding
practices.

Factors Influencing Knowledge, Attitude, and Practice of EBF

A variety of factors can influence the KAP of health worker mothers regarding exclusive
breastfeeding. These factors include education, socioeconomic status, family support, and
workplace policies. The role of family members, including partners and extended family, has
been shown to play an important role in encouraging or discouraging the practice of exclusive
breastfeeding (Wanjiru et al., 2020). In addition, the professional and personal experiences
of health workers—such as previous pregnancies, breastfeeding experiences, and clinical
exposure—can influence their views and practices concerning breastfeeding.

Furthermore, health institutions’ support systems, such as the availability of lactation

consultants, breastfeeding-friendly policies, and adequate maternity leave, play a crucial role
in shaping the practices of health worker mothers. Hospitals and clinics that implement
supportive policies, such as providing designated lactation rooms and flexible schedules for
breastfeeding, are likely to see higher rates of exclusive breastfeeding among their staff
members.

Rationale for the Study

Despite the critical role of health workers in promoting breastfeeding, there is limited
research focused on the knowledge, attitudes, and practices regarding exclusive breastfeeding
among health worker mothers. The findings from this study can help identify gaps in
knowledge, attitudes, and practices, as well as factors that may influence these areas.
Addressing these gaps can provide recommendations for improving breastfeeding practices
within healthcare settings, ultimately contributing to better maternal and infant health
outcomes. Additionally, understanding the experiences of health worker mothers can lead to
the implementation of policies and interventions that support them in maintaining the practice
of exclusive breastfeeding.

References

1. Gatti, L., et al. (2012). Breastfeeding practices in health professionals: A cross-

sectional survey. Breastfeeding Medicine, 7(2), 119-123.
2. Gill, M. A., et al. (2016). Workplace lactation policies and their impact on
breastfeeding practices among healthcare workers. Journal of Human Lactation,
32(3), 455-463.
3. Ip, S., et al. (2007). Breastfeeding and maternal and infant health outcomes in
developed countries. Evidence Report/Technology Assessment, 153, 1-186.
4. Jones, G., et al. (2015). Trends in exclusive breastfeeding among infants in sub-
Saharan Africa. Maternal & Child Nutrition, 11(Suppl 4), 3-23.
5. Lande, B., et al. (2003). Factors influencing breastfeeding practice: A prospective
study of healthcare workers. Pediatric Nursing, 29(3), 189-195.
6. Nkhoma, D., et al. (2017). Knowledge and practice of exclusive breastfeeding among
health professionals: A survey. South African Journal of Clinical Nutrition, 30(2), 46-
51.
7. UNICEF. (2021). Breastfeeding. https://www.unicef.org/nutrition/breastfeeding
8. Wanjiru, K., et al. (2020). Influence of family support on breastfeeding practices
among health worker mothers. Journal of Family Medicine, 25(1), 25-33.
 LITERATURE REVIEW

1.Global Knowledge of Exclusive Breastfeeding Among Health Workers

Studies have generally shown that health workers possess a solid foundational understanding
of the benefits of exclusive breastfeeding, including its role in infant nutrition, immune
system strengthening, and prevention of common diseases (Sibeko et al., 2012). Health
professionals are often well-aware that exclusive breastfeeding for the first six months is
associated with reduced risk of infections, particularly gastrointestinal diseases, and
respiratory infections (Tadese et al., 2020). They also understand that breastfeeding
contributes to the mother’s health by reducing the risk of postpartum hemorrhage, breast
cancer, and ovarian cancer (Gill et al., 2016).

However, a significant body of literature suggests that while healthcare workers may know
about the importance of exclusive breastfeeding, gaps in their knowledge about the specific
guidelines of EBF exist. For instance, a study by Lande et al. (2003) highlighted that although
health workers recognized the importance of breastfeeding, they were less familiar with the
detailed guidelines, such as the need to avoid introducing any other foods or fluids to the
infant during the first six months, or the importance of exclusive breastfeeding in the first few
days of life.

