Breastfeeding patterns, beliefs and attitudes among

Kurdish mothers in Diyarbakir, Turkey

GUNAY SAKA
1
, MELIKSAH ERTEM
1
, ALIDA MUSAYEVA
2
, ALI CEYLAN
1
& TAHIRE KOCTURK
3
1
Department of Public Health, School of Medicine, Dicle University, Diyarbakir, Turkey,
2
UNICEF Ofce, Ankara,
Turkey, and
3
Centre for Family Medicine, Karolinska Institute, Stockholm, Sweden
Abstract
Aim: The aim was to rapidly assess existing breastfeeding patterns, beliefs and attitudes in the province of Diyarbakir, a
socio-economically disadvantaged region of Turkey. Methods: A cross-sectional survey exploring demographic and breast-
feeding patterns was carried out among 921 mothers with children 618 mo of age. Results were quantitatively analysed.
Focus group interviews dealing with beliefs and attitudes were separately carried out among 107 mothers and analysed by
qualitative content analysis. Results: Nearly all mothers had breastfed their infants at some time, but exclusive breastfeeding
was rare. About 62.2% of the mothers had waited for at least 24 h before initiating breastfeeding. Almost half of the infants
received sweetened water as a rst feeding. There was agreement on the superiority of breastfeeding and awareness of its
contraceptive effect. Early introduction of sugared water, water and supplementary feeds was considered desirable. Working
in the elds and pregnancy were considered situations counteracting breastfeeding.
Conclusion: The attitude to breastfeeding was highly positive, but more information is needed to encourage the use of
colostrum, discourage early supplementation and promote exclusive breastfeeding during the rst 6 mo of life.
Key Words: Breastfeeding, colostrum, Diyarbakir, mothers, Kurdish
Introduction
Breastfeeding has unique qualities of importance for
mother and child health. This is why international
organizations [1,2] as well as national authorities,
including the Turkish government, recommend ex-
clusive breastfeeding during the rst 6 mo, continued
thereafter for at least 1 y or beyond [3].
A recent country-wide demographic and health
survey shows that breastfeeding is well established in
Turkey. In 1998 the average duration of breastfeeding
was almost 14 mo, and 95% of all infants received
breast milk at some time. Basic problems were late
initiation of breastfeeding, early weaning, the absence
of exclusive breastfeeding and the widespread useage
of bottle feeding (increasing the risk for gastrointestinal
infections) [4,5].
In 2003 the largest province in southeastern Turkey,
Diyarbakir, was selected for launching a programme
to protect, promote and support breastfeeding. This
programme is supported by the government and
UNICEF [6].
Knowledge of local breastfeeding patterns, cultural
practices, beliefs and attitudes facilitate planning
strategies for promoting breastfeeding. This knowledge
can be derived through rapid ethnographic assessment
methods which have been successfully utilized in a
number of community health and nutrition projects
[79].
The purpose of this explorative study was to rapidly
assess the existing breastfeeding patterns and beliefs
in southeastern Turkey by employing a quantitative
and a qualitative approach. The quantitative part of the
study aimed at describing socio-demographic factors
and breastfeeding patterns among mothers with
children 618 mo of age, living in urban and rural areas
of the province. This was complemented with a series
of focus group interviews among women with breast-
feeding experience, to reach a better understanding
of cultural beliefs and attitudes. The study was carried
Correspondence: Meliksah Ertem, Dicle Universitesi Tip Fakultesi, Halk Sagligi Anabilim Dali O

gretim Uyesi, 21280 Diyarbakir, Turkey.

Tel: +90 4122488432. Fax: +90 4122488432. E-mail: mertem@dicle.edu.tr
(Received 11 February 2005; accepted 15 March 2005)
Acta Pdiatrica, 2005; 94: 13031309
ISSN 0803-5253 print/ISSN 1651-2227 online # 2005 Taylor & Francis Group Ltd
DOI: 10.1080/08035250510036732
out in 2003. To the best of our knowledge, this is the
rst study of its kind carried out in this region.
Material and methods
Rapid ethnographic assessment (REA) method
REA is a holistic methodology based on the triangu-
lation of quantitative and qualitative data into one
source of knowledge. REA methodology aims at
reaching a synthesis of both traditional and modern
health practices in a community. Its methodology can
involve any or all procedures including formal and
informal interviews, conversations with key persons
or groups, participant observations, and focus group
discussions (FGDs) [8,9]. In this study, a cross-
sectional survey provided quantitative data. This was
complemented with qualitative information gathered
through FGDs, providing insights into beliefs and
attitudes supporting these practices.
