Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

Clinical Epidemiology and Global Health

journal homepage: www.elsevier.com/locate/cegh

Effectiveness of educational intervention on breastfeeding among primi

pregnant women- a longitudinal study
Renuka Ma, Nayanabai Shabadia,∗, Praveen Kulkarnia, D. Sunil Kumara, G. Anupb,
M.R. Narayana Murthya
a
Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
b
Bioclinica Inc, India

A R T I C LE I N FO A B S T R A C T

Keywords: Background: Breast milk is a unique source of nutrition. All mothers can adequately and appropriately breastfeed
Antenatal care when they have accurate information and skilled practical help.
Breastfeeding education Objectives: 1. To assess the knowledge and attitude of breastfeeding among primi Pregnant women attending
Exclusive breastfeeding antenatal clinic. 2. To assess the effect of educational intervention on knowledge, attitude and practice among
Educational intervention
women after delivery.
Materials and methods: a prospective intervention study was conducted involving 70 primigravidae women at-
tending the antenatal clinic of JSS Hospital, Mysuru. Baseline knowledge and attitude towards Breastfeeding was
assessed, and socio-demographic details were collected. Breastfeeding Education was given through a printed
booklet in local language for this study purpose. The women were followed up for three times post-delivery,
within one week, at the end of 3rd month and 6th month of delivery.
Results: Pre-intervention knowledge was found to be poor in all the participants; the statistically significant
difference in knowledge and attitude level was found between three follow up. After the delivery, 58.6% of
mothers initiated breastfeeding within 1 h, 17.1% gave prelacteals and 90% of mothers fed colostrum. At six
month exclusive breastfeeding, complementary feeding and bottle feeding was followed by 45.7%, 48.6% and
35.7% of mothers respectively.
Conclusion: knowledge of breastfeeding benefits and correct method has to be given to the women during
pregnancy itself to empower and encourage them to follow the exclusive Breastfeeding and proper infant feeding
practices.

1. Introduction with decreased risk of breast and ovarian cancers and hip fractures later
in life.6 The beneficial effects of Breastfeeding depend on breastfeeding
“Breast milk is the best milk” an age-old saying holds good even initiation, its duration and age at which complementary feeding is
today. started.
WHO recommends exclusive Breastfeeding for the first six months
Breastfeeding is a unique source of nutrition; it provides adequate
followed by the introduction of semisolid & solid foods to complement
and essential nutrients for infant's growth and development, protects
breast milk and to continue breastfeeding until at least two years of age
the infants against infections and ensures chances of survival. The
or more.7
benefits of Breastfeeding, especially exclusive Breastfeeding, are well
Though Breastfeeding is universal in India, despite its countless
established.1,2 It provides numerous immunologic, psychological, so-
benefits to children, mothers and community at large, exclusive
cial, economic and environmental benefit.3
breastfeeding rate in our country remains below the desirable level,
Breast-milk has a significant positive impact on child growth and
46.3% (National Family Health Survey-3).8
development and decreases the risk for many acute and chronic dis-
Breastfeeding is a natural act and also a learned behaviour.
eases.4 including infections such as diarrhoea and respiratory tract in-
Unfortunately, many mothers and newborns do not receive the help
fections during infancy.5 It also imparts benefits on the mother, such as
they need to initiate Breastfeeding within 1 h, and to practice exclusive
reduced post-partum bleeding and early uterine involution, coupled

∗
Corresponding author.
E-mail addresses: [email protected], [email protected] (N. Shabadi).

https://doi.org/10.1016/j.cegh.2020.05.002
Received 21 March 2020; Received in revised form 27 April 2020; Accepted 1 May 2020
2213-3984/ © 2020 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of INDIACLEN.

