The Health Agenda, Volume 2. Issue 1.

January, 2014

ORIGINAL ARTICLE

Breastfeeding and weaning practices among literate mothers

A community based study in rural area of Perambalur taluk, Tamil Nadu

Authors: Rahul H Dandekar, Mohd. Shafee, Rakesh Kumar

Corresponding author: Dr. Rahul H Dandekar
Assistant Professor, Dept. of Community Medicine
Dhanalakshmi Srinivasan Medical College and Hospital
Perambalur, Tamil Nadu - 621212
Mail ID: rh.dandekar@gmail.com
ABSTRACT
Background: The barriers for breastfeeding and weaning practices include lack of mothers’ knowledge
regarding breastfeeding and weaning practices, inadequate IEC activities in hospital, advertisement of
breast milk substitutes, lack of support for the act and also many women identify employment as barrier.
Breastfeeding practices in rural communities are shaped by their beliefs which are influenced by social,
cultural and economic factors. Objective: This study was carried out to know breastfeeding and weaning
practices among literate mothers living in rural area. Methodology: The present community based cross-
sectional study was carried out in rural area of Perambalur taluk in Tamil Nadu state from January to June
2013. In a selected village, Siruvachur, all literate mothers having children between 0-2 years of age were
interviewed. This study was conducted on 250 literate mothers. The statistical analysis was done by using
software package Epi Info™ 7 (7.1.2). Results: Out of 250 mothers, the education of 138 (55.2%) mothers
were below matriculation, and 112 (44.8%) above matriculation. Only 104 (41.6%) mothers initiated
breastfeeding within one hour after delivery. Weaning was started before 6 months by 21.6% mothers.
The present study revealed that mothers with above matriculation education gave more pre-lacteal
feeding and lesser colostrum to babies as compared to lower education level mothers. The prevalence of
exclusive breastfeeding upto 6 months of age was 79.2%, but lesser in mothers with education above
matriculation. Breastfeeding more than 12 months period was continued by 7.2% mothers.
Conclusion: Breastfeeding and weaning practices among literate mothers were satisfactory.
Key words: Breastfeeding, Literate mothers, Weaning