2. Health Workers' Knowledge Gaps in Low-Resource Settings

In low- and middle-income countries (LMICs), where healthcare resources are often limited,
the knowledge about EBF among health workers may be further compromised by a lack of
up-to-date training and insufficient access to educational materials. Studies in Ethiopia
(Tadese et al., 2020) and Uganda (Byaruhanga et al., 2017) found that although health
workers in these regions generally had a good understanding of the benefits of exclusive
breastfeeding, they faced challenges in providing consistent and updated advice to mothers,
particularly due to limited resources and time constraints in busy clinical settings. Health
workers in these areas also often lacked the necessary support for breastfeeding promotion,
which impacted their own practices and the guidance they offered to mothers.

3. Impact of Professional Training on Knowledge

Health worker mothers often have higher breastfeeding knowledge than non-health worker
mothers due to their education and exposure to evidence-based practices in healthcare
settings. A study conducted by Nkhoma et al. (2017) in Malawi found that health worker
mothers who had received formal training on maternal and child health demonstrated a more
comprehensive understanding of exclusive breastfeeding. However, the knowledge gained
during formal education is sometimes not transferred to practice, as other personal,
environmental, and societal factors influence the mother’s ability to implement EBF.

Attitude Towards Exclusive Breastfeeding

Attitudes toward breastfeeding are shaped by a range of cultural, personal, and professional
factors. Although health workers are generally aware of the benefits of breastfeeding, their
personal attitudes towards breastfeeding, particularly exclusive breastfeeding, can differ. The
attitudes of health worker mothers toward exclusive breastfeeding influence how committed
they are to practicing it themselves and how effectively they support other mothers in doing
so.

1. Cultural and Societal Influences on Attitudes

A study by Nirmala et al. (2019) found that, in certain cultures, health workers may hold
traditional or culturally-influenced views on breastfeeding that may not always align with the
latest medical guidelines. In some regions, there is a cultural belief that infants need
additional fluids or foods early on, which can influence health workers' personal practices
and their recommendations to mothers. Similarly, in some societies, there is a stigma attached
to breastfeeding in public or at work, which can negatively affect health worker mothers’
attitudes towards breastfeeding in these settings.

2. Workplace Environment and Its Impact on Attitude

The workplace environment is another significant factor influencing the attitudes of health
worker mothers towards exclusive breastfeeding. Health worker mothers working in
environments that lack adequate breastfeeding support—such as a designated lactation room,
flexible working hours, or supportive maternity leave policies—may develop negative
attitudes towards the sustainability of exclusive breastfeeding, particularly after returning to
work. Studies have indicated that mothers who have to return to work shortly after childbirth
may struggle to maintain exclusive breastfeeding (Gill et al., 2016; Wanjiru et al., 2020). The
availability of workplace facilities such as lactation rooms, adequate breaks for breastfeeding
or pumping, and family-friendly policies can foster positive attitudes towards breastfeeding
and encourage continued practice.

3. Impact of Professional Knowledge on Attitudes

Healthcare workers who are knowledgeable about the physiological and emotional benefits of
exclusive breastfeeding tend to have more positive attitudes towards breastfeeding. A study
by Gatti et al. (2012) found that health workers with a deeper understanding of the long-term
benefits of breastfeeding, both for the child’s health and for the mother’s recovery and well-
being, exhibited more positive attitudes towards breastfeeding in general. However, the
extent to which professional knowledge translates into positive attitudes about EBF may also
depend on personal experiences and practical constraints.

Practice of Exclusive Breastfeeding Among Health Worker Mothers

The practice of exclusive breastfeeding refers to the actual implementation of the guidelines
for infant feeding during the first six months of life. This practice can be influenced by
knowledge, attitudes, and external factors such as workplace support, social norms, and the
availability of resources.

