Background: The practice of exclusive breastfeeding (EB) in Morocco has witnessed a worrying decline in recent decades, contrary to the recommendations of the World Health Organization (WHO) which advocate s it during the first six months as a significant public health tool. The present study aims to assess the impact of educational materials on mothers’ behaviour with regard to keeping up EB as long as six months, at least. Methods: This is a cohort study with a prospective collection of data over a period of one year, through a questionnaire-based survey of 500 women who delivered at the Souissi Maternity Hospital in Rabat. The subjects were divided into an intervention group sensitized, during the medical visit, by means of information delivered orally about breastfeeding and a booklet containing instructions on breastfeeding management and the benefits of EB, especially when extended for the first six months; and a control group attending the same operation with no awareness-rising through educational materials. To assess EB rates, the subjects had been followed for six months through telephone. Results: 372 women who delivered were followed, 194 from the intervention group and 178 from the control group. The remaining 128 women not followed were lost sight of. A higher percentage of mothers in the intervention group exclusively breastfed their babies up to the age of six months compared to the control group, 55.2% against 38.8% (p = 0.002). The main reason produced by most mothers who ceased to exclusively breastfeed their babies is milk insufficiency. Conclusion: The postnatal nutritional education strategy based on the distribution of educational materials has considerably raised the number of women who exclusively breastfed their babies until the age of six months.
Breastfeeding offers significant short-term and long-term environmental, psychosocial, economic, and particularly health benefits for the infant, mother and community [
Breastfeeding reduces child mortality and morbidity, and enables children to enjoy good health and optimal growth and development [
As a matter of fact, health benefits are much more guaranteed and improved when EB endures into the first six months than with partial breastfeeding [
Unfortunately, world breastfeeding rates (especially exclusive breastfeeding) remain sub-optimal [
Several factors related to the child, work and socio-demographic situation affect mothers’ decision with regard to breastfeeding. Findings from studies in developed and developing countries have shown that pregnant women harnessed with better knowledge about breastfeeding are more likely to offer breastfeeding, and to follow breastfeeding recommendations afterwards [
To improve health in the short term, WHO and UNICEF are working to promote breastfeeding as a key strategy and indispensable component of life programming, such a position is supported by most health ministries and professional organizations [
This study aims to assess the impact of educational materials, distributed on the day after delivery, on mothers’ behaviour in order to maintain exclusive breastfeeding for at least six months. This would allow the achievement of the objectives set out in the 2011-2019 national nutrition strategy.
This is a prospective study conducted over a period of 13 months (October 2015 - November 2016) at the Ibn Sina University Hospital, more particularly at the Souissi Maternity Hospital in Rabat, a reference hospital in Morocco, receiving almost 18.000 births annually (40 births per day).
The sampling method used in this study is probabilistic. The survey was carried out on all women who were cared for by the Souissi Maternity Hospital in Rabat. From this population and based on a national prevalence of 27.8% [
In this study, we included all women who delivered vaginally, mothers of singletons, born between 37 and 41 weeks of amenorrhea, and having a mobile phone.
Women who delivered by caesarean section, who had low birth weight newborns (<2500 g), premature, or hospitalized newborns were excluded from the study.
Cesarean delivery women were excluded because most of them are not well awake (effect of anesthesia) and can’t breastfeed in the first hours after delivery, while our study is based on postpartum recruitment of women, in addition to the objective of following the practice of breastfeeding just after birth.
During the study period, the women recruited were divided into two groups: an intervention group and a control group. The intervention group women (n = 250) were first sensitized through a short educational session (10 minutes) that included information delivered orally during the medical visit on the benefits of breastfeeding for women and their infants, mainly EB by shedding light on its definition, and the good practices of breastfeeding as well as the production of breast milk. During the session, mothers were encouraged, whenever necessary, to ask questions about breastfeeding and to express their views. Afterwards, the women received an educational booklet on the intervention, in Arabic and French, containing illustrations and information on: the benefits of breast milk, the importance of skin-to-skin contact immediately after birth, the importance of early breastfeeding and giving colostrum to the baby, the criteria of good positioning for corrective breast-taking, the signs of effective suckling, the signs of effective breastfeeding for the first six months, on-demand breastfeeding and its daily frequency, breastfeeding accessories, techniques for collecting and storing breast milk, and questions and answers about different maternal concerns (depression, hygiene, nipple pain, quantity of milk produced, duration and number of feedings, mixed feeding, diet to be followed during breastfeeding, mothers’ illness and breastfeeding, weaning of the baby, etc.)
