Factors Affecting Infant Feeding Practices of Mothers

A STUDY ON FACTORS AFFECTING INFANT FEEDING PRACTICES OF MOTHERS IN THE PHILIPPINESSantos, Samuel Edelson Pingol, Aaron Paul Villanueva, Lovely Ann Bermas, Mhelrick Andrew Brecia, Froyland Miguel Faustino, Donald Bulacan State University BSECE 2A Introduction Every day, as many as 4,000 infants and young children die worldwide because they are not breastfed. According to UNICEF (United Nations Children’s Fund), it is because their mothers are not empowered with adequate knowledge about breastfeeding and do not receive enough motivation and support. Babies, their mothers, their families, their community, their environment, even the economy of the country in which they live, all benefit from breastfeeding. This research is generally about breastfeeding: its benefits and significance to infant nutrition and factors that makes impact on breastfeeding; the practices in the Philippines that affect breastfeeding; and analyses by organizations concerned in breastfeeding. The given timeframe for the group research is the month of July and some weeks of August. The group decided to use a topic about health and wellness since nutrition is celebrated in that month. Another reason that encouraged pursuing the topic is that the world has celebrated its 20th Annual Breastfeeding Week last August 1-7, 2012 making the research timely. Abstract The objective of conducting this study is to evaluate the breast feeding practices adopted by women in the Philippines, and to show factors affecting time of initiation of breast feeding, age of weaning, and food given to the baby other than breast milk. It aimed to describe the elements affecting breastfeeding and to find out the significant relationship between breastfeeding and health of the child. The breast feeding practices adopted in terms of duration, frequency, exclusiveness of breast feeding and weaning have great impact on complete physical, mental and psycho-social development of the child. The superiority of breast milk compared to other types of milk for the nourishment of the human infant offering better health benefits. Early childhood is characterized by rapid growth, maturation of tissues and remodeling of organs. Breastfeeding is the optimal method for feeding infants. All the nutritional needs for most of these children are provided by breast milk in the right amounts and duration. Exclusive breast feeding was practiced by 40% of the mothers for first six month of life. The data obtained were analyzed using percentiles. Although the findings indicated that 34% of the mothers practiced breastfeeding and 84% supplemented with complementary foods, only 40% practiced exclusive breastfeeding. This study emphasizes the need of breast feeding education program regarding the duration of exclusive breast feeding. In comparison between rural and urban countries, studies have found out that mothers from rural areas have higher rates of breastfeeding than urban mothers. Another concept of the study is about the factors that affect breastfeeding patterns of mothers. These are demographic, socioeconomic and health service factors. Apart from breastfeeding, the research prior discussed about the loads of benefits people can get from breastfeeding and breast milk. There are psychological, health and contraceptive benefits one could get through breastfeeding and breast milk. To all infants, specifically Filipino children, should have the best protective ways against infection and malnutrition through exclusive breastfeeding. I. Breast milk: The most suitable food for human newborn A. Benefits of Breastfeeding 1. Emotional Health 2. Protective Action 3. Anti-infective properties of breast milk 4. Psychological profit 5. Effective contraception B. Formula Feeding II. Practices in the Philippines that contribute to problem of breastfeeding A. Duration (short) of breastfeeding in the Philippines B. Deprivation of beneficial effects of colostrum due to delayed breastfeeding III. Literature Review A. Breastfeeding and Supplementary Feeding 1. Breastfeeding in rural countries . Breastfeeding in developed countries B. WHO Recommendations 1. WHO Code (Definition of Terms) 2. DOH (Philippines) C. Factors Influencing duration of breastfeeding 1. Demographic Factors a. Mother’s age b. Parity c. Subsequent pregnancy d. Birth order of child e. Sex of the child f. Residence 2. Socioeconomic Factors a. Mother’s Education b. Mother’s Occupation c. Father’s Education d. Household economic statu s 3. Health Service Factors a. Antenatal care visits b. Place of delivery and mode of delivery c. Advice from health personnel 4. Conceptual Framework IV. Personal Overview and Conclusion Breast milk: The most suitable food for human newborn. The benefits of breastfeeding There are loads of benefits we can get from the natural way of giving food to babies. It can be emotional, physical, psychological and economical. Breastfeeding contribute to emotional health. Babies and mothers who gave birth recently are quite emotional persons. Being sensitive is a natural effect that occurs after giving birth and babies are still delicate up to the time they are still crying a lot. According to Gerber [1], â€Å"from birth up to 6 months of age and beyond, breast milk is still the best milk mother’s can give to their babies. The best nutrition they can give at the same time having these advantages: Preventing allergies and