Factors effecting breast feeding practice among working women in Hodan

District, Mogadishu- Somalia.

SUBMITTED BY:
Asma Omar Mumin
Khadra Abdullahi Abdi

SUPERVISOR BY:

Dr Sucdi Abdullahi Nor

RESEARCH THEIS SUBMITTED IN PARTIAL FULLFILMENT OF THE
REQUIREMENT OF DEGREE BACHELOR MIDWEFERY

FACULTY OF HEALTH SCIENCE

AT AFRICA UNIVERSITY

MOGADISHU –SOMALIA

JAN, 2024

i
 SUPERVISOR’S DECLARATION

I confirm that the work in this

thesis report was done by the
candidate under our supervision

Supervisor: Dr Sucdi Abdullahi Nor

Signature

Date / /2024

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 STUDENT'S DECLARATION
We declare that this thesis is a result of our own independent research effort and
study. It has not been submitted to any other organization for any award. Where it is
indebted to the work of others, due Acknowledgement has been made.

Name: Asma Omar Mumin

Signature:

Date: / /2024

Name: Khadra Abdullahi Abdi

Signature:

Date: / /2024

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 APPROVAL

This thesis is submitted in partial fulfilment of the requirement for the degree of
Midwifery in African University.

For Graduate Committee

Name and Sig. Of Chairman:
Name and Sig. Of Panellist:
Name and Sig. Of Supervisor:
Name and Sig. Of H.O.D:
Name and Sig. Of the Dean:

iv
 Dedication
We wish to dedicate this thesis which represents the hard work
and outcome of our entire stay in African University in
particular to our parents. Their unwavering love, compassion
and care nurtured and gave as the sense of direction and the
ability to focus in life, in as much as their sacrifices and
confidence entrusted in us strengthened and gave us the
motivation to acquire as much knowledge as we could, and
also we dedicated this thesis to our dear lecturers.

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 Acknowledgement
All thanks to Allah, who created our made Muslims and enabled this thesis to be completed
successfully.
Thanks to my supervisor Drs sucdi Abdullahi Nor her valuable suggestions support and
guidancein successful completion of this thesis.
We would like to express my deepest gratitude to our beloved our dear Mothers and our dear
Fathers for their remarkable suggestions and an unforgettable helping in all our lives.
We would like to acknowledge plasma University Especially Faculty of Health Sciences
department of nursing &&midwifery in provision of education to Somali community and also
thank to some of our lecturers in the University who also encouraged learning.
Although it's not possible to name every individual we greatly extend my appreciation to various
persons who directly or indirectly helped this research.
For all time, guidance and excellent supervision that more than words can describe. Without his
precious guidance, help, we couldn‘t be able to accomplish this thesis.
Special thanks to the dean of the faculty, all our golden teachers for their valuable teaching,
guidance, training, helping and supporting to get the right way

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Table of Contents
DECLARATION ........................................................................................................................................... i

APROVAL .................................................................................................................................................... ii

DEDICATION ............................................................................................................................................. iii

ACKNOWLEDGEMENT ............................................................................................................................ iv

ABSTRACT .................................................................................................................................................. x

List abbrevations .......................................................................................................................................... xi

List key definition......................................................................................................................................... xi

CHAPTER ONEs .......................................................................................................................................... 1

INTRODUCTION ......................................................................................................................................... 1

1.0 Overview ................................................................................................................................................. 1

1.1 Background of the study.......................................................................................................................... 1

1.2 Statement of the problem ........................................................................................................................ 3

1.3 Objectives of the Study ........................................................................................................................... 4

1.3.1 General objective.................................................................................................................................. 4

1.3.2 Specific objectives ................................................................................................................................ 4

1.4 Research questions .................................................................................................................................. 5

s1.5 Significance of the study ........................................................................................................................ 5

1.6 scope of the study .................................................................................................................................... 5

1.7 Conceptual framework ............................................................................................................................ 6

CHAPTER TWOs ......................................................................................................................................... 7

(Literature Review) ....................................................................................................................................... 7

2.0 overview .................................................................................................................................................. 7

2.1. . Theoretical review ................................................................................................................................ 7

2.2 Workplace breastfeeding facilities provided to working mothers ......................................................... 13

2.3 Awareness of breastfeeding practice among working women ............................................................... 14

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2.5 Summary ............................................................................................................................................... 17

2.6 Conclusion............................................................................................................................................. 17

CHAPTER THREE ..................................................................................................................................... 19

MATERIAL AND METHODS .................................................................................................................. 19

3.0 introduction ........................................................................................................................................... 19

3.1 Research Design .................................................................................................................................... 19

3.2 Study population.................................................................................................................................... 19

3.3 Sample size ............................................................................................................................................. 19

3.4 Sampling technique ............................................................................................................................... 20

1.5 Research Instruments............................................................................................................................ 20

3.6 Data analysis ......................................................................................................................................... 20

3.7 validaty and reliability .......................................................................................................................... 20

3.7.1 Validity ............................................................................................................................................... 20

3.7.2 Reliability ........................................................................................................................................... 21

3.8 limitations .............................................................................................................................................. 21

3.9 Inclusion criteria and Exclusion criteria ................................................................................................ 21

3.10 Ethical Considerations ......................................................................................................................... 21

CHAPTER FOUR ....................................................................................................................................... 22

DATA ANALAYSIS .................................................................................................................................. 22

4.0 Introduction ........................................................................................................................................... 22

4.3 Marital status of respondents ................................................................................................................. 24

Table 4.4: level of education ....................................................................................................................... 25

4.5 Job site of respondents.......................................................................................................................... 26

4.6 How many hours do you work per day? ............................................................................................... 27

4.7. What shifts do you work? .................................................................................................................... 28

4.8. Are you able to take a break from work when you need to breast-feed your baby? ............................ 29

4.9 Do you have a nursery available for childcare at your workplace?........................................................ 30

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Figure 4.9 Do you have a nursery available for childcare at your workplace .............................................. 30

4.10 Do you provide maternity leave when it is due? ................................................................................. 31

4.11 Do you offer task adjustment or lighter job to working mothers during lactation period? .................. 32

4.12 Do you provide information regarding breastfeeding options for working mothers upon their return
to work, after maternity leave? .................................................................................................................... 33

4.13 Have you breast-fed your baby after he/she was born? ...................................................................... 34

4.14 Do you believe that infant who do not get enough breast milk will become growth retardation and
mental retardation? ...................................................................................................................................... 35

4.15 Do you believe that infants consuming breast milk have fewer infections than infants consuming
formula milk? .............................................................................................................................................. 36

4.16 Do you believe Poor education of the mother is a barrier of the breast feeding practice?................... 37

4.17 Do you believe that awareness of the mothers increase breast feeding practice?................................ 38

4.18 Do you agree that some mothers are interesting income only while them doing work and breastfeed
together? ...................................................................................................................................................... 39

4.19 Do you believe that women cannot make with breastfeed and work according to their culture?........ 40

4.20 Do you believe that breast feeding for the baby precipitates to child‘s growth .................................. 41

4.21 Do you believe that breast feeding for the baby gives full immunity to protect infections?................. 42

CHAPTER FIVE ......................................................................................................................................... 43

CONCLUSIONS, RECOMMENDATIONS, FINDINGS........................................................................... 43

5.0. INTRODUCTION ................................................................................................................................ 43

5.1. Summary of findings ............................................................................................................................ 43

5.2. Conclusions .......................................................................................................................................... 45

5.3. Recommendation .................................................................................................................................. 45

5.4 REFERENCES ...................................................................................................................................... 46

APPENDIX I Questionnaire ........................................................................................................................ 52

AppendixI Questionaire............................................................................................................................... 59
Appendix I: Map of Somalia ................................................................................................................... 58
Appendix II: Map of Mogadishu ................................................................................................................. 59

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 List tables

Table: 4.2. Respondents by age ................................................................................................................... 23

Table 4.3 Marital status of respondents ....................................................................................................... 24

Table 4.4: level of education ....................................................................................................................... 25

Table 4.5 Job site of respondents................................................................................................................. 26

Table 4.6 How many hours do you work per day? ...................................................................................... 27

Table 4.7. What shifts do you work? ........................................................................................................... 28

Table 4.8. Are you able to take a break from work when you need to breast-feed your baby? ................... 29

Table 4.9 Do you have a nursery available for childcare at your workplace?.............................................. 30

Figure 4.9 Do you have a nursery available for childcare at your workplace .............................................. 30

Table 4.10 Do you provide maternity leave when it is due? ........................................................................ 31

Table 4.11 Do you offer task adjustment or lighter job to working mothers during lactation period? ......... 32

Table 4.12 Do you provide information regarding breastfeeding options for working mothers upon their
return to work, after maternity leave? .......................................................................................................... 33

Table 4.13 Have you breast-fed your baby after he/she was born? ............................................................. 34

Table 4.14 Do you believe that infant who do not get enough breast milk will become growth retardation
and mental retardation? ............................................................................................................................... 35

Table 4.15 Do you believe that infants consuming breast milk have fewer infections than infants
consuming formula milk? ............................................................................................................................ 36

Table 4.16 Do you believe Poor education of the mother is a barrier of the breast feeding practice? ......... 37

Table 4.17 Do you believe that awareness of the mothers increase breast feeding practice?....................... 38