Quantitative survey
Study population. This study was conducted in the
province of Diyarbakir in southeastern Turkey, with
a population size of 1362708 and a growth rate of
2.1%. Sixty per cent of the population lives in urban
areas. Basic occupations are agriculture and animal
husbandry, with an unemployment rate of 14%. About
half of the population is younger than 18 y of age. The
infant mortality rate is 6.2%, and the literacy rate
is 70%. As such, the province constitutes one of the
poorest regions in the country [10].
Thirty clusters of women with children 618 mo of
age from urban and rural areas were selected from
health centre registries. Mothers were approached by
the interview team and verbally informed about the
aims of the study. The impartiality of the study aims
regarding ethnicity, creed and political opinion, and
the anonymity of participants were ensured. Only
women who gave informed verbal consent were
included in the study. About 1518 mothers from
each cluster participated. Thirty mothers refused to
participate, without giving any reason. Thus, a total
sample of 921 mothers were interviewed.
Questionnaire. The questionnaire was pre-tested on a
group of 100 women (subsequently excluded from
the study) living in a peri-urban district of Diyarbakir,
and the questions were revised and adjusted by
the research team. The nal questionnaire included
33 close-ended questions with multiple choice
alternatives. The questionnaires were administered
face-to-face by trained interviewers speaking the local
Kurdish dialect (Kurmanch).
Statistical analysis. Data from the questionnaires were
quantitatively analysed with help of the programme
package EpiInfo 2000. Breastfeeding and the intro-
duction of supplements were described in terms of
frequencies. Differences between mothers living in
urban and rural areas were compared with w
2
and
simple odds ratio analysis.
Focus group interviews
The sample. Mothers aged 1549 y with at least one
child and experience of breastfeeding, living in four
urban and four rural areas in different households
were invited to participate in focus group discussions
(FGDs). Each FGD was attended by 1015 mothers.
The total number of participants was 107.
Focus group discussions. FGD methodology is used for
exploring beliefs and attitudes in a community, and is
extensively used in health research [11,12]. A set of
questions probing beliefs and attitudes on prelacteal
feedings, colostrum, exclusive breastfeeding, food
taboos, and the benets and disadvantages of breast-
feeding were prepared. Interviews were conducted in
the local Kurdish dialect and supervised by the social
scientists in the research team. Each session lasted
about 1 h. All FGDs were tape recorded with the
consent of the participants, transcribed verbatim and
translated into Turkish. Interviews continued until a
different opinion failed to arise (saturation).
Qualitative analysis. Transcripts were analysed by a
modied content analysis method [13]. Through the
coding of phrases and statements, themes regarding
different aspects of breastfeeding were identied and
explained.
Results
The survey
Table I presents the demographic characteristics of
the mothers. Demographic differences between urban
and rural areas were not signicant. Only 4.8% of the
mothers were gainfully employed. Mean maternal age
at the time of interview was 27.2 (SD 5.8) y. Six per
cent of the mothers were adolescents, and 4.2% were
older than 40. As many as 45.1% of the mothers
had received no schooling, whereas only 3.4% had
university-level education. About a quarter (24.9%) of
the mothers had ve or more children (mean 3.26, SD
2.1). About a third (30.9%) of the mothers lived in
extended families, i.e. they shared the household with
other relatives. During the prenatal period, 42.3% of
the mothers had had no contact with health personnel
1304 G. Saka et al.
and 33.3% had performed their last delivery at home,
without professional assistance.
Table II shows the pattern of breastfeeding among
mothers. Ninety-eight per cent of the mothers had
breastfed their infants at one time or another. The
percentage of mothers initiating breastfeeding within
an hour after delivery was, on average, 37.8%, whereas
a majority of mothers (62.2%) had waited for at least
Table II. Patterns of breastfeeding among 921 mothers in Diyarbakir (%).
