Infant Feeding Knowledge and Practices of Mothers with 6–24-Month-Old Babies in the “Baby-Friendly City” of Diyarbakir

Abstract

Objective:

This study examined factors related to breastfeeding behavior of mothers in the “Baby-Friendly City” of Diyarbakir, Turkey.

Subjects and Methods:

The study was cross-sectional. The cluster sample technique was used in which 992 mothers from 50 clusters were contacted. Data were collected by face-to-face interview. The breastfeeding behavior of the mothers and the demographic variables affecting such behavior were recorded and collected. Analysis was performed by χ² test, and logistic regression used to estimate relative risks and 95% confidence intervals (CIs).

Results:

We found that 78.3% of the mothers breastfed their babies for the first 6 months and that 92.4% gave their babies colostrum. The risk of not giving colostrum increased 2.7-fold (95% CI=1.25–5.75) in mothers giving birth at home compared with those giving birth in a hospital (p=0.011). The same risk increased 3.99-fold (95% CI=2.00–7.93) in mothers with no knowledge of breastfeeding compared with mothers instructed on the subject by health professionals (p<0.0001).

Conclusion:

The breastfeeding behavior on the part of mothers giving birth with the help of healthcare personnel and receiving information on the subject is positive.

Introduction

The Turkish Ministry of Health has been implementing a “Breast Milk Promotion and Baby-Friendly Hospitals Program” since 1991 for the purpose of encouraging breastfeeding. The objective of the program is to ensure that mothers start to breastfeed their babies early with the help of trained healthcare personnel and to support them in continuing breastfeeding. The Ten Steps to Successful Breastfeeding are implemented in “Baby-Friendly” hospitals. These steps are recommended by the World Health Organization and UNICEF.¹

The concept of the “Baby-Friendly City” has also been translated into reality. In order to become a “Baby-Friendly City,” all the hospitals that provide childbirth services in the provincial center have to be “Baby-Friendly,” and 20% of village clinics and mother and child care and family planning centers must have breastfeeding rooms and trained healthcare personnel so mothers can be given breastfeeding advice. These healthcare organizations do not advertise supplementary foods or baby formulas. Supplementary foods and baby formulas are not given for the first 6 months, and the pharmacies in the region are informed accordingly. Cities that fulfill all of these requirements are awarded the title of “Baby-Friendly City.”²

Despite these improvements, suboptimal practices in breastfeeding are still to be found in Turkey. Such behavior includes not giving colostrum, or giving other foods or liquids (besides breastfeeding) before 6 months of age, which may result in children being insufficiently nourished.^3,4 Studies demonstrating that healthcare personnel do not provide adequate support in encouraging breastfeeding have also been published.^4–8

One study of breastfeeding behavior in 2000 determined that mothers exhibited suboptimal baby feeding practices and that healthcare personnel did not show sufficient interest in the subject. Thanks to training and other measures taken subsequently, the city of Diyarbakir was awarded “Baby-Friendly City” status in 2004. During that time, mothers were offered breastfeeding education in the Departments of Gynecology and Pediatric Surgery and Pediatrics of maternity hospitals, children's hospitals, and university hospitals in the city. The medical staff in the city were also given training. Mother support groups were organized, and the village clinics in the region started to provide training. These training courses were held twice a year. Healthcare personnel working in maternity wards, pediatric services, and clinics were offered training courses. These are repeated twice a year, and it is a first priority for newly appointed healthcare personnel to attend these training courses. Hospitals awarded “Baby-Friendly” status are inspected once a year by the provincial supervisory board, consisting of five members. During these inspections, criteria involved in the maintenance of “Baby-Friendly Hospital” status are evaluated. Mothers who give birth at the hospital concerned or apply to it for any reason are also interviewed, for the purpose of determining whether or not they have been given accurate information.

The objective of this study was to analyze the effects of “Baby-Friendly City” activities in Diyarbakir on the breastfeeding behavior of mothers. Our goal was to determine the breastfeeding and baby-feeding practices of mothers with 6–24-month old babies in Diyarbakir City, to determine their knowledge and behavior and the reasons for suboptimal practices and to clarify the changes in breastfeeding knowledge and practices after the city was declared “Baby-Friendly.”