infections by providing natural immunities; Speeding up the recovery of the uterus; decreasing intestinal problems for babies; and promoting psychological and emotional insurance for both moms and babies. † Breastfeeding executes protective action. Breast milk can provide protective action to infants. These are immunities and colostrums. According to Cocabo and Kin [3], ‘through antibodies found in breast milk, mothers can ensure protection from immunization. Breastfeeding naturally promotes proper nutrition for the babies. ’ â€Å"Breast milk contains infection fighting antibodies from the mother, and breastfed babies are believed to be at a reduced risk for many acute and chromatic infections early in life. The cholesterol content is also high in human milk and very low in formulas. Cholesterol promotes brain growth and provides the building blocks of hormones, vitamin D and intestinal bite† [4 p. 2]. 1] Gerber, â€Å"Some notes on breastfeeding†, Countdown: Nine Months to a Perfect Delivery, vol. 1, no. 1, 2004, pp. 31 [3] S. Cocabo and P. Kin, â€Å"Childcare: the first 3 years†, Your Health Guide: The Family Wealth, Medimarketing, Inc. , Makati, Metro Manila, Philippines, 1994, pp. 26 [4] Medicine Net, Breastfeeding and formula feeding, Medicine Net, 1996, p. 2 [Online]. Availab le: http://www. medicinenet. com [Accessed: 18 July 2012] â€Å"Breast milk is best for your baby and the earlier he begins breastfeeding, the better. It has all the right nutrients at the right amounts. It costs nothing and helps you get back in shape. The first week after delivery, your breasts will produce colostrum – a thick, yellowish milk that is high in protein but very low in fat than actual breast milk. It also contains antibodies† [5 p. 23]. And according to Paraz [8], high-quality human capital may depend on mothers’ effort to breast feed their children. Health expenditures are lessened through breastfeeding, resulting to an organized health system. Breast milk contains anti-infective properties. Aside from immunity, breastfeeding has contents that can establish strong relationship between mother and child. Another one is that it can avoid pre- menopausal breast cancer. â€Å"If a multinational company develop a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumer’s needs, the very announcement of their find would send their shares rocketing to the top of the stock market. Women have been producing such miraculous substance, breast milk, since the beginning of human existence† [7 p. 1]. Breast milk gives psychological profit. Apart from emotions, the way mothers think, especially moms who gave birth on their first child, are vulnerable. They are experiencing adjustments on their lifestyle and even on their minds. The website Psychology today [2] says that, ‘the link between breastfeeding and anxiety decrease could serve as a source of sanity-preserver. The attention of nourishing of a child can appear remarkable in the best of situations. If a first-hand mother’s stress system where to boost in full-throttle every while the child cries or spits-up, motherhood can seem even more psychologically stimulating than it is. [2] PT Staff, â€Å"The benefits of breastfeeding†, Psychology Today, 01 January 1996 [Online]. Available: http://www. psychologytoday. com/articles/199601/the-benefits-breast-feeding [Accessed: 18 July 2012] [5] Wyeth, â€Å"Breast milk: The ideal first food†, Pampering Baby with Care: Your Baby Care Guide, Wyeth Nutrition, pp. 23, pp. 25 [7] The Quote Garden, â₠¬Å"Breastfeeding†, 1998, p. 1 [Online] Available: http://www. quotegarden. com/breastfeeding. html [Accessed: 18 July 2012] [8] Carisa Paraz, â€Å"Breastfeeding can cut infant deaths†, Medical Observer: Passing Problem, no. , August 2007, pp. 8 Breastfeeding is an effective contraceptive. Parents usually wait for a year or more before making another child. But they cannot get rid of having coital activities with one another hence, they do family planning and make use of contraceptives. One form of a natural contraceptive is breastfeeding. The simplest way of contraception is Lactational Amenorrhea Method. It doesn’t require counting or any contraceptive method. For it to be successful, Epigee [6] suggests that ‘breastfeeding should be ASAP (as soon as possible), frequent, uninterrupted and exclusive. ’ As your baby suckles, nerve impulses travel through your body and are received by your brain. This signal the production of a hormone called prolacti n, which works to inhibit both FsH (Follicle stimulating Hormone) and GnRH (Gonadotropin Releasing Hormone). As a result, ovulation does not occur and menstruation stops, making it almost possible to become pregnant’ [6]. Formula feeding There are cases that mothers are advised not to breastfeed. It could be a medical or a personal reason. However, there is an option for mothers that they can use if ever breast milk is not offered. Based on Wyeth Nutrition [5 p. 5], â€Å"prepared milk products are good replacement for breast milk. A paediatrician will suggest formulas that will suit for baby. These formulas have nutrients that are also found in breast milk. Conventional types of milk products are not advisable because it may lead to indigestion. Another thing is that those products have low iron content, not good aid curing IDA, and is lacking vitamin C, D and E. † Practices in the Philippines that contribute to problem of breastfeeding. Across East Asia, mothers are turning away from breastfeeding in huge numbers, regardless of the well-attested health risks to their babies. Filipino mothers are not mentally deficient but many are quite unsuspicious consumers and susceptible to the advance and sophisticated marketing techniques deployed by the milk powder companies. â€Å"Despite of the underlying beneficial effects of breastfeeding, both incidence and duration have been varying in most developing countries of the world, not the case in the Philippines. From 14. 