ABSTRACT

Background: Expression and storage of breast milk is becoming a normalized behavior among breastfeeding women. Regular expression is consistently seen to be associated with employment. In Cameroon, the exclusive breastfeeding rate was 40.0% in 2018 according to the Cameroon demographic health survey (CDHS). This means that work might have a negative effect on the overall ability of a woman to maintain lactation. Aim: The study aimed to determine the knowledge and challenges regarding breastmilk expression and storage among employed mothers in the Buea town community. Materials and Method: A descriptive cross-sectional study was conducted among 100 employed mothers in March 2023.Eligible participants were selected by a convenience sampling technique. Results: Of the 100 employed nursing mothers sampled, 42 (42.0%) were aged 15 – 25 years old. Regarding their religious affiliations, 90.0% were Christians and 10.0% were Muslims. Majority (60.0%) of the employed nursing mothers were in the private sector while 40.0% were in the public sector. Slightly more than half 56 (56.0%) of the employed nursing mothers had attended university. Majority (60.0%) of the employed nursing mothers were married while 6.0% were divorced. Of the 100 employed nursing mothers sampled, 84 (84.0%) had less than 3 children. A majority of them 82.0% knew that expressed breast milk was still nutritious for the baby to feed on. Conclusion: The knowledge of employed nursing mothers on breast milk expression and storage was average and sub-optimal. The main reasons for the expression and storage of breastmilk by employed nursing mothers were busy schedule at work and the need to achieve exclusive breast feeding. Recommendations: Mothers need to be equipped in relevant knowledge on the techniques of expressing breastmilk to overcome the challenge of pain and cumbersome attitude while expressing breastmilk.

CHAPTER ONE

INTRODUCTION

1.1 Background

The 2016 Lancet series on breastfeeding estimate that scaling up breastfeeding to near universal levels would prevent 823,000 deaths in children under five years annually (Victora et al., 2016). The World Health Organization recommends exclusive breastfeeding for the first six months of life. The fifth global target in the comprehensive implementation plan on maternal infant and young child nutrition is to increase the rate of exclusive breastfeeding from 38.0% in 2012 to greater than 50% by 2025 (WHO, 2018).

In Cameroon, the exclusive breastfeeding rate was 40.0% in 2018 according to the Cameroon Demographic Health Survey (CDHS). However, there seems to be a steady decline of exclusive breastfeeding rates from 3-5 months (CDHS). This could be explained by a Cameroon study by Van et al. (2019) which showed that 52.0% of women resumed work within 3 months of child birth. This means that work might have a negative effect in the overall ability of a woman to maintain lactation. With exerted efforts towards improving the quality of life of the girl child, more and more women are joining the work force. Currently, women make up 50% of the total labour work force globally, and 46.0% in Cameroon (CDHS, 2018).

The International Labour Organization (ILO) convention 2000 proposed a period of paid maternity leave of not less than 14 weeks (ILO, 2000). The Cameroonian labour laws provide for 12 weeks maternity leave in the Employment Act. Only the women working in the formal sector can benefit from such a provision yet three quarters of the Cameroonian population work in the informal sector (ILO, 2000).

With time, lactating women who are faced with the prospect of returning to work, have developed strategies to continue breast-feeding while working e.g. expressing breast milk, cease breastfeeding, or negotiate a reduced-hour or flexible schedule with their employer (Sarah et al., 2018). Expression of breast milk is becoming a normalized behavior among breastfeeding women. Regular expression is consistently seen to be associated with employment (Labiner-Wolfe, 2018). Refrigeration and freezing of milk has been shown to have no effect on the fat, protein, lactose and zinc content. A significant decline has been seen with vitamin C, A and E (Din et al., 2004). This study aims to examine the knowledge, attitudes and practices around breast milk expression and storage among employed women in the Buea Town Community.

1.2 Problem Statement

It is estimated that scaling up exclusive breastfeeding to near universal levels would prevent 823,000 deaths in children under five years annually (Victora et al., 2016). The World Health Organization recommends exclusive breastfeeding for the first six months of life. In Cameroon, the exclusive breastfeeding rate was 40.0% in 2018 according to the Cameroon Demographic Health Survey (CDHS). This relatively low value of EBF could even be lower in employed mothers. Breastmilk expression and storage rates are relatively low in Africa (Sarah et al., 2018) and this could be a contributing factor to both the low rate of EBF and high infant mortality in Cameroon 48 deaths per 1000 live births) (CDHS, 2018).

1.3 Rationale

Currently, there has been no study done in Buea Town that looks into the knowledge of breast milk expression and storage among employed women. Globally women contribute approximately 50.0% of the total labor force. In Cameroon, the percentage of women in the labour work force is 46.0% (CDHS, 2018). Forced by the need to provide income, 52% of Cameroonian mothers report resuming work after 3 months (Van-Houten, 2019). Employed women have been found to wean early as they are not able to exclusively breast-feed (Don-Dery et al., 2016). Factors contributing to breastfeeding discontinuation among employed women include working in the private sector, lack of breastfeeding support in the work place, lack of a separate refrigerator to store expressed breast milk and lack of flexible time schedules among others (Ismail et al., 2012). Studies done in Cameroon on expressing milk show that breast milk expression and storage is a relatively new practice and culturally unacceptable (Talbert et al., 2018). The Cameroonian Government has shown political goodwill in supporting breast feeding among employed mothers. This includes 3 months of maternity leave with full pay as part of the labour laws (ILO, 2000). Lactation rooms can only be of benefit if the employed mother is conversant with how to properly utilize them for the purposes of achieving exclusive breastfeeding.

1.4 Research Questions

1. What is the level of knowledge of employed mothers on breastmilk expression and storage in the Buea Town Community?
2. What are the reasons for breastmilk expression and storage among employed mothers in the Buea Town Community?
3. What are the challenges faced by employed mothers in breastmilk expression and storage in the Buea Town Community?

1.5 Research Objectives

1.5.1 General Objective

The purpose of this study is to assess the knowledge and challenges regarding breastmilk expression and storage among employed mothers in the Buea Town Community

1.5.2 Specific Objectives

1. To assess the level of knowledge of employed mothers on breastmilk expression and storage in the Buea Town Community
2. To identify the reasons for breastmilk expression and storage among employed mothers in the Buea Town Community
3. To identify the challenges faced by employed mothers in breastmilk expression and storage in the Buea Town Community