Subjects and Methods

This cross-sectional study was conducted in the Diyarbakir provincial center, Turkey, using the cluster sample technique. Fifty village clinics and mother and child care and family planning center regions located in the Diyarbakır provincial center were regarded as a cluster, and we decided to contact 20 mothers from each cluster. All streets and districts were enumerated using the village clinic or mother and child care and family planning center region records. The decision whether to visit a street was made from a table of random numbers. Selection of with which house to start in the street or district to be visited was made by lot. Visits were paid in a particular street or district until 20 mothers in the cluster with a baby under 2 years old and who agreed to take part in the research had been identified. In this way, 1,000 mothers were finally contacted. While data were being entered onto the computer, we realized that data for eight mothers were incomplete, and these were thus excluded from the research. As a result, data from 992 mothers constituted the main subject of the study. In calculating the sample size, we used the Epi Info™ 2000 package (Centers for Disease Control and Prevention, Atlanta, GA). We calculated sample size on the following bases: margin of error was set at 0.05, confidence level at 95%, and estimated prevalence at 50%.

This article provides analyses and results for “giving only breastmilk for the first 6 months” and “giving colostrum.” Those mothers who fed their younger babies by breastfeeding alone and rarely with water during the first 6 months were included in the category of “giving only breastmilk for the first 6 months.” On the other hand, those mothers who gave colostrum to their baby without giving water, sugared water, herbal tea, etc., were included in the category of “giving colostrum.”

Data were collected between January and March 2008 by face-to-face interview with mothers through a data collection form developed by the authors. During the surveys, names were asked for, and mothers were told they could cease answering the questions whenever they wanted. In addition, mothers were informed about the research, and their “informed consent” was obtained. All procedures followed were in accord with the ethical standards of the relevant institutional committee. Because this study was based on interviews there was no need to have it reviewed by an ethical institution. The Dicle University Institute of Science for Public Health reviewed the study and decided that it was exempt from Institutional Review Board review.

All data were recorded and evaluated. The frequency of breastfeeding behavior and the frequency distribution of the factors affecting such behaviors were calculated. The χ² test was used in the analysis of the relationship between “giving breastmilk for the first 6 months” and “giving colostrum” and mothers' place of residence (whether shanty or urban), educational background, employment status (working or not), age, location of the most recent birth, number of children the mother had, presence of an older person at home (such as an infant's grandmother), acquisition of information about breastfeeding by the mother, and the gender of the baby. Corrected risks of various factors affecting breastfeeding behavior and the 95% confidence intervals (CIs) of these risks were calculated using logistic regression analysis.

Results

Table 1 shows various demographic characteristics and figures for “feeding only breastmilk for the first 6 months.” Of the respondents, 793 mothers (79.9%) lived in the provincial center, 328 (33.1%) were not literate, and 60 (6.0%) were college graduates. Eight hundred ninety-four (90.1%) did not work outside the home. Nine hundred eighteen of the mothers who participated (92.5%) gave birth with the help of healthcare personnel; 79.7% of the mothers who gave birth with the help of healthcare personnel (732 mothers) fed their babies only with breastmilk during the first 6 months. In terms of age, 17 (1.7%) of the mothers were adolescents (younger than 19 years old), 321 (32.4%) were between 25 and 29 years old, and 68 (6.8%) were 40 years or over. Of the mothers who participated, 182 (18.3%) had five or more children. For 793 subjects (80.0%) there was no infant's grandmother influencing the mother in terms of baby feeding and breastfeeding at home. Forty-seven (23.6%) of the mothers who lived in a shanty did not give breastmilk alone for the first 6 months, compared with 21.2% (168) for urban women. However, this was not statistically significant (p=0.45, odds ratio=1.15, 95% CI=0.78–1.69). Twenty-five percent of the mothers who were illiterate (82 individuals) and 17.6% of the high school graduates (25 mothers) did not give only breastmilk to their babies for the first 6 months. No statistically significant difference was identified in terms of the educational background of the mothers (p=0.02, odds ratio=0.61, 95% CI=0.38–0.97). Six of the 992 mothers we interviewed (0.6%) had never breastfed their babies. Four hundred four (40.7%) of the 992 mothers who participated breastfed their babies in full (breastfeeding supplemented with water but not with other substances).