Table 4.18 Do you agree that some mothers are interesting income only while them doing work and
breastfeed together? ..................................................................................................................................... 39

Table 4.19 Do you believe that women cannot make with breastfeed and work according to their culture?
. .................................................................................................................................................................. 40

Table 4.20 Do you believe that breast feeding for the baby precipitates to child‘s growth.......................... 41

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Table 4.21 Do you believe that breast feeding for the baby gives full immunity to protect infections? ...... 42

list figures
figure: 4.2. Respondents by age................................................................................................................... 23

figure: 4.3 Marital status of respondents..................................................................................................... 24

figure: 4.4: level of education ..................................................................................................................... 25

figure: 4.5 Job site of respondents .............................................................................................................. 26

figure: 4.6 How many hours do you work per day?.................................................................................... 27

figure: 4.7. What shifts do you work?......................................................................................................... 28

figure: 4.8. Are you able to take a break from work when you need to breast-feed your baby? ................. 29

figure: 4.9 Do you have a nursery available for childcare at your workplace? ........................................... 30

Figure 4.9 Do you have a nursery available for childcare at your workplace .............................................. 30

figure: 4.10 Do you provide maternity leave when it is due? ..................................................................... 31

figure: 4.11 Do you offer task adjustment or lighter job to working mothers during lactation period? ...... 32

figure: 4.12 Do you provide information regarding breastfeeding options for working mothers upon their
return to work, after maternity leave? .......................................................................................................... 33

figure: 4.13 Have you breast-fed your baby after he/she was born? ........................................................... 34

figure: 4.14 Do you believe that infant who do not get enough breast milk will become growth
retardation and mental retardation? ............................................................................................................. 35

figure: 4.15 Do you believe that infants consuming breast milk have fewer infections than infants
consuming formula milk? ............................................................................................................................ 36

figure: 4.16 Do you believe Poor education of the mother is a barrier of the breast feeding practice? ....... 37

figure: 4.17 Do you believe that awareness of the mothers increase breast feeding practice? .................... 38

figure: 4.18 Do you agree that some mothers are interesting income only while them doing work and
breastfeed together? ..................................................................................................................................... 39

figure: 4.19 Do you believe that women cannot make with breastfeed and work according to their culture?
.................................................................................................................................................................... 40

figure: 4.20 Do you believe that breast feeding for the baby precipitates to child‘s growth ....................... 41

figure: 4.21 Do you believe that breast feeding for the baby gives full immunity to protect infections? .... 42

xi
 List abbreviations

EBF Exclusive breastfeeding

IYCF infant and young child feeding

IMNCI intrgrated management and neonatal and childhood illness program

LBW low birth weight

UNICEF united nation intertional child‘s emergency fund

NFHS national family health survey

WHO world health organisation

IMS ACT infant milk substitues feeding bottles and infant food act

RDA recommended dietery allowance

TBA traditional birth attendence

xii
 List key definition

Breastfeeding: the method of feeding a baby with milk directly from the mother's breast.

Exclusive breastfeeding is defined as feeding infants only breast milk, ... be exclusively
breastfed for the first six months of life,
Child feeding; Proper feeding of infants and young children can increase their chances of
survival. ... Starting at 6 months, breastfeeding should be combined with safe, age-appropriate
feeding of solid

Breast milk; Breast milk: Milk from the breast. Human milk contains a balance of nutrients that
closely matches infant requirements for brain development, growth and a healthy immune system

xiii
 ABSTRACT
 background Breastfeeding is a feeding of a babies and young children with milk from a
female breast. Breastfeeding should be started during the hour after birth and allowed as
the baby wishes. During the first few weeks of life babies may nurse eight to twelve
times a day. The duration of a feeding is usually ten to fifteen minutes on each breast.
Breastfeeding is extremely important among the preventive measures to reduce
malnutrition, death and disease among young Somali children. In fact it is critical, when
one out of every six Somali children is acutely malnourished and young children bear the
burden of the lack of clean water and adequate sanitation. Research Objective the of the
study is to determine factors affecting breast feeding practice among working women in
Hodon District . To assess workplace breastfeeding facilities provided to working mothers
in Hodan district. To find out the awareness factors affecting on the breastfeeding practice
among working women in Hodan District. To asses of Socio- cultural factors affecting on
the breast feeding practice among working women in Hodan District. Study design the
study will be cross-sectional and descriptive in design. The study will adopt a cross-
sectional study that will utilize a quantitative method (questionnaire) and qualitative (IDIs)
for data collection. It will be a cross-sectional because the researcher will collect data from
study subject‘s one point in time. Target population The study population will be selected
Hodan district, in Mogadishu. The target population of this study will be 50 respondents
from Hodon district, scope of thestudy The study will concentrate on factors affecting
breastfeeding practice among working woman in Hodan district .the study will be
conducted between march up to July 2020 Lack of resource limitation 1.Insecurity
conditions stopped a lot of times the research to reach the location of some distinct 2.The
time of the study to collect was also too little 3.Luck financial support during preparing the
thesis.

xiv
 CHAPTER ONE

INTRODUCTION

1.0 Overview
This section contains the background of the study, problem statement, general objectives of the
study, specific objective of the study, research questions/ hypotheses, scope of the study,
significance, conceptual framework.

1.1 Background of the study

Breastfeeding is a feeding of a babies and young children with milk from a female breast.
Breastfeeding should be started during the hour after birth and allowed as the baby wishes. During
the first few weeks of life babies may nurse eight to twelve times a day. The duration of afeeding
is usually ten to fifteen minutes on each breast. The frequency of feeding decreases asthe child
gets older. Some mothers pump milk so that it can be used later when their child isbeing cared
for by others. Breastfeeding benefits both mother and baby. Infant formula does not have many of
the benefits. Women play multiple roles in the family that affect the health and well being of all
family members. (UNDP 1992) According to a statement by the World Health Organization
(WHO), ―Breastfeeding is the cornerstone for an infant‘s survival, nutrition and development‖
(WHO 2015). Early initiation of breastfeeding and exclusive breastfeeding help in child survival,
it accounts for healthy brain development, promotes cognitive and sensory performance and is
noted for enhancing intelligence and academic performance in children (Isaacs et al. 2010, AAP
2012, UNICEF 2015). Feeding an infant with only breast milk is advocated by stakeholders in
health, is one of the most important practices in an infant ‘s life and the best way a mother can
invest into the wellbeing of her child. Among the numerous benefitsof breastfeeding, UNICEF
in a breastfeeding Campaign in 2013, termed the essence of breastfeeding as a ―first immunization
and an inexpensive life saver. In almost all societies around the world, they are assigned by
custom to be the primary caregivers to infants and children. Activities carried out by women such
as breastfeeding, preparing food, collecting waterand fuel, and seeking preventative and curative
medical care are crucial for children ‘s healthy

1
development. (UNDP 1995).Because of the time constraints women face, however, their roles as
care-givers and as providers of family income may conflict with one another, with potentially
important implications for the welfare of children. (UNDP 1995).

For developing countries, the implications for child nutrition, in particular, have been the subject
of much empirical investigation and debate during the past two decades (Leslie 1989; Glick and
Sahn 1998; Lamontagne et. al. 1998). Although there will be market substitutes for at least some
time-intensive inputs (e.g., prepared foods, hired domestic help), these may be too costly for many
women. Working women may rely on other members of the household to provide childcare, but
the quality of care provided by these substitutes, especially if they are older children, may be poor.
(Leslie 1989).

On the other hand, the additions to family income from mother‘s employment should benefit
children‘s nutrition and may more than compensate for any reductions in the quantity or quality of
care, implying a net improvement in nutrition as a result of maternal work. This will be more likely
if women have strong preferences for spending their income in ways that benefit their children.
Although most of the empirical literature has focused on the effects on children‘s nutrition,
women‘s work may have significant impacts on other types of investment in children‘shuman
capital—in particular, their schooling. Again, the effects may be positive or negative. (Lamontagne
et. al. 1998).

In Africa, especially developing countries Women (like men) shift out of agriculture and into
expanding manufacturing, service, and commerce sectors. These and concomitant changes in the
living situations of women and families throughout the globe—including urbanization and changes
in family structure—are changing women‘s incomes, flexibility of employment, and childcare
needs and options. Hence the relation of women‘s work to child welfare is itself evolving. Because
of the time and resource constraints facing poor families, women‘s or households‘ labor market
decisions will be tightly linked with choices regarding both nutrition and (especially girls‘)
schooling. Hence it is appropriate to consider both health and schooling outcomes when discussing
women‘s employment, though this has not usually been done in the existing literature. (WHO,
UNICEF 1989)

2
In Somalia, Workplace barriers have been reported as one of the major reasons for early cessation
of breastfeeding among working mothers. Return to work for a mother after delivery proves very
harmful for her breastfeeding status. Several studies reported that facilitating working mother at
workplace increase her chances to breastfeed. In urban areas of Somalia most of the women cannot
afford to live at home longer because they serve as an important contributorof their family income.
Within two to three months after delivery they are expected to resume their work and perform like
normal employees. Most workplaces do not have the supportive environment for breastfeeding.
This will probably result in discontinuation of breastfeeding.(WHO 1992)

The situation is assumed to be worse in private compared with the governmental sector as in the
private sector the country‘s maternity leave ordinance is not strictly followed. These findings
suggest the need for more observational studies to investigate the status of workplace breastfeeding
facilities. Present research will provide useful insights to understand the available breastfeeding
facilities status and will help further in policing and implementation level. Most children they don‘t
get proper breastfeeding and in contrast artificial feeding is very common than in general which
is the leading cause of malnutrition and improper child‘s development ;( WHO 1992)

1.2 Statement of the problem

The 1st year of life of a child is very decisive in developing countries like Somalia, due to extreme
morbidity and mortality. Somalia has the highest child mortality rates in East Africa. Nairobi
Kenya, 31 July 2009: In Somalia, where one child in every ten dies before its first birthday,
exclusive breastfeeding in the first six months would be one of the most effective life- saving
interventions for thousands of children.This is according to UNICEF Representative to Somalia
Ms. Rozanne Chorlton. Commenting at the start of World Breastfeeding Week (1-7 August) Ms.
Chorlton said, "Breastfeeding is extremely important among the preventive measures to reduce
malnutrition, death and disease among young Somali children. In fact it is critical, when one out
of every six Somali children is acutely malnourished and young children bear the burden of the
lack of clean water and adequate sanitation."The commonest causes of under five year children
mortality are respiratory infections, diarrhea and under nutrition.