Women in the control group (n = 250), however, benefited only from the usual oral awareness-raising operation (short educational session) without educational materials.
Our intervention was based on the WHO guidelines and the terms were defined according to their data.
Definition of exclusive breastfeeding
Breastfeeding is exclusive when babies are fed only breast milk or expressed milk, and receive no other liquid or solid, not even water, with the exception of oral rehydration solutions, medicines, minerals or vitamins drops or syrups [
In order to study all aspects related to the topic, we used a reference questionnaire prepared by nutrition and breastfeeding experts, which had been tested, modified and validated two months before our research team1 started the study (following a pilot study conducted on 20 women to determine whether the questions were clear and understandable), and then administered in a standardized fashion to women in both groups (intervention group and control group). Data collection was carried out in two stages. Firstly, we filled out the questionnaire designed for mothers who had delivered at the maternity, subject of the study, following a face-to-face interview with participants from both groups at the delivery place. Our interview included the socio-demographic, prenatal and natal information about mothers and newborns, as well as information related to mothers’ knowledge and practices of breastfeeding.
Secondly, we completed the questionnaire with a follow-up sheet of breastfeeding mothers through telephone interviews with each participant on the 2nd day, first week, 3rd and 6th months after delivery.
The socio-demographic variables collected from the mothers who delivered were:
・ Age: quantitative variable;
・ Living area: divided into urban, peri-urban and rural areas;
・ Education level: divided into 5 categories: illiterate, literacy courses, primary school, secondary school, university;
・ Mother’s profession: the participants were categorized into three groups: housewives, employees or other.
For mothers, we included information about the number of children, pregnancy follow-up, the number of pre-natal visits, the place of follow-up, as well as the delivery method. Infants’ data only concerned the Apgar score and birth weight.
The major data collected were:
・ Maternal knowledge about breastfeeding: early breastfeeding, milk production, intended breastfeeding duration, breastfeeding benefits;
・ Mothers’ breastfeeding practices: first feeding time, administration of other liquids, position of the newborn, breast-taking, sucking;
・ Breastfeeding difficulties: problem type and timing;
・ Nipples condition;
・ Milk production index.
In the follow-up sheet, we have retained the following parameters:
・ Exclusive breastfeeding duration stratified into EB on the 2nd day, EB in the 1st week, EB in the 3rd month, and EB in the 6th month;
・ Babies’ nutritional alternatives, in case EB discontinuation, subdivided into several methods: Breast and pharmacy milk, Breast and cow milk, Breast and complementary food, Pharmacy milk alone, Cow milk alone, Pharmacy milk and complementary food, Breast, pharmacy milk and complementary food, Cow milk and complementary food or other;
・ Cause of EB discontinuation: infant illness, return to work, milk insufficiency, mother illness, new pregnancy, breastfeeding difficulty or other.
The data were entered and analyzed using SPSS software (Statistical Package for Social Sciences) version 21. The Kolmogorov-Smimov test was used for the study of variables. Thus, the Gaussian-distributed quantitative variables were expressed on the basis of the mean and standard deviations, while the non-Gaussian-distributed variables were expressed in median and quartiles. The qualitative variables were compared using Pearson chi-squared test or the Least Significant Difference test (LSD). We also used the Mann Whitney test to compare non-Gaussian-distributed variables. A value of p < 0.05 was considered significant for all statistical analyses.
The study has received the approval of the administration of the Souissi Maternity Hospital in Rabat, as well as the approval of the ethics committee for biomedical research at the Faculty of Medicine and Pharmacy in Rabat, registered with the Office for Human Research Protection of the US Health and Human Services Department (Registration Number: IORG0006594). Medical secrecy and anonymity of the participants were rigorously respected. Besides, the process and purpose of the work were explained to all the mothers before filling the forms and informed consent was obtained. Every mother was free to leave the study any time she wished.