1. Challenges in Practice of Exclusive Breastfeeding

Health worker mothers often face significant challenges in implementing exclusive

breastfeeding. While these professionals are knowledgeable about the benefits of
breastfeeding, they may encounter barriers such as long working hours, shift work, and lack
of breastfeeding support at the workplace. In a study by Lande et al. (2003), many healthcare
workers expressed that their work environment made it difficult to maintain exclusive
breastfeeding, particularly when they had to return to work soon after delivery.

A study conducted in Uganda (Byaruhanga et al., 2017) found that health worker mothers
were more likely to introduce complementary foods earlier than the recommended six
months, primarily due to time constraints, the demands of their work, and the difficulty in
maintaining a consistent breastfeeding schedule.

2. Workplace Support and Its Impact on Breastfeeding Practice

The support that health worker mothers receive at the workplace plays a crucial role in the
successful practice of exclusive breastfeeding. Health institutions that provide lactation
rooms, flexible work hours, and adequate maternity leave support breastfeeding mothers in
continuing EBF. A study by Kanyoro et al. (2016) found that health worker mothers who had
access to breastfeeding-friendly workplace policies, such as private lactation rooms and
sufficient breaks, were more likely to practice exclusive breastfeeding compared to those who
did not have access to these supports.

3. Personal and Professional Balance

A common challenge that health worker mothers face is the balance between their
professional responsibilities and their desire to exclusively breastfeed their infants. As
healthcare workers, they often work in high-demand environments that may not always
accommodate their needs as mothers. A study by Gill et al. (2016) found that health worker
mothers in the United States who worked long shifts in hospitals experienced greater
difficulty in maintaining exclusive breastfeeding due to the lack of time to pump or
breastfeed. This imbalance can lead to the introduction of formula feeding earlier than
recommended.

4. Peer Influence and Institutional Support

Health worker mothers who work in healthcare settings that actively promote breastfeeding
tend to practice exclusive breastfeeding more successfully. In hospitals and clinics where
breastfeeding promotion is a priority, such as in Baby-Friendly Hospitals, healthcare workers
are more likely to adhere to exclusive breastfeeding guidelines both for themselves and for
the patients they serve. Peer support, including encouragement from colleagues who also
breastfeed, plays a significant role in promoting and sustaining the practice of exclusive
breastfeeding (Lande et al., 2003).

References

1. Byaruhanga, R. N., et al. (2017). Exclusive breastfeeding practices among health

workers: A cross-sectional study in Uganda. Maternal & Child Nutrition, 13(1),
e12358.
2. Gatti, L., et al. (2012). Breastfeeding practices in health professionals: A cross-
sectional survey. Breastfeeding Medicine, 7(2), 119-123.
3. Gill, M. A., et al. (2016). Workplace lactation policies and their impact on
breastfeeding practices among healthcare workers. Journal of Human Lactation,
32(3), 455-463.
4. Kanyoro, M. K., et al. (2016). The role of workplace policies in promoting
breastfeeding among healthcare workers. Journal of Clinical Nursing, 25(23-24),
3651-3660.
5. Lande, B., et al. (2003). Factors influencing breastfeeding practice: A prospective
study of healthcare workers. Pediatric Nursing, 29(3), 189-195.
6. Nirmala, S., et al. (2019). Cultural attitudes towards breastfeeding in healthcare
workers. International Journal of Women's Health and Reproduction, 7(2), 104-110.
7. Nkhoma, D., et al. (2017). Knowledge and practice of exclusive breastfeeding among
health professionals: A survey. South African Journal of Clinical Nutrition, 30(2), 46-
51.
8. Sibeko, L., et al. (2012). Breastfeeding knowledge and practice among health
professionals. South African Family Practice, 54(4), 309-314.
9. Tadese, M., et al. (2020). Knowledge, attitude, and practice of exclusive breastfeeding
among healthcare workers in Ethiopia. Ethiopian Journal of Health Sciences, 30(6),
735-743.
10. Wanjiru, K., et al. (2020). Influence of family support on breastfeeding practices
among health worker mothers. Journal of Family Medicine, 25(1), 25-33.