5 months in 1963 – 67, the average duration of breast-feeding was declining to 12. 1 months during 1978 – 82. These decreasing rates drastically affect families having low income and inadequate child nutrition† [10]. Paraz [8] said, â€Å"Non-violation of the International Code of Marketing of Breast-Milk Substitutes adopted by WHO in 1981 will initiate sufficiency on breastfeeding recommendations among mothers and families. † Duration (short) of breastfeeding in the Philippines. During 1997, the Philippines demonstrated only 10 percent of infants that were never breastfed at birth. The proportion of â€Å"never breastfed infant† was comparatively higher in 1983, which has an increase of 10 percent in rural and 27 percent in urban areas. Breastfeeding discrepancies between urban and rural, marked 34 percent of never breastfed infants, were found in Manila [10]. Breastfeeding duration is short though it is widely exercised and culturally established in the Philippines. No more than 14 percent of mothers keep on breastfeeding up to 2 years. [8] Carisa Paraz, â€Å"Breastfeeding can cut infant deaths†, Medical Observer: Passing Problem, no. 7, August 2007, pp. 8 Deprivation of beneficial effects of colostrum due to delayed breastfeeding. Filipino women influenced by cultural norms and beliefs often think that colostrum is a dirty milk and should be eliminated. They delay breastfeeding several days after birth. Benefits of colostrum are consequently deprived. Practice of initiating supplements and non-nutritive liquids at an early age is a more serious problem. This supplementary feeding may contaminate diet for infants because of unfamiliar chemicals present in the food. It further reduces contraceptive effects for mothers. â€Å"Male infants in the Philippines are completely breastfed for a shorter duration compared to many Asian countries. Boys are supplemented, earlier than girls to meet the increasing necessities for growth. Increased diarrhoeal rates are caused mainly by this kind of supplementation among male infants. Moreover, boys receive more starchy staples while girls consume larger amount of green leafy vegetables. In effect, girls are much likely prone to malnutrition than boys. They have more serious eye damage from Vitamin A deficiency. †[10] All mentioned statements are considered as contributors to breastfeeding problems in the Philippines. For child survival, breastfeeding period should be given priority. For benefits of both mother and child, primary factors in feeding infants should be recognized. Many studies showed that breastfeeding manifests child health and well-being, including child survival and child spacing. Thus, it is important to know and to be updated about the current breastfeeding practices in the Philippines. Likewise, analysis of factors affecting short breastfeeding period should be dealt with. Literature Review In this section, the study made by experts regarding matters affecting breastfeeding and infant feeding will be assessed. It is expected that the data created by prior tests provide a framework for a review that follows. Breastfeeding and supplementary feeding WHO [9] states that, ‘babies must be completely breastfed for six months of age to attain the primary development and sufficient nutrition— important for lifetime wellness. ’ However, dietary necessities for infants are increasing as they grow, they should be also given complementary or supplementary foods but breastfeeding is still ongoing until two or more years. â€Å"As babies grow into young children, their nutritional needs change quickly. At around six months, breast milk alone is no longer sufficient to meet a baby’s energy and nutrition requirements. The baby is also at a stage of development where he/she can start to swallow non-liquid food. The introduction of appropriate and nutritious complementary food to babies from this age is extremely important as it plays a crucial role in the child’s physical and cognitive development†[13]. From about 6 months of age, breast milk alone is no longer sufficient to cover a baby’s nutritional requirements. He or she can also start to swallow non-liquid complementary foods at this stage, helping to support growth, brain development and the building of natural defenses. The period of weaning is critical for the future development and growth of infants. Breastfeeding in developed countries vs. developing (rural) countries. In urban countries, as Kyi [10] studied, duration of breastfeeding is reduced and supplemental foods are introduced early. It is because of [9] WHO, Exclusive breastfeeding, World Health Oraganization, 15 January 2011 [Online]. Available: http://www. who. int [Accesed: 19 July 2012] [13] Nestle, Breastfeeding and Complementary Feeding, Nestle, 2008. [Online] Available: http://www. babymilk. nestle. om/complementary-feeding [Accessed: 28 July 2012] the mothers’ occupation, which is conflicting with extended breastfeeding. Also, in these areas, availability of breast milk substitutes is sufficient making them to shift from breast to bottle feeding. On the other hand, in developing countries, breastfeeding is done until eight to twelve months due to unavailability of milk substitute and scarcity. Supplementary foods are deferre d causing malnutrition. Table 3. 