Please cite this article as: Renuka M, et al., Clinical Epidemiology and Global Health, https://doi.org/10.1016/j.cegh.2020.05.002
R. M, et al. Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

Breastfeeding during the first six months. All mothers can adequately Questions were also asked to know their attitude for insufficient milk
and appropriately breastfeed when they have accurate information, secretion, bottle feeding, food fads, etc. In the same visit, the educa-
skilled practical help and support through their families, communities tional material about Breastfeeding, which was developed in local
and health care system. The practical advice can build mothers' con- language Kannada for the purpose of this current study, was given to
fidence, improve feeding technique and prevent/resolve breastfeeding the pregnant women. They were also explained about the subsequent
problems; inturn prevents breast conditions like sore nipples and mas- three follow-ups. For this purpose information about contact details of
titis, which usually arise due to lack of correct breastfeeding techni- participant, her husband and father/mother, expected delivery date
ques. was collected.
Lack of confidence in mothers' ability to breastfeed, problems with
the infant latching or suckling, breast engorgement/soreness, percep- 3.6. Health education material/booklet
tions of insufficient milk supply, and lack of individualised counselling
in the antenatal period and early post-partum period are some of the The booklet was in local language Kannada. It includes information
factors that result in reduced breastfeeding rate. Some of these pro- regarding.
blems can be overcome if the woman is informed during the antenatal
period about the proper technique.9,10 1 Benefits of breastfeeding to the baby and to the mother.
Therefore, the present study was conducted to know the impact of 2 Exclusive breastfeeding.
educating pregnant women about breastfeeding practices during the 3 Importance of feeding colostrum.
antenatal period. 4 Pre-lacteal feeds: ill effects of feeding pre-lacteal feeds.
5 Correct way of latching (with pictures) and position of mother and
2. Objectives baby during breastfeeding (with pictures).
6 Adverse effects of bottle feeding.
1 To assess the knowledge and attitude of breastfeeding among primi 7 Ways to identify that the baby is fed adequately.
Pregnant women attending antenatal clinic. 8 ways to feed Expressed milk: helping working mothers.
2 To assess the effect of educational intervention on knowledge, at- 9 Table with pictures showing when to initiate Complementary
titude and practice among women after delivery. feeding: foods preferred, amount of food to be given, consistency of
food, hygiene to be followed during feeding.
3. Methodology
Fig. 1 shows the steps in educational intervention and data collec-
3.1. Design tion during successive follow up.

It was a prospective interventional study. Education regarding 3.7. Data analysis

Breastfeeding was given to the pregnant women through a written
booklet which was developed in local language Kannada for this study For assessing the effect and statistical significance of written edu-
followed by a post-delivery assessment of breastfeeding education for cational material on knowledge and attitude scores between pre-test to
the adequate and appropriate feeding of the newborn and infant. the post-test level throughout three follow up, a non-parametric test
Friedman test was used. For assessing the practice level proportions
3.2. Setting were used for three follow up. Socio-demographic details were assessed
using percentages. Statistical significance was considered at p level <
The study was conducted in the outpatient Department of Obstetrics 0.05.
and Gynecology, JSS Medical College and Hospital, Mysuru, Karnataka
state of India. 4. Results

3.3. Sample size A total of 73 people were included in the study. Three women were
lost for follow up during the study; therefore, the total women added for
Considering the prevalence of exclusive Breastfeeding given by the final analysis was 70.
Dhandapany9 prevalence of Exclusive Breastfeeding among mothers Table 1 shows Among the study participants, the majority of
who got antenatal counselling regarding breastfeeding as 78%. At 95% women, i.e. 38 (54.3%) were in the age group of 21–25 years. 21
confidence level and allowable error of 10%, and taking 10% as buf- (30.0%) belonged to middle socio-economic class according to Modified
fering, a total of 73 people were included in the study. B.G. Prasad classification. All mothers in the study were literate, and 32
(45.7%) had studied up to high school, and 23 (32.8%) had studied up
3.4. Sample to PUC. Among the study participants, 62 (88.6%) of them were
homemakers. Majority of them, 39 (55.7%) belonged to joint family
Primigravida, gestational age of ≥28 weeks and having singleton and most of them, 63(90%) were Hindu by religion.
pregnancy and who were able to read the Kannada language were in- Table 2 shows the knowledge regarding Breastfeeding among
cluded, and women with high-risk pregnancy were excluded from the pregnant women, 68.7% of them did not know when to start breast-
study. feeding after birth, and only 2.8% knew it must begin within 1 h after
birth. 22.8% of women knew that exclusive Breastfeeding for six
3.5. Data collection months. 5.7% said that colostrum food should be given to babies.
77.1% of women did not know about feeding the colostrum. Regarding
After obtaining informed written consent from the participants, the duration of Breastfeeding, 7.1% of mothers said it must continue till
their socio-demographic details and pre interventional knowledge and two years of age, and 5.7% of the mother said to continue as many years
attitude on Breastfeeding were assessed using pre-tested structured as possible, but 57.1% of women did not know about duration. 48% of
questionnaire. The questionnaire included questions regarding time of women stated at least two benefits of breastfeeding for mothers, 55.7%
initiation of Breastfeeding after delivery, prelacteal feeds, colostrum of women reported at least two advantages for children. 30.0% of
feeding, and benefits of breastfeeding for mother and child, duration of women said prelacteal food should be given to the baby. 22.8% of
exclusive Breastfeeding and introduction of complementary feeding. pregnant women knew that they must start complementary feeding at

