Abstract
BACKGROUND AND AIMS
International guidelines on infant feeding in emergencies advise protecting, promoting, and supporting breastfeeding (BF) for all infants in these settings. The re-establishment of exclusive BF (EBF) is also a central part of the management of acutely malnourished infants under six months old. More evidence on the feasibility, acceptance, and impact of BF promotion and support during emergencies is needed. Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) experiences and perceptions of BF practice, promotion, and support.
METHODS
We conducted a qualitative study using in-depth interviews, focus group discussions and non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programmes or reached during health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data was collected involving a local translator and analysed using reflexive thematic analysis directly from audio recordings. [Download full PDF for more information on participants.]
RESULTS
Data shows how BF practices are strongly influenced by family and community. BF is common, although EBF for the first six months remains suboptimal. Frequent perception of breastmilk insufficiency, leading to early supplementary feeding, is associated with poor maternal nutrition, stress, and inadequate BF practice, in a context shaped by displacement and food insecurity. Yet, EBF seems to increase over time, due to growing access to BF promotion. The provision of comprehensive in-patient care generally leads to acceptance and positive outcomes of BF support. The achievement of EBF may be reversed after discharge if CGs lack an enabling environment for BF.
CONCLUSIONS
When designing promotion and support strategies, BF should be understood as an embodied experience shaped by socio-cultural and contextual factors. More emphasis should be placed on the follow-up and management of nutritionally at-risk mothers and infants in the community.