The overall analysis of the 500 mothers surveyed (
The analysis of
Characteristics | Global analysis N = 500 | Bivariate analysis | p | |
---|---|---|---|---|
Control group N = 250 | Intervention group N = 250 | |||
Characteristics of mothers | ||||
Age | 27 [23 - 31] | 27 [23 - 32] | 26 [2 3- 31] | 0.847 |
Place of residence | 0.465 | |||
Urban | 337 (67.4) | 172 (68.8) | 165 (66.0) | |
Suburban | 85 (17.0) | 44 (17.6) | 41 (16.4) | |
Rural | 78 (15.6) | 34 (13.6) | 44 (17.6) | |
Educational levels | 0.180 | |||
Illiterate | 61 (12.2) | 34 (13.6) | 27 (10.8) | |
Literacy courses | 16 (3.2) | 8 (3.2) | 8 (3.2) | |
Primary | 166 (33.2) | 93 (37.2) | 73 (29.2) | |
Secondary | 224 (44.8) | 99 (39.6) | 125 (50.0) | |
University | 33 (6.6) | 16 (16.4) | 17 (6.8) | |
Mother’s profession | 0.433 | |||
Housewife | 452 (90.4) | 229 (91.6) | 223 (89.2) | |
Employee | 41 (8.2) | 19 (7.6) | 22 (8.8) | |
Other | 7 (1.4) | 2 (0.8) | 5 (2.) | |
Number of children | 0.384 | |||
1 | 223 (44.6) | 106 (42.4) | 117 (46.8) | |
2 | 146 (29.2) | 72 (28.8) | 74 (29.6) | |
3 | 89 (17.8) | 53 (21.2) | 36 (14.4) | |
4 | 27 (5.4) | 13 (5.2) | 14 (5.6) | |
5 | 1 (2.8) | 6 (2.4) | 8 (3.2) | |
≥6 | 1 (0.2) | 0 (0.0) | 1 (0.4) | |
Pregnancy follow-up | 0.399 | |||
No | 13 (2.6) | 5 (2.0) | 8 (3.2) | |
Yes | 487 (97.4) | 245 (98.0) | 242 (96.8) | |
Number of prenatal visits | 0.123 | |||
1 | 8 (1.6) | 3 (1.2) | 5 (2.1) | |
2 | 24 (4.9) | 7 (2.9) | 17 (7.0) | |
3 | 62 (12.7) | 32 (13.1) | 30 (12.4) | |
4 | 91 (18.7) | 53 (21.6) | 38 (15.7) | |
≥5 | 302 (60.4) | 150 (61.2) | 152 (62.8) | |
Place of follow-up | 0.011 | |||
Public sector | 215 (44.1) | 107 (43.7) | 108 (44.6) |
Private sector | 199 (40.9) | 90 (36.7) | 109 (45.0) | |
---|---|---|---|---|
Both | 73 (15.0) | 48 (19.6) | 25 (10.3) | |
Mode of delivery | 0.002 | |||
Vaginal delivery without episiotomy | 168 (33.6) | 68 (27.2) | 100 (40.0) | |
Vaginal delivery with episiotomy | 332 (66.4) | 182 (72.8) | 150 (60.0) | |
Delivery by: | 0.705 | |||
Midwife | 332 (66.4) | 168 (67.2) | 164 (65.6) | |
Gynaecologist | 168 (33.6) | 82 (32.8) | 86 (34.4) | |
Characteristics of newborns | ||||
APGAR | 0.780 | |||
10/10/10 | 492 (98.4) | 245 (98.0) | 247 (98.8) | |
08/10/10 | 4 (0.8) | 2 (0.8) | 2 (0.8) | |
07/08/10 | 2 (0.4) | 1 (0.4) | 1 (0.4) | |
06/10/10 | 2 (0.4) | 2 (0.8) | 0 (0.0) | |
Birth weight | 0.616 | |||
2500 g - 3500 g | 363 (72.6) | 179 (71.6) | 184 (73.6) | |
>3500 g | 137 (27.4) | 71 (28.4) | 66 (26.4) |
Values are expressed as median and quartile or in count and percentage. A p < 0.05 value is considered significant.
