UNDERSTANDING BREASTFEEDING PRACTICES IN BANGLADESH: LINKS BETWEEN MOTHER'S PERCEPTION AND PRACTICE

Although exclusive breastfeeding (EBF) for 6 months protects infants from morbidity and growth retardation, 70% of Bangladeshi mothers introduced non-breast milk foods during the first 6 months of lactation. The aim of our study was to understand mother's decisions related to introduction of non-breast milk foods to 0-6 month old infants. The qualitative study consisted of interviews with 27 women from the participants of Maternal Infant Nutrition Initiative in Matlab (MINIMat), key informant interviews and focus group discussions. We used constant comparative method to analyze data and compared the finding to the framework of theory of breastfeeding self-efficacy. We found that mothers introduced non-breast milk foods intermittently for different reasons but the perception of breast milk inadequacy resulted in early and sustained introduction of non-breast milk foods. Furthermore, mother's experience of breastfeeding was shaped both by the determinants of self-efficacy and contextual factors such perception of breast milk inadequacy, workload and network support. Therefore, ecological theory was more suitable than the theory of self-efficacy to describe the experience of breastfeeding. We operationalized the new theory with conceptual framework of insufficient milk supply (IMS) for the quantitative analysis. In the quantitative analysis, using the data from 1472 MINIMat mothers, we used the insights about normative and non-normative breastfeeding practices from the qualitative study and the EBF recommendation to create breastfeeding trajectories from monthly assessments of breastfeeding practices. The trajectories were: full breastfeeding (breast milk and water), committed mixed feeding (continuous introduction of non-breast milk foods starting 0-4 months considered non-normative) and intermittent mixed feeding (other types breastfeeding practices, considered normative). The findings revealed that compared to mothers who practice normative breastfeeding, mothers from full breastfeeding trajectory were from poorer household and probably could not afford non-breast milk foods. Mothers who practiced non-normative breastfeeding were different in terms of compelling biological and socio-cultural factors that could be barriers to successful breastfeeding, compared to mothers who practiced normative breastfeeding. In conclusion, efforts focused on individual mother's behavior change need to consider the influence of social structure and collective socio-cultural values on mother's beliefs and behavior.NIH maternal and child nutrition training gran