3
Whereas, the lack of exclusive breastfeeding and the use of formula milk, and unhygienic bottles
are proved to be the main contributor of these diseases. Breastfeeding has direct relation to
reducing the under-five children ‘s mortality. Of the infant under 6 months were on bottle feed
and majority of their mothers were reported employed.

As one of the major reasons for early cessation of breastfeeding among working mothers. Return
to work for a mother after delivery proves very harmful for her breastfeeding status. Several studies
reported that facilitating working mother at workplace increase her chances to breastfeed.In urban
areas of Somalia most of the women cannot afford to live at home longer because they serve as an
important contributor of their family income. Within two to three months after delivery they are
expected to resume their work and perform like normal employees. Most workplaces do not have
the supportive environment for breastfeeding. This will probably resultin discontinuation of
breastfeeding. The situation is assumed to be worse in private compared with the governmental
sector as in the private sector the country‘s maternity leave ordinance is not strictly followed.
These findings suggest the need for more observational studies to investigate the status of
workplace breastfeeding facilities. Present research will provide useful insights to understand the
available breastfeeding facilities status and will help further in policingand implementation level.
In the gap between ideal and current there is no compatible, because they are so far away from the
acceptable level of the breast feeding intervention.

1.3 Objectives of the Study

1.3.1 General objective

To determine factors effecting breast feeding practice among working women in Hodan District,
Mogadishu- Somalia.

1.3.2 Specific objectives

1. To assess workplace breastfeeding facilities provided to working mothers in Hodan
district, Mogadishu – Somalia.

2. To examine awareness of breastfeeding practice among working women in Hodan

District, Mogadishu, Somalia

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 3. To identify Socio-cultural factors affecting on the breast feeding practice among
working women in Hodan District, Mogadishu, Somalia

1.4 Research questions

1. What kinds of breastfeeding facilities are available to working mothers at workplaces in
Hodan district Mogadishu Somalia?

2. How far do the working woman be aware of breast feeding practice in hodan district
Mogadishu Somalia?

3. Are there socio-cultural factors affecting breastfeeding practice among working women
in Hodan district Mogadishu Somalia?

1.5 Significance of the study

This study has generated information on factors influencing exclusive breastfeeding practices in
a poor-resource setting. The findings will be useful to the Ministry of Public Health and Sanitation
(MOPHS) and other organizations working in child survival programmes to design interventions
to improve the practice of exclusive breastfeeding in the area and other similar circumstances. The
findings will also be useful as a contribution to the ongoing research efforts on exclusive
breastfeeding and child survival.

1.6 SCOPE OF THE STUDY:

The scope of this study was contain: Content scope, geographical scope and time scope

content scope:

The content scope of this study of the factors effecting breast feeding practice among working
women in hodan district, Mogadishu-Somalia

Geographic scope

Geographical Scope of study in hodan district, Mogadishu-Somalia

5
Time scope:

This study has the conduct between july-jan 2024 in hodan district, Mogadishu-Somalia

1.7 Conceptual framework

Independent variable Dependent variable

Awareness of community

Breastfeeding
Sociocultural status

Workplace breastfeeding
facilities

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 CHAPTER TWO

(Literature Review)

2.0 overview
This chapter contains theoretical review, and summarizes literatures that are relevant to the
understanding factors affecting breastfeeding practice among working woman in Hodan district,
summary and conclusion.

2.1. Theoretical review

Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant
needs for the first months of life, and it continues to provide up to half or more of a child‘s
nutritional needs during the second half of the first year, Breast milk promotes sensory and
cognitive development, and protects the infant against infectious and chronic diseases. Exclusive
breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or
pneumonia, and helps for a quicker recovery during illness.(Hanson et al., 1985).
Breastfeeding contributes to the health and well-being of mothers; it helps to space children,
reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a
secure way of feeding and is safe for the environment. While breastfeeding is a natural act, it is
also a learned behavior. An extensive body of research has demonstrated that mothers and other
caregivers require active support for establishing and sustaining appropriate breastfeeding
practices. (Hanson et al., 1985).
Breast milk is the most nutritious food for babies. It also protects from infection, allergies, some
chronic diseases and childhood cancers, and sudden infant death syndrome(SIDS).
Breastfeeding allows eye-to-eye contact and physical closeness, strengthening the bond between
the child and mother. Breastfeeding is linked to lower levels of stress and fewer

7
negative moods. It can help with post-pregnancy recovery and, over the long term, lowers the risk
of obesity, osteoporosis and breast and ovarian cancer (Hanson et al., 1985).

Breastfeeding helps to develop stronger sense of bonding with their babies. The benefits of
breastfeeding are clear; the challenge is to find ways to support mothers to make the choice to
breastfeed (Hanson et al., 1985).

Deaths of an estimated 820,000 children under the age of five could be prevented globally every
year with increased breastfeeding. Breastfeeding decreases the risk of respiratory tract infections
and diarrhea, both in developing and developed countries. Other benefits include lower risks of
asthma, food allergies, type 1diabetes, and leukemia. Breastfeeding may also improve cognitive
development and decrease the risk of obesity in adulthood. Mothers may feel pressure to
breastfeed, but in the developed world children generally grow up normally when bottle fed
(Hanson et al., 1985).

Benefits for the mother include less blood loss following delivery, better uterus shrinkage, and
decreased postpartum depression. Breastfeeding delays the return of menstruation and fertility, a
phenomenon known as locational amenorrhea. Long term benefits for the mother include
decreased risk of breast cancer, cardiovascular disease, and rheumatoid arthritis. Breastfeeding is
less expensive than infant formula (Hanson et al., 1985).

Health organizations, including the World Health Organization (WHO), recommend breastfeeding
exclusively for six months. This means that no other foods or drinks other than possibly vitamin
D are typically given.] After the introduction of foods at six months of age, recommendations
include continued breastfeeding until one to two years of age or more Globallyabout 38% of infants
are only breastfed during their first six months of life. In the United States in 2015, 83% of women
begin breastfeeding and 58% were still breastfeeding at 6 months, although only 25% exclusively.
Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational
drugs and medications should not breastfeed. Smoking, limited amounts of alcohol or coffee are
not reasons to avoid breastfeeding (Hanson et al., 1985).

Changes early in pregnancy prepare the breast for lactation. Before pregnancy the breast is largely
composed of adipose (fat) tissue but under the influence of the

8
hormones estrogen, progesterone, prolactin, and other hormones, the breasts prepare for
production of milk for the baby. There is an increase in blood flow to the breasts. Pigmentation
of the nipples and areola also increases. Size increases as well, but breast size is not related to the
amount of milk that the mother will be able to produce after the baby is born. By the second
trimester of pregnancy colostrums, a thick yellowish fluid, begins to be produced in the alveoli
and continues to be produced for the first few days after birth until the milk "comes in", around
30 to 40 hours after delivery. There is no evidence to support increased fluid intake for
breastfeeding mothers to increase their milk production. Oxytocin contracts the smooth muscle
of the uterus during birth and following delivery; called the post partum period, while
breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding
the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the
milk ejection reflex, or let-down, in response to suckling, to occur (Hanson et al., 1985).

Current research strongly supports the benefits of breastfeeding have been illustrated throughout
the literature and there is evidence that shows the benefits increase with duration and exclusivity
(Wright et al., 2004). Breastfeeding is considered the best food source for infants and it has been
advocated as a cost-effective means of improving child health, mother‘s health, and mother- infant
bonding (Simard et al., 2005). There is also evidence that increasing breastfeeding duration rates
can contribute to the improvement of maternal health and the reduction of child mortality (WHO,
2013). However, despite the many advantages and extensive promotion of breastfeeding, the
current rates in Canada aren‘t ideal; even though breastfeeding initiation rates have started to rise
in recent years, the number of women who continue to exclusively breastfeed through six months
is still very low, especially in adolescent mothers (Simard et al., 2005; Volpe& Bear, 2000).

Breastfeeding is a way to ensure that the nutrient needs, for healthy growth and development, for
infants are being meet for the first six months (WHO 2013;). Breast milk is readily available and
affordable, which guarantees that infants get adequate nutrition . Almost all mothers are able to
breastfeed (WHO 2013). Exclusive breastfeeding is recommended for the first 6 months, and then
continued breastfeeding, with appropriate complementary foods, is recommended to 2 yearsand
beyond (WHO, 2013).