69.1% had been sensitized about the benefits of breastfeeding. The majority of mothers (88.6%) did not breastfeed in the delivery room, and among the 57 mothers who breastfed their infants, 26 (that is, 45.6%) received practical help from a health professional to breastfeed their babies in the delivery room. It should be noted that the average time spent in the delivery room was 3 hours [2 - 4.22]. As far as knowledge about breastfeeding is concerned (
As far as good breastfeeding practices are concerned, we found that 99% of mothers breastfed their babies correctly. In the same vein, breast-taking was done correctly and sucking effectively by almost all infants. Regarding the continuation
Characteristics | Global analysis n = 500 | Bivariate analysis | P | ||
---|---|---|---|---|---|
Control group n = 250 | Intervention group n = 250 | ||||
Knowledge | |||||
Advice received during the prenatal visits | 0.201 | ||||
No | 406 (83.4) | 199 (81.2) | 207 (85.5) | ||
Yes | 81 (16.6) | 46 (18.8) | 35 (14.5) | ||
Type of advice | 0.641 | ||||
Latching on | 3 (3.7) | 2 (4.3) | 1 (2.9) | ||
Advantage of breast milk | 56 (69.1) | 34 (73.9) | 22 (62.9) | ||
Other | 2 (2.5) | 1 (2.2) | 1 (2.9) | ||
Two or more | 20 (24.7) | 9 (19.6) | 11 (31.4) | ||
Waiting for milky climb | 0.001 | ||||
Not obligatory | 482 (96.4) | 233 (9.2) | 249 (99.6) | ||
Obligatory | 15 (3.0) | 14 (5.6) | 1 (0.4) | ||
No answer | 3 (0.6) | 3 (0.6) | 0 (0.0) | ||
Put to the breast in delivery room | 0.033 | ||||
Not important | 97 (19.4) | 51 (20.4) | 46 (18.4) | ||
Important | 397 (79.4) | 193 (77.2) | 204 (81.6) | ||
No answer | 6 (1.2) | 6 (2.4) | 0 (0.0) | ||
Delay for breastfeeding after delivery | 0.001 | ||||
<1/2 hour | 144 (28.8) | 89 (35.6) | 55 (22.0) | ||
<1 hour | 194 (38.8) | 87 (34.8) | 107 (42.8) | ||
<2 hours | 96 (19.2) | 48 (19.2) | 48 (19.2) | ||
<4 hours | 50 (10.0) | 14 (5.6) | 36 (14.4) | ||
<6 hours | 4 (0.8) | 1 (0.4) | 3 (1.2) | ||
>6 hours | 2 (0.4) | 1 (0.4) | 1 (0.4) | ||
No answer | 10 (2.0) | 10 (4) | 0 (0.0) | ||
Envisaged duration of breastfeeding | 0.432 | ||||
< 6 months | 3 (0.6) | 2 (0.8) | 1 (0.4) | ||
6 à 12 months | 52 (10.4) | 30 (12) | 22 (8.8) | ||
>12 months | 445 (89.0) | 218 (87.2) | 227 (90.8) | ||
Reasons for the continuation of breastfeeding | 0.001 | ||||
Health and protection of the child | 175 (35) | 74 (29.6) | 101 (40.4) | ||
Health and protection of the mother | 1 (0.2) | 0 (0.0) | 1 (0.4) | ||
Health and protection of the child and the mother | 132 (26.4) | 57 (22.8) | 75 (30.0) | ||
Importance of breast milk | 126 (25.2) | 96 (38.4) | 30 (12) | |
---|---|---|---|---|
Nutrition of the child | 3 (0.6) | 1 (0.4) | 2 (0.8) | |
No answer | 63 (12.6) | 22 (8.8) | 41 (16.4) | |
Practices | ||||
Time spent in the delivery room | 3 [2 - 4.22] | 3 [2.25 - 4.04] | 3 [2 - 4.33] | 0.784 |
(in hour) | ||||
Breastfeeding in the delivery room | 0.888 | |||
No | 443 (88.6) | 222 (88.8) | 221 (88.4) | |