INTRODUCTION
The optimal practice of breastfeeding (BF) is
exclusive breastfeeding for the first six months
of life and thereafter cereals are introduced
while BF is continued till the age of two years
and beyond. (1) The barriers for BF and weaning
practices include lack of mothers’ knowledge
regarding BF and weaning practices, inadequate
IEC activities in hospital, advertisement of
breast milk substitutes, lack of support for the
act and also many women identify employment
as barrier. (2,3,4)
The newborn is very active during the first half
an hour after birth. If the baby is kept with the
mother and made to breastfeed, the infant
learns sucking very fast. In caesarean deliveries
newborn infants can be started with BF within
The Health Agenda, Online ISSN No: 2320-3749
4-6 hours which helps for early secretion of
breast milk and better milk flow.(5) In infants
aged 0-5 months age, non-exclusive BF results in
more than 2-fold increased risk of dying from
diarrhoea or pneumonia.(6)
Breastfeeding practices in rural communities
are shaped by their beliefs, which are influenced
by social, cultural and economic factors.(7) Poor
feeding practices in infancy and early childhood,
resulting in malnutrition, contribute to impaired
cognitive and social development, poor school
performance and reduced productivity in later
life.(8) The beneficial effects of breastfeeding
depend on breastfeeding initiation, its duration,
and the age at which the breast-fed child is
weaned.(9)
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 Dandekar RH, Mohd. Shafee, Rakesh Kumar: Breastfeeding and weaning practices among mothers
The female literacy rate in rural areas of
Perambalur district is 62.95%, while 73.9% in
Tamil Nadu state as per census data 2011.(10)
The previous study showed that mothers
education had no role in practicing healthy
BF.(11) Till date there were very few community
based studies on literate mothers regarding BF
and weaning practices. Therefore, the present
study was conducted in a rural population to
study the BF and weaning practices among
literate mothers.
METHODOLOGY
Study setting: The present community based
cross-sectional study was carried out in rural
area of Perambalur taluk in Tamil Nadu state.
The study was conducted from January to June
2013.
Study population: There were 27 villages in
Perambalur taluk. Out of this one village,
Siruvachur was selected because
of availability of mothers and easy access. In this
village all literate mothers having children
between 0-2 years of age were interviewed. A
mother having more than 2 years of age children
were excluded to minimise recall bias. There
were 283 mothers having the criteria for study.
Of these, 24 were illiterate, hence excluded.
Despite three household visits, 9 mothers were
not available for interview. Therefore, study was
conducted on 250 mothers.
Data collection procedure: The interviews of
mothers were taken after written informed
consent and using a pre-tested semi-structured
questionnaire. The socio-demographic features
such as age, religion, education, occupation and
monthly family income were collected.
In the present study, data obtained from literate
mothers was the place of delivery (in home or
hospital), pre-lacteal feeding given, time of BF
initiation after delivery (within 1 hour or after 1
hour), colostrum given, exclusive or non-
exclusive BF, bottle feeding given, whether top
feeding given, breast milk substitute given, prior
awareness of BF practice and total duration of
BF. The data regarding weaning practices was
age of initiation of weaning, immediately
stopped BF following initiation of weaning, type
of weaning food as liquid or solid, used milk
substitutes and weaning diarrhoea.
Statistical analysis: Data was processed by
software package Epi Info™ 7 (7.1.2) from
Center for Disease Control and Prevention, USA.
The information was analyzed by appropriate
statistical tests. Results were expressed in
percentages, odds ratios, 95% confidence
interval of odds ratio and chi square tests (χ2).
The p value less than 0.05 were taken as
statistically significant.
RESULTS
Out of 250 mothers having children less than 2
years of age, the education of 138 (55.2%)
mothers were below matriculation and 112
(44.8%) above matriculation. Among 136
(54.4%) mothers whose age above 25 years, 70
(51.47%) mothers education was below
matriculation. Of 242 (96.8%) Hindu mothers,
68 (59.65%) mothers education was below
matriculation.
With respect to the occupation of mothers, 196
(78.4%) mothers were housewives and 54
(21.6%) employed. Among housewives, 68
(59.65%) mothers education was below
matriculation. Among employed mothers, 28
(51.85%) mothers education was below
matriculation. There were 150 (60%) mothers
having monthly family income below 5000
rupees. The mothers with education below
matriculation were significantly more (102) in
low family income group i.e. below 5000 rupees
(χ2=24.84, p=0.0001). Since statistically no
difference was observed between two groups of
mothers in terms of age, religion and
occupation, mothers were comparable at the
time of data collection (p values <0.05).
The present study revealed that 8 (2.5%)
mothers delivered babies in their home and 242
(96.8%) in hospital. The mother’s literacy status
was not associated with the place of delivery.
Pre-lacteal feeding to neonates was given by 70
(28%) mothers. 36 (51.43%) mothers with
above matriculation education fed pre-lacteal
food to babies. Among 194 (77.6%) mothers
who fed colostrum to babies, the education of
104 (53.61%) mothers was below matriculation.
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 The Health Agenda, Volume 2. Issue 1. January, 2014

Table 1: Distribution of mothers according to socio-demographic features

Below Above
matriculation matriculation Total
Variables OR 95% CI p value
N=138 N=112 N=250
n (%) n (%)
Age < 25 years 68 (59.65) 46 (40.35) 114 1.4 0.84-2.31 0.19
Religion - Hindu 134 (55.37) 108 (44.63) 242 1.24 0.23-6.81 1
Employed 28 (51.85) 26 (48.15) 54 1.19 0.65-2.17 0.58
Income < 5000 rupees 102 (68) 48 (32) 150 3.78 2.22-6.44 <0.001

Only 104 (41.6%) mothers initiated BF within
one hour of delivery. 86 (58.9%) mothers with
education below matriculation initiated BF after
one hour of delivery. Exclusive BF was given by
198 (79.2%) mother to their babies. But 22
(42.31%) mothers with education having above
matriculation were not given exclusive BF. 160
(64%) mothers breastfed their infants upto 6
months and then started weaning. A statistically
significant difference was found among two
groups in terms of bottle feeding (χ2=10.37,
p<0.05).