1- Percentage (%) of children (2003-2008) who are: Country| exclusively breastfed| breastfeedingwith complementary feeding| till breastfed(extended)| | 0-5 months| 6-9 months| 12-15 months| 20-24 months| Afghanistan| -| 29| 92| 54| Bangladesh| 43| 74| 95| 91| Brazil| 40| 70| 50| 25| Cambodia| 60| 82| 90| 54| China| -| 32| 43| 15| Ethiopia| 49| 54| 94| 88| India| 46| 57| 88| 77| Indonesia| 32| 75| 80| 50| North Korea| 65| 31| 67| 37| Laos| 26| 70| 82| 48| Malaysia| 29| -| -| 12| Mexico| 38| 36| 32| 21| Myanmar| 15| 66| 85| 67| Pakistan| 37| 36| 79| 55| Philippines| 34| 58| 58| 34| Qatar| 12| 48| 32| 21| Saudi Arabia| 31| 60| 59| 30| Sri Lanka| 76| 86| 92| 83| Thailand| 5| 43| 32| 19| Turkey| 40| 71| 58| 26| United Arab Emirates| 34| 52| 50| 29| Vietnam| 17| 70| 78| 23| Zimbabwe| 22| 79| 87| 40| Above is a table containing statistics of children from selected developing countries who were breastfed, exclusively, with complementary foods and extended breastfeeding by UNICEF [16]. Countries Australia, France, Italy, Spain United Kingdom and United States were not included since they are [16] UNICEF, Statistics about breastfeeding, UNICEF, 2009. [PDF] Available: http://www. childinfo. org [Accessed: 28/ 7 /12] considered developed countries. Also Asian countries, also known as Four Asian Tigers or Asian Dragons, Hong Kong, Japan, Singapore and Taiwan, were excluded as they have graduated from being a developing country as declared by IMF (International Monetary Fund) [14] . Bangladesh and Ethiopia, countries from Asia and Africa respectively, and listed as least developed countries by the United Nations [14], has the higher percentage of breastfeeding rate compared to Malaysia and Thailand, considered the more developed countries, gaining lower rates with regards to the list. Breast feeding strengthens the economy by adding significantly to the national food supply. The economic value of mothers’ milk production is large, worth billions of dollars even in small countries. †[8 p. 8 para. 7] WHO Recommendations The World Health Organization (WHO) is the agency that supports and evaluates matters regarding nutrition, especially breastfeeding. Along with UNICEF (United Nations Children's Fund), powered by the Un ited Nations, their primary concern is child health and nutrition. For mothers to be able to start and maintain breastfeeding for six months, UNICEF and WHO [9] suggest that ‘breastfeeding should be initiated within the first hour of life, exclusive, on demand, and bottles or others should be avoided. WHO recommends mothers worldwide to exclusively breastfeed their infants for the child’s first six months to achieve optimal growth, development and health. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond. ’ Globally less than forty-percent (40%) of infants fewer than six months of age are exclusively breasted. Adequate breast feeding support for children, mothers and families could save many young lives† [9]. [14] Wiki, Developing Countries, Wikipedia. org, 28 July 2012 [Online]. Available: http://en. wikipedia. org/wiki/Developing_country [Accessed: 29 July 2012] [8] Carisa Paraz, â€Å"Breastfeeding can cut infant deaths†, Medical Observe r: Passing Problem, no. 7, August 2007, pp. 8 [9] WHO, Exclusive breastfeeding, World Health Oraganization, 15 January 2011 [Online]. Available: http://www. who. int [Accesed: 19 July 2012] Definition of terms Based on WHO Code (International Code of Marketing of Breast milk Substitutes) Breast-milk substitute- means ‘any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose [17 p. 8]’. Complementary food- means ‘any food whether manufactured or locally prepared, suitable as a complement to breast milk or to infant formula, when either become insufficient to satisfy the nutritional requirements of the infant. Such food is also commonly called weaning food or breast-milk supplement [17 p. 8]’. Infant formula- means a breast-milk substitute formulated industrially in accordance with applicable Codex Alimentarius standards, to satisfy the normal nutritional requirements of infants up to between four and six months of age, and adapted to their physiological characteristics [17 p. 9]’ . Exclusive Breastfeeding- as Kathy ; Sue [12] said, it means, ‘setting off other foods for the infant, including water, the breast milk is the only food to be in taken by the child’. The Philippines Department of Health (DOH). Aside from WHO, the Department of Health is the main institution that is imposing activities and information egarding health and nutrition for Filipino mothers and infants particularly in breastfeeding. â€Å"In response to the 1981 International Code of Marketing of Breast Milk Substitutes by the World Health Organization (WHO), the Philippines Department of Health strongly advocates breastfeeding for nursing mothers instead of using breast milk subst itutes. Republic Act 7600, known as The Rooming-In and Breastfeeding Act of 1992, provides incentives to all government and private health institutions in the Philippines that support rooming-in and breastfeeding. The Act