Yes | 57 (11.4) | 28 (11.2) | 29 (11.6) | |
Help to breastfeed in the delivery room | 0.045 | |||
Health professional | 26 (45.6) | 9 (32.1) | 17 (58.6) | |
No one | 31 (54.4) | 19 (67.9) | 12 (41.4) | |
Time of the first breastfeed | 0.528 | |||
<30 min | 2 (0.4) | 1 (0.4) | 0 (0) | |
De 30 à 60 min | 32 (6.4) | 18 (7.2) | 14 (5.6) | |
>60 min | 466 (93.2) | 231 (92.4) | 236 (94.4) | |
Liquid received before the first breastfeed | 0.648 | |||
No | 480 (96.0) | 241 (96.4) | 239 (95.6) | |
Yes | 20 (4.0) | 9 (3.6) | 11 (0.4) | |
Type of liquid | 0.711 | |||
water | 1 (5) | 1 (11.1) | 0 (0.0) | |
Tisane | 17 (85) | 7 (77.8) | 10 (90.9) | |
Artificial milk | 2 (10) | 1 (11.1) | 1 (12.5) | |
Reasons for liquid administration | 0.251 | |||
Waiting for the milky climb | 1 (5) | 1 (11.1) | 0 (0.0) | |
Facilitate the elimination of meconium | 1 (5) | 0 (0.0) | 1 (9.1) | |
Calming the baby’s colic | 1 (5) | 1 (11.1) | 0 (0.0) | |
Calming the baby’s crying | 8 (40) | 2 (22.2) | 6 (54.5) | |
Other | 9 (45) | 5 (55.6) | 4 (36.4) | |
Means of administration | 0.770 | |||
Baby bottle | 4 (20) | 2 (22.2) | 2 (18.2) | |
Spoon | 15 (75) | 6 (66.7) | 9 (81.8) | |
Glass | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Other | 1 (5) | 1 (11.1) | 0 (0.0) | |
Problems with breastfeeding | 0.275 | |||
No | 393 (78.6) | 202 (80.8) | 191 (76.4) | |
Yes | 107 (21.4) | 48 (19.2) | 59 (23.6) |
Timing of problems | 0.199 | |||
---|---|---|---|---|
Just after birth | 105 (98.1) | 46 (95.8) | 59 (100.0) | |
Other | 2 (1.9) | 2 (4.2) | 0 (0.0) | |
Type of problems | 0.220 | |||
Refusal of breast | 43 (40.2) | 19 (39.6) | 24 (40.7) | |
Insufficient milk | 11 (10.3) | 2 (4.2) | 9 (15.3) | |
Flat or umbilical nipples | 19 (17.8) | 7 (14.6) | 12 (20.3) | |
Painful nipples | 2 (1.9) | 2 (4.2) | 0 (0.0) | |
Cracked nipples | 4 (3.7) | 3 (6.2) | 1 (1.7) | |
Pain related to episiotomy | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Other | 15 (14.0) | 8 (16.7) | 7 (11.9) | |
Two or more problems | 13 (12.1) | 7 (14.6) | 6 (10.2) | |
Nipple | 0.009 | |||
Normal | 414 (82.8) | 218 (87.2) | 196 (78.4) | |
Flat or retracted | 86 (17.2) | 32 (12.8) | 54 (21.6) | |
Assessment of lactogenesis | 1.000 | |||
No changes | 224 (44.8) | 112 (44.8) | 112 (44.8) | |
Slight increase | 271 (54.2) | 135 (54.0) | 136 (54.4) | |
Significant increase | 5 (1.0) | 3 (1.2) | 2 (0.8) | |
Discomfort / Severe pain/ Fever | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Correct position of the newborn | 0.061 | |||
No | 5 (1.0) | 5 (2.0) | 0 (0.0) | |
Yes | 495 (99.0) | 245 (98.0) | 250 (100.0) | |
Correct breast taking | 0.371 | |||
No | 50 (10.0) | 22 (8.8) | 28 (11.2) | |
Yes | 450 (90.0) | 228 (91.2) | 222 (88.8) | |
Effective sucking | 0.271 | |||
No | 60 (12.0) | 26 (10.4) | 34 (13.6) | |
Yes | 440 (88.0) | 224 (89.6) | 216 (86.4) |
Values are expressed as median and quartile or in count and percentage. A p < 0.05 value is considered significant.
