Midwives' perceptions of barriers to exclusive breastfeeding in Bhutan: A qualitative study.

PROBLEM: In Bhutan, exclusive breastfeeding is not routinely practised according to the World Health Organisation recommendation, thereby placing infants and women at increased risk of morbidity and mortality. BACKGROUND: Research indicates that support from midwives is positively associated with longer breastfeeding duration. Previously, no studies had been conducted in Bhutan to explore midwives' perceptions of the barriers to the promotion of exclusive breastfeeding. AIM: To explore midwives' perceptions of the barriers to promoting exclusive breastfeeding among Bhutanese women. METHODS: A qualitative exploratory descriptive study design was used, involving individual semi-structured audio-recorded interviews. The Framework approach was utilised for data analysis. FINDINGS: Five themes emerged from a total of 26 interviews. The themes were: 'cultural and traditional practices', 'women's return to work', 'midwives' advice in response to breastfeeding problems', 'shortage of staff in a busy maternity service' and 'lack of professional development about breastfeeding'. DISCUSSION: Midwives reported that upholding Bhutanese cultural and traditional practices by women and their families was a powerful barrier to the promotion of exclusive breastfeeding. Midwives experienced difficulty in promoting exclusive breastfeeding among women in the immediate postnatal period during women's short hospital stay. A shortage of midwives, coupled with a lack of professional development about breastfeeding promotion and support, were additional barriers to the promotion of exclusive breastfeeding. CONCLUSION: The study findings highlight the need for continuing professional development of midwives in relation to exclusive breastfeeding. Additionally, a review of the midwifery workforce model is recommended, to ensure midwives have time to provide women with breastfeeding support.

An Exploration of Breastfeeding Practices by Bhutanese Women.

BACKGROUND:: Researchers have shown beneficial influences of exclusive breastfeeding for women and infants. Therefore, the World Health Organization recommends exclusively breastfeeding infants for the first 6 months following birth. In Bhutan, researchers have found, through survey research, variable exclusive breastfeeding rates at 6 months. They have not, however, explored the experiences and views of participants in relation to breastfeeding. RESEARCH AIM:: The aim was to explore first-time mothers' views, intentions, and experiences related to exclusive breastfeeding. METHODS:: A qualitative, prospective, longitudinal, descriptive study was undertaken using semistructured, audio-recorded interviews at two points of time with first-time mothers prenatally during late third trimester ( n = 24) and at 6 weeks after birth ( n = 22). The framework approach to analysis was used to identify themes. RESULTS:: Two themes (breastfeeding, but uncertainty about achieving exclusive breastfeeding and acceptance that breastfeeding is painful) were identified from interviews at term. Five themes were identified from interviews at 6 weeks after birth (lack of timely breastfeeding information and support from health professionals, misconceptions about exclusive breastfeeding, being unprepared for the reality of breastfeeding, limited control or choice over feeding, and adoption of cultural and traditional practices). CONCLUSION:: The participants breastfed but did not practice exclusive breastfeeding due to a lack of timely breastfeeding information and inadequate breastfeeding support. While family elders supported breastfeeding, they also promoted the adoption of certain traditional and cultural practices, which affected exclusive breastfeeding.