According to the World Health Organization (WHO), EBF is the practice of providing solely breast milk to feed newborns during the initial six months of their life [1]. Thus, newborns should not be given other foods or liquids, including water. Practicing exclusive breastfeeding for the best outcome is to initiate the process during the first few hours after birth [2, 3]. Exclusive breastfeeding is linked to favorable health outcomes not only for the baby and mother but also for the community as a whole. EBF is recommended because breast milk is clean and includes all the essential nutrients vital for newborns in the first few months of life [9]. Breast milk is the primary first food for newborns and contains all the important nutrients and energy required by infants during their first six months of life and subsequently up to two years of life [4, 5].
Globally, breast milk is the benchmark for infant feeding [8, 11] and optimal for newborn growth and development, as recommended by the WHO and United Nations Emergency Children Fund (UNICEF). Breast milk also provides immunity to infections due to the existence of the mother’s antibodies in milk [9]. The type of nutrition fed to newborns during the first six months of life determines the structure and sturdiness of the viscera microbiome developed only after birth [6]. Digestion of solid foods is made simpler through the actions of these bacteria by inhibiting infections and gut complications later in life [6]. EBF has proven to be one of the best forms of preventive medicine, enhancing the growth and survival status of newborns [13]. With an improvement in breastfeeding practices, over 800,000 estimated children less than age 5 could be saved yearly, with newborns beneath six months of age constituting the majority group [12]. Another benefit of EBF is its role in reducing the risk associated with numerous early-life illnesses and complications, such as diarrhea, inflammation, respiratory illnesses, and childhood obesity [14]. Findings from a review supported the hypothesis that EBF increases the duration of lactational amenorrhea [5], and breastfeeding among mothers has been shown to reduce the risk of breast and ovarian cancer [16]. UNICEF and WHO 2002 global joint policy on infant and young child feeding (IYCF) stressed breastfeeding as a unique practice that offers children the ultimate nutrients required for optimal growth and development. The Innocenti Declaration of 1990 and the Baby-Friendly Hospitals Initiative (BFHI) of 1991 are the foundational blocks upon which the joint global policy was formed. The IYCF and BFHI programs are aimed at addressing the challenges of newborns birthed by HIV-infected mothers, low birth weight infants, and infants with critical illnesses. Breastfeeding is the central focus and is regarded as being protective against the undesirable effects of poor nutrition and low immune response that help children attain their maximum abilities [8]. EBF was highly recommended in a famous policy statement in 1997 by the American Academy of Pediatrics, which mentioned that EBF is a crucial practice and emphasized the different roles pediatricians can contribute to promoting the practice. In Ghana as well as Africa at large, EBF and the introduction of complementary feeding that is age-appropriate with continued breastfeeding for two years of age are recommended. [2, 15].
One out of three infants has been exclusively breastfed in Africa [who, 2012], and in sub-Saharan Africa, the practice of EBF in some countries is underachieved when compared to the WHO and UNICEF recommendations [7]. A study noted that the practice in West Africa is depressing, as only 6.1% of infants under the age of six months were breastfed exclusively [2, 8]. There was an abrupt decrease in Ghana’s EBF rates from 63% in 2008 to 52% in 2014 [7]. In Ghana, 98% of women reported ever breastfeeding their children, with less than 40% of infants between four and five months of age being exclusively breastfed [9, 10]. Despite the increased awareness in Ghana, exclusive breasting feeding practices are astonishingly low [2] and are accompanied by the greatest burden of suboptimal levels. The declining rates may be attributed to not properly abiding by the recommendations and the education gap in fully understanding the short- and long-term health advantages of exclusive breastfeeding, family, and diverse ethnic and cultural beliefs and practices [2, 7]. Other factors negatively affecting exclusive breastfeeding practices are the early introduction of complementary feeding and pre-lacteal [17]. As a way of ensuring a smooth transition for infants to home-cooked or other meals, complementary feeding is introduced at a very early age. In its efforts to promote exclusive breastfeeding practices across the nation, Ghana has in the past and continues to team up with the United States Agency for International Development (USAID) to improve newborn and young child feeding by training over 1,570 health workers and 2,030 community volunteers [10]. Other intervention attempts include the Legislative Instrument of 1667, also referred to as the Ghana Breastfeeding Promotion Regulation 2000, the execution of the Baby-Friendly Hospitals Initiative (BFHI) of 1991, and the creation of the BFHI Authority, and Information, Education and Communication (IEC) and advocacy materials intended for health professionals and public use [7].
Although breastfeeding after birth is a prescriptive way of life among Ghanaian women for infant feeding and nutrition, several factors may impact a woman’s ability to exclusively breastfeed in the wake of the WHO and UNICEF recommendations for optimal results. To create fruitful interventions to improve the current rates and subsequently increase better health outcomes for infants and their mothers and achieve WHO recommendations set approximately 25 years ago, a comprehensive comprehension of the predictors of why mothers are not practicing EBF in Ghana is required to plan interventions. The ultimate objective of this research is to explore the factors that do not exclusively affect breastfeeding among Ghanaian women.