of breastfeeding, we noticed that 445 mothers (89%) intended to breastfeed their babies for more than 12 months. On the other hand,
Overall, 372 (178 from the control group, and 194 from the intervention group) of the 500 women surveyed could be followed and answered all of our telephone calls during the second stage of our survey (
The present study shows that the education offered on the first day after delivery, based on a pedagogical program dealing with breastfeeding through the distribution of educational booklets (subject of the study) and associated with a short support session and oral education, has proven effective in promoting exclusive breastfeeding for the first six months of a baby’s life. On the 2nd day, in 1 week and 3 months following delivery, the percentage of mothers who exclusively breastfed their infants is almost similar between the two groups (respectively, 178/194 (91.8%) against 164/178 (92.1%) “p = 0.892”; 173/194 (89.2%) against 155/178 (87.1%) “p = 0.532”; 148/194 (76.3%) against 126/178 (70.8%) “p = 0.229”). However, a higher percentage of mothers in the intervention group exclusively breastfed their babies until the age of 6 months, compared to the control group, that is, 107/194 (55.2%) against 69/178 (38.8%) with a statistically very significant difference of p = 0.002, which proved that the educational booklet has a positive impact on the duration of EB. The parameters of previous studies in this context vary and lack comparability. For instance, the study of Mattar et al. revealed a marginal increase in EB at six months after delivery among the group which received a prenatal educational intervention highlighting the benefits as well as the management of breastfeeding issues as the main content of the educational material (booklet), video, coaching session and counselling, compared to the group receiving only the booklet and the video, and the one recipient of only routine prenatal care, concluding that that educational material alone in the prenatal period is not enough and that specific prenatal education that addresses breastfeeding following a single meeting through counselling can significantly improve
Variables | Population N = 372 | p | |
---|---|---|---|
Control group n = 178 | Intervention group n = 194 | ||
Duration of EB | |||
EB at 2 days | 0.892 | ||
No | 14 (7.9) | 16 (8.2) | |
Yes | 164 (92.1) | 178 (91.8) | |
EB at 1 week | 0.532 | ||
No | 23 (12.9) | 21 (10.8) | |
Yes | 155 (87.1) | 173 (89.2) | |
EB at 3 months | 0.229 | ||
No | 52 (29.2) | 46 (23.7) | |
Yes | 126 (70.8) | 148 (76.3) | |
EB at 6 months | 0.002 | ||
No | 109 (61.2) | 87 (44.8) | |
Yes | 69 (38.8) | 107 (55.2) | |
Nutrition mode after stopping EB | 0.107 | ||
Breast and PM | 63 (57.8) | 56 (64.4) | |
Breast and CM | 2 (1.8) | 3 (3.4) | |
Breast and CF | 36 (33) | 17 (19.5) | |
FM alone | 7 (6.4) | 11 (12.6) | |
Breast and PM and CM | 1 (0.9) | 0 (0) | |
Reasons for discontinuing EB | 0.124 | ||
Child’s disease | 5 (4.6) | 2 (2.3) | |
Return to work | 8 (7.3) | 9 (10.3) | |
Insufficient milk | 45 (41.3) | 32 (36.8) | |
Mother’s disease | 0 (0) | 3 (3.4) | |
Occurrence of new pregnancy | 0 (0) | 3 (3.4) | |
Difficulty in sucking | 41 (37.6) | 34 (39.1) | |
Other | 10 (9.2) | 4 (4.6) |
Values are expressed as median and quartile or in count and percentage. EB: exclusive breastfeeding; PM: pharmacy milk; CM: cow milk; CF: complementary food. A p < 0.05 value is considered significant.
