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Indian Journal of Community Medicine

Breast Feeding Behaviour of Indian Women

Author(s): A. A. Kameswararao*

Vol. 29, No. 2 (2004-04 - 2004-06)


Research question: What is the extent of Exclusive Breast Feeding (EBF) in Indian Mothers.

Objectives: (1) To know all types of breast feeding behaviour in mothers. (2) The extent of EBF practice. (3) Urban/Rural comparison of breast feeding practice. (4) The relationship of breast feeding and other social variables like income, literacy age at marriage and parity of mothers.

Design: Cross-sectional study.

Setting: Urban and rural areas of Latur and Osmanabad districts of Maharashtra (India).

Participants: Urban and rural mothers: 314, medical students : 32. Two Lecturers from Deptt. of Community Medicine.

Study variables: ( l) EBF practices in urban and rural mothers. (2) Other types of breast feeding. Almost exclusive partial and token feeding. (3) EBF and social factors.

Statistical method: ( 1) WHO 30 cluster sampling technique.

Results: (1) EBF practice was inadequate (39.5%). (2) EBF practice improved with increasing parity and with marriage between 19-25 Yrs. (3) There was no relation of EBF with literacy status or income of mother. (4) Almost exclusive type, breast feeding was found in 19% of mothers whereas partial breast feeding 38% and token feeding 3.6% mother.

Conclusion: (1) There is a need for intensifying IEC activities in CSSM programme to increase EBF practice (2) There is a need for community involvement.

Key words: Exclusive breast feeding, parity, age at marriage, urban/rural


Malnutrition of child begins from infancy itself, if the infant do not receive enough nutrients. This may be due to poor infant feeding practice because of poor knowledge about significance of breast feeding, especially of exclusive breast feeding. Proper knowledge and practice of breast feeding and weaning are essential for complete physical, mental and psychological growth of child.

The change in the infant feeding practice occurred initially in the industrialised countries. Soon the educated women in the underdeveloped countries began curtailing duration of breast feeding''. Soon uneducated poor women from urban and rural areas began follow the footsteps of their more educated counterparts WHO. took the lead and recommended ten steps for promoting. protecting and supporting breast feeding 6.

Exclusive breast feeding (EBF) takes care of two essential elements of newborn care-nutrition and infection control. EBF can save many lives by preventing malnutrition and reducing the risk of infections and hypothermia. No child should be denied the benefit of EBF due to lack of information to the mother. EBF should bee practiced for at least four months and preferably six months in poor countries since they have a high risk of infection through contaminated water and food.'

Exclusively breastfed babies do not require water even in hot climates. Prelecteal feeds are not necessary as breast milk is easily digestible. Such feeds carry the risk of infection and also delays the establishment of lactation9, 10 . Premature interaction of supplements is harmful for the baby as it interferes with maintenance of lactation". Benefits of breast feeding get diluted as its exclusivity decreases. Thus the health worker should discourage the practice of prelacteal feeds and premature supplementation 12 .

In this study, it was attempted to find out the various types of brastfeeding behaviour of mothers living in rural and urban areas of Maharashtra state of India, with a special emphasis on exclusive breastfeeding behaviour and other infant feeding practices.


l. To know different types of breast feeding behaviour among mothers. 2. To find out the extent of practice of exclusive breast feeding by mothers. 3. To compare the practice of breastfeeding in urban and rural areas. 4. To study the additional aspects of breastfeeding like the frequency, duration, interval between feeds and relationship of breastfeeding with the income, literacy, age at marriage and parity of mothers.

Materials and methods

1. This study was conducted from 4-2-97 to 20-2-97 in Latur and Osmanabad districts of Maharashtra state. An oral questionnaire was prepared containing questions about various types of breast feeding behaviour based on "Scheme and framework for breast feeding behaviour" recommended by Inter agency group for action on breast feeding' 3. The four types of Breast feeding were defined as follows: The feeding may be from either one or both the breasts'.

Exclusive breast feeding (EBF): Except breast milk, nothing enters the infant's mouth for the first four months of life, Even water is not allowed.