2
R. M, et al. Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

Fig. 1. Flow diagram of Data collection.

Table 1 the women feel that mother and child bonding will be better with
Socio-demographic characteristics of the study participants (n = 70). breastfeeding. 40% women strongly agree and 45.7% agree for re-
Variables Frequency(No) Proportion (%)
striction of certain foods during breastfeeding. Around 23% of women
Age (in Years) agree and 11.4% of women strongly that prolonged breastfeeding dis-
15–20 31 44.3 figures the breast.
21–25 38 54.3 Fig. 2 shows that, pretest knowledge of pregnant women regarding
26–30 01 01.4
breastfeeding was poor. After the educational intervention at first
Socio-Economic Class
Upper 11 15.7 follow up 80% of women had good knowledge. At second and third
Upper middle 13 18.6 follow up 87.1% and 85.7% of the women had good knowledge re-
Middle 21 30.0 spectively.
Lower middle 19 27.1 In Table 4 The knowledge scores obtained were classified as good if
Lower 06 08.6
Education
more than seven and poor if less than or equal to seven. The baseline
Primary school 03 04.2 knowledge at 1st visit, of all the women in the study, was poor re-
Middle school 10 14.3 garding Breastfeeding before the intervention. At first, follow up during
High school 32 45.7 the hospital stay- 56(80%) of women had good knowledge, At second
PUC 23 32.8
follow up at three months after delivery, the knowledge level was good
Graduate 02 02.8
Occupation in 61(87.1%), at third follow up at the end of sixth months following
Working 08 11.4 delivery, knowledge level was good among 60(85.7%) of mothers, In
Homemaker 62 88.6 Table 5 shows among study participants, 87.1% had positive attitude
Family type regarding Breastfeeding. 92.9%, 85.7%, 75.7% of mothers had a posi-
Nuclear family 31 44.3
Joint family 39 55.7
tive attitude towards Breastfeeding during the 1st, 2nd and 3rd follow
Religion up, respectively.
Hindu 63 90.0 Table 6 shows 41(58.6%) mothers initiated breastfeeding within 1 h
Muslim 05 07.1 after delivery. 12(17.1%) of babies were given prelacteal feeds. Co-
Others 02 02.9
lostrum was fed to 63(90%) babies.
Majority of mothers 58(82.9%), 55(78.6%) and 49(69.7%) followed
Exclusive Breastfeeding at one week, three months and six months re-
six months.
spectively. Demand feeding was followed by 54(77.1%), 55(78.6%), 58
Table 3 shows, 42.8% of pregnant women believe that insufficient
(82.9%) mothers respectively at 1st,2nd and 3rd follow up. Majority of
milk secretion is the reason for baby not getting milk while sucking.
mothers (74.3%) followed the correct position during Breastfeeding,
12.8% agree that bottle feeding is better than beastfeeding. Majority of
and 65.7% of mothers followed the correct position as well as latching

3
R. M, et al. Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

Table 2 Table 3
Pretest Knowledge status of Pregnant women regarding Breastfeeding (n = 70). Pretest Attitude of Pregnant women regarding Breastfeeding (n = 70).
Sl. No Particulars Number Percentage (%) Sl. No Particulars Number Percentage

