Constraints to implementation of the 10 Steps to Successful Breastfeeding

Abstract

Breastfeeding has been identified as an important method of improving health outcomes for infants in South Africa. South Africa is currently not meeting the Millennium Development Goal of reducing infant morbidity and mortality rates by the year 2015. The Department of Health has recognised the Baby Friendly Hospital Initiative as a means of improving breastfeeding figures and states that all maternity services should implement the initiative, through the 10Steps to Successful Breastfeeding. The midwives working with new mothers appear not to be incorporating the principles of this initiative into their practice and South Africa’s breastfeeding has been described as poor. Dissemination of policy changes are poorly communicated to the midwives and consequently their breastfeeding practices are often out dated. The purposeof this research was to investigate why midwives are not practicing the 10 steps to successful breastfeeding. The study design was qualitative and exploratory and contextual in design. The study method was a modified nominal group technique. The population was all midwives working in the purposefully selected sites. Data collection ceased when data saturation occurred. Template analysis was carried out using Walt’s Policy model i.e. using three themes namely, policy, players and processes and Tesch’s open coded method to populate the three themes. All ethical requirements were adhered to. Validity and reliability were ensured. Three main themes were identified from the study, these were; policy, players and processes with categories existing within these main themes. Policy The 10 steps policy has been implemented using a top down approach, which has not allowed for input from the midwives implementing the policy. The midwives may 5 lack the skills and tools necessary to effectively involve themselves in policy development. The importance of having an effective breastfeeding policy was confirmed but it must be for all health care workers that work with mothers and babies. Without effective communication of the policy to all healthcare workers the desired high standards of breastfeeding practice will not be achieved. Through the process of implementation the policy will change from what is drafted on paper to what is put into practice, therefore continuous monitoring and assessment is needed. Players Two categories of players emerged from the study data. Health care providers are those providing care for the breastfeeding mother. Health care users are anyone influenced directly or indirectly by the actions and knowledge of the health care providers. The health care provider is described as a consumer and as such will use certain strategies when making health care choices. Both the health care provider and user will influence the outcomes of the policy through their interpretation and actions. Process Without improvement of the knowledge and skills of the healthcare providers the standards of breastfeeding practice will not improve. Poor levels of knowledge and low levels of interest were described amongst all areas of heath care providers. The professionaltraining the midwives described was poor and inadequate for their needs. The importance of good antenatal education for women was emphasized. It is in the antenatal period that the majority of women form an intention to breastfeed, yet the antenatal education the mothers receive is failing to help them create a positive intention to breastfeed. The education given to the community and women must be meaningful and relevant to their needs. The community at large places little 6 importance on breastfeeding and this influences strongly on the mothers decision to breastfeed or not. The midwives face time and resource constraints, some working in understaffed hospitals that keep their postnatal mothers for 6 hours. Poorly trained staff working in resource strained environments are not able to adhere to the most basic elements of the 10 steps. The issue of advocacy emerged from the data. Midwives allow other co-professionals to undermine their unique relationship with the mother by allowing them to dominate the decisions and actions taken around breastfeeding. The mother has the ultimate right to choose how her baby is fed and this must be recognized by the health care providers. The government and Department of Health have voiced support for breastfeeding and publically recognised the importance of improving the breastfeeding figures in South Africa, however they have not explored breastfeeding in its broader context and have therefore failed to provide midwives with the tools necessary to successfully implement the 10 steps policy. Based on the findings of the study recommendations are made in relation to education, practice and research. The limitations of the study are discussed in chapter five.