Table 1.

Demographic Characteristics and Distribution of Giving Only Breastmilk for the First 6 Months for 992 Women Examined Within the Scope of Research on Breastmilk Behavior in Diyarbakır, Turkey, 2008

	Number (%)
	Giving only breastmilk during the first 6 months	Not giving only breastmilk during the first 6 months	Total	χ²	p value	Odds ratio (95% CI)
Residence
Shanty	152 (76.4)	47 (23.6)	199 (20.1)
Town	625 (78.8)	168 (21.2)	793 (79.9)	0.55	0.45	1.15 (0.78–1.69)
Educational background
Illiterate	246 (75.0)	82 (25.0)	328 (33.1)	4.88	0.02	0.61 (0.38–0.97)
Literate	101 (77.1)	30 (22.9)	131 (13.2)	1.98	0.16	0.68 (0.38–1.22)
Elementary	169 (77.2)	50 (22.8)	219 (22.1)	2.37	0.12	0.68 (0.41–1.14)
Secondary	93 (83.0)	19 (17.0)	112 (11.3)	0.00	0.97	1.01 (0.52–1.95)
High school^a	117 (82.4)	25 (17.6)	142 (14.3)	Ref
College	51 (85.0)	9 (15.0)	60 (6.0)
Employment status
Working	84 (85.7)	14 (14.3)	98 (9.8)	Ref
Not working	693 (77.5)	201 (22.5)	894 (90.1)	3.5	0.06	1.74 (0.94–3.28)
Where birth took place
With assistance of healthcare personnel	732 (79.7)	186 (20.3)	918 (92.5)	Ref
At home with help of a local midwife or alone	45 (60.8)	29 (39.2)	74 (7.5)	14.45	0.0001	2.54 (1.50–4.27)
Age group (years) of mothers
Younger than 19^b	13 (76.5)	4 (23.5)	17 (1.7)
20–24	178 (80.2)	44 (19.8)	222 (22.4)	Ref
25–29	255 (79.4)	66 (20.6)	321 (32.4)	0.02	0.83	1.03 (0.67–1.60)
30–34	175 (74.2)	61 (25.8)	236 (23.8)	2.2	0.13	1.39 (0.88–2.18)
35–39	101 (78.9)	27 (21.1)	128 (12.9)	0.05	0.81	1.06 (0.61–1.86)
40 or older	55 (80.9)	13 (19.1)	68 (6.8)	0.03	0.86	0.94 (0.45–1.95)
Number of children
2 or fewer children	389 (78.9)	104 (21.1)	493 (49.7)
3–4 children	250 (78.9)	67 (21.1)	317 (32.0)	0.00	0.98	1 (0.70–1.44)
5 or more children	138 (75.8)	44 (24.2)	182 (18.3)	0.74	0.39	1.19 (0.78–1.82)
Infant's grandmother at home
No	629 (79.3)	164 (20.7)	793 (80.0)
Yes	148 (74.4)	51 (25.6)	199 (20.0)	2.29	0.12	1.32 (0.91–1.93)
Breastfeeding information acquisition
Information acquired	739 (80.7)	177 (19.3)	916 (92.3)
Not acquired	38 (50.0)	38 (50.0)	76 (7.7)	38.9	<0.00001	4.18 (2.52–6.92)
Infant's gender
Female	386 (77.7)	111 (22.3)	497 (50.1)
Male	391 (79.0)	104 (21.0)	495 (49.9)	0.25	0.61	0.92 (0.68–1.25)
Total	777 (78.3)	215 (21.7)	992 (100)

College and high school were combined during analysis.