1. When to start breastfeeding after birth 1. If the baby is not getting the breast milk on
a) < 1hr 02 02.8 sucking, it is always due to insufficient milk
b) 1–6 h 10 14.3 secretion in the mother.
c) 6–12 h 06 08.6 a) Strongly agree 06 8.5
d) 12–24 h 02 02.8 b) Agree 30 42.8
e) > 24 h 02 02.8 c) Neither 23 32.8
f) don't know 48 68.6 d) Disagree 11 15.7
2 Duration of exclusive Breastfeeding e) Strongly disagree – –
a) 6 months 16 22.8 2 Bottle feeding is better than Breastfeeding
b) < 6 months 21 30.0 a) Strongly agree – –
c) > 6 months 23 32.6 b) Agree 09 12.8
d) don't know 10 14.3 c) Neither 24 34.3
3 Colostrum should be given at birth to the baby d) Disagree 30 42.8
a) Yes 04 05.7 e) Strongly disagree 07 10
b) No 12 17.1 3 Mother and child bond is better with
c) Don't know 54 77.1 Breastfeeding
4 How long baby should be breastfed? a) Strongly agree 24 34.3
a) < 2year 21 30.0 b) Agree 28 40
b) 2 years 05 07.1 c) Neither 17 24.3
c) Continue as long as possible 04 05.7 d) Disagree 01 1.4
d) don't know 40 57.1 e) Strongly disagree – –
5 Benefits for mother from Breastfeeding (at 28 40.0 4 Certain foods have to be avoided during
least two) Breastfeeding
6 Benefits for baby from Breastfeeding (at least 39 55.7 a) Strongly agree 28 40
two) b) Agree 32 45.7
7 can you give Prelacteals to the baby? c) Neither 06 8.5
a) Yes 21 30.0 d) Disagree 03 4.2
b) No 08 11.4 e) Strongly disagree 01 1.4
c) Don't know 41 58.6 5 Prolonged Breastfeeding disfigures the breast
8 Is using katori or spoon-feeding is better than bottle feeding? a) Strongly agree 08 11.4
a) Yes 08 11.4 b) Agree 16 22.8
b) No 04 5.7 c) Neither 34 48.5
c) Don't know 58 82.8 d) Disagree 12 17.1
9 If the mother is working, can expressed breast milk be given? e) Strongly disagree – –
a) Yes 05 7.1
b) No 04 5.7
c) Don't know 61 87.1
baby and same with prelacteal feeds.
10 at what age we can start Complementary feeds?
a) 6 months 16 22.8
The study by Ekambaram et al. similarly reports about inadequate
b) < 6months 33 47.1 knowledge of mothers regarding the time of initiation of Breastfeeding
c) > 6 months 10 14.3 (92%), colostrum feeding (56%), duration of exclusive Breastfeeding
d) Don't know 11 15.7 (38%), knowledge on expressed breastmilk (51%) and continuation of
Breastfeeding while the baby is sick.11 80%, 87.1% and 85.7% of mo-
thers had good knowledge at 1st, 2nd and 3rd follow up respectively.
of the baby to the breast. Regarding complementary feeding 18(25.7%)
The knowledge score after the intervention has increased, and the
of mothers started it at 3rd month and 21(30.0%) mothers practised
change is statistically significant. A study was done in Puducherry also
bottle-feeding practices at 3rd month and 25(35.7%) mothers at six
reports that women who had received antenatal counselling about
months.
Breastfeeding, had better awareness regarding Breastfeeding compared
to non-counselled mothers.9
5. Discussion In the present study, before the intervention, 87.1% of women had a
positive attitude regarding Breastfeeding. Even though knowledge of
Breastfeeding is a cost-effective public health measure that has a the women was poor, but they had a positive attitude towards
significant impact on infant morbidity and mortality. In a country with Breastfeeding, which indicates the majority of women want to breast-
limited healthcare resources like India, developing an effective breast- feed their children. Still, there exists a lack of access to the right in-
feeding promotion and support intervention that is easily replicated formation and awareness about breastfeeding in the community closer
across various settings becomes a priority. The present study would to pregnant women. In the present study, we can observe that mothers
provide a generalizable model to improve breastfeeding promotion ef- with a positive attitude are decreasing from 1st follow up through the
forts and contribute to improved child health. 3rd follow up, despite having a better knowledge at baseline visit. The
In the present study, 58.6% of women were in the age group of most common reasons quoted for their change in attitude towards
21–25 years. Majority of them belonged to the Hindu religion. Breastfeeding was feeling of insufficient milk secretion, the baby would
Even though all the pregnant women in the study had more than not be healthy, the baby would not gain sufficient weight with
four antenatal checkups before enrolling into the study, their knowl- breastfeeding alone until six months. The other reasons cited were the
edge regarding Breastfeeding was found to be poor. This implies a influence of the elderly in the family and the complications like breast
failure on the part of the health system, creating a missed opportunity engorgement, sore nipples during feeding.
to educate women about breastfeeding at their most receptive antenatal Therefore there is a need for timely reinforcement of information of
visits. Similar observations were seen in a study by Ekambaram et al.11 breastfeeding to the mothers and family and regular post-partum visits
Majority of mothers did not know when to start breastfeeding after for addressing the problems of the mother and the baby.
birth and for how many months the baby should be exclusively In our study, 58.6% of mothers initiated Breastfeeding in less than
breastfed. The women also did not know whether to feed colostrum to 1 h, which is high compared to the national average of 31.1% according