Almost Exclusive breast feeding (AE): Water, drugs, vitamins and ritual feeds are allowed into infant's mouth in addition to breast milk. Partial Breast Feeding : Types

High Partial (HP): More than 80% of infant feeds are breastfeeds.

Medium Partial (MP): Only 20-80% of infant feeds are breastfeeds. Low Partial (LP) . Less than 20% of infant feeds are breast feeds. Token Feeding (TF) : Breast feeding from either one or both the breasts for less than 15 minutes per day, only to console the baby who is crying. It has got very little nutritive value.

In addition to the above four main types of breast feeding behaviour, the questionnaire also contained enquiries about the age at marriage, parity, monthly income, literacy status, residential status of mothers and frequency, duration and interval between feeds.

Multi indicator coverage survey (Mother and Child Health Survey) was conducted jointly by UNICEF and Govt. of Maharashtra in all the districts of Maharashtra State, selecting 30 clusters from each district for survey. WHO 30 cluster sampling technique was used to select 30 villages (clusters) from each district. Preliminary training for 3 days (4-2-97 to 6-2-97) was given to 24 students investigators in our department of Community Medicine. Sample survey was conducted on 5.2.97 in 4 villages. This opportunity was utilized for conducting this study on breastfeeding behaviour in these two districts using 12 female medical students as investigators. The questionaire was pretested on 5.2.97 during sample survey. A lecturer from the department acted as coordinator and supervisor. Actual study was carried out simultaneously along with multi-indicator survey from 10.2.97 to 20.2.97 for ten days. Each investigator covered five cluster in 10 days i.e, one cluster (village) in two days. The cluster selected belonged to both urban and rural areas of the two districts. During the survey, the mothers were interviewed regarding the breastfeeding using the pretested questionaire.


Sixty five urban mothers (20.7%) and 249 rural mothers (79.3%) 1314 mothers in total) were interviewed for their breast feeding behaviour. Urban mothers are less when compared to rural counterparts. 87% of mothers belong to families with monthly income of Rs. 1000/- 3000/­ only. Urban mothers (86%) and 194 rural mothers (78%) are having three living children. 55 rural mothers (22%) are having four living children when compared to only 09 urban mothers (14%). 55 of urban mothers (85% ) and 192 of rural mothers (77%) got married between 14-19 years of age. 10 of urban mothers 157 and 147 of rural mothers (18%) got married between 19-25 years of age. Literacy status is almost same in both the groups (Urban 41% and rural 40%)

Table I : Breast feeding practices

Type of feeding Urban (65) Rural (249) Total(314)
n (%) n( (%) n (%)
EBF 32 (49) 92 (37) 124 (39.5)
AE 11 (91.6) 49 (19) 60 (19)
HP 10 (15) 40 (16) 50 (16)
MP 10 (15) 28 (11) 38 (12)
LP I1 (1.5) 31 (12) 32 (10)
TF 1 (1.5) 9 (3.6) 10 (3.2)

Table II: EBF Practice with Social Variables

Social factors Urban (32) Rural(92)
n (%) n (%)
Socio- economic status 18 (56) 48 (52)
Middle 8 (25) 35 (38)
High 6 (18) 9 (10)
Literacy 18 (56) 45 (49)
High School 7 (22) 37 (40)
College 7 (9) 10 (11)
Age at marriage 9 (28) 28 (30)
14-19 yrs.
19-21 yrs. 23 (72) 64 (90)
Tiny Children 13 (40) 10 (11)
2 10 (31) 8 (9)
3 5 (16) 27 (29)
4 4 (12.5) 47 (51)

The usual frequency 5-9 times by all mothers, usual duration of feeding 5­10 minutes by all mothers and usual interval between feeding is 1-3 hours

The practice of EBF is seen increasing with parity in rural mothers and decreasing, with parity in urban mothers (Table II). EBF practice is seen more in the mothers who got married between 19-25 yrs. than with early marriage between 14-19 yrs age (Table I) Peculiarly more poor and illiterate women were practicing EBF (Table II). Forty mothers (32%) had continued EBF up to the age of one year 52 mothers of EBF group (41.9%) have continued breastfeeding along with weaning foods up to age of one year. About 32 mothers of EBF group (25.8%) have continued breast feeding with foods up to two years. About 80% AE and 85% PBF groups are also seen continuing breast feeding beyond 4 months up to 1-2 yrs.