9
Breastfeeding has many advantages. For instance, breast milk may help prevent chronic diseases
and conditions such as childhood obesity, type 2 diabetes, and asthma (WHO, 2013; , )Since breast
milk contains antibodies it can also protect against common childhood diseases such as diarrhea
and pneumonia (WHO, 2013;) In addition, breastfeeding also benefits mothers; for example,
exclusive breastfeeding is associated with delayed fertility (98% effective method of birth control
for 6 months), it reduces the risk of breast and ovarian cancers later in life, it helps women return
to their pre-pregnancy weight faster, it lowers rates of obesity, and it has been associated with
lower levels of post-partum depression (WHO 2013; Jessri et al., 2013; Nesbitt etal., 2012).

Breastfeeding is thought to be associated with better neurologic outcomes in a person from infancy
to adulthood. This article reviews the existing research on breastfeeding and neurodevelopment in
areas of neuromotor development, visual development, cognitive development, educational
achievement, and social adaptation, with an emphasis on cognitive development. Existing theories
(biochemical, behavioral, and genetic) used to explain the effect of breastfeeding on
neurodevelopment are explained including the supporting research. The methodology of published
studies is critiqued in the areas of classification of infant feeding, definition of outcomes, study
design and statistical analysis, control of confounding variables, and interpretation of results.
Taking a historical perspective, the aim of this review is to inform readers on past and current
research and its applicability to the current perspective on the benefits of breastfeeding.(UNDP
2011)

infants who are exclusively breastfed for six months experience less morbidity from
gastrointestinal infection than those who are partially breastfed as of three or four months, and no
deficits have been demonstrated in growth among infants from either developing and developed
countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such
infants have more prolonged lactational amenorrhea. Although infants should still be managed
individually so that insufficient growth or other adverse outcomes are not ignored and appropriate
interventions are provided the available evidence demonstrates no apparent risks in
recommending, as a general policy (WHO 1998)

10
Early or timely initiation of breastfeeding, specifically within 1 h of birth, refers to the best practice
recommendation by the World Health Organization (WHO). A recent systematic review and meta-
analysis revealed that breastfeeding initiation after the first hour of birth doubles the risk of
neonatal mortality In specific countries, initiating within 1 h reduced deaths by 19 % in Nepal and
22 % in Ghana The evidence, drawn from meta-analysis and over 63 developing countries, shows
that early initiation of breastfeeding prevents newborn infections, averts newborn death due to
sepsis, pneumonia, diarrhea and hypothermia, and facilitates sustained breastfeeding. In South
Asia, merely 41 % of newborns are breastfed within 1 h of birth Several South Asian countries
have some of the worst early initiation of breastfeeding practices in the world; the rates in Pakistan,
India, Bangladesh and Nepal are only 29, 41, 47 and 45 % respectively .(WHO 2000)

Insufficient attention is afforded to the public health issue of early or timely initiation of
breastfeeding, and the causes of poor practice, even though this preventive intervention is highly
cost-effective. Breastfeeding research predominantly focuses on exclusive breastfeeding to the age
of 6 months and other infant and young child feeding (IYCF) indicators [. Existing systematic
literature reviews on early initiation primarily draw on evidence from developed countries and on
the effect of skin-to-skin contact on breastfeeding rates . It is important to understand the factors
associated with delayed breastfeeding initiation and the existing barriers and facilitators to early
initiation in order to design and deliver effective strategies to improve thepractice and accelerate
progress in newborn survival.(Hanson et al., 1995).

Breastfeeding benefits preterm infants from a nutritional, gastrointestinal, immunological,

developmental, and psychological perspective. Despite the benefits, the incidence and duration of
breastfeeding preterm infants continues to be less than that of full-term infants. The lower
incidence is probably related to breastfeeding challenges that preterm infants and parents face,
including establishing and maintaining a milk supply and transitioning from gavage feeding to
breastfeeding. In order to increase the incidence and duration of breastfeeding preterm infants,
researchers must examine breastfeeding experiences longitudinally.(Kramer mskakuma 2012)

11
Researchers and clinicians can begin to understand the barriers to breastfeeding at various time
periods in the breastfeeding experience and begin implementing strategies to remove thesebarriers.
Despite the documented benefits of human milk, the incidence and duration of breastfeeding
preterm infants continues to be less than that of full-term infants. In the United States, while 69%
of term infants and mothers initiate either partial or exclusive breastfeeding,[1] the average rate
of breastfeeding for preterm infants is approximately 50% at hospital discharge(maguladevine and
trikalion 2007)
Breastfeeding has a beneficial effect on the health of women. Studies have shown that
breastfeeding helps in losing pregnancy weight faster (Kramer and Kakuma 2012; Baker
Gamborg, Heitmann, Lissner, et al 2008; Sanusi and Falana, 2013). A study revealed that women
who breastfed lost 4.4kg within a year, while those who did not breastfeed only lost 2.4 kg (P<0.05)
(Dewey, Heinig and Nommsen, 1993).This underlines the effectiveness of breastfeeding
especially if practiced exclusively in the first six months, in reducing weight gain
duringpregnancy(Nommsen, 1993.

Breastfeeding promotes uterine contraction, thereby reducing blood loss after delivery and
promotes uterine involution (NRDC, 2005). Breastfeeding reduces the risk of type 2 diabetes and
cardiovascular diseases (Davis, Stichler and Poeltler, 2012). It also lowers the risk of breast,
endometrial and ovarian cancers (Labbok, 2001; NRDC, 2005; Centre for Community Child
Health, 2006; Huo, Adebamowo, et al 2008; Sule, 2011; Davis, Stichler and Poeltler, 2012).
Absence of menstruation due to breastfeeding serves as temporary contraception for somewomen
(Kuti, Adeyemi and Owolabi, 2007).This is effective for some women who breastfed exclusively
for six months (Kuti, Adeyemi andOwolabi, 2007).

.Breastfeeding is cost effective as finances do not have to be set aside for infant formula (NRDC,
2005 Centre for Community Child Health, 2006).Breastfeeding gives women a sense of bonding
with their babies (NRDC, 2005 Centre for Community Child Health, 2006) and promotes mental
health of women (Davis,Stichler and Poeltler, 2012). Breastfeeding is also beneficial for the infant.
Adequately breastfed infants grow more rapidly and are healthier than those who were not
(Ukegbu, Ebenebe and Ukegbu, 2010, Gale, Logan, et al, 2012). Breast milk confers a child with
significant protection against many infectious diseases because it containsantibodies (immuno

12
globulins) that strengthen the Childs immunity (Ukegbu, 2010; Murimi et al, 2012; Lamberti,
Zakarija-Grković, et al, 2013)

Breastfeeding reduces the incidence of meningitis, malaria, asthma, respiratory diseases (such as
pneumonia), ear infection, diarrhoea, and urinary tract infection (Ukegbu, 2010; Murimiet al,
2012; Ibadin et al, 2012; Lamberti et al 2013). Kramer and Kakuma (2012) posited that in the first
six months of life, exclusive breastfed infants are six times less likely to die from diarrhoea and
2.5 times less likely to die from acute respiratory infection. Breastfeeding lowers the risk of allergy
and food intolerance and improve brain development (Centre for Community Child Health, 2006:)

2.2 Workplace breastfeeding facilities provided to working mothers

Within two to three months after delivery, working mothers are expected to resume their work and
perform like normal employees. Most workplaces do not have the supportive environmentfor
breastfeeding this will probably result in discontinuation of breastfeeding (6,24). Mothers need a
safe, clean and private place in or near their workplace to be able to continue breastfeeding. A
supporting environment at work, such as paid maternity leave, part time work engagements,
facilities for expressing and storing breast milk and breastfeeding breaks can help A recent WHO
internal employee‘s based study recommended that the employer should provide, prenatal/
postpartum services, which include separate rooms for breastfeeding, nursery for childcare,
provide flexible time and lighter job to working mothers (30).

Supporting breastfeeding among employees only involves limited costs for employers, both in
terms of the employee‘s time and the infrastructure that it requires.

Addati gives the example of the Los Angeles Department of Power and Water, which provides a
comprehensive breastfeeding programme to support workers, including on-site lactation rooms
and flexible scheduling. A few years after the programme was introduced, health-care claims were
35 percent lower, 33 per cent of new mothers returned to work sooner than anticipated,
absenteeism rates were 27 per cent lower among both men and women, and 67 per cent of all
employees said they planned to stay with the company in the long run.In
countries like Belgium and Estonia, breastfeeding breaks are covered by social insurance and

13
public funds. This means that the employers are not directly responsible for them. Such measures
improve gender equality at work. Progress is also being made in developing countries. Addati
describes the example of Mozambique. Both employers and workers from the tourism industry in
Mozambique have benefited from one of our programmes to improve working conditions, which
include maternity protection,‖ says Addati. ―It was impressive to see how employers were happy
and enthusiastic to witness benefits in terms of lower absenteeism and increased worker retention
after deciding to set up breastfeeding facilities.‖Countries such as the Philippines, where the ILO
is supporting a joint UN programme on maternity protection and child nutrition, have also
extended maternity protection and, in particular, breastfeeding arrangements and lactation stations
to informal workers. Other countries – for example India – provide cash transfers to pregnant and
nursing mothers if they fulfil certain conditions, including breastfeeding.
―Contrary to a common belief, informal workers also face problems in continuing to breastfeed
when they return to work, as they are often unable to take their children with them to the fields,
to collect firewood or water or to the employers‘ household, in the case of domestic workers. When
they do so, it often comes with risks to the child‘s health and well-being and may lead to early
involvement in child labour,‖ explains Addati

2.3 Awareness of breastfeeding practice among working women

Mother absent examples, mothers may opt out of nursing, although classes, books and personal
counseling (professional or lay) can help compensate. Some women fear that breastfeeding will
negatively impact the look of their breasts. However, a 2008 study found that breastfeeding had
no effect on a woman's breasts; other factors did contribute to "drooping" of the breasts, such as
advanced age, number of pregnancies and smoking behavior. Practitioner – Primary physicians
and nurses have little training in lactation and lactation support and are often unprepared to provide
the information that mothers need. The Surgeon General‘s Call to Action to Support Breastfeeding
attempts to educate practitioners. (Wright, 2001).