Table 2: Breastfeeding practices according to literacy status of mothers

Below Above
matriculation matriculation Total
Variables OR 95% CI p value
N=138 N=112 N=250
n (%) n (%)
Place of delivery
Home 2 (25) 6 (75) 8 0.26 0.03- 1.50
0.17
Hospital 136 (14.88) 106 (43.80) 242
Pre-lacteal feeding
Yes 34 (48.57) 36 (51.43) 70 0.69 0.40-1.20
0.19
No 104 (57.78) 76 (42.22) 180
Colostrum feeding
Yes 104 (53.61) 90 (46.39) 194 0.75 0.41-1.37
0.35
No 34 (60.71) 22 (39.29) 56
BF initiation after delivery
Within 1 hr 52 (50) 52 (50) 104 0.7 0.42-1.16
0.16
After 1 hr 86 (58.9) 60 (41.1) 146
Type of breastfeeding
Exclusive 108 (54.55) 90 (45.45) 198 1.14 0.61-2.11
0.69
Non-exclusive 30 (57.69) 22 (42.31) 52
Bottle feeding
Yes 46 (43.4) 60 (56.6) 106 0.43 0.26-0.72
0.001
No 92 (63.89) 52 (36.11) 144
Total duration of BF (in months)
Upto 6 92 (57.5) 68 (42.5) 160 1.29 0.77-2.17
0.33
Above 7 46 (51.11) 44 (48.89) 90
Top feeding
Yes 38 (48.72) 40 (51.28) 78 0.68 0.4-1.17
0.17
No 100 (58.14) 72 (41.86) 172
Breast milk substitute given to the newborn
Yes 32 (57.14) 24 (42.86) 56 1.11 0.61-2.02
0.74
No 106 (54.64) 88 (45.36) 194
Prior awareness regarding exclusive breastfeeding
Yes 108 (56.25) 84 (43.75) 192 1.2 0.67-2.16
0.54
No 30 (51.72) 28 (48.28) 58

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 Dandekar RH, Mohd. Shafee, Rakesh Kumar: Breastfeeding and weaning practices among mothers

The total duration of BF in 160 (64%) mothers
was upto 6 months. Of 78 (31.2%) mothers, who
had given top feeding, 40 (51.28%) mothers’
education was above matriculation. Breast milk
substitute were used by 194 (77.60%) mothers.
The education of 32 (57.14%) mothers, who fed
breast milk substitute to babies, was below
matriculation.
Weaning was started to below 6 months infants
by 54 (21.6%) mothers. More than half
(52.04%) of the study mothers started weaning
their children at 6 months age. Immediately
after starting weaning, 106 (42.4%) mothers
stopped giving breastfeeding. Due to this abrupt
initiation of weaning, a statistically significant
difference was observed among two groups of
educated mothers (χ2=13.95, p<0.05).
Table 3: Weaning practices according to literacy status of mothers
During weaning liquid food was given by 56
(22.4%) mothers, and solid food by 194 (77.6%)
mothers. The mothers with below matriculation
education who fed solid weaning food to babies
were 108 (55.67%). Among 78 (31.2%) mothers
who fed milk substitutes to babies during
weaning, the education of 52 (66.67%) mothers
was above matriculation. A statistically
significant difference was found among two
groups of educated mothers in terms of use of
milk substitutes for babies (χ2=21.92, p<0.05).
Weaning diarrhoea was reported by 30 (12%)
mothers. Occurrence of weaning diarrhoea was
high (53.33%) among babies of mothers with
above matriculation level of education as
compared to below matriculation mothers.

Below Above
matriculation matriculation Total
Variables OR 95% CI p value
N=138 N=112 N=250
n (%) n (%)
Age of initiation of weaning (in months)
Below 6 36 (66.67) 18 (33.33) 54 1.84 0.98-3.47
0.06
Above 6 102 (52.04) 94 (47.96) 196
Immediately stopped BF following initiation of weaning
Yes 44 (41.51) 62 (58.49) 106 0.38 0.23-0.63
<0.001
No 94 (65.28) 50 (34.72) 144
Type of weaning food
Liquid 30 (53.57) 26 (46.43) 56 1.09 0.60-1.98
0.78
Solid 108 (55.67) 86 (44.33) 194
Used milk substitutes
Yes 26 (33.33) 52 (66.67) 78 0.27 0.15-0.47
<0.001
No 112 (65.12) 60 (34.88) 172
Weaning diarrhoea
Yes 14 (46.67) 16 (53.33) 30 0.68 0.32-1.46
0.32
No 124 (56.36) 96 (43.64) 220