Women younger than 19 years and between the ages of 20 and 24 years were combined during analysis.

CI, confidence interval; Ref, reference.

Multiple logistic analysis showed that home birth and acquisition of information about breastmilk and breastfeeding affected breastfeeding during the first 6 months. The risk of “not feeding only breastmilk for the first 6 months” for mothers giving birth at home increased 1.9-fold (p=0.027, 95% CI=1.07–3.35), and that of “not feeding only breastmilk for the first 6 months” for the mothers with no knowledge of breastfeeding increased 3.51-fold (p<0.0001, 95% CI=2.09–5.92) (Table 2).

Table 2.

Logistic Regression Analysis of the Factors Affecting Mothers' Giving Only Breastmilk

			95% CI for corrected odds ratio
	p value	Corrected odds ratio	Lower	Upper
Place of residence
City center	0.985	1.004	0.669	1.506
Educational background
Illiterate	0.939
Literate	0.702	1.217	0.446	3.322
Elementary	0.617	1.298	0.468	3.601
Secondary	0.635	1.274	0.470	3.451
High school	0.949	0.966	0.333	2.800
College	0.902	1.063	0.402	2.812
Mother not working	0.262	1.545	0.723	3.303
Home birth	0.027	1.901	1.078	3.354
Number of children
Fewer than 3 children	0.299
3–4	0.129	0.727	0.482	1.097
5 or more	0.295	0.738	0.418	1.302
Infant's grandmother at home	0.260	1.253	0.846	1.856
Possession of information about breastmilk	0.000	3.519	2.092	5.921
Female infant	0.715	1.060	0.774	1.452
Age group (years) of mothers
Younger than 19	0.267
20–24	0.984	0.986	0.235	4.128
25–29	0.939	1.034	0.443	2.412
30–34	0.648	1.199	0.549	2.619
35–39	0.128	1.793	0.845	3.804
40 or older	0.385	1.422	0.643	3.147
Stable	0.000	0.110

CI, confidence interval.

Table 3 shows the relationship between the 992 mothers' demographic characteristics and behavior related to giving colostrum. Educational background did not result in a statistically meaningful difference in the giving of colostrum (p=0.27, odds ratio=1.49, 95% CI=0.69–3.30). The number of the women giving birth at home alone and not giving colostrum was 3.28-fold higher than that of women giving birth with the help of healthcare personnel (p=0.00012). No statistically significant difference was identified between age groups in terms of giving colostrum (p>0.05). Nearly one-fourth of the mothers who had not been educated about the importance and method of breastfeeding (17 mothers) did not give colostrum, compared with 6.3% of those mothers who had been so instructed (58 mothers). A statistically significant difference was identified between these two groups. Mothers who had not received education did not give colostrum 4.26-fold more compared with the mothers who had been given it (p=0.0000004, odds ratio=4.26, 95% CI=2.23–8.07). The gender of the children did not have a significant effect on the giving of colostrum (p=0.705).

Table 3.

Mothers' Demographic Characteristics and Distribution of Giving Colostrum to Their Babies