4
R. M, et al. Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

Fig. 2. Comparison of Good Knowledge of breastfeeding before and after the intervention(n = 70).

Table 4 to NFHS-3 data.12 A study conducted by Mria Sandor and Koustuv Dalal
Association of Knowledge status during Pre and Post-intervention (n = 70). showed that the Education level, economic status, place of delivery and
Visits Knowledge status
prenatal visits to health care facilities are essential factors influencing
time of initiation of breastfeeding.19 A study conducted by Owais shows
Median Interquartile Range Pa that mothers who got antenatal counselling, 96% of them initiated
breastfeeding within 1 h and those did not get the counselling 84%
Pre-intervention (Baseline 01 0–3 < 0.001
Knowledge)
them initiated within 1 h.13
1st follow up(Within one week) 10 8–11 In our study, the magnitude of colostrum feeding to babies was
2nd follow up(Third month) 10 8–11 90%. A study done on the promotion of Breastfeeding showed that
3rd follow up(Sixth month) 10 9–11 colostrum was given by 97% of mothers in the intervention group
a compared to the control group (30%).14 In yet another study on the
Friedman Test.
effect of breastfeeding education programme, significantly more ex-
perimental mothers (p < 0.001) reported giving colostrum to study
Table 5
infants compared to their previous children.
Association of Attitude status during Pre and Post-intervention (n = 70).
In the present study, 17.1% of mothers had given prelacteal feeds to
Visits Attitude status their babies, Ghutti, honey, and animal milk were the commonly used
pre-lacteal feeds in the present study. Honey and water were commonly
Median Interquartile range Pa
used as a pre-lacteal feed in rural West Bengal as reported by Mandal
Pre intervention (Baseline attitude) 11 10–12 0.01 et al. .15
1st follow up(Within one week) 12 10–13 In the present study, Exclusive breastfeeding prevalence was 82.9%,
2nd follow up(Third month) 12 10–13
78.6%, 69.7% in the first week after birth, 3rd month and 6th month,
3rd follow up(Sixth month) 12 9.7–13
respectively. According to NFHS-3 data, Children who were exclusively
a
Friedman Test. breastfed (0–5 months) in national level is 46.3% and in Karnataka
state was 59%.15 A study on breastfeeding practices in villages of
Table 6 central Karnataka which studied 1050 infants aged between 0 and 24
Breastfeeding practice during three follow up (n = 70). months found that Exclusive Breastfeeding was noted in 94% at 1st
month, 83.5% at 2nd month, 72.5% at 3rd month, 61.2% at 4th month,
Variables 1st follow up 2nd follow up 3rd follow up
43.4% at 5th month and 26.8% at 6th month of age.16
Time of Initiation of 41 (58.6%) NA NA A systematic review study on intervention studies shows that com-
Breastfeeding pared to lactation consultation plus a Breastfeeding booklet with the
<1 h provision of a BF booklet alone reported no significant differences be-
Prelacteal feeds given 12(17.1%) NA NA
tween the two groups in EBF rates at three months (RR 0.85, 95% CI
Colostrum is given 63(90%) NA NA
Exclusive Breastfeeding followed 58(82.9%) 55(78.6%) 49(69.7%) 0.68 to 1.08).17 According to another study, there was a marginally
Demand feeding practised 54(77.1%) 55 (78.6%) 58 (82.9%) significant increase in exclusive BF at six months in a group receiving a
Correct Position of the mother 52(74.3) 55(78.6%) 56(80.0%) booklet plus video plus lactation consultation (LC) compared with the
followed
booklet plus video group. A BF booklet plus video plus LC was sig-
Correct Position and latching of 46(65.7%) 56(80.0%) 55 (78.6%)
the baby
nificantly better than no formal BF education for exclusive BF at three
Complementary feeding started 0 18(25.7%) 34(48.6%) months (RR 2.23,95% CI 1.01 to 4.92)17. Similar to the present findings
Bottle feeding practised 0 21(30.0%) 25(35.7%) in a study conducted by Rajesh K Chudasama et al. reported that Pre-
valence of Exclusive Breastfeeding at three months was 97% which
declined to 62% by six months of age of infants. Bivariate analysis