provides that newborn infants with normal deliveries be put to the mother’s breast immediately after birth, and roomed-in within 30 minutes; infants delivered by caesarean section should be roomed-in and breastfed within 3 to 4 hours after delivery†[15]. [17] WHO and Nestle, International Code of Marketing of Breast-milk Substitutes, World Health Organization Geneva, 1981 [PDF] Available: http://www. babymilk. nestle. com/who-code-compliance and http://www. who. int [Accessed: 28 July 2012 12] Sue Ann Kendall and Kathy Dettwyler, Exclusive breastfeeding, Kathy Dettwyler, 3 August 1995. [Online] Available: http://www. kathydettwyler. org/detexclusive. html [Accessed: 25 July 2012] [15] NSO Manila and ICF Macro, Philippines: National Demographic and Health Survey 2008, National Statistics Office Manila, Philippines and ICF Macro Calverton, Maryland, USA, December 2009, Chapter 11. [EBook]. Available: Measure DHS, http://www. measuredhs. com/publications [Accessed: 29 July 2012] Factors Influencing duration of breastfeeding Demographic Factors Maternal age: Many researchers found that older women tend to breast feed longer. It is likely that older women have more experience in infant feeding than younger women. They may know the benefits of breast-feeding by their own experience and as a result, they are more likely to breastfeed longer. A study [10] found that older women are more likely to continue breast-feeding beyond 18 months than younger women in rural. Parity: Parity of mother has significant effect on breast-feeding duration, usually women with higher parity breastfeed their children for longer duration. It is most likely that women with higher parity are usually older, less educated and less likely to involve in formal employment sector. Also, women with many children are more likely to be from rural areas and follow the traditional lifestyles. Therefore, they can breastfeed longer, which is a common phenomenon in rural areas. However, studies [10] found out that it could be depending on the setting. They found out that the tradition is a key in the duration of breastfeeding when it comes to parity. Birth order of the child: Some researchers found the positive relationship between birth order of the child and duration of breast-feeding. The higher the birth order of the child is, the longer is the duration of breast-feeding. It is because children of higher birth order are more likely to be borne by older mothers, who are less likely to engage in employment sector and can breastfeed them longer. Another reason may be that these mothers may have older children who help them in household work, so they have more time to breastfeed their babies. This is the common pattern in many societies. Sex of the child: It is one of the important factors influencing duration of breast-feeding. In some countries, male children are breastfed for longer period than female children due to son preference by cultural or religious reason. It is a common phenomenon in China, some South Asian countries and also in some Arab countries. A study [10] says that, in China of 4,084 ever-married women under age 50 in Shaanxi found that male children are breastfed longer than female children. On the other hand, reverse phenomenon is seen in some countries. Male children are fully breastfed for a shorter period than female children in the Philippines. Mothers supplement boys earlier to meet their increasing needs for growth than to girls or because of sex preferences that favor the provision of supplements to boys rather than to girls. Subsequent pregnancy: Researchers found the association between duration of breast-feeding and subsequent pregnancy of mothers. Generally, mothers discontinue breast-feeding as soon as they know that they are pregnant. It is because of a common belief that breast milk of pregnant women can rot and cause disease in the child. Similar pattern is found out based on the study [10] in Cebu, Philippines. Strongest determinant of breast-feeding duration is the mother’s perception of being pregnant. Most women who become pregnant while lactating stop breast-feeding before the end of the first trimester because they often say that pregnancy is associated with â€Å"sour milk†. Residence: Many researchers found that duration of breast-feeding varies markedly between urban and rural mothers. Although there is no exact reason why rural women breastfeed more and longer duration than urban women, some suggested that changing lifestyles in urban areas are not compatible with breastfeeding. This finding was supported by Kyi [10], that in the Philippines, during the period 1973-88, women who breastfed shortest duration lived in Manila City. This common phenomenon is the result of urbanization and changing social system in many parts of the world. Usually, family members can encourage women to breastfeed especially in extended families. Such families are more prevalent in rural areas. It is one of the reasons why rural women breastfeed more and longer than urban women. Along with modernization, women become more educated and take part in employment sector, which is usually incompatible with prolonged duration of breast-feeding. Moreover, utilization of modern maternity care services is common among educated women especially in urban areas, which less encourage women to breast feed for long period. These factors together with other factors contribute to marked difference in the