	Number (%)
	Giving colostrum	Not giving colostrum	Total	χ²	p value	Odds ratio (95% CI)
Place of residence
Shanty	182 (91.5)	17 (8.5)	199 (20.0)
Town	735 (92.7)	58 (7.3)	793 (79.9)	0.34	0.55	1.18 (0.65–2.15)
Educational background
Illiterate	302 (92.1)	26 (7.9)	328 (33.1)	1.19	0.27	1.49 (0.69–3.30)
Literate	117 (89.3)	14 (10.7)	131 (13.2)	3.14	0.07	2.08 (0.85–5.10)
Elementary	206 (94.1)	13 (5.9)	219 (22.1)	0.05	0.82	1.10 (0.45–2.69)
Secondary	101 (90.2)	11 (9.8)	112 (11.3)	2.12	0.14	1.89 (0.73–4.88)
High school^a	132 (93.0)	10 (7.0)	142 (14.3)
College	59 (98.3)	1 (1.7)	60 (6.0)	Ref
Total result				6.58	0.25
Employment status
Working outside of home	94 (95.9)	4 (4.1)	98 (9.9)	Ref
Not working	823 (92.1)	71 (7.9)	894 (90.1)	1.88	0.16	2.03 (0.69–6.68)
Place where birth took place
With assistance of official health personnel	857 (93.4)	61 (6.6)	918 (92.5)
At home with help of a local midwife or alone	60 (81.1)	14 (18.9)	74 (7.5)	14.76	0.00012	3.28 (1.65–6.44)
Age group (years) of mothers
Younger than 19^b	16 (94.1)	1 (5.9)	17 (1.7)
20–24	207 (93.2)	15 (6.8)	222 (22.4)	Ref
25–29	299 (93.1)	22 (6.9)	321 (32.4)	0.01	0.99	1.03 (0.50–2.10)
30–34	217 (91.9)	19 (8.1)	236 (23.8)	0.32	0.57	1.22 (0.58–2.57)
35–39	117 (91.4)	11 (8.6)	128 (12.9)	0.44	0.50	1.31 (0.55–3.10)
40 or older	61 (89.7)	7 (10.3)	68 (6.8)	0.99	0.31	1.60 (0.57–4.37)
Total result				1.69	0.89
Number of children
2 or fewer	461 (93.5)	32 (6.5)	493 (49.7)	Ref
3–4	288 (90.9)	29 (9.1)	317 (32.0)	1.96	0.16	1.45 (0.83–2.53)
5 or more	168 (92.3)	14 (7.7)	182 (18.3)	0.30	0.58	1.20 (0.59–2.40)
Total result				1.96	0.37
Infant's grandmother at home
No	732 (92.3)	61 (7.7)	793 (80.0)
Yes	185 (93.0)	14 (7.0)	199 (20.0)	0.10	0.75	0.91 (0.47–1.71)
Breastfeeding information acquisition
Acquired	858 (93.7)	58 (6.3)	916 (92.3)
Not acquired	59 (77.6)	17 (22.4)	76 (7.7)	25.82	0.0000004	4.26 (2.23–8.07)
Infant's gender
Female	461 (92.8)	36 (7.2)	497 (50.1)
Male	456 (92.1)	39 (7.9)	495 (49.9)	0.14	0.705	1.09 (0.68–1.75)
Total	917 (92.4)	75 (7.6)	992 (100)

College and high school were combined during analysis.

Women younger than 19 years and between the ages of 20 and 24 years were combined during analysis.

CI, confidence interval; Ref, reference.

Multiple logistic analysis showed that home birth and acquisition of information about breastfeeding affected the giving of colostrum. The risk of not giving colostrum for mothers giving birth at home increased 2.7-fold (p=0.011, 95% CI=1.25–5.75), and the risk of not giving colostrum for mothers with no knowledge about breastfeeding increased 3.99-fold (p<0.0001, 95% CI=2.00–7.93) (Table 4).

Table 4.

Logistic Regression Analysis of the Factors Affecting Giving Colostrum

			95% CI for corrected odds ratio
	p value	Corrected odds ratio	Lower	Upper
Place of residence
City center	0.630	0.858	0.459	1.602
Educational background
Illiterate	0.150
Literate	0.413	2.585	0.266	25.165
Elementary	0.142	5.436	0.567	52.097
Secondary	0.365	2.862	0.294	27.821
High school	0.118	6.149	0.631	59.956
College	0.211	4.118	0.449	37.752
Mother not working	0.693	1.266	0.393	4.082
Home birth	0.011	2.691	1.259	5.751
Number of children
2 or fewer	0.412
3–4	0.918	1.033	0.554	1.927
5 or more	0.284	0.608	0.244	1.510
Infant's grandmother at home	0.541	0.817	0.427	1.563
No information about breastmilk acquired	0.000	3.991	2.007	7.936
Female infant	0.737	0.919	0.564	1.500
Age group (years) of mothers
Younger than 19	0.785
20–24	0.433	0.382	0.034	4.244
25–29	0.239	0.493	0.152	1.599
30–34	0.264	0.546	0.189	1.578
35–39	0.603	0.762	0.273	2.126
40 or older	0.720	0.821	0.278	2.418
Stable	0.003	0.029

CI, confidence interval.