breastfeeding practice [
Our results support current evidence for educational intervention since mothers with more information about EB, and therefore more knowledge, are more likely to practice it than their counterparts who lack enough information. This proves, once again, that the level of knowledge is a factor strongly linked to the practice of EB. These results are supported by the study conducted by Sriram et al. and that of Mogre et al. revealing the relation between high prevalence of EB and better maternal knowledge in the field [
Resort to more than one method of education and support in the present study (booklets + oral counselling) has proved more effective than choosing one (oral counselling) to improve mothers’ knowledge, and consequently, continue to exclusively breastfeed until the age of 6 months. It has been reported in systematic reviews that educational interventions based on different methods have proved more effective than those focused solely on a simple method [
The strategy adopted during our intervention is based on face-to-face support. First, through short oral training, and then through the distribution of educational materials in the form of booklets encouraging women to read and follow the instructions enshrined therein as they would guide them throughout the postnatal period. The strategy has been successful in extending the duration of EB, a result supported by a systematic review which has shown that non face-to-face support strategies are ineffective in promoting breastfeeding [
Our intervention was conducted shortly after delivery, so we focused mainly on the postnatal period, which yielded good results showing an improvement of EB practice. It had been stated in a study that the advice given during the postnatal visit on infant nutrition is positively related to the duration of EB, thus reducing the risk of discontinuation [
In this study, the main reasons for stopping EB in the course of the first six months, according to mothers in both groups, were milk insufficiency and breastfeeding difficulties. A study found four main reasons for the cessation of breastfeeding among which are: the perception of inadequate milk supply and chest discomfort, including nipple pain, which reflects breastfeeding difficulty [
According to our results, the alternative nutritional method in case of discontinuation of EB is primarily breast with pharmacy milk, and according to the literature and this study, the concern about milk insufficiency and breastfeeding difficulties present common reasons for the introduction of the infant formula [
The most important thing in this work is that our intervention based on educational materials has been successful, reaching 55.2% of babies’ breastfed exclusively until the age of six months. This percentage is higher compared to the one reflecting the situation in Morocco in 2011, which was 27.8%, and slightly lower than the target set by the National Nutrition Strategy for 2019, which is 60% [
In our work, we found that the majority of women surveyed in this study did not receive breastfeeding counselling during the prenatal visit (83.4%), and that most of them were unable to breastfeed in the delivery room (88.6%), which supports the results that 93.2% of women were not able to breastfeed their babies until after the first hour after delivery despite the nutritional importance of colostrum. As a result, the level of knowledge, and consequently the practice, of mothers is not encouraging in the promotion of EB, which explains the decline in rates over the years. Hence the need to strengthen the skills of health professionals in terms of infant nutrition [
The difficulty of following the 500 women recruited given the number of lost to follow-up (unable to reach them by telephone).
The educational intervention assessing the efficiency of booklets during the postpartum period with regard to the practice of EB has achieved a significant percentage of exclusively breastfed babies until the age of six months. Such a result will encourage the adoption of these forms of support and finding more effective measures to improve EB rates in Morocco. Therefore, a next step will be to make this program available to health professionals in order to support pregnant women first through prenatal education, and then women who have just delivered through postnatal education.
We extend our thanks to all participants for their contribution.
The authors declare that they have no conflict of interest in relation to this article.
Amina Barkat and Amina Bennis conceived and designed the study; Amina Bennis recruited and conducted the onsite survey of mothers; Amina Bennis and Fatima Zahra Laamiri analyzed, verified and interpreted the data; Aicha Kharbach, Hassan Aguenaou, Anas Ansari Chebguiti, and Mustapha Mrabet helped to design the study and critically revised the manuscript. Amina Bennis wrote the paper. All the authors read and approved the final manuscript.
Bennis, A., Laamiri, F.Z., Chebguiti, A.A., Aguenaou, H., Mrabet, M., Kharbach, A. and Barkat, A. (2017) Impact of Educational Materials on the Duration of Exclusive Breastfeeding Assured by Women Who Delivered at the Souissi Maternity Hospital in Rabat. Open Journal of Obstetrics and Gynecology, 7, 1300-1318. https://doi.org/10.4236/ojog.2017.713133