CHAPTER ONE

1.1 INTRODUCTION / BACKGROUND

LACTATION /BREAST FEEDING

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all post – pregnancy female mammals. Capuco, A.V: Akers, RM (2009). In humans the process of feeding milk is also known as breast feeding or nursing. New born infants often produce some milk from their own breast tissue, known as colloquially as “witch’s milk”.

Breast feeding according to Unicef 2009 is giving breast milk to a baby after it has been born. Also according to WHO 2010 breast feeding is an unequalled way of proving ideal food for healthy growth and development of infants. It is also an integral part of the productive process with important implications for the health of mothers.

SEXUAL INTERCOURSE

Sexual intercourse (coitus or corpulation) is sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure, reproduction or both. Macmillan dictionary com ma (2019). According to World Health Organization (2006) sexual intercourse is the thrusting of the penis into the vagina for pleasure and reproduction which determines the physical, emotional, mental and social well-being.

POST PARTUM

Post- partum is the period just after delivery. It begins immediately after child birth as mother’s body, including hormone levels and uterus size, returns to a non – pregnant state. Kanskyc (July 2016) and this term post-partum period is commonly used to refer to the first six weeks following child birth. Romano M, Cacciatore A (May 2010).

The delivery of a child brings about a variety of changes to the mothers health and wellbeing including fatigue, depression and changes in sexual function. Thompson JF, Roberts CL (2002). There are inconsistent reports concerning women’s sexuality after delivery. However reports often shows that interest in sexual activity often decrease throughout pregnancy, but eventually returns to normal post – partum with average resumption of intercourse, ranged between 5 weeks and 8 weeks after child birth. Byrd JE, Hyde Js, signorellol LB (2005).

Although it is a period of joy and great expectations for parents and their families as they look forward to getting to know and love a new healthy baby the period following child birth is accompanied by a critical phase in the lives of both the mother and their new born babies. Indeed, pregnancy and birth brings changes to the postpartum sexual health and wellbeing of mothers

World health Organization (2013)

Post-partum sexual activity is a common concern that is often not discussed during prenatal or post-partum care and has received little attention from their Clinicians or researcher. Consequently health promotion and education on post-partum sexual health is limited in current maternity care.

Leeman LM, Rogers RG (2012): O’Malley D, Higgins A, (2015).Especially in developing counties.

Abstinence from sexual intercourse after child birth until the child is fully weaned from breast feeding is a deeply rooted practice in cultures of different communities. Grudzinskas JG, Dada OA (2002) WHO (2009) recommends an adequate complementary feeding with continued breast feeding from age of six months up to the age of two years or beyond.

By six months only breast feeding is no longer sufficient to meet the nutritional requirements and complementary feeding becomes necessary. However breast milk remains to be a critical source of nutrients. Malnutrition during the early child hood can result in stunting and impaired intellectual performance. Pneumonia and diarrhea are more common and severe among children who are artificially fed in developing countries. Infants who are not breast fed are most likely to die in the first months. UNICEF Global Nutrition Targets (2019).

The World Association for sexology was pronounced an international declaration of sexual rights for alerting the world about these rights. In the declaration it is established that it is essential for a human being to have liberty of choice and automatic decisions about sexuality and family planning. Family planning according to Fathaua (2003) is a method that promote the mother and infant health by not conceiving again too soon after the last pregnancy. Even though sexuality is something that is important to emphasize within health care, it is identified by nurses and doctors as an embarrassing topic. Hulter (2004). These make them unsecure and unmotivated to talk about sexuality and they find it too complex to recognize it as a problem area. When handling such a topic reactions like laughing and censured answers are encountered. Hulter (2004)

The Health care system in Cameroon pays little much attention to maternal and family care after child birth. MOH (2000), referred in Mbekenga, and Olsson (2011) notwithstanding, after birth of the baby there are organized follow up plans for women using government facilities. There are existing programs where the women come back for maternal child health but these programs mainly focus on the infant. The new mothers need for knowledge and skills related to parenting are not being assessed by midwives Lugina, Christensson and Lindmark (2001). Nurses have a pedagogical role to develop patient’s knowledge. Historically the breast feeding period has been marked by myths and prescribed behaviors. Women abstained from their sexual life with their partner’s post-partum during breast feeding, because of concerns of getting contaminated breast milk. P. and Cleland.J (2010). Men on the other hand pressured the women to shorten the breastfeeding period so that they could resume sexual intercourse.

These beliefs are still an issue in some developing countries (Wambach and Riordan, 2010). Herdt (2006) clarified that some cultures associate breast milk with semen.