Formal breastfeeding education is that which is provided over and above the breastfeeding
information given as part of standard antenatal care, and which may include individual or group
education sessions led by peer counselors or health professionals, homes visits, lactation
consultation, distribution of printed/written materials, video demonstrations and inclusion of
14
prospective fathers in learning activities. The antenatal period affords an opportunity for providing
pregnant women and their partners and families with information about the benefits of
breastfeeding at a time when many decisions about infant feeding are being contemplated.

Systematic review of the available evidence suggests that breastfeeding education is effective in
increasing both the rate of breastfeeding initiation and breastfeeding duration. Though these
reviews focus largely on studies in developed countries, a number of highly successful
interventions implemented in low- and middle-income countries have been described in the
literature. Some studies have further demonstrated the feasibility of scaling up interventions in
settings as diverse as Bolivia, India, Ghana and Madagascar by taking advantage of existing health
and nutrition activities.1 Limited evidence suggests that it may be possible to scale up even with
relatively ―low-intensity interventions‖ as demonstrated by studies in Mexico city, where
improvement in exclusive breastfeeding was observed with as little as three home visits bypeer
counselors and in Sub-Saharan Africa, where a recent multicentre randomized controlled trial
demonstrated that five or more home visits by peer counselors resulted in a significant increase in
exclusive breastfeeding at 12 and 24 weeks postpartum.(WHO).

2.4 Socio-cultural factors affecting on the breast feeding practice among working women

Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were
highlighted including; considering colostrums as ‗dirty‘ or ‗curdled milk‘, a curse ‗bad omen‘
associated with breastfeeding while engaging in extra marital affairs, a fear of the ‗evil eye‘
(malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding
in public and breastfeeding being associated with sagging breasts. (Humenick et al., 1998).

In India, the belief that mother‘s milk is not ready until 2-3 days postpartum delays initiation of
breastfeeding while colostrum is generally discarded (Bandyopadhyay, 2009).

Among Lebanese women concerns that the mother could potentially harm her infant through
breastfeeding were rooted in a number of cultural beliefs among them having an inherited inability
to produce milk, having "bad milk", and transmission of bdominal cramps to infants through breast
milk (Osman, Zein and Wick, 2009). Other obstacles to exclusive breastfeeding include the
perception of insufficient breast milk, fear of dying or becoming too sick to
15
breastfeed, (Fjeld et al., 2008). These findings agree with those of many studies in China (Xu et
al., 2009) and in Kenya (Ochola, 2008)

which have shown perceived breast milk insufficiency as a reason for discontinuing exclusive
breastfeeding. From most of the studies, cultural practices do not agree with exclusive
breastfeeding for 6 months. There is need to identify the cultural factors that may negatively affect
exclusive breastfeeding in different communities so that they can be addressed during promotion
of appropriate breastfeeding practices.The role society plays in the perception and actions of
individual within the society cannot go unnoticed. The study results show a positive role played
by society in breastfeeding. Breastfeeding is a common act which has been practiced in ages, the
traditional duty of the Ghanaian woman is to ensure that her children are been fed. Society play a
communal role of ensuring that a new mother continually breastfeed her baby since breast milk is
perceived as the main food for an infant. Due to this reason, social supports especially from close
relatives are usually provided to a lactating mother in a form of assistance with domestic chores to
make way for an adequate breastfeeding time (Ayawine & Ae-Ngibise 2015). Although society
appreciate the acts of breastfeeding, there were evidence from responsesby mothers that certain
societal beliefs and culture undermine the importance of exclusive six months breastfeeding hence,
contribute to the failure by most mothers to adhere to this practice (TampahNaah & Kumi-
Kyereme 2013, Fosu-Brefo & Arthur 2015). For instance, concerns were raised that a baby needs
to drink water and denying him or her of such privilege is perceived as an act of punishment.
Another reason was that exclusive breastfeeding is perceived as a foreign culture which was
invented by Western health advocates and was not practiced in the past. Results from the study
shows that religion play a key role in influencing the perceptions of mothers on breastfeeding. It
advocates the promotion of exclusive breastfeeding and child health in general. Religious leaders
acknowledge the divine responsibility of mothers in ensuring the growth and wellbeing of their
children. Breastfeeding an infant is considered an ideal way of ensuring the nourishment of the
child. During religious gatherings and activities, religious leaders use this 46 avenue to advocate
the positive health implications of breastfeeding on both mother and child, while emphasizing on
its cost-effectiveness (Burdette et al. 2012.)

16
2.5 Summary
Several factors affect mother‘s infant feeding choices and options, including their social roles,
availability of artificial baby milks, cultural norms and hospital birth practices. A woman's return
to work has frequently been found to be a main contributor to the early termination of
breastfeeding. There are many issues that disrupt mother‘s breastfeeding plan at work. Commonly
cited issues are lack of workplace breastfeeding facilities, lack of family support, mothers
inadequate knowledge about breastfeeding and feeling of embarrassment. Workingmothers often
face inflexibility in the working hours, unable to find facility for childcare at or near the workplace,
lack privacy for breastfeeding, place to store breast milk (refrigerator), limited paid maternity leave
and fear over job insecurity. Almost all mothers can breastfeed, as long as they have correct
information and support from their family, employer, health care system and society. Often
healthcare providers have limited knowledge and training on breastfeeding and breastfeeding
support at work. A study described that significant number of primary healthcare providers were
unable to provide mothers with the necessary information on breastfeeding.

2.6 Conclusion
Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant
needs for the first months of life, and it continues to provide up to half or more of a child‘s
nutritional needs during the second half of the first year, Breast milk promotes sensory and
cognitive development, and protects the infant against infectious and chronic diseases. Exclusive
breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or
pneumonia, and helps for a quicker recovery during illness.(Hanson et al., 1985).
Within two to three months after delivery, working mothers are expected to resume their work and
perform like normal employees. Most workplaces do not have the supportive environmentfor
breastfeeding this will probably result in discontinuation of breastfeeding (6,24). Mothers need a
safe, clean and private place in or near their workplace to be able to continue breastfeeding. A
supporting environment at work, such as paid maternity leave, part time work

17
engagements, facilities for expressing and storing breast milk and breastfeeding breaks can help A
recent WHO internal employee‘s based study recommended that the employer should provide,
prenatal/ postpartum services, which include separate rooms for breastfeeding, nursery for
childcare, provide flexible time and lighter job to working mothers (30).

Mother absent examples, mothers may opt out of nursing, although classes, books and personal
counseling (professional or lay) can help compensate. Some women fear that breastfeeding will
negatively impact the look of their breasts.

18
 CHAPTER THREE

MATERIAL AND METHODS

3.0 introduction

This chapter presents the research design, population of study, , sampling and sample techniques,
sample frame, data collection procedure , data processing and analysis validity and reliability and
limitations Inclusion criteria and Exclusion criteria and ethical considerations.

3.1 Research Design

The study was cross sectional study because; cross sectional study is in depth investigation of an
individual, group, institution. Cross sectional study helps the study to describe and explain study
single or same entities in depth in order to gain insight into the larger case. This design is
appropriate for rich understanding of community study on factors affecting breastfeeding practice
among working woman in Hodan district

3.2 Study population

The study population will be any working woman do breastfeeding practice living at the some
selected in Hodan district Mogadishu Somalia, Therefore, the target population of the study will
be 100 people consist of any working woman living in Hodan district.

3.3 Sample size

According to different perspectives, the larger the sample, the more representative of the
population it is likely to be. Smaller samples produce in accurate results. If the population is small,
the sample should comprise a large percentage of the population. Larger samples enable
researchers to draw more representative and more accurate conclusions, and to make more accurate
predictions than smaller samples. The researchers in this study will be used Slovene‘s formula, for
determining the sample size from this people

19
N= sample population.
n= sample size.

E= 0.1(confidence level)

n= N = 100 = 50 respodents.

1+N (e) 2 1+100(0.1)2

3.4 Sampling technique

The sampling procedure will be non-probability sampling, specially the purposive sampling
technique. This type of sampling can be very useful in situations when the researchers need to
reach a targeted sample quickly, and where sampling for proportionality is not the main concern

3.5 Research Instruments

A questionnaire and face to face interview will be applied for the participants to inquire the study
questions. Therefore, the questionnaire comprised of three parts; awareness of community,
sociocultural, workplace facilities.

