Psycho-social factors influencing exclusive breastfeeding among the primigravida mothers at a public hospital in the Ugu District, KwaZulu-Natal, South Africa

Abstract

Satisfaction is one of the psychological benefits of exclusive breastfeeding (EBF). This behaviour encourages the mother to continue breastfeeding for up to two or more years. First-time mothers are generally inexperienced at motherhood, which affects breastfeeding initiation and intent. They need frequent professional and social support that must be clinically practical for successful EBF outcomes. Aim of the study The aim of the study was to explore the psychosocial factors influencing exclusive breastfeeding among primigravida mothers at a public hospital in the uGu District, KwaZulu-Natal (KZN), South Africa, using Bandura`s Self-efficacy model as a theoretical framework to promote, support and sustain EBF. Methodology An explorative qualitative design was used in the study. Eleven primigravida mothers from the postpartum ward, aged 18 years and above, who had attended antenatal clinics (ANCs) and delivered at the selected hospital setting, were nominated for the study using purposive sampling. The participants were from day one to day four post-delivery, and all were South African Nationals who belonged to two race groups, namely two Indians and nine Blacks. The ethnicity of Indian participants was Hindu and Muslim, and Zulu and Xhosa for the Blacks. Four participants were HIV-positive. Semi-structured one-on-one interviews, with an interview guide containing demographic sections and the main question to focus the discussion were used. The interview questions were based on Bandura’s Self-efficacy model. Data was collected until data saturation was reached. An accredited research assistant was recruited from the hospital to assist with the language translation of isiZulu to English and English to isiZulu during the interviews. The translation of isiXhosa was not required as the participants were able to understand and speak isiZulu as well. Creswell`s six steps of qualitative thematic analysis were used to analyse the data. Findings Based on Bandura's Self-Efficacy and Social Cognitive Theoretical (SCT) framework, the study has shown that personal, social, and environmental factors strongly influenced maternal attitudes towards breastfeeding efficacy. Five significant themes that emerged from the data analysis were (a) factors influencing maternal self-efficacy, (b) challenges to EBF, (c) cultural influence on EBF, (d) the role of support systems to EBF, and (e) breastfeeding support strategies. Conclusion This study recognized psychosocial and demographic factors influencing breastfeeding efficacy among primigravida mothers. The data suggests the need for critical clinical interventions to be applied by health care workers at health care facilities, policymakers, the Department of Health, the Department of Education, the Department of Labour, the Department of Social Services, and Employers if South Africa wants to reach the global nutritional target of 50% EBF by 2025. In addition, family and partner involvement in education programmes, improved antenatal care services and quality of EBF educational material hand outs, effective utilization of waiting times at Antenatal Centres and implementation of long-acting contraceptives, and sexual reproductive health teachings by school health nurses at schools are among the recommendations to improve EBF practice.