Total Urban Rural p
Odds ratio
(95% CI)
Breastfeeding
Mothers who ever breastfed 904 (98.1) 488 (98.4) 413 (97.9) 0.56 1.32
Mothers who never breastfed 17 (1.9) 8 (1.6) 9 (2.1) (0.503.47)
Time of initiation of breastfeeding
Within 1 h postpartum 348 (37.8) 208 (41.8) 140 (33.1) 0.007 1.45
After 24 h postpartum 573 (62.2) 290 (58.2) 283 (66.9) (1.101.89)
Introducing sweetened water rst
Not given 477 (51.8) 269 (54.0) 208 (49.2) 0.14 1.21
Given 444 (48.2) 229 (46.0) 215 (50.8) (0.931.57)
Exclusive breastfeeding
No 911 (98.8) 493 (99.0) 417 (98.6) 0.55 1.43
Yes 11 (1.2) 5 (1.0) 6 (1.4) (0.395.44)
Timing of breastfeeding
On demand 546 (59.3) 307 (72.4) 239 (66.0) 0.05 1.35
Every 14 h 240 (26.1) 117 (27.6) 123 (34.0) (0.991.83)
Other 135 (14.6)
Introducing additional nutrients other than water within rst 6 mo
Such nutrients not introduced for 6 mo 415 (45.1) 224 (45.0) 191 (45.2) 0.95 0.95
Such nutrients introduced within 6 mo 506 (54.9) 274 (55.0) 232 (54.8) (0.761.28)
Table I. Demographic characteristics of the sample of 921 mothers in Diyarbakir, Turkey (%).
Total Urban Rural p
921 498 (54.1) 423 (45.9)
Employment
Not employed 864 (93.8) 469 (94.2) 408 (96.5) 0.10
Age
Under 19 55 (6.0) 32 (6.4) 23 (5.4)
20 to 24 276 (30.0) 141 (28.3) 135 (31.9)
25 to 29 286 (31.1) 152 (30.5) 134 (31.7)
30 to 34 184 (20.0) 110 (22.1) 74 (17.5)
35 to 39 82 (8.9) 46 (9.2) 36 (8.5)
40 and above 38 (4.19) 17 (3.4) 21 (5.0) 0.37
Education
university 31 (3.4) 17 (3.3) 14 (3.4)
high school 56 (6.1) 30 (6.0) 26 (6.1)
primary school 290 (31.5) 173 (34.7) 117 (27.7)
literate 129 (14.0) 67 (13.5) 62 (14.7)
illiterate 415 (45.1) 211 (42.4) 204 (48.2) 0.38
Number of children
12 401 (43.5) 214 (43.0) 187 (44.2)
34 291 (31.6) 168 (33.7) 123 (29.1)
5 or more 229 (24.9) 116 (23.3) 113 (26.7) 0.25
Family formation
Nuclear family 636 (69.1) 364 (73.1) 272 (64.3)
Extended family 285 (30.9) 134 (26.9) 151 (35.7) 0.04
Prenatal care
PNC received at least once 531 (57.7) 301 (61.7) 230 (54.8) 0.03
No PNC received at all 390 (42.3) 488 (38.3) 190 (45.2) 0.03
Type of delivery
Health personnel assistance 614 (66.7) 334 (67.1) 280 (66.2)
At home with local midwife 307 (33.3) 164 (32.9) 143 (33.8) 0.77
Breastfeeding and Kurdish mothers 1305
24 h before introducing the breast. A signicantly
higher percentage (41.8%) of urban mothers than rural
mothers (33.1%) had initiated breastfeeding within
an hour postpartum. Forty-six per cent of the mothers
in urban areas and 50.8% in rural areas in this study
had also introduced water sweetened with sugar or
pekmez (grape molasses) immediately after birth as
a rst feeding. The primary reason for not breastfeed-
ing immediately after birth was lack of milk. Other
reasons included not knowing it was necessary,
having been hindered from breastfeeding because
of a caesarean section, traditions such as waiting
for the rst three ezan (prayer calls) and concern
that this might have been harmful, etc. (not shown in
table form).
The most common breastfeeding timing method
was on demand (59.3%). Urban mothers used on-
demand feeding signicantly more often than rural
mothers (72.4% and 66.0%, respectively; Table II).
Two hundred and twenty-six mothers (24.5%) had
already weaned their infants from breast milk at the
time of the study (Table 4). Sixty-ve mothers were
exclusively breastfeeding at the time of the study. Table
III shows the pattern of supplementary feeding among
the 856 mothers who were partially breastfeeding.
Tables II and III show that the frequency of exclusive
breastfeeding during the rst 6 mo was very low. Only
1.2% of the mothers stated they exclusively breastfed
their infants during the rst 6 mos. More than half of
the mothers (54.9%) had introduced supplementary
foods other than water during this period. Other
noteworthy practices included a somewhat high useage
of paciers (39.5%) and bottles for giving supplements
(38.9%).
Qualitative ndings
Content analysis of data compiled through FGDs were
codied and collected under eight major themes.