3.6 Data analysis

Data using SPSS 20 to describe the data by using descriptive method. Frequency summary
statistics and graphical summaries in charts pie, bar, correlations variables and Excel were
presented.

3.7 validaty and reliability

3.7.1 Validity
 All interviews conducted in the local language to ensure accuracy and consistency
 Questionnaires will be frequently being checked after completing the interviews.
 The data noticed very carefully and systemically.
 The privacy of the respondents will be strictly be maintained.
 The questionnaires translated in to local languages Maay & Mahatiri to ease
understanding.

20
3.7.2 Reliability
The researchers will be method and conduct pretest for instrument and test will conducted after
One week in the same manner, to know if the respondents were provided the same result.

3.8 limitations
The research faced number of problems includes:

 Lack of resource
 Insecurity conditions stopped a lot of times the research to reach the location of some
distinct
 The time of the study to collect was also too little
 Luck financial support during preparing the thesis.

3.9 Inclusion criteria and Exclusion criteria

The study subjects will be all working women living in Hodan, District Mogadishu Somalia. And
exclusion criteria are residents of other districts and men live in Hodan district were not included
in the sample.

3.10 Ethical Considerations

Every respondent will asked for permission to complete the questionnaire. Good explanation of
the respondents will be done before filling the questionnaire. Privacy and confidentiality was
kept. Choice/freedom to participate the study or not was given to every respondent.

21
 CHAPTER FOUR

DATA ANALAYSIS

4.0 Introduction
This chapter presents findings and indicates how data was collected, presented, interpreted, and
analyzed. The findings of this chapter are consistent with research questions. Fortunately,
questionnaires were distributed and the questionnaires returned from the respondents. In order to
analysis the data percentages and frequency distribution tables and graphs were used.

The questionnaires will consist of 20 questions, which I intended to collect the necessary
information for the research and also see the questionnaires in appendix and also presented,
interpreted and analyzed below.

SPSS 20 (version) which is software package for statistical system was used to present and analyze
the data appropriate way.

4.1. Profile of Respondents

The profile of the respondents are personal information of the participants, this allows us toknow
the gender, marital status, age, educational level, and years of experience of the respondents of the
research.

22
Table: 4.2. Respondents by age
Age Number Percentage of respondents

18-25 15s 30
26-30 13 26
31-35 10 20
36-40 9 18
41-45 3 6
Total 50 100

Table: 4.2. Results in table above and figure below, show age of respondents. A total of 50
respondents of fifteen were between 18-25 years old, where thirteen of them were between 26-
30years old, while teen of them were between 31-35years old wile nine of them were between 36-
40, where three of them were between 41-45. In form of percentage 30% of the respondents were
between 18-25 and % 26 of them were between 26-30, while 20% of them were between 31-35and,
% 18 of them were between 36-40 and %6 of them were between 41-45 So results stated that the
majority of the respondents were the in the age between (18-25).
Figure 4.2. Age of respondents

23
 Table 4.3 Marital status of respondents
Marital status Number #%of respondents

Married 32 64

Divorced 18 34

Total 50 100

Table:
4.3. Regarding to the above table and below figure thirty two of respondents were married, while
eighteen of them were divorced. In percentage 64% of the respondents were married, 34% of them
were divorced. So, this result indicated that the married respondents got the highest percentage of
the total respondents.

Figure 4.3Marital status

24
Table 4.4: level of education
Categories Frequency Percentage

Level of education

Primary level 5 10

University level 25 50

Secondary level 16 32

informal 4 8

Total 50 100

Table 4.4: As written on the table given above and below the graph, educational level of the
respondents answered the questionnaires was five of the respondents were primary level, while
sixteen of them were secondary level, while 25 of them were university while four of them were
informal. In form of percentage, 10% of the respondents were primary level, while 32% of them
were secondary level, while 8%of them were informal. The result shows that most participants
were university level.

Figure 4.4 Educational level

25
Table 4.5 Job site of respondents
Category Number Percentage
Bank 2 4
School 11 22
University 14 28
Hospital 16 32
Business company 7 14
Total 50 100
Table: 4.5 According to the table given above and below figure, two of the respondents were bank,
and eleven respondents were school, where fourteen of them were university, and sixteenof them
were hospital, where seven of them were Business Company. According to their percentage 4%
of the respondents were bank t, 22% were school, w h i l e 28% were university, %32 were
hospital, while%14 was business company. So, as shown above the hospital was the most
participants.

Figure 4.5 Job site of respondents

26
Table 4.6 How many hours do you work per day?
Category Number Percentage
Less than one hour 13 26
2-4 hours 16 32
5-3 hours 16 32
More than 8 hours 5 10
Total 50 100

Table: 4.6. According to the table given above and below figure, of thirteen respondents were said
less than one hour, and sixteen respondents were said 2-4 hours , while sixteen of them weresaid
5-3 hours , and five of them were said more then 8hours, where seven of them were . According
to their percentage 26% of the respondents were said less than one hour, and 32% were said 2-4
hours ,while 32% were said 5-3 hours, 10%were said more then 8 hours, . So, as shown above the
2- 4hours and 5-3 hours were the most participants.

Figure 4.6. How many hours do you work per day?

27
Table 4.7. What shifts do you work?
Number Percentage
Only day shift 33 66
Day and evening shift 9 18
Night shift 8 16
Total 50 100
Table: 4.7 According to the table given above and below figure, of thirty three respondents were
said only day shift, and nine respondents were said day and evening shift , while eight of them
were said night shift . According to their percentage 66% of the respondents were said lonely day
shift, and 18% were said day and evening shift, while 16% were said night shift. So,as shown
above only day shift were the most participants.

Figure 4.7 what shifts do you work?

28
Table 4.8. Are you able to take a break from work when you need to
breast-feed your baby?
Number Percentages
Yes 27 54
NO 23 46
Total 50 100

Table: 4.8 the table above and figure below, indicate that twenty seven respondents were said yes
and twenty three of them were said no. In other words 54% said yes, 46% said no. So this implies
that majority of respondents said yes.
Figure 4.8 Are you able to take a break from work when you need to breast-feed your baby?

29
Table 4.9 Do you have a nursery available for childcare at your
workplace?
Number Percentages
Yes 9 18
No 41 82
Total 50 100

Table: 4.9 the table above and figure below, indicate that nine respondents were said yes and forty
three of them were said no. In other words 18% said yes, 82% said no. So this implies that majority
of respondents said no.
Figure 4.9 Do you have a nursery available for childcare at your workplace?

30
Table 4.10 Do you provide maternity leave when it
is due?
Number Percentages
Yes 35 70
No 15 30
Total 50 100

Table: 4.10 the table above and figure below, indicate that thirty five respondents were said yes,
and the fifteen of them were said no. In other words 70% said yes, 30% said no. So this implies
that majority of respondents said yes.
Figure 4.11 Do you provide maternity leave when it is due?

31
Table 4.11 Do you offer task adjustment or lighter job to working
mothers during lactation period?
Number Percentages
Yes 27 54
No 23 46
Total 50 100

Table: 4.11 the table above and figure below indicate that twenty seven respondents were said
yes and twenty three of them were said no. In other words 54% said yes, 46% said no. So this
implies that majority of respondents said yes.
Figure 4.11 Do you offer task adjustment or lighter job to working mothers during lactation
period?

32
Table 4.12 Do you provide information regarding breastfeeding options
for working mothers upon their return to work, after maternity leave?
Number Percentages
Yes 33 66
No 17 34
Total 50 100

Table: 4.12 the table above and figure below indicate that thirty three respondents were said yes,
and seventeen of them were said no. In other words 66% said yes, 34% said no. So this implies
that majority of respondents said yes.
Figure 4.12 Do you provide information regarding breastfeeding options for working
mothers upon their return to work, after maternity leave?

33
Table 4.13 Have you breast-fed your baby after he/she was born?
Number Percentages
Yes 41 82
No 9 18
Total 50 100

Table: 4.13 the table above and figure below indicate that forty one respondents were said yes, and
nine of them were said no. In other words 82% said yes, 18% said no. So this implies that majority
of respondents said yes.
Figure 4.13 Have you breast-fed your baby after he/she was born?

34
Table 4.14 Do you believe that infant who do not get enough breast milk
will become growth retardation and mental retardation?
Number Percentages
Yes 32 76

No 12 24

Total 50 100

Table: 4.14 the table above and figure below, indicate that forty one respondents were said yes,
and nine of them were said no. In other words 82% said yes, 18% said no. So this implies that
majority of respondents said yes.
Figure 4.14 Do you believe that infant who do not get enough breast milk will become: growth
retardation and mental retardation?

35
Table 4.15 Do you believe that infants consuming breast milk have fewer
infections than infants consuming formula milk?
Number Percentage
Yes 42 84
No 8 16
Total 50 100

Table: 4.15 the table above and figure below indicate that forty two respondents were said yes,
and eight of them were said no. In other words 84% said yes, 16% said no. So this implies that
majority of respondents said yes
Figure 4.15 Do you believe that infants consuming breast milk have fewer infections than infants
consuming formula milk?

36
Table 4.16 Do you believe Poor education of the mother is a barrier of
the breast feeding practice?
Number Percentage

Yes 40 80
No 10 20

Total 50 100

Table: 4.16 the table above and figure below indicate that forty respondents were said yes, and
teen of them were said no. In other words 80% said yes, 20% said no. So this implies that majority
of respondents said yes.
Figure 4.16 Do you believe Poor education of the mother is a barrier of the breast feeding practice?