DISCUSSION found that 93.3% infants were fed colostrum

Breastfeeding practices of rural mothers
In the present study, 96.8% babies were
delivered in hospital. Pre-lacteal feeding to
neonates was given by 28% mothers, and 77.6%
mothers fed colostrum. Singh J et al. showed that
36% of mothers had discarded the colostrum
and 33% mothers given pre-lacteal feeds.(12)
Mohd. Shafee et al. showed that 60% mothers
fed colostrum to their babies.(13) Mandal et al.
and 71.7% were given pre-lacteal (commonest
being Honey).(14) Banapurmath found that rural
mothers of central Karnataka delay initiation of
BF, reject colostrum, use pre-lacteal foods of
bottle feeding and commercial weaning
foods.(15)
In our study, 41.6% mothers initiated
breastfeeding within one hour of delivery. About
58.9% of mothers with education below
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 The Health Agenda, Volume 2. Issue 1. January, 2014
matriculation initiated BF after one hour of
delivery. The national average of mothers who
had initiated breastfeeding within 1 hour after
the birth was 23.4%. (16) Mohd. Shafee et al.
showed that only 28% mothers initiated BF
within one hour. (13) Khapre et al. found that
20% women initiated BF within 1 hour.(17)
In this study, exclusive BF was given by 79.2%
mother to their babies. But 42.31% mothers
with education above matriculation did not
breastfed their children exclusively. 64%
mothers breastfed their infants upto 6 months
and then started weaning. Medhi et al. showed
69.35% prevalence of exclusive BF up to six
months of age.(18) Radhakrishnan showed that
34% children were exclusively breastfed for six
months.(19) The total duration of BF in 64%
mothers was upto 6 months, but Singh et al
showed that 19.6% mothers had breastfed their
child for less than six months of their age.(12)
The practice of top feeding along with BF was
observed in 31.2% mothers and breast milk
substitute used by 22.4% mothers. Parmar et al.
revealed reasons for starting bottle feeding
before six months, working mother (13%) and
to habituate the baby to bottle (12%).(20)
Weaning practices in rural mothers
Weaning was started below 6 months of infants
by 21.6% mothers. 102 (52.04%) mothers had
initiated weaning in infants above 6 months.
Sharma M and Sharma S showed that 75% of
rural mothers initiated weaning in babies below
6 months of age. (21)
Immediately after starting weaning, 42.4%
mothers stopped giving breastfeeding.
Significantly more mothers (58.49%) with
above matriculation level of education abruptly
stopped breastfeeding. During weaning, liquid
food was given by 22.4% mothers and solid food
by 77.6% mothers. More mothers (55.67%) with
below matriculation education level gave solid
food to their babies. 31.2% mothers had given
milk substitutes during weaning.
Weaning diarrhoea was reported by 12%
mothers. Of these, 53.33% babies of mothers
with above matriculation level of education had
diarrhoea. Mihrshahi et al. had found that
partially breastfed infants had a higher
incidence of diarrheal infection. (22)
CONCLUSION
In our study, mothers with above matriculation
education gave more pre-lacteal feeding and
lesser colostrum to babies as compared to lower
education level mothers. The practice of
commencement of breastfeeding within one
hour of delivery was found in less than half
percentages of mothers (41.6%). 21.6% mothers
initiated early weaning. The prevalence of
exclusive breastfeeding was 79.2%, but in
mothers with education above matriculation it
was less. Only 7.2% mothers continued
breastfeeding for more than 12 months period.
The practice of top feeding and breast milk
substitute use should to be minimised. The rural
mothers’ knowledge regarding weaning
practices of commencement, gradual transition
from liquid to solid and slowly reduction of
breast milk needs to be strengthened.
Acknowledgements
Authors would like to acknowledge medical
students N. Ranjitha and R. Rahavi; medical
social workers Mr. A. Emayvaram and
Mr. L. Satiraj of DSMCH, Perambalur, Tamil Nadu
and also mothers who participated in the study.
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 Dandekar RH, Mohd. Shafee, Rakesh Kumar: Breastfeeding and weaning practices among mothers
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 The Health Agenda, Volume 2. Issue 1. January, 2014

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Particulars of Contributors:

1. Dr. Rahul H Dandekar, Assistant Professor

Dept. of Community Medicine
Dhanalakshmi Srinivasan Medical College and Hospital
Perambalur, Tamil Nadu
2. Dr. Mohd. Shafee, Professor and Head Source of funding: Nil
Conflict of interest: None
Dept. of Community Medicine
JIIU’s Indian Institute of Medical Science and Research Date of Submission: 23 October, 2013
Jalna, Maharashtra Date of Acceptance: 11 November, 2013
3. Dr. Rakesh Kumar, Assistant Professor Date of Publishing: 5 January, 2014
Dept. of Community Medicine
Dhanalakshmi Srinivasan Medical College and Hospital
Perambalur, Tamil Nadu

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