In this study, all types of breast feeding behaviour observed both in urban and rural areas.

Good sign was EBF was more practiced when compared to other types of breast feeding behaviour, though not yet adequate, EBF is essential up to 4 months of life for infection control and improving nutritional status in a developing country like India as an effective intervention to reduce child mortality. EBF practice of about 40% in this study is not adequate. It should be universally practiced by all mothers (100%) to get the full benefits. Some researchers consider Almost exclusive (AE) type, which includes water and vitamins also as full breast feeding. In that case, the combined practice of EBF and AE in this study is about 58.5%, still less than the required. But it is not at all desirable to dilute EBF by adding AE to it, as simple addition of water itself makes the child more vulnerable for infections and mortality. Benefits of breast feeding get diluted as its exclusivity decreases.

EBF practice in urban mothers is not as high as expected (only 49%) when compared to practice in rural mothers (37%). We expect better practice in urban area as there will be btter dissemination of information about EBF.

As a whole, the practice of EBF in this study is increasing in rural mothers with parity indicating that mothers are gaining experience in breast feeding with increased parity. This practice of EBF is seen decreasing in urban mothers with increasing parity. The reason for this dropout may be either negligence or cosmetic purposes.

EBF practice is less (40%) with early marriages between 14-15 years. This is expected because of physical immaturity and unawareness of art and significance of breastfeeding itself. On the contrary, EBF practice is much better (60%) if the age at marriage is between 19-25 years.

Peculiarly more number of poor and illiterate mothers of both urban and rural areas are practicing EBF than well to do mothers (Table 1). This indicates that the socioeconomic status (income and literacy status) may not always be the factor for non-practice. May be poor women, though they are illiterate might have received better information on EBF by our health workers. Hence inspire of illiteracy and poverty, they are practicing EBF. This shows that something can be done inspire of poverty and illiteracy. These two are be not absolute obstacles for implementation of health programmes.

About 38% of mothers, almost equal to EBF practice (40%) are practicing partial breast feeding of different grades. The practice of three grades of partial breast feeding-high partial, medium partial and low partial are 16%, 12% and 10% respectively. There is no urban and rural difference in the former two, whereas low partial type is more practiced by rural mothers (12%). The partial breast feeding itself is less acceptable and less nutritious when compared to EBF. Rural practice of low partial breastfeeding (12%) is serious matter because feeds less than 20% of infant feeds is very poor food and increases child mortality. Token feeding to console the child for less than 15 minutes/ day either from one or both the breasts is not at all advisable to be practiced by mothers as it is little nutritious. Token feeding in rural mothers (3.6%) and urban mothers (1.5%) is high and is to be curtailed.

Source of information about breast feeding was not obtained during survey as it was not included in the objectives. It could be a better tool for breast feeding promotion. Relationship of breast feeding behaviour could be obtained only with regard to urban or rural residence but not with exact place of delivery which can be more useful for motivation of breastfeeding. Importance was not given whether the breastfeeding is from one or both the breasts. Only behaviour was emphasized.


To summarise, a cross sectional study on breast feeding behaviour was conducted among 314 mothers during Feb' 97, and it was found the EBF practice was 4 O 'lo and was not adequate. This practice was found to increase with parity and when age at marriage is between 19-25 years. It has no relationship with income and literacy status of mothers. Regarding other types of breastfeeding behaviour, almost exclusive type (AE) was practiced by 19%. Low partial (LP) and token feeding (TP) were practiced by rural mothers and were to be corrected. The usual duration of breast feeding is 5-10 minutes and interval between feeds is 1-3 hrs. Though EBF practice was not adequate the practice of prolonged breast feeding up to 1-2 years was significant enough to combat malnutrition and infections.


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