37
Table 4.17 Do you believe that awareness of the mother’s increase breast
feeding practice?
Number Percentage
Yes 38 76
No 12 24
Total 50 100

Table: 4.17 the table above and figure below indicate that thirty eight respondents were said yes,
and twelve of them were said no. In other words 76% said yes, 24% said no. So this implies that
majority of respondents said yes.
Figure 4.17 Do you believe that awareness of the mothers increase breast feeding practice?.

38
Table 4.18 Do you agree that some mothers are interesting income only
while them doing work and breastfeed together?
Number Percentage
Agree 28 56
Disagree 22 44
Total 50 100

Table: 4.18 the table above and figure below, indicate that twenty eight respondents were said
agree, and twenty two of them were said disagree. In other words 56% said agree, 44% said
disagree. So this implies that majority of respondents said agree.
Figure 4.18 Do you agree that some mothers are interesting income only while them doing work
and breastfeed together?

39
Table 4.19 Do you believe that women cannot make with breastfeed and
work according to their culture?
Number Percentage
Yes 35 70
No 15 30
Total 50 100

Table: 4.19 the table above and figure below, indicate that thirty five respondents were said yes,
and fifteen of them were said no. In other words 70% said yes, 30% said no. So this implies that
majority of respondents said yes.
Figure 4.19 Do you believe that women cannot make with breastfeed and work according to
their culture?

40
Table 4.20 Do you believe that breast feeding for the baby precipitates to
child’s growth
Number Percentage
Yes 41 82
No 9 18
Total 50 100

Table: 4.20 the table above and figure below indicate that forty one respondents were said yes, and
nine of them were said no. In other words 82% said yes, 18% said no. So this implies that majority
of respondents said yes.
Figure 4.20 Do you believe that breast feeding for the baby precipitates to child‘s growth?

41
Table 4.21 Do you believe that breast feeding for the baby gives full
immunity to protect infections?
Number Percentage
Yes 41 82
No 9 18
Total 50 100

Table: 4.21 the table above and figure below, indicate that forty one respondents were said yes,
and nine of them were said no. In other words 82% said yes, 18% said no. So this implies that
majority of respondents said yes.
Figure 4.21 Do you believe that breast feeding for the baby gives full immunity to protect
infections?

42
 CHAPTER FIVE

CONCLUSIONS, RECOMMENDATIONS, FINDINGS.

5.0. INTRODUCTION
This chapter clearly presents the summary of the findings, recommendations, conclusions
respectively; finally, this research will bring recommendations about further research for this
study.

5.1. Summary of findings

The data collection tools was planned and discussed, after data collection analysis was done by the
use of SPSS 20 ver. (Statistical Package for Social Science) the data analysis and itsinterpretation
revealed that exclusive breastfeeding is an existed problem in Hodan District.

From the findings of the data on table 4.7 showed that most of the respondents 66% answered the
questionnaire agreed that working only day shift, due to lack of awareness of the community,
and institution that provides facilities of breast feeding, and socio cultural factors that promotes
exclusive breastfeeding practice.

No public health mobilization teams that could give them some sort of alertness what to do when
they have seen such a case

The table 4.16 showed that most of the respondents 80% answered the questionnaire agreed that
they believe Poor education of the mother is a barrier of the breast feeding practice.

The table 4.17 exhibited that 76% of the respondents have agreed that they believe that awareness
of the mothers increase breast feeding practice among working woman in Hodan district.

From the findings of the data on table 4.21 showed that most of the respondents 82% answered
the questionnaire agreed that they believe that breast feeding for the baby gives full immunity to
protect infections, Breast milk promotes sensory and cognitive development, and protects the

43
infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality
due to common childhood illnesses such as diarrhea or pneumonia, and helps for a quicker
recovery during illness .breastfeeding contributes to the health and well-being of mothers; it helps
to space children, reduces the risk of ovarian cancer and breast cancer, increases familyand
national resources, is a secure way of feeding and is safe for the environment. While breastfeeding
is a natural act, it is also a learned behavior.

An extensive body of research has demonstrated that mothers and other caregivers require active
support for establishing and sustaining appropriate breastfeeding practices. .Breast milk is the most
nutritious food for babies. It also protects from infection, allergies, some chronic diseases and
childhood cancers, and sudden infant death syndrome (SIDS). Breastfeeding allows eye-to- eye
contact and physical closeness, strengthening the bond between the child and mother.
Breastfeeding is linked to lower levels of stress and fewer negative moods. It can help with post-
pregnancy recovery and, over the long term, lowers the risk of obesity, osteoporosis and breast and
ovarian cancer.Breastfeeding helps to develop stronger sense of bonding with their babies. The
benefits of breastfeeding are clear; the challenge is to find ways to support mothers to make the
choice to breastfeed. Changes early in pregnancy prepare the breast for lactation. Before pregnancy
the breast is largely composed of adipose (fat) tissue but under the influence of the hormones
estrogen, progesterone, prolactin, and other hormones, the breasts prepare for production of milk
for the baby. There is an increase in blood flow to the breasts. Pigmentationof the nipples and
areola also increases. Size increases as well, but breast size is not related to theamount of milk that
the mother will be able to produce after the baby is born.

By the second trimester of pregnancy colostrum‘s, a thick yellowish fluid, begins to be produced
in the alveoli and continues to be produced for the first few days after birth until the milk "comes
in", around 30 to 40 hours after delivery. There is no evidence to support increased fluid intake for
breastfeeding mothers to increase their milk production. Oxytocin contracts the smooth muscle of
the uterus during birth and following delivery; called the partum period, while breastfeeding.
Oxytocin also contracts the smooth muscle layer of band-like cells surroundingthe alveoli to
squeeze the newly produced milk into the duct system. Oxytocin is necessary for the milk ejection
reflex, or let-down, in response to suckling, to occur

44
5.2. Conclusions
Breastfeeding is a feeding of a babies and young children with milk from a female breast.
Breastfeeding should be started during the hour after birth and allowed as the baby wishes.
During the first few weeks of life babies may nurse eight to twelve times a day. The duration of a
feeding is usually ten to fifteen minutes on each breast. The frequency of feeding decreases as
the child gets older. Some mothers pump milk so that it can be used later when their child is
being cared for by others. The main objective of this study was to determine factors effecting breast
feeding practice among working women in Hodan District, Mogadishu- Somalia. A specific
objective of this study was: To identify Workplace breastfeeding facilities on the breastfeeding
practice among working women in Hodan District, Mogadishu, Somalia , To find out the
knowledge effect of the breastfeeding practice among working women in Hodan, District,

Mogadishu, Somalia, to asses effects of socio-cultural on the breast feeding practice among
working women in Hodan District, Mogadishu, Somalia.

The study design was descriptive study of cross-sectional method and questionnaire was used to
collect information from the respondents.

The table 4.16 showed that most of the respondents 80% answered the questionnaire agreed that
they believe Poor education of the mother is a barrier of the breast feeding practice.

The table 4.17 exhibited that 76% of the respondents have agreed that they believe that awareness
of the mothers increase breast feeding practice among working woman in Hodan district.

5.3. Recommendation
Breastfeeding is not an obstacle to productivity: research shows that women are more likely to stay
in their job in the longer term, if they can breastfeed at work which is good way of retaining skilled
works.
The following are recommendation of the study:
To make suitable places near the work place where mothers can breastfeed.
To educate mothers who return to work sooner after giving birth.

45
To allow working mothers to breastfeed their babies during working hours.
To support working mothers to increase their feeding.
To make easy the ability to take break from the work to breastfeed their babies.
Working mothers should be encouraged to take longer leave from the work.
APPENDEXIS
A ) REFERENCES
1. Adair L.S., Popkin B.M. et al., (1993). ―The duration of breast-feeding: how is it affected
by biological, sociodemographic, health sector, and food industry factors?‖ Demography
1993; 30(1) 63-79.
2. Anand S.K. and Singh R.S., (1988). ―Infant feeding practices -- a survey‖. Indian Journal
of medicine. 1988 Sept; 42 (9): 209-12.
3. Ahmad S. and Alam M.S., (1996). ―Determinants of breast-feeding in an urban area of
Bangladesh. Journal of Family Welfare‖. 1996 Mar;42(1):1-6.
4. Barber-Madden R., Petschek M.A. and Pakter J., (1987). ―Breast-feeding and the
working
5. mother: barriers and intervention strategies‖. Journal of Public Health Policy 1987 Winter,,
8(4):531-541
6. Bongaarts J. and Menken J., (1983). In: Bulako RA, Lee RD, eds. Determinants of fertility
in developing countries. New York: Academic Press, 1983; 1: 27-60.
7. Bongaarts J. and Pottter R.G., (1983). ―Fertility, Biology and behavior: an analysis of the
proximate determinants‖. New York: Academic Press, 1983; 1: 61-80.
8. Bouvier P. and Rougemont A., (1998). ―Breastfeeding in Geneva: prevalence, duration
and determinants‖. Soz Praventivmed 1998;43(3):116-23
9. Chen Y., (1992). ―Factors associated with artificial feeding in Shanghai‖. American
Journal of Public Health. 1992 Feb; 82 (2): 264-6.
10. Chengdu Coordination Group of Breast-feeding surveillance, (1985). ― An investigation
on feeding condition of infants of 0-6 months of age in Chengdu‖. Sichuan Medical Journal
1985; 6 (5): 259-262
11. Chye J.K., Zain Z. et al., (1997). ―Breast-feeding at 6 weeks and predictive factors‖.
Journal of Tropical Pediatrics 1997 Oct;43 (5) 287-92