1. Breastfeeding is best for baby. There was universal
agreement on the superiority of breastfeeding. State-
ments included: Breast milk is very good . . . it protects
babies from disease . . . the baby will gain more weight
. . . breast milk is always ready and does not need
heating or preparing . . . easier than giving other food
. . . comfortable.
2. Breastfeeding is protective against a new pregnancy.
Mothers were well aware of the contraceptive effect
of breastfeeding. Many mothers stated that they had
breastfed their babies for a long period in order to
prevent pregnancy. Having many children, especially
boys, enhanced the womans status and was a source of
Table III. Pattern of introducing supplementary foods into infant diets among 856 mothers.
Total Urban Rural p CI (95%)
Using dummy/pacier 364 (39.5) 205 (41.2) 159 (37.6) 0.26 0.86 (0.661.12)
Time for introducing additional foods
a
After 6 mo 349 (37.9) 204 (42.7) 145 (38.4) 0.13 1
First month 49 (5.3) 30 (6.3) 19 (5.0) 0.71 1.12 (0.582.17)
Second month 58 (6.3) 37 (7.7) 21 (5.6) 0.44 1.25 (0.652.32)
Third month 73 (7.9) 35 (7.3) 38 (10.1) 0.09 0.65 (0.381.12)
Fourth month 108 (11.7) 61 (12.8) 47 (12.4) 0.71 0.92 (0.581.46)
Fifth month 104 (11.3) 47 (9.8) 57 (15.1) 0.06 0.66 (0.411.05)
Sixth month 115 (12.5) 64 (13.4) 51 (13.5) 0.59 0.89 (0.571.40)
Feeding method
a
With spoon or glass 523 (61.1) 289 (60.6) 234 (61.7) 0.73 0.95 (0.721.26)
With feeding bottle 333 (38.9) 189 (39.4) 145 (38.3) 1
Total 856 (92.9) 478 (100.0) 378 (100.0)
a
Sixty-ve women (7.1%) who had not yet started to give additional nutrients were not taken into account.
Table IV. Breastfeeding cessation time in 226 mothers (%).
Breastfeeding
cessation time, mo Total Urban Rural p CI (95%)
1 19 (8.4) 10 (7.3) 9 (10.1) 0.17 2.03 (0.656.31)
2 21 (9.3) 10 (7.3) 11 (12.4) 0.06 2.47 (0.847.39)
3 21 (9.3) 11 (8.0) 10 (11.2) 0.14 2.05 (0.696.09)
4 25 (11.1) 14 (10.2) 11 (12.4) 0.22 1.77 (0.644.91)
5 29 (12.8) 16 (11.7) 13 (14.6) 0.17 1.83 (0.704.80)
6 33 (14.6) 22 (16.1) 11 (12.4) 0.79 1.13 (0.432.91)
After 6 78 (34.5) 54 (39.4) 24 (26.9) 0.41 1
Total 226 (100.0) 137 (100.0) 89 (100.0)
1306 G. Saka et al.
prestige. It was witheld that mothers who want to get
pregnant should stop breastfeeding.
3. The newborn baby should be given liquids. In most
situations, the rst food given to the newborn was
water sweetened with sugar (sucrose) or pekmez (grape
molasses). It is believed that such prelacteals cleanse
the bowels of the newborn. One mother said: The
child who takes sweetened water vomits the black dirt
in its stomach, and it clears its inside.
Generally, colostrum is not perceived as having
nutritive value. Mothers complained they could not
produce milk right after birth: My baby cried and was
hungry . . . I wanted to breastfeed but there was no
milk, so I gave sugar water . . . An older woman said:
the mother should rest a little after delivery. Preg-
nancy and birth makes the mother tired . . . after resting
for a while, she can breastfeed.
4. Colostrum is not good food for babies. Not holding
the infant to the breast soon after delivery was
common practice. Opinions on howlong to wait before
presenting the breast varied: some suggested a waiting
period of 3 to 6 ezan (Islamic prayer calls), or until the
mother had taken a bath. Others suggested periods of
up to 3 d. One mother stated, the baby does not need
to be fed for the rst two days, and therefore there is
no harm in not giving the breast during this time.
Colostrum was often deemed unsuitable for babies.
Mothers referred to colostrum with local names such
as: yellow milk, afterbirth milk, dirty milk, rst milk,
corrupt milk (fro, herrish in Kurdish). The view
that it is necessary to remove this yellow, dirty milk
that had loitered inside the breasts throughout preg-
nancy was widespread. Opinions such as the rst milk
can cause discomfort for the babmake the baby ill or
be harmful in some way . . . will make the baby swell
up. . . cause jaundice were expressed. A 45-y-old
grandmother explained: we squeeze this pus-like dirty
milk and pour it away until white milk begins to come.
