Weaning Practices of Turkish Mothers: A Mixed-Model Research

Introduction

It has been strongly demonstrated that breast milk is extremely important for the growth and development of the baby in the first 2 years of life.^1,2 Breastfeeding has also a positive effect on the health and emotional proximity of the mother and the baby. ³ The World Health Organization recommends exclusive breastfeeding in the first 6 months of life and complementary feeding with nutritionally adequate and healthy foods from then until 2 years of age or more. ⁴ However, The report of Center for Disease Control and Prevention demonstrated that 49% of infants born in 2011 were breastfed at the age of 6 months and 27% at 12 months. ⁵

Despite many encouraging initiatives on breastfeeding, Turkish Population and Health Research (TPHR) conducted in 2013 presented that only 30.1% of infants were exclusively breastfed in the first 6 months of life in Turkey. TPHR also showed that the median duration of breastfeeding was 16.7 months and only 14.2% of babies were breastfed at the age of 2 years. ⁶

Some of the main reasons for the termination of breastfeeding are breast problems and perceptions of mothers as if they produce insufficient milk. ⁷ Age, employment status, and inadequate breastfeeding knowledge of mothers, mother's health problems, pregnancy, early food introduction, place of residence and socioeconomic status, lack of familial and societal support, and lack of guidance and encouragement from health care professionals are other barriers to breastfeeding.^8,9

Proper weaning is as important as initiation and maintenance of breastfeeding for healthy growth of infants. Natural weaning is a process that starts spontaneously between 2 and 4 years of age as the baby consumes sufficient variety and quantity of complementary foods. Natural weaning of infants has healthier effects on mother–infant attachment. ¹⁰ Since it is a process that starts with both the baby and the mother being ready, it creates less trauma for the baby and mother couple. As the baby meets nutritional needs, the frequency of sucking will decrease and baby will stop sucking spontaneously. Therefore, natural weaning is an issue that needs to be supported by health professionals. ¹¹ One of the most serious obstacles to natural weaning is that mothers do not have enough information on this subject and the process is removed from naturalness and replaced by inappropriate traditional methods.^9,12,13 The aim of this study is to determine the desired and current duration of breastfeeding and weaning practices of mothers who have children between the ages of 2 and 5 years.

Materials and Methods

Results

Of the 114 participants, the overall mean age was 29.2 ± 4.5 years. Thirty eight (33.3%) of the participants were college graduates and 34 (29.4%) of them were employed. Demographic and obstetric characteristics of mothers are seen in Table 1.

The mean and the median of breastfeeding duration were 15.3 ± 8.2 and 15 months, respectively. Reasons for cessation of breastfeeding and weaning practices of mothers are seen in Table 2. Sixty five (57.0%) of participants terminated breastfeeding themselves and 55 (85.9%) of them used traditional methods for weaning their children. When the reasons for termination are examined, the most common reason is that the mothers perceived that only complementary foods were sufficient and there was no need for breast milk. There was also no significant relationship between mothers' weaning reasons and their use of traditional methods (p > 0.05). It was determined that the traditional methods were learned most frequently from family elders or other relatives. Traditional methods used for weaning were applying nipples with a bad taste or smell to make baby disgust (40.0%);

staining the nipples to make baby startle (16.4%);

covering the nipples with various materials (18.2%);

using a pacifier or feeding bottle (20.0%);

separation from mother (5.5%);

Discussion

Breastfeeding is the most convenient way to feed an infant because it is a cost-free, clean, fresh and ideal nutrient. ¹⁵ Although it is the natural food for babies, it is also under the influence of many complex factors. The main factors related with breastfeeding process are maternal and familial sociodemographic characteristics, biomedical factors, health care practices, psychosocial factors, social support, community attitudes, and public policy factors. ¹⁶ One of the breastfeeding processes affected by these factors is the duration of breastfeeding and it varies from country to country. ¹⁷ In this study, the median breastfeeding duration was found to be 15.0 months, higher than many countries and similar with the TPHR study.^6,17