duration of breast-feeding according to urban-rural differential. Socioeconomic Factors Mother’s Education: Effect of maternal education on duration of breastfeeding varies in different societies. Along with modernization, well-educated women tend to breastfeed for a shorter period especially in urban areas. It may be that as women become more educated, they are more likely to involve in formal employment, which is not compatible for longer duration of breast-feeding. However, the reverse pattern is seen in some developed countries since well educated women are more likely to breastfeed their babies and for a longer period. The possible explanation is that as women become more educated they become more aware of advantages of breast-feeding and thus they breastfeed their babies longer. A research [10] done in the Philippines found that women with higher education are more likely to breastfeed for a short time. The result is based on a study of 2,622 mothers in both urban and rural communities of Cebu City. Also, that highly educated mothers from families with highest income or asset categories are least likely to breastfeed and they do so for a short period. Mother’s Occupation: The work status of women causes a major difference in the duration of breast-feeding since it requires leaving the infant at home during working hours. Therefore, duration of breast-feeding is shorter among working mothers. In addition, type and pattern of job of mothers also influence the duration of breast-feeding in different societies. Location of work or distance of work from home, type of work, the other alternative available for child care and the income derived from the work all seem to be important. For mothers who work as suggested by WHO [9], time and place are the key things that affect the duration of breastfeeding. There is a necessity of time and place for them to continue breastfeeding. However, solutions like maternity leave, part-time work arrangements, breastfeeding breaks, etc. can help them going on with breastfeeding. Father’s Education: Like other factors, father’s education can also affect duration of breast-feeding. Usually, well- educated men can get a good job and as a result, they can earn sufficient income. Also, better-educated man tends to marry better-educated women. If both of them are employed, they can earn more income for the family. As their income increases, they can purchase household items such as refrigerator, gas or kerosene stove, which favors the use of breast milk substitutes. As such, it will lead to shorter duration of breast-feeding. Father’s education may also have positive effect on breastfeeding. It is because as fathers are well educated, they have more access to the messages from the health sector or from the mass media. As they understand the benefits of breastfeeding, they will encourage their spouses to breastfeed longer. The research [10] found out that there is an inverse relationship between father’s education and duration of breast feeding. Longer duration of breastfeeding is seen among children whose fathers are with no schooling or less schooling. Household Economic Status: In countries like Bangladesh, Mexico, Philippines and Vietnam, the relationship between household economic status and breastfeeding is inversed. Upper class babies are less likely to be breastfed than those of others [10]. [10] Aye Kyi Kyi, Factors Affecting Breastfeeding in the Philippines: An Analysis of 1998 NDHS Data, M. A. Thesis, Faculty of Graduate Studies, Mahindol University, Myanmar, 2000. [9] WHO, Exclusive breastfeeding, World Health Oraganization, 15 January 2011 [Online]. Available: http://www. who. int [Accesed: 19 July 2012] Health Service Factors In most developing countries, lower rates of breastfeeding and shorter duration are associated with health care services. ‘Breastfeeding rates are decreasing because health services are not receiving the support they need. [8 p. 8]’ Ante natal Care Visits: During these periods, the attitudes and beliefs of the health professionals influence the women’s own knowledge and attitude towards breastfeeding. The more the pregnant women visit her ob-gyne, the more knowledge she can receive. It will lead to successful initiation of breastfeeding and continuation for the period advised by the health personnel. Place and mode of delivery: Utilization of health care services has an important effect on duration of breastfeeding. Practice of health workers at different health facilities can influence the women’s decision to breastfeed. On the other hand, the form of delivery can affect the duration of breastfeeding. Ireland [11] said that in normal delivery, women are more likely to breastfeed than those of via caesarean section. Healing process or the condition of the baby could be the two main factors given that women cannot choose their mode of delivery. Advice from health personnel: Duration of breastfeeding also depends on whether the woman receive advice on breastfeeding from health worker or not. In the Philippines, as researched by Kyi [10], there is no statistically significant effect of breastfeeding promotional messages on the intention and duration of breastfeeding. Conceptual Framework The underlying concept of this study is that duration of breast-feeding can be affected by demographic, socioeconomic and health service factors. Among many demographic factors; age of mother, parity, subsequent