Meanwhile the baby is fed with sugared milk.
5. Colostrum is good food for babies. Although the view
that colostrumshould not be given to infants prevailed,
some participants thought otherwise. A woman with
an urban background said, I know colostrum is very
good . . . it is the rst vaccine of the infant . . . Another
mother said: I know that this rst milk is very useful
for the baby, but in the rst days of birth it is very hard
to breastfeed . . . First of all, milk does not come and
the mother is very tired . . .
6. Water is essential for babies. Water was not perceived
as a supplementary food by the mothers, but a necessity
for the maintenance of infant health. Statements
included: it is absolutely necessary to introduce water
to the baby . . . water is good . . . water makes internal
organs work properly . . . the infants bowels will stick to
each other if not given water . . . everybody gives water
to their babies . . . our elders tell us to give water . . . a
baby who does not get water will become dehydrated
and ill. In addition to water, different types of teas
were given. These included teas made with anise
(agastache foeniculum) and meryemotu (avens, geum
urbanum), used to treat colic.
7. Supplementary feeding before 6 mo is desirable. Exclu-
sive breastfeeding for at least the rst 6 mo was a very
rare practice. Only one older mother said: I formerly
fed my babies with breast milk only and, as a result, my
babies were protected from disease and have been
stronger and healthier. Otherwise, none of the parti-
cipants had breastfed exclusively for 6 mo, and the
attitude towards supplementary foods was positive.
Some mothers were proud of themselves for having
started supplementary feedings early. A mother said,
I am good at managing baby growth . . . I have ve
children . . . I gave all kind of foods to my babies within
the rst four months . . . all of them are healthy.
Another mother said, if you start giving foods to
your baby early, he/she will become familiar and
accept them easier . . . he/she will grow faster . . . he/she
will be stronger . . . so I think supplements should be
introduced as early as possible.
8. Some situations counteract breastfeeding. Some
mothers thought that the ability to produce good milk
was something women inherited from their mothers.
One woman gave the reason for stopping breastfeeding
early as: I had to stop earlier . . . My mothers milk also
stopped early . . . this is our hereditary feature. Some
mothers were considered simply unable to produce
good milk: Some womens milk is not good for their
babies. Children breastfed by such women remain
weak, do not develop, become ill and get diarrhoea . . .
Such women should not breastfeed, and must use
baby food instead.
Some of the participants engaged in seasonal agri-
culture work. Working outside the home was con-
sidered something that makes breastfeeding difcult,
but still possible. In this context, a situation termed
weariness milk or heated milk was believed to
occur when a mother stays or works under the sun for
a long time and is tired. This causes the milk in her
breasts to get warm and reduces its nutritive value. It
is believed that children fed with such milk may
have diarrhoea or suffer from a griping pain in their
stomach. Mothers said: weariness milk should not
be given to a baby . . . the baby should be suckled only
after this milk is squeezed out or the breasts are
washed with cold water . . . a breastfeeding woman
should not work under the sun. Furthermore, it is
believed that breastfeeding when the mother is sad or
Breastfeeding and Kurdish mothers 1307
ill can be harmful to the baby: When the mother is
sad, her milk is no good to the baby . . . it disturbs the
baby . . . A breastfeeding woman has to be free from
grief, troubles or other things like that . . . if a mother is
grieving she should not breastfeed.
Furthermore, all participants considered pregnancy
a situation counteracting breastfeeding: It is wrong for
a pregnant woman to go on breastfeeding. Once a
mother is pregnant, her milk is due to the baby in her
womb . . . A mother who has become pregnant, even
if not deliberately, must stop breastfeeding. Another
opinion was: When a woman becomes pregnant, her
milk will stop automatically anyway or a pregnant
womans milk will make her baby ill. It is yellow milk
and should not be given.
An interesting opinion against prolonged breast-
feeding was also expressed: Everybody says that if a
child is breastfed for a long period, he will be imbecile
. . . mothers should stop breastfeeding before one and
one and a half years . . .
Discussion
This paper explores the pattern, beliefs and attitudes
towards breastfeeding in a socio-economically dis-
advantaged region of Turkey, inhabited mostly by
people of Kurdish ethnicity. The promotion of breast-
feeding in this area is crucial, since the infant mortality
rate in the region is the highest in the country (38%)
[5] and the poverty and low level of education among
mothers increases the vulnerability of their children.