Discussion

The implementation of the criteria determined by UNICEF for successful breastfeeding differs between cultures because giving breastmilk varies according to mothers' behavior, social structures, and cultural values.⁹ Mothers' breastfeeding behavior differs throughout the world. In countries such as Australia, Vietnam, and Africa, the figure for breastfeeding babies at least one time varies between 60% and 81%.^10,11 On the other hand, in countries such as Ireland, Scotland, Wales, and England, it varies between 54% and 71%.⁹ The frequency of breastfeeding at least one time is therefore lower in more-developed European countries compared with developing countries. In Turkey, in spite of some characteristics similar to those in European countries, the frequency of breastfeeding at least one time corresponds to that in developing countries. For instance, the number of mothers who breastfeed their babies at least one time is almost 100% in the cities of Isparta and Kocaeli, but between 95.7% and 98.9% in the cities of Mersin, Van, Kayseri and Nigde.^7,12–15 In Diyarbakir City, 98.1% of mothers breastfeed their babies at least one time.³ The figure was 99.4% in our study.

Feeding only with breastmilk for the first 6 months, a crucial criterion in the demonstration of breastfeeding behavior, was determined at a level of 41.6% according to Turkish National Health Survey results.¹⁶ The figure was 45.1% in a study conducted on 921 women in Diyarbakir before it acquired “Baby-Friendly City” status.³ In addition, 78% of the 992 mothers in our study fed only breastmilk to their babies for the first 6 months. Feeding only with breastmilk for the first 6 months is more common now in Diyarbakir, a “Baby-Friendly City,” compared with both the studies previously performed in the city and other study findings reflecting the entire country. The fact that this positive development was seen after the city had been granted “Baby-Friendly City” status is significant.

It is to be expected that in large families with traditional structures, mothers' breastfeeding behavior will be more traditional. In extended/large families, under the influence of mothers-in-law or older relatives, traditional practices such as expressing and disposing of the colostrum or the idea that feeding only with breastmilk is inadequate may prevail. Kocoglu et al.¹⁷ reported that, in families living with the mother-in-law, she is the person whose opinion largely counted in terms of baby feeding. In our study, the presence of an infant's grandmother did not result in a statistically significant difference in terms of not giving only breastmilk for the first 6 months. Living in a traditional family did not affect breastfeeding behavior for the mother.

The person with the highest degree of responsibility for the healthy growth and feeding of the baby is the mother. Numerous studies on breastfeeding have stated that the breastfeeding instruction offered to mothers has a significant positive effect on the duration of breastfeeding.^18,19 If accurate, education may positively affect mothers' and children's health. On the other hand, poor practices may reduce breastfeeding and further promote feeding with supplementary foods. It has been shown that mothers who received breastfeeding education from midwives fed their babies with breastmilk only for a longer time.²⁰ Furthermore, instructions of mothers regarding breastfeeding affected the giving of only breastmilk for the first 6 months⁵ and the use of the correct technique for breastfeeding.⁷ We determined that mothers who had been given information about breastfeeding were more likely to give only breastmilk for the first 6 months than those who had not. The fact that an effort was made to offer instruction on breastfeeding to mothers at “Baby-Friendly” hospitals led to the idea it could contribute to this positive improvement.

