The world health organization adopted a comprehensive strategy called the Continuum of Care to improve reproductive, maternal, neonatal, and child health (20–21). In view of this, we studied the behavior of lactating mothers EBF practice and the factors enabling towards ood practive among mothers who recently delivered in the two available health facilities of the town. Based on our findings, about three-fourth adhered to EBF which indicates that present finding is better than the the 2016 national figure reported by Ethiopian Demographic Health Survey report (13) which was 58%. It is likely to see such discrepancies since the nature of the sampled mothers enrolled in our study were all from health facilities suggesting that they all had probably accessed the services provided and to some extent attributed to their awarenesses about the importance of breastfeeding.
Though breastfeeding is almost universal in Ethiopia and exclusive breastfeeding up to 6 months after birth is an important contraceptive method, the status of exclusive breastfeeding in the studied area as well as in the country is less than the global recommendations (22) calls for more focused advocacy work to be done in this regard.
The good practice when compared with previous studies report, our study is concordant with Mizan-Aman town findings which reported 60.2% of the mothers to initiate breastfeeding immediately within an hour (60.2% vs 60.1%). The similarity of the findings is attributed to the fact that all the sampled mothers are from health facilities where they had access to appropriate councelling on newborn feedings (19, 23) though still more is expected to achiev a better result and maximize the benefites of EBF.
In this study, pre-lacteal feeding (PF) observed is higher compared to the findings reported by other authors (18, 22–24). The differences may be attributed to time constrains emanating from work related activities - most mothers with better education often get better job with better income and often such mothers rush to their work and consequently forced to practice PF. There could be others as well which need further expoloratory study. The most common PF given in this study was plain water, cow’s milk, butter and formula milk. Compared with the Mizan Aman findings on provision of water (12.3% vs 48.2 %), and cow’s milk (24.4% vs 50.2%), our finding is by far better. These difference might be due to the socioeconomic factors and to some extent to maternal awareness towards EBF though needs further study.
The major enabling factors or that influenced mothers to adhere to EBF were education, proper antenatal and postnatal cares, and infant’s gender. Mothers who had primary education were 4.5 time more likely to adher to EBF than their counterparts. Although the education system differs and various experiences exist across the world, some studies reported maternal and paternal educational attainment as a common predictor for maternal service utilization in developing countries including Ethiopia (25–26).
Mothers who had 3 or more antenatal follow-up were 20 percent more likely practicing EBF than those who had none. In the same breath, mothers who had postnatal follow-up also were 22.0% more likely practicing EBF than those who had no PNC. Some previous studies documented service utilization of mothers to be low particularly among rural women due to the high domestic workload and little time left after attending to essential household chores until term and beyond (27–28).
Interestingly, mothers who delivered male infant were observed to practice 2.3 times more likely than those who delivered females probably due to cultural preferences for males. Unexpectedly, although more mothers that had received information from health facilities adhered to EBF, there was no significant association with the maternal practice of EBF in our study probably due to an unfocussed councelling/ less trained health educators. This is in contrary to some previous studies where they reported some associations and thus needs to be interpreted cautiously (15, 26). Therefore, this calls for further exploratory study to uncover why the sources of information did not bring the desired/expected change toward EBF practice.
Strength and Limitations
The strength of the study is that it included the available health facilities in the town and has generated some new evidence for programmatic implications to improve the EBF practice in the region. The information generated would be a bench mark for future studies as well. Despite the aforementioned strengths, the findings had some limitations and thus need to be interpreted cautiously since facility-based studies as well as the design employed may make estimates unstable and associations between dependent and independent variables undetectable.