pregnancy, sex of child, birth order of child and residence (urban / rural) are assumed as important factors influencing duration of breast-feeding. Out of many socioeconomic factors, mother’s education, occupation, father’s education and economic level of household are regarded as major [8] Carisa Paraz, â€Å"Breastfeeding can cut infant deaths†, Medical Observer: Passing Problem, no. 7, August 2007, pp. 8 [11] Jae Ireland, Factors affecting breastfeeding mothers, Livestrong, 15 July 2011. [Online]. Available: http://www. ivestrong. com/article/493114-factors-affecting-breastfeeing-mothers [Accessed: 18 July 2012] [10] Aye Kyi Kyi, Factors Affecting Breastfeeding in the Philippines: An Analysis of 1998 NDHS Data, M. A. Thesis, Faculty of Graduate Studies, Mahindol University, Myanmar, 2000. determinants of duration of breast-feeding. Among various health service factors, 3 factors are considered important for duration of breast-feeding. There are number of antenatal care visits, place and mode of delivery and whether the woman had received an advice on breast-feeding during the post-partum period or not. This conceptual framework is presented in the figure below. Independent VariablesCategoryDependent Variable Mother’s Age Parity Subsequent Pregnancy Birth Order of the Child Demographic Factor Sex of the Child Residence Mother’s Occupation Duration of Breastfeeding Mother’s Education Father’s Education Socioeconomic Factor Household Economic Status Ante natal Care Visits Place and Mode of Delivery Health Service Factor Advice from Health Worker Fig. 3. 1- Conceptual Framework: Factors Influencing Duration of Breastfeeding The most valuable thing mothers can give their babies during early years is the milk obtained from breastfeeding. This means of feeding infants is the earliest known form. It is widely used since the first human had existed. Until the present time, breastfeeding continues to promote many useful effects for people in diverged societies. â€Å"Breast milk is the most suitable food for human newborn and the safest way of feeding infants for the first four to six months of life†[8]. According to studies, it gives perfect nutrition for babies and builds the foundation for their healthy psychosocial progress. Human milk is the milk made specifically for human infants. It is always natural as it is. Because of this exceptional reason, benefit earners involve not only the infants but as well their mothers, their families, their community, their environment and even the economy in which they live The researchers observed several studies that revealed many advantages of breastfeeding. It is recognized as the best nutrient for infants; natural contraceptive for mothers for about 6 months post-partum; preventive action for mothers against breast and ovarian cancers and provision of bonding between mother and child. Breastfeeding is not just a matter of supplying better milk. Of course, the increased opportunity for parent-child bonding offered by breastfeeding is a widely known benefit of nursing. One of the most important advantages of breastfeeding is that the mother is present. This is nature's plan for keeping mother and child close, providing the connection and reassurance the child needs so profoundly. Breastfeeding, beyond all of its many physical benefits, has the built-in bonus of requiring the mother's close presence. In addition to its nutritive value, breast milk also has protective action against common infections. The milk secreted called â€Å"colostrums† contains anti-infective property which can prevent the newborn from diarrhea and pneumonia. If babies are probably prevented from those diseases, they will have a stronger immune system. The protective action of breast milk is very important for the child wellness. In the Philippines, to be particular, warm weather affects the spread rate of bacteria. As a result, infants may be largely exposed to common infections. Malnutrition plays a huge role in child mortality because the immune systems of these children are less resistant to common childhood diseases. This is why a common cold or bout of diarrhea can kill a malnourished child. By simply ensuring exclusive breast feeding for infants, malnutrition is somehow addressed. Aside from its direct effects on the health and well-being of babies, breast feeding has a profound impact on the economy. It strengthens the economy by adding significantly to the national food supply. The economic value of mothers’ milk production is large, worth billions of dollars even in small countries like Philippines. It also reduces future burdens on the health system. Exclusive breast feeding is giving infants is giving infants with only breast milk until 4 to 6 months of age. It greatly matters since it is attributed with almost complete protection against cholera and diarrhea. The World Health Organization (WHO) has recommended that all infants should be exclusively breastfed and begin to receive supplementary foods between fourth to sixth months. This means that feeding infants is not just to breastfeed them. It is to give them the proper nutrition through â€Å"exclusive breastfeeding†. With the right duration and process, organized health system is assured. Both â€Å"too short† and â€Å"too long† duration of breast feeding is not appropriate for child nutrition. The Philippines showed short duration of breast feeding cases according to the researchers’ study. Despite of