Breast feeding promotion in an urban and a rural Jamaican hospital

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n=62) and one rural (n=51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital. Moreover, there was no difference between urban and rural mothers' knowledge about breast feeding, despite the input of far greater educational resources to mothers at the urban hospital. This study suggests that merely educating mothers about breast feeding is insufficient. Efforts to promote breast feeding must emphasize specific health professional practices that support early initiation of breast feeding. The health policy implications of these findings are discussed.