Previous studies showed that if mother perceives that she is not providing an adequate quality or quantity of milk to her infant, she is likely to stop breastfeeding regardless of the infant's age. ¹⁸ Whereas it was also found that <5% of women are biologically incapable of producing a sufficient quantity of milk or are unable to accomplish adequate infant weight gain through breastfeeding alone. Odom et al. ¹⁹ revealed that ∼60% of mothers who stopped breastfeeding did so earlier than desired and early termination was positively associated with mothers' concerns regarding difficulties with lactation, infant nutrition and weight, illness or need to take medicine, and the effort associated with pumping milk. Complementary feeding after 6 months, child's refusal to breastfeed, belief of mothers that breastfeeding duration is sufficient, mother's employment, pregnancy, health problems, and use of pacifier or feeding bottle were found to be the other reasons for cessation. ⁹ In our study, the first two reasons for termination breastfeeding were mothers perceive that only complementary food was sufficient or their milk was insufficient. For this reason, health professionals should have the ability to enable mothers to believe in the adequacy of breast milk and to eliminate false beliefs.

Weaning from the breast is an inherent indispensable stage in a child's development. This process is complex and covers nutritional, immunological, biochemical, and psychological arrangements. ¹¹ In contrast to natural weaning, an incorrect weaning method can undermine the positive effects of breastfeeding and baby–mother attachment. Although there are many studies in the literature on the reasons of cessation of breastfeeding, there are very few studies examining weaning methods. These few studies determined that mothers use improper traditional methods such as creating a bad taste, making the breast scary to the child, preventing the suction of the children, and making breast access more difficult as weaning practices.^9,12,13 Similarly, this study showed that mothers resort to inappropriate methods such as disgust, intimidation, and separation. These methods improperly detach an object that is very important in the baby's attachment process. It has been suggested that following a practice of child-led weaning is most congruent with attachment parenting ideas. ²⁰ This study also stated that only low percentage of mothers were counseled for weaning methods from health care professionals. Whereas most of them used traditional practices and learned the methods mostly from relatives.

To the best of our knowledge, there is no study investigating the relationship between reasons for weaning and weaning methods in the literature. In our study, we did not find any significant relationship between the reasons for weaning and the use of traditional methods. However, most of the mothers preferred traditional methods for whatever the reason. The replacement of traditional methods with natural methods may be related to the lack of knowledge and hasty behaviors of mothers. For instance, a mother who starts to use medication or becomes pregnant may want to stop breastfeeding as soon as possible in the absence of adequate and proper counseling. This hastiness may also lead mothers to extremely wrong methods, such as intimidation, disgust, or separation, instead of day-by-day natural weaning.

For some children “breast loss also means loss of the mother” because breastfeeding provides the child unlimited right of access to the mother at any time and at any age. This “right of access” is related not only to the breast but also to everything that the mother can provide: warmth, care, and comfort. ²¹ It is evident that even if only leaving the breast arouses the feeling of mother's loss in the child, it will be more abrasive for both the child and the mother to wean so quickly, in a hasty and improper way.

Considering the possibility of applying these wrong methods in many parts of the world, we can say that there is a gap in the literature for this subject. Although there are several studies in the literature emphasizing that wrong weaning methods cause trauma in children,^9–11 no information is available about its immediate or long-term psychological effects. Nevertheless, if the mother's breast is an important object in the attachment of a child,^9,10 methods such as intimidation, disgust, and separation may cause ambivalent feelings and anxiety in a child who is not yet ready to be weaned. In support of this opinion, it is determined that some disgust experiences may turn into anxiety disorders in risk groups.^22,23 There is a need to investigate the psychological effects of disgust and all other inappropriate methods, which are often used as an incorrect weaning method.

There are some limitations to be taken into account in our study. First, it was a descriptive study so any outcome related to the causality is not possible to allege. Second, it was a survey study, which might have risks of perfunctory, exaggeration, concealment, and short-term memory biases.

In conclusion, our results revealed that mothers mostly did not wean their babies naturally, but resorted to methods that could traumatize their babies. It is important to focus on this issue with new studies and to strengthen the weaning phase title in breastfeeding programs. Deficiencies related to this subject should be eliminated within the scope of breastfeeding counseling.