the beneficial effects derived from breast feeding, both incidence and duration have been changing. This is a serious problem. When mothers shortly breastfeed, their babies tends to receive limited infection-fighting antibodies. Beneficial effects of colostrum are likewise deprived. It is necessary for mothers to know what contributes to problem of breast feeding practices in the Philippines. Because of traditions and customs in the Philippines, a belief passed over generations is often conceptualized. Filipino women believe that colostrum should be discarded because it is dirty milk. This common misconception about the colostrum must be rejected. In this case, mothers must also learn the current breast feeding practices to be informed and updated. Support for breast feeding must go beyond the hospital, and involve communities, work-places, local governments, workers’ unions, mass organizations and consumer associations, in addition to the already very acute nongovernment organizations. Mother’s effort is worth the health of their children. Health services should have support coming from the government. Breastfeeding period depends on whether the woman receives counseling on breast feeding from health workers or not. A health worker may influence a lot of mothers and encourage them to breastfeed exclusively. However in the Philippines, there is no significant effect of breast feeding promotional messages on the purpose and period of breast feeding. Furthermore, mothers breastfeed their babies for a dramatically shorter period if they were told to feed formula. As infant-formula sales increase, the number of breastfeeding mothers goes down. Local infant- formula companies spend billions of dollars a year to endorse their products. This is in contrast to poorly funded public health systems that fail to provide health workers with the skills and knowledge needed to promote breast feeding. Filipino mothers must be wise consumers and be aware of the marketing techniques to be considered on buying milk powder formulas. For wide application, the researchers found that breast feeding can be a solution to the rapid growth of population in the country. If mothers fully breastfeed longer than the old tradition, there is a delay for next pregnancy eve if she does not use any contraceptive method. Breastfeeding can be an instant and effective contraception. Considering all benefits offered by breast feeding, the group concluded that all infants, specifically Filipino children, should undergo exclusive breast feeding. References [1] Gerber, â€Å"Some notes on breastfeeding†, Countdown: Nine Months to a Perfect Delivery, 2004, vol. 1, no. 1, pp. 31 [2] PT Staff, The Benefits of Breastfeeding, Psychology Today, 01 January 1996 [Online]. Available: http://www. psychologytoday. com/articles/199601/the-benefits-breast-feeding [Accessed: 18 July 2012] [3] S. Cocabo and P. Kin, â€Å"Childcare: the first 3 years†, Your Health Guide: The Family Wealth, Medimarketing, Inc. , Makati, Metro Manila, Philippines, 1994, pp. 26 [4] Medicine Net, Breastfeeding and formula feeding, Medicine Net, 1996, p. 2 [Online]. Available: http://www. medicinenet. com [Accessed: 18 July 2012] [5] Wyeth, â€Å"Breast milk: The Ideal First Food†, Pampering Baby with Care: Your Baby Care Guide, Wyeth Nutrition, pp. 23, pp. 25 6] Epigee,ContraceptiveBenefitsofBreastfeeding,Epigee,2012. [Online]. Available: http://www. epigee. org/fetal/contraception. html [Accessed: 19 July 2012] [7] The Quote Garden, Breastfeeding, 1998, p. 1 [Online] Available: http://www. quotegarden. com/breastfeeding. html [Accessed: 18 July 2012] [8] Carisa Paraz, â€Å"Breastfeeding can cut infant deaths†, Medical Observer: Passing Problem, no. 7, Augus t 2007, pp. 8 [9] WHO, Exclusive breastfeeding, World Health Oraganization, 15 January 2011 [Online]. Available: http://www. who. nt [Accesed: 19 July 2012] [10] Aye Kyi Kyi, Factors Affecting Breastfeeding in the Philippines: An Analysis of 1998 NDHS Data, M. A. Thesis, Faculty of Graduate Studies, Mahindol University, Myanmar, 2000. [11] Jae Ireland, Factors affecting breastfeeding mothers, Livestrong, 15 July 2011. [Online]. Available:http://www. livestrong. com/article/493114-factors-affecting-breastfeeing- mothers [Accessed: 18 July 2012] [12] Sue Ann Kendall and Kathy Dettwyler, Exclusive breastfeeding, Kathy Dettwyler, 3 August 1995. [Online] Available: http://www. kathydettwyler. org/detexclusive. tml [Accessed: 25 July 2012] [13] Nestle, Breastfeeding and Complementary Feeding, Nestle, 2008. [Online] Available: http://www. babymilk. nestle. com/complementary-feeding [Accessed: 28 July 2012] [14] Wiki,DevelopingCountries,Wikipedia. org,28July2012[Online] Available: http://en . wikipedia. org/wiki/Developing_country [Accessed: 29 July 2012] [15] NSO Manila and ICF Macro, Philippines: National Demographic and Health Survey 2008, National Statistics Office Manila, Philippines and ICF Macro Calverton, Maryland, USA, December 2009, Chapter 11. EBook]. Available: Measure DHS, http://www. measuredhs. com/publications [Accessed: 29 July 2012] [16] UNICEF, Statistics about breastfeeding, UNICEF, 2009. [PDF] Available: UNICEF, http://www. childinfo. org [Accessed: 28 July 2012] [17] WHO and Nestle, International Code of Marketing of Breast-milk Substitutes, World Health Organization Geneva, 1981 [PDF] Available:http://www. babymilk. nestle. com and http://www. who. int [Accessed: 28 July 2012]