In the study, 565 participants participated which made a response rate of 95.9%. Concerning ethnicity, 463 (81.9%) study participants were Oromo and 19 (16.1%) were Amhara. The majority (58.4%) were Orthodox in religion. Concerning the educational status of mothers, the majority (60.5%) could not read and write. The mean age of the mothers was 28 years (standard deviation, SD ± 5.0) (Table 1).
Infant and maternal health service utilization characteristics
The majority (91.7%) of the mothers had an antenatal care visit during their recent pregnancy and were counseled about breastfeeding. More than half (55.4%) of the mothers gave birth to their last child in health facilities (Table 2).
The qualitative finding proved that majority of the discussants mentioned the ideal desire of their exclusive breastfeeding and most of the women FGD discussants mentioned, “Breastfeeding is our culture”. However, they perceived mixed feeding than exclusive breastfeeding. A 31 years old breastfeeding mother said, “We have been informed by health professionals that giving cow’s milk and other foods even water to infants less than six months old is unnecessary". Women FGD discussants agreed, "Even if, majority of mothers attend antenatal care and get breastfeeding counseling, they did not apply exclusive breastfeeding practice properly".
The Men FGD discussants described exclusively breastfed babies as having higher intelligence, physically stronger, and protected from illness. Exclusively breastfed babies are described as much healthier than babies who started additional foods or liquids before six months of age.
Knowledge about breastfeeding
The majority, 564(99.8%), of mothers had known the importance of breastfeeding. but 70(12.4%) of mothers had known the importance of breastfeeding which is very low. The majority 562(99.5%) of mothers knew to initiate breastfeeding immediately after birth.
A 27 years old mother explained her knowledge about the importance of breastfeeding for infant health as shown in the following extract. “Feeding a baby only breast milk for the first 6 months is becoming our culture due to the information we got from the health facility and the house-to-house visits of the health extension workers. Our current practice is only breast milk, no other additional foods for the first 6 months.” Some women of FGD discussants mentioned that they do not know the importance of breastfeeding for maternal health.
Exclusive breastfeeding practices
The prevalence of exclusive breastfeeding practice was 400(70.8%). Among mothers who did not exclusively breastfeed their infant, perception of breast milk only being not sufficient for the infant 113(68.5%) was the main reason mentioned. More than half, 328(58.1%), of mothers have been advised about exclusive breastfeeding by their husbands (Table 3).
In-depth interviews identified that poor knowledge was the main barrier to exclusive breastfeeding. For instance, a 29 years old rural health extension worker expressed that ‘‘Mothers do not consider breast milk as adequate and important.”
Among qualitative findings, both men and women FGD discussants raised that the reasons for not exclusively breastfeeding were due to different perceptions of the community such as breast milk only not sufficient, babies thirsty unless they drink water, breast milk alone enough for only the first two months, and workload of mothers. The role of the father was as a supporter, the expectation being that they were responsible for financially supporting the family and enabling the purchase of food that would contribute to the health of the mother and their children. The men FGD discussants perceived that exclusive breastfeeding is important for babies but not for mothers. For example, a 24 years old breastfed mother explained, “The baby fed with breast milk for 6 months will have better health. If I breastfeed for six months, it will be good for the health of the baby but not for the mother.”
Regarding the importance of breastfeeding for the mothers, the majority of men discussants perceived that mothers frequently breastfeeding their infants and breastfeeding for a long period were physically weak and ill.
EBF is a culturally acceptable practice among all of the participants. The majority 328 (58.1%) of mothers were supported by their husbands to feed their infant exclusively on breast milk. Most 192 (34%) of mothers had heard information about exclusive breastfeeding was from health providers.
A qualitative study showed that only a few fathers participate in caring for children in addition to financial supporting of the family. As FGD discussants mentioned that, they know different sources of information on the importance of breastfeeding such as health professionals, different Media such as television, radios, and their neighbors. However, most of them have not been following attentively this source of information regarding the importance of breastfeeding. For instance, a 37 years old man from the men FGD group said that “I have Television in my house, health extension workers also counseling our community on the importance of exclusive breastfeeding by going house to house but I didn’t follow it due to workload as well as because of negligence by perceiving as it is important only for women.”
A 35 years man FGD discussant mentioned on "Health posts didn't provide their duties regularly, it was closed on most of the working days, because of this my wife has interrupted her ANC follow up and gave birth at home". Majority of men FGD discussants mentioned that there was no health education given at the community level during different meetings, rather than during home visits. KI interview added, "Breastfeeding mothers experience several challenges in their quest to practice exclusive breastfeeding". These challenges include knowledge gaps especially for mothers who do not attend ANC follow-up.
Barriers of exclusive breast-feeding
Among the barriers mentioned by the participants, 22 (3.7%) of mothers had experienced breastfeeding problems (like mastitis and soreness) and lack of organizational/social support for breastfeeding, 545 (96.5%). The women FGD discussants said, “No adequate information about exclusive breastfeeding was provided to mothers from health care providers.” Thus, mothers who were not breastfeeding infants were implemented properly. Most men FGD discussants said, “Health facilities only invite pregnant mothers during ANC follow up.”
Independent predictors of EBF
Bivariate analysis was conducted to select candidate variables with P-value < 0.25. Independent predictors of exclusive breastfeeding practice were determined using multivariable logistic regression. In the final model, variables with P-value < 0.05 were considered significant.
In this study, the mother’s age was found to be an independent predictor of EBF practice. Mothers in the age of 20–24 years interval were found more than two times more likely and exclusively breastfed their infant as compared to those breastfeeding mothers aged 35 and above years [AOR = 2.67 (1.79, 4.60)].
Mothers who had attended antenatal care services during their pregnancy exclusively breastfeed their infants two times more likely than mothers who were not attended antenatal care services during their pregnancy [AOR: 2.31 (1.31, 4.71)]. Mothers who attended delivery in health facilities exclusively breastfeed their infant 1.34 times more likely as compared to mothers delivered at home [AOR: 1.34 (1.21, 2.11)].
Mothers who had information about exclusive breastfeeding were two times more likely to exclusively breastfeed than those mothers who had no information [AOR: 2.34 (1.13, 4.76)]. Mothers who knew the importance of exclusive breastfeeding for maternal health were more than one times more likely to exclusively breastfed their infants up to six months of age when compared with breastfeeding mothers who hadn’t the knowledge on the importance of exclusive breastfeeding of infants less than six months for maternal health [AOR: 1.46 (1.12–3.73)] (Table 4).