Giving birth with the help of healthcare personnel is an opportunity for mothers to receive breastfeeding instruction. Healthcare personnel can provide mothers with information and hands-on help about how to breastfeed immediately after birth. At “Baby-Friendly” hospitals, this instruction is offered to all postpartum women.²¹ However, there are studies reporting no difference between women giving birth with the help of healthcare personnel and those giving birth at home with the help of the local midwife. Gun et al.¹² found no significant correlation between the place of childbirth and the person assisting and breastmilk alone being provided for the first 6 months.⁴ However, whether or not the healthcare personnel had offered training in breastfeeding behavior to mothers where these studies were carried out was investigated. Accordingly, just as in “Baby-Friendly” hospitals, there were differences between hospital births and home births in terms of breastfeeding behavior in the event that healthcare personnel were interested in the matter and personal breastfeeding assistance was provided.^16,22 No difference was determined between the mothers giving birth with the help of the healthcare personnel and mothers giving birth without in terms of breastfeeding behavior. This is because the healthcare personnel working at the hospitals in Diyarbakir did not provide breastfeeding advice before Diyarbakir became a “Baby-Friendly City.”³ One important change identified in this study was that mothers giving birth in a hospital exhibited more optimal breastfeeding behavior. Mothers giving birth with the help of healthcare personnel were more likely to breastfeed than those giving birth without such assistance.

According to Turkish National Health Survey data for 2008, approximately 39% of babies are breastfed within 1 hour of birth, and 73.4% are breastfed within the first day.¹⁶ An important policy at “Baby-Friendly” hospitals is to bring the mother and the baby together within the first half-hour and ensure that breastfeeding starts at an early stage. In studies performed in Turkey, the frequency of breastfeeding shortly after birth varies between 51% and 80%.^7,12,23–25 In Diyarbakir, the level was 37.8%³ in 2003. In this study, however, performed after Diyarbakir had been awarded the status of “Baby-Friendly City,” it rose to 75.1%. This significant change may be due to a change in the traditional structure of society as well as the organizational regulations in “Baby-Friendly” hospitals.

There is a common idea that first milk is not pure because it washes out the milk channels and should not be given to the baby. According to the qualitative findings of a study performed in Diyarbakır by Ergenekon-Ozelci et al.,⁴ mothers cited justifications such as their first milk not being white and resembling pus, many people having told them not to give first milk, their babies not liking first milk, or their older children having been made ill by it. Not giving colostrum results in the baby being deprived of an important nutrient and a late start to breastfeeding.²⁶ In the qualitative study conducted in 2006 by Samlı et al.,¹³ justifications for not giving colostrum included beliefs such as “first milk is impure and should be thrown away” or “first milk is indigestible to the baby” and the idea that it is septic. Although the giving of colostrum is heavily affected by traditional thought systems, the frequency of mothers giving colostrum to their babies in Diyarbakir City was very high, at 92.4%. This means that there is has been a definitive and positive development in mothers' giving colostrum to their babies.³

To start giving supplementary foods to babies early both deprives them of the protective effect of breastmilk on the intestinal mucosa and also increases the risk of intestinal infection, which is one of the causes of infant deaths in Turkey.^27,28 It has also been shown that to start giving supplementary foods at an early age has a negative effect on the frequency and duration of giving breastmilk.²³ Studies from different parts of Turkey have reported that giving supplementary foods starts at an early age.^12,29,30 A study by Saka et al.³ in 2003 in Diyarbakir reported a level of giving supplementary food for the first 6 months of 54.9%. We identified a decrease in the level of starting giving supplementary foods at an early age in Diyarbakir, although 215 mothers (21.7%) still started giving supplementary foods at an earlier age than recommended.

Conclusions

Almost all the women in our study breastfed their babies. Diyarbakir has experienced an improvement in breastfeeding behavior within the contexts of both feeding only with breastmilk for the first 6 months and of giving colostrum.

The difference between women giving birth at home or in a hospital in terms of “giving only breastmilk for the first 6 months” and “giving colostrum,” and the fact that no such difference has been demonstrated in previous studies, may be regarded as a positive contribution of “Baby-Friendly City” activities.

Women who acquired information about the benefits of breastmilk and breastfeeding exhibited more optimal breastfeeding behavior. This highlights the benefit of providing all mothers with breastfeeding advice at “Baby-Friendly” hospitals.

Breastfeeding behavior was more optional among mothers giving birth with the help of healthcare personnel and being instructed about the benefits of breastmilk and breastfeeding.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

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