Elliston (2005) explained post-partum taboos of having sexual intercourse while the woman is breastfeeding as the semen will contaminate the breast milk and make the infant sick. Fathalla (2003) declared that traditional post-partum abstinence was observed in many African communities in order to avoid the destruction of the breast milk. Post-partum abstinence was described as a cultural norm whereby the breastfeeding mothers are expected to abstain from sex until the baby has been weaned (Achana, Debpuur, Akweongo and Cleland, 2010).  According to a study from CAMEROON, SOUTHWEAST REGION/MEME SUB-DIVISION (The Balong culture,) first time mothers and Fathers in low-income suburbs of BAI SOMBI VILAGE had feelings of uncertainty concerning sexuality in relation to breastfeeding (Mbekenga, et.al, 2011). The main reasons for waiting to resume sex were according to the breastfeeding – related taboos, to protect the health of mothers and baby, for birth spacing and in few cases religious prescriptions. They believed that sexual relations during the breastfeeding period “poisoned” the breast milk and destroyed the nutritive quality of it. As a consequence the child would get poor health. Local names were described for the illness that the child contracted through the breast milk called DIYOI (Which is described as a condition where the infants have poor development, difficulties in motor activities and ill health with diarrhea as a result from sexual intercourse during breastfeeding). There are three revealed mechanisms that can cause DIYOI: heat or sweat produced during sexual intercourse, sperms that entered and contaminated the breast milk and touching the baby after sexual intercourses without washing the body. However, the parents described other reasons to why DIYOI appears for example when the woman conceived during the breastfeeding period (Mbekenga et al., 2011). In low-income villages they believed that if lactating woman became pregnant the milk became bad and gave the child diarrhea, (Degree-du-lou and Brou, 2005). Another reason to why DIYOI appears was if the parents had extramarital sex (Mbekenga et al., 2011.

Archana et al. (2010) identified ill health to be one of two major risk factors associated with sex during post-partum; the other risk factor was pregnancy during the breastfeeding period. Study participants believed that having sex while breastfeeding would affect the baby’s health indirectly since poor space of pregnancies compels the mother to wean their baby prematurely.

They believed that the baby would die if the mother continued to breastfeed while she was pregnant. Even if the mother managed to avoid pregnancy they believed that the child would be sick.

And so parents tried to prevent DIYOL by abstaining from sexual intercourse during the breast feeding period until the child until the child was three to four years old Mbekangaetral (2011). Resent studied have shown that 89% of women resume sexual activity within six months after giving birth. Sexual dysfunction prevalence rates vary from 41% to 83% at 2-3 months post-partum. About 28% of breast feeding women and 22.9% of non-breast feeding women had sexual intercourse within one month of post-partum period. Previously women were culturally obliged to stay away from their husbands to breast feed for as long as 2 to 3 years, compared to resent reports which indicates that duration of post-partum abstinence is becoming considerably shortened to an average of six to eight weeks. Gynecologists new recommend waiting for up to 4 to 6 weeks after delivery to allow cessation of lochial loss and healing of episiotomies, tears and perinea injuries.

• Statement of Problem

Professional information about breast feeding is important to achieve a sufficient nutrition for the infant. It is also important to inform the parents about sexuality in relation to breast feeding to maintain sexual health after child birth. Research has shown that parents are not given sufficient information regarding breast feeding and sexuality at health centers Mbekenga, et al (2011). Patients “lack of knowledge” about this, is a problem that may threaten their sexual health.

It is important that parents obtain professional information about the benefits of breast feeding to ensure infants health and development. Moreover, it is important with adequate information about sexuality related to DIYOI to protect parents and infant health and wellbeing. The investigator witnessed a scenario during one of her clinical practice where a nursing mother rushed with her baby about 6 weeks old with purging and vomiting and also stated that “she had killed her baby with her own hand”. When asked why she said resumed sexual intercourse while breastfeeding and it has affected the baby. This made the investigator to find out if  truly resumption of sexual intercourse during breast feeding period had any effect on the breast milk and also if many women also thought in this same light ( that sexual intercourse affected breast milk).

• Research Questions

• What knowledge do breast feeding mothers have with respect to sexual intercourse during Lactation?
• What factors are associated with nursing mother’s resumption of sexual intercourse during breast feeding (Lactation).
• What are some of the challenges faced by breast feeding mothers on the practice resumption of sexual intercourse?
  • General Objective

To evaluate nursing mothers knowledge and perception as well as attitude on the practice of sexual intercourse during Lactation and its effect on the breast milk attending Infant Welfare Clinic. (IWC) at the Limbe District Hospital

 1.5 Specific Objectives

1) To assess the knowledge of women on what happens when having sexual intercourse during Lactation period.

1. ii) To identify the attitude, women exhibit on the resumption sexual intercourse during Lactation/breast feeding.

iii) To determine some of the challenges faced by breast feeding mothers on the practice of sexual intercourse post-partum.