46
12. Corbett-Dick and Bezek A.K., (1997). ―Breast-feeding promotion for the employed
mother‖. Journal of Pediatr Health Care 1997 Jan-Feb;11(1):12-19
13. Davies-Adetugbo A.A., et al., (1996). ―Maternal education, breastfeeding behaviors and
14. lactational amenorrhoea: study among two ethnic communities in Ile Ife‖. Nigeria.
15. Nutrition and Health 1996; 11(2):115-26
16. Diaz S., (1989). ―Determinants of lactational amenorrhea‖. Int Gynecol Obstest 1989;
(suppl)
17. 1: 83-9.
18. Ding Y.M. and Chai W.W., (1990). ―An analysis of riew and action of effecting breast-
feeding‖.
19. Chinese J of Maternal and Child Health Care 1990; 5 (6): 31-33.
20. Fein S.B. and Roe B., ― The effect of work status on initiation and duration of breast-
feeding‖. American Journal of Public Health. 1998 Jul;88(7):1042-6
21. Gielen A.C., Faden R.R., et al., (1991). ―Maternal employment during the early
postpartum
22. period: effects on initiation and continuation of breast-feeding‖. Pediatrics 1991 Mar;
87(3): 298-305
23. Glasier A., Mcneilly A.S., et al., ― Fertility after childbirth: changes in serum
gonadotrophin levels in bottle and breast-feeding women‖. Clin Endocrinol 1983; 19: 493-
501.
24. Guldan G.S., Zhang M., et al., (1995). ― Breast-feeding practices in Chengdu, Sichuan,
China‖. Journal of Hum Lact. 1995 Mar:11(1):11-5
25. Haider Rashid Mannan and M. Nurul Islam, (1995). ―Breast-feeding in Bangladesh:
Patterns and impact on fertility‖. Asia-Pacific Population Journal 1995;10(4): 23-38
26. Hanson L.A., et al., (1985). ―Protective factors in milk and the development of the
immune system‖. Pediatrics 1985;75:172-6
27. Hills-Bonczyk S.G., Avery M.D., et al., (1993). ―Women's experiences with combining
28. breast-feeding and employment‖. Journal of Nurse Midwifery 1993 Sep- Oct;38(5):257-
66

47
29. Howit P.W., McNeilly A.S., et al., (1981). ― Effect of supplementary food on suckling
patterns and ovarian activity during lactation‖. Br Med 1981; 283: 757-63.
30. Howie P.W., (1991). ―Breast-feeding : a natural method for child spacing‖. American
Journal of Obstetrics and Gynecology. 1991 Dec;165(6 pt 2): 1990-1.
31. Huffman S. L and Lamphere B. B., (1984). " Breastfeeding performance and child
survival " Population and Development Review. 1984;A Supplement to Vol. 10:115
32. Hu P., Cai R.Q. and Zhao Y.J., (1991). ―An analysis of factors influencing infant's
breastfeeding
33. with logarithmic linear model‖. Chinese Journal of Maternal and Child Health
34. Care 1991; 6 (5): 45-48.
35. International Labor Organization, (1998). ―More than 120 Nations Provide Paid
Maternity
36. Leave, Gap in Employment treatment for Men and Women Still Exists‖.
37. International Labor Organization, ( 1999). ―Maternity protection at work, International
38. Labor Conference 87th Session 1999, Revision of the Maternity Protection Convention
(Revised), 1952 (No. 103), and Recommendation, 1952 (No. 95)‖.
39. Jason J.M,. Nieburg P., et al., (1984). ―Mortality and infectious disease associated with
infant-feeding practices in developing countries. Part 2‖. Pediatrics 1984;74:702-27
40. Jason J., (1991). ―Breastfeeding in 1991‖. New England Journal of Medicine. 1991, Oct
3;325(14):1036-8
41. Kearney M.H. and Cronenwett L., (1991). ―Breast-feeding and employment‖ . Journal of
Obstet Gynecol Neonate 1991;20:471-480.
42. Liu D.S. and Wang W., (1995). ―Breast-feeding in China‖. Would Review of Nutrition
and Dietitics. 1995;78:128-38
43. Lindberg L. D., (1996). ―Women's decisions about breastfeeding and maternal
employment‖. Journal of Marriage and the Family 1996;58:239-51
44. Martines J.C., Rea M., et al., (1992). ―Breast feeding in the first six months‖. BMJ. 1992
Apr 25;304(6834):1068-9
45. McNeilly A.S., Howie P.W., et al., (1982). ―Fertility after childbirth: adequacy of
postpartum

48
B) TIME FRAMEWORK
NO. TIME FRAME ACTIVITIES

1 July 25-2023 Selecting Project title

2 Aug 21-2023 Chapter one.

3 Sep 28- 2023 Chapter two and three.

4 Oct 21- 2023 Chapter four.

5 Nov 7- 2023 Chapter five.

6 Dec 23-2023 Revising the thesis.

7 Jan 25-2024 Submitting gradulation

project.

49
C) Budget Frame

Item Cost (Sh/so) Cost dollars ($)

1:Computer and 125,00 5$
internet service

2: Stationary 175,000 7$
3: Travelling expenses 200,000 8$
Total cost 500,000 20.$

50
D) TRANSMITTAL LETTER
Dear sir/Madam

Greetings!

We are bachelor degree of Collage of health Science School of Nursing & midwifery candidate

of African University. Part of the requirements for the award is a dissertation. Our study under the

Title Factors effecting breast feeding practice among working women in Hodan Distric, in this

context we request from you to participate in our study by answering the questionnaire

Kindly do not leave any option unanswered. Any data you will provide shall be for academic
Purpose only and no information of such kind shall be disclosed to others.
Thanks you very much in advance.

Yours faithfully,

GROUP NAMES:

1- Asma Omar Mumin

2- Khadra Abdullahi Abdi

51
E) QUESTIONAIRE

Title: Factors affecting breast feeding practice among working women in Hodan district
Instruction to the respondents

1. Please don ‘t write your name on the Questionnaire

2. The All information provide is confidential and private
3. The research is only for academic purpose and not for money

So I am requesting kindly to spare your precious time to answer the following questions
Section 1: PERSONAL INFORMATION:

Please p r o v i d e your Personal information in the questionnaire and tick (√)

where
appropriate:

1- Age:

a) 18-25 ……………….

b) 26- 30……………….

c) 31- 35………………...

D)36 – 40 …………….

e) 41 – 45………………

2- Marital status:

a) Married……………………

b) Divorced. …….………..

c) Widow……………………… .

3- Education level:

a) Primary level ……………….

52
b) Secondary level…………….

c) University…………………….

d) Informal……………………

4- Job site:

a) Bank…………………

b) School ……………

c) University …………

d) Hospital ……………

e) Business company ….

Section 2: Workplace breastfeeding facilities

5- How many hours do you work per day?

a) Less than 1 hours …………………..

b) 2-4 hours………………………….

c) 5 – 8 hours ………………………….

d) More 8 hours………………………

6- What shifts do you work?..

a) Only day shift………………….

b) Day and evening shift…………..

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c) Night shift ……………………
7- Are you able to take a break from work when you need to breast-feed your baby?
a) Yes …………………

b) No…………………….

8- Do you have a nursery available for childcare at your workplace?

a) Yes……………………..

b) No…………………….

9- Do you provide maternity leave when it is due?

a) Yes …………………….

b) No ……………………..

10- Do you offer task adjustment or lighter job to working mothers during lactation period?

a) Yes ………………………

b) No……………………

11- Do you provide information regarding breastfeeding options for working mothers upon their
return to work, after maternity leave?

a) Yes …………………………

b) No…………………………..

Section 3: Awareness of community

12- Have you breast-fed your baby after he/she was born?
a) Yes……………………………

b) No …………………………….

54
13- Do you believe that infant who do not get enough breast milk will become: growth
retardation and mental retardation?

a) Yes…………………………..

b) No…………………………

14- Do you believe that infants consuming breast milk have fewer infections than infants
consuming formula milk?

a) Yes ………………………………

b) No ………………………………

15- Do you believe Poor education of the mother is a barrier of the breast feeding practice?
a) Yes………………………….

b) No……………………………
16- do you believe that awareness of the mothers increase breast feeding practice?.

a) Yes………………………….

b) No…………………………….

Section 4: Socio- cultural

17- Do you agree that some mothers are interesting income only while they doing work and
breastfeed together?

a) Yes ……………………………….

b) No ………………………………..

18- Do you believe that women cannot make with breastfeed and work according to their culture?

a) Yes …………........................

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 b) No………………………….

19- Do you believe that breast feeding for the baby precipitates to child‘s growth?

a) Yes………………………….

b) No …………………………...

20- Do you believe that breast feeding for the baby gives full immunity to protect infections?

a) Yes………………………….….

b) No…………………………….

Thanks for your Co-operation

56
F) Map of Somalia

57
.

G) Map of Mogadish

58
59