5
R. M, et al. Clinical Epidemiology and Global Health xxx (xxxx) xxx–xxx

revealed no significant association between the interruption of ex- infant feeding practices on infection-specific neonatal mortality: an investigation of
clusive Breastfeeding before six months of age and various demo- the causal links with observational data from rural Ghana. Am J Clin Nutr. 2007
Oct;86(4):1126–1131.
graphic, socio-economic, maternal and infant characteristics.18 2. Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and
In the present study, 2.9% of mothers started complementary feeds regional exposures and health consequences. Lancet Lond Engl. 2008 Jan
like formula feeds and animal milk to the babies, within the first week 19;371(9608):243–260.
3. Agostoni C, Grandi F, Gianni M, et al. Growth patterns of breast fed and formula-fed
of birth. The reason was the babies had low birth weight and were kept infants in the first 12 months of life: an Italian study. Arch Dis Child [Internet]. 1999
in NICU for a prolonged period after which the mother failed to lactate. Nov. [cited 2015 Oct 5];81(5):395–9. Available from:. http://www.ncbi.nlm.nih.
At 3rd month and 6th month, 25.7% and 48.6% of mothers started gov/pmc/articles/PMC1718130/.
4. Food and Nutrition Bulletin - Volume 17. . Number 4, December 1996 [Internet].
complementary feeds respectively. In a Randomised control study of [cited 2015 Oct 5]. Available from:. http://archive.unu.edu/unupress/food/8F174e/
antenatal preparation for improving Breastfeeding, found that the mean 8F174E0h.htm.
age at which infants were complemented with solids was 17.24 weeks. 5. Jalil F, Karlberg J, Hanson LA, Lindblad BS. Growth disturbance in an urban area of
Lahore, Pakistan related to feeding patterns, infections and age, sex, socio-economic
In the group received a breastfeeding hand out, video and one session of
factors and seasons. Acta Paediatr Scand Suppl. 1989;350:44–54.
lactation counselling started complement any feeding at 17.04 ± 3.6 6. Eidelman AI, Schanler RJ, Johnston M, et al. Breastfeeding and the use of human
weeks, mothers who received only hand out and video started solids at milk. Pediatrics [Internet]. 2012 Mar 1. [cited 2015 Oct 5];129(3):e827–41. Available
17.75 ± 4.6 weeks, and infants in the group who did not receive any from:. http://pediatrics .aappublications.org/content/129/3/e827.
7. Organisation WH. UNICEF. Global Strategy for Infant and Young Child Feeding.
intervention started solids at 16.95 ± 3.1 weeks. The difference in [Internet]. World Health Organization; 2003. [cited 2015 Oct 5]. Available from:.
these groups was not statistically significant (P = 0.313). http://books.google.com/books.
In the present study, bottle feeding practice was not seen at the end 8. . India_volume_I_corrected_17oct08.pdf [Internet]. [cited 2015 Oct 5]. Available
from: http://rchiips.org/nfhs/NFHS-3%20Data/VOL-1/India _volume_I_corrected
of the first week but its seen in 30%, and 35.7% at 3rd month and 6th _17oct08.pdf.
month respectively. According to NFHS-3 data, the prevalence of bottle 9. Dhandapany G, Bethou A, Arunagirinathan A, Ananthakrishnan S. Antenatal coun-
feeding in the country is 14.8%.15 Over one-third of study participants selling on Breastfeeding - is it adequate? A descriptive study from Pondicherry. India
Int Breastfeed J [Internet]. 2008. [cited 2015 Oct 5];3(1):5. Available from:. http://