It is noteworthy that breastfeeding patterns in
urban and rural areas were similar, despite the fact
that women living in urban areas had more access
to health services. This shows the need to improve
maternal and child health services, and especially the
knowledge and efciency of health personnel, so they
can be better motivated to counsel mothers about
infant feeding.
Findings conrm the positive attitude to breast-
feeding and its universal practice among this group of
mothers, which can partly be explained by the religion
(Islam) [14] and also by the fact that poor and less-
educated mothers in developing countries seem to
breastfeed with higher frequencies than more afuent
groups [15,17,19,20]. Mothers in this study, as in
other parts of Turkey [18], were also well aware of the
contraceptive effects of breastfeeding.
Despite the positive attitude towards breastfeeding,
there were several problematic practices. One problem
was that many mothers did not give colostrum based
on beliefs that this was somewhat unsuitable food
for a baby. This is common in many parts of the
world [15,17,18]. Neonates are not held to the breast
for various periods of time either because of unfavor-
able maternity ward routines [19] or because of
traditions allowing the discarding of colostrum and
delaying introduction to the breast for 13 d, during
which time the infants receive various concoctions of
sugar water, herbal teas, cows milk, honey and
butter, etc.
Some mothers can initiate breastfeeding without
help, but most need information from health pro-
fessionals on skin-to-skin contact, positioning of the
infant to the breast, the imporatnce of colostrum,
etc. during the prelacteal period. Mothers should be
informed that such prelacteal uids can cause delay
in the production of breast milk [15,20,26]. Colostrum
is a source of bioactive and immunological substances,
including some important micronutrient minerals
with high bioavailability. That the newborn infant
receives colostrum soon after delivery is important
from an immunological point of view, and WHOs
baby-friendly hospital initiative promotes early initia-
tion. In this study, mothers were replacing colostrum
with diluted sugar or pekmez, solutions which may
be contaminated with micro-organisms and increase
neonatal morbidity, especially diarrhoea. Acute diar-
rhoea in this region is particularly high among infants
[5,27].
Another problem was the early introduction and
frequent use of water and herbal teas. Early supple-
mentation of breastfeeding with water is common
practice [2123], while in other communities breast
milk is considered to be pure and the infant is con-
sidered unpolluted as long as it is being exclusively
breastfed [24]. However, breast milk consists of about
90% water, and exclusively breastfed infants can
maintain water homeostasis, even under high summer
temperatures [25]. Giving water may counteract
optimal breast milk production and is unneccesary
for exclusively breastfed infants. Many mothers also
used herbal teas in order to reduce colic or act as a
laxative. Herbal teas in infant feeding are also perceived
as benecial in other communities [26,27], but there
are some questions as to how appropriate these may
be [28,29].
Other problems included the early introduction of
supplements and the virtual absence of exclusive
breastfeeding on the grounds of having insufcient
milk; a common nding in many studies [7,30].
Another reason for early supplementation was that
mothers believed the infants will have a better appetite
in the future, if they receive small portions of food as
early as possible.
Most mothers mentioned contraception as an added
advantage of breastfeeding and did not wish to stop
breastfeeding unless a new pregnancy occured. Next
to insufcient milk, a new pregnancy or a desire for
getting pregnant were reasons for discontinuing
breastfeeding [18,20]. There was a belief that pregnant
women should not continue breastfeeding, because in
such an occurrence, the nutrient value of breast milk
is due the fetus. It was believed that breast milk from
1308 G. Saka et al.
a pregnant woman would be harmful and cause illness
in the child [17,30].
Conclusions
In this study, the attitude towards breastfeeding
is highly positive among mothers, regardless of differ-
ences in demographic variables. Mothers are aware of
the contraceptive value of breastfeeding. Most infants
are generally breastfed. Problem areas are the intro-
duction of sugar water instead of colostrum during
the prelacteal period, the early introduction of water,
use of herbal teas and other supplements, and the
virtual absence of exclusive breastfeeding. A strategy
for promoting breastfeeding in the region should
encourage a higher level of engagement of maternity
and child health personnel in infant nutrition and
advocacy of an early initiation of breastfeeding, intro-
duction of colostrum as a highly valuable infant
food, and maintenance of exclusive breastfeeding
without additional uids or supplements for 6 mo.
Information on the health hazards of bottle feeding is
needed. The advocacy should incorporate the positive
aspects of traditional beliefs and practices into modern
messages on optimal breastfeeding.
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