NDLI: Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania

Content Provider	Springer Nature : BioMed Central
Author	Vesel, Linda Benotti, Emily Somji, Sarah Bellad, Roopa M Charantimath, Umesh Dhaded, Sangappa M Goudar, Shivaprasad S Karadiguddi, Chandrashekhar Mungarwadi, Geetanjali Vernekar, Sunil S Kisenge, Rodrick Manji, Karim Salim, Nahya Samma, Abraham Sudfeld, Christopher R Hoffman, Irving F Mvalo, Tisungane Phiri, Melda Saidi, Friday Tseka, Jennifer Tsidya, Mercy Caruso, Bethany A Duggan, Christopher P Israel-Ballard, Kiersten Lee, Anne CC Mansen, Kimberly L Martin, Stephanie L North, Krysten Young, Melissa F Fishman, Eliza Fleming, Katelyn Semrau, Katherine EA Spigel, Lauren Tuller, Danielle E Henrich, Natalie
Abstract	Background Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. Methods This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. Results All participants believed that mother’s own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. Conclusion This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system.
Related Links	https://internationalbreastfeedingjournal.biomedcentral.com/counter/pdf/10.1186/s13006-023-00597-7.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
ISSN	17464358
DOI	10.1186/s13006-023-00597-7
Journal	International Breastfeeding Journal
Issue Number	1
Volume Number	18
Language	English
Publisher	BioMed Central
Publisher Date	2023-11-08
Access Restriction	Open
Subject Keyword	Maternal and Child Health Low birthweight Breastfeeding Infant feeding Facilitators Barriers Qualitative
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology Pediatrics, Perinatology and Child Health
Journal Impact Factor	2.9/2023
5-Year Journal Impact Factor	3.6/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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