using bottle feeding at the end of the third and sixth month in spite of www.internationalbreastfeedingjournal.com/content/3/1/5.
good knowledge about hazards of bottle-feeding calls for reinforcing 10. WHO | Indicators for Assessing Infant and Young Child Feeding Practices [Internet].
that component in education to ensure that none use bottle feeds except WHO. [cited 2015 Oct 3]. Available from: http://www.who.int/nutrition/
publications/infant feeding/9789241599757/en/.
when it's necessary on any medical conditions. 11. Ekambaram M, Bhat VB, Asif Padiyath Ahmed M. Knowledge, attitude and practice
of breastfeeding among postnatal mothers. Curr Pediatr Res [Internet. 2010;14(2).
6. Conclusion 12. Ishak S, Adzan NAM, Quan LK, Shafie MH, Rani NA, Ramli KG. Knowledge and
beliefs about breastfeeding are not determinants for successful breastfeeding.
Breastfeed Med [Internet. 2014 Jun 3;9(6):308–312. Available from: http://online.
The educational intervention has clearly made improvement in the liebertpub.com/doi/abs/10.1089/bfm.2013.0124.
initiation of breastfeeding within 1 h after birth and colostrum feeding 13. Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal counselling
practice. It has shown a little improvement in the practice of exclusive on exclusive Breastfeeding. J Ayub Med Coll Abbottabad [Internet.
2012;24(2):116–119. Available from: http://www.ayubmed.edu.pk/JAMC/24-2/
Breastfeeding, increasing the age of introduction of complementary Owais.pdf.
feeds. 14. Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Antenatal
Even with poor knowledge of the women before the intervention Breastfeeding Education for Increasing Breastfeeding Duration. [Internet]. Cochrane
Database Syst Rev. 2011 Nov 9. [cited 2015 Nov 22];(11):CD006425. Available from:.
they had a positive attitude towards the Breastfeeding, which indicates http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164447/.
the majority of women want to breastfeed their children, but there is 15. International Institute for Population Sciences (IIPS) and Macro International.
lack of access to the right information and awareness about breast- National Family Health Survey (NFHS-3), 2005–06: India. ume I. Mumbai: IIPS; 2007.
16. Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal counselling
feeding to the pregnant women. Therefore there is the need for regular on exclusive Breastfeeding. J Ayub Med Coll Abbottabad [Internet.
antenatal education on breastfeeding to the pregnant women. 2012;24(2):116–119. Available from: http://www.ayubmed.edu.pk/JAMC/24-2/
Owais.pdf.
17. Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal counselling
Funding
on exclusive Breastfeeding. [Internet]. J Ayub Med Coll Abbottabad. 2012. [cited
2015 Nov 27];24(2):116–9. Available from:. http://www.ayubmed.edu.pk/JAMC/
None. 24-2/Owais.pdf.
18. Chudasama RK, Amin CD, Parikh YN. Prevalence of exclusive Breastfeeding and its
determinants in first six months of life: a prospective study. Online J Health Allied Sci.
Declaration of competing interest 2009;8(1):3.
19. Sandor M, Dalal K. Influencing factors on time of breastfeeding initiation among a
nationally representative sample of women in India. Health (N Y) [Internet]. 2013
None. Dec 5 05(12):2169. Available from: http://www.scirp.org/journal/
PaperInformation.aspx?PaperID=41458&#abstracthttp://www.scirp.org/journal/
References PaperInformation.aspx?PaperID=41458&#abstract.

1. Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early