Father’s knowledge and attitude towards breast feeding

K. Abhinaya 1, T. S. Arunprasath 2, L. N. Padmasani3 

1Ms. Abhinaya, Final year MBBS, 2Dr. T.S.Arunprasath, Assistant Professor in Pediatrics, 3Dr. L.N. Padmasani, Professor of Pediatrics, authors are affiliated with Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India

Address for correspondence:  Dr. T. S. Arunprasath, Email: drtsarunprasath@yahoo.com

Abstract

Introduction: A father’s knowledge and attitude towards breastfeeding are very important for the success of breastfeeding practices. There is no uniform practice of including them in the education sessions in our country. Objectives: To assess the knowledge and attitude towards breastfeeding among fathers of infants aged 6 months to 2 years attending well baby clinic. Material and Method: A cross sectional study with convenient sampling was conducted on 93 fathers. A self-administered, pretested and pre-validated questionnaire with regards to breastfeeding practices was then distributed among the fathers. Results: 93 respondents completed this study. 70 fathers (75.3%)  had  babies exclusively breast fed between 4-6 months of age. 54 fathers (58.1%) had knowledge about breastfeeding before baby’s birth  and 68(73.1%) were keen to get more information after baby’s birth. 90 fathers (96.8%) felt that they got required information , but only 34 (36.6.%)  had received education from health care providers. Knowledge regarding exclusive breastfeeding (n=84), breast milk superiority,(n=86), emotional bonding created by breastfeeding (n=70) was adequate in most. Father’s age, education status, occupation, family type had no influence on knowledge or attitude. Father’s whose child was born by caesarean section or had co morbidities in neonatal period had better knowledge and positive attitude. Fathers with better knowledge had positive attitude towards breastfeeding, but this had no influence on duration of exclusive breastfeeding. Conclusion: Father’s knowledge was positively affected by health care exposure and education. Fathers with good knowledge had positive attitude towards breast feeding.  Hence they should be included in discussions regarding breastfeeding in antenatal counselling.

Keywords: knowledge, Fathers, Breastfeeding

Manuscript received: 25th September 2016, Reviewed: 7th October 2016
Author Corrected: 19th October 2016, Accepted for Publication: 31st October 2016

Introduction

The World Health Organization [WHO] recommends exclusive breastfeeding [EBF] till six months of age [1]. In spite of many initiatives to promote EBF, the rates continue to be low in India [2]. The influences of factors like maternal education, socioeconomic status and antenatal services have been studied in detail. [3, 4, 5]. However, a woman’s decision is often influenced by her partner’s attitude [6]. There is very little data available about Indian fathers’ knowledge and attitude towards breastfeeding.

Methodology

A cross sectional, observational study was conducted in May - June 2016, as a part of MBBS Undergraduate Summer research fellowship program in our university. Fathers of children aged 6 months to 2 years, coming for well-baby check-up were interviewed with a structured pre-validated questionnaire.

Tools: KAP questionnaire: The questionnaire had five sections: Section 1 on baby’s and parents socio-demographic details, Section 2 on baby’s details like birth and feeding details, Section 3 to evaluate fathers knowledge about breast feeding and Section 4 to evaluate attitude of fathers towards breastfeeding.

A 5 point Likert scale was applied [strongly agree = +2, agree = +1, neutral=0 disagree = -1, and strongly disagree = -2] for the knowledge questions valued as positive and [strongly agree = -2, agree = -1, neutral=0 disagree = +1, and strongly disagree = +2] for the knowledge questions valued as negative. Similar scales were applied for the statements used to test attitude.

The total score was calculated and was transformed into mean ‘percent score’ by dividing the score with possible maximum score and multiplied by 100. Scores for Knowledge was categorized as poor [0-<=30%], moderate [>30 %-< =70%] and high [>70%]. Scores for attitude was categorized as negative [0-<=30%], neutral [>30 %-< =70%] and positive [>70%].

The study was done with the approval of the Institution’s Ethics Committee and informed consent of parents.

Analysis: Descriptive analysis was done to analyse the socio-demographic data and Pearson Chi square test analysis was used to compare the knowledge score with attitude score and to compare the knowledge and attitude scores with other variables.

Results

A total of 93 respondents completed this study. The demographic details of the participants and their baby details is shown in Table 1-3. Majority babies had been exclusively breast fed for 4-6months of age.[n=70,75.3%]
The mean knowledge score was 11.247[SD=6.79] and the mean attitude score was 16.151[SD=7.52].

Table-1: Demographic variables of fathers

 

Number

Percent

Age group

21 to 30

37

39.8

31-40

55

59.1

more than 40

1

1.1

Education

Profession

8

8.6

Graduate

44

47.3

Post High School Diploma

9

9.7

High School

24

25.8

Middle School

5

5.4

Primary School

3

3.2

Working status

 

 

Profession

16

17.2

Semi-profession

25

26.9

Clerical/shop owner / farmer

4

4.3

Skilled worker

27

29.0

Semi-skilled worker

15

16.1

Unskilled worker

6

6.5

Family type

Nuclear

44

47.3

Joint

49

52.7

Residence

Hut

1

1.1

Flat

26

28.0

Independent house

66

71.0

Table 2: Demographic variables of baby details

Baby details

Number

Percent

Sex

Male

45

48.4

Female

48

51.6

Birth Order

1st born

62

66.7

2nd born

24

52.8

3rd born

6

6.5

4th born

0

0

5th born

1

1.1

Gestation age

Term

83

89.2

Pre-term

9

9.7

Post-term

1

1.1

Birth weight

<2.5kg

28

30.1

2.5-4kg

64

68.8

>4kg

1

1.1

Nicu stay in hours

<24

89

95.7

24-72

4

4.3

Co Morbidities

Absent

85

91.4

Present

8

8.6

Mode Of Delivery

Vaginal

53

57.0

Assisted

4

4.3

Lscs

36

38.7

Table 3: Feeding pattern of subject

Feeding details

 

Number

Percent

Time of initiation of breastfeeding

<=  1 hour

34

36.6

>1 -  4 hours

29

31.2

>4 - 24 hours

15

16.1

>  24 hours

15

16.1

Prelacteal feeds given

No

79

84.9

Yes

14

15.1

Duration of exclusive breastfeeding

< =4 months

17

18.2

4 - 6 months

70

75.3

>6 months

6

6.5

Early initiation of complimentary feeds

Not enough milk

51

55.4

Inadequate milk

23

25.0

Family influences

17

18.5

Others

1

1.1

Duration of stay in maternal home

<= 4 months

60

64.5

4 – 6 months

25

26.9

> 6 months

8

8.6

54 fathers [58.1%] had knowledge about breastfeeding before baby was born and 68[73.1%] were keen to get more information after the baby was born.

90 fathers [96.8%] felt that they got required information about breastfeeding, but only 34 [36.6. %] of them had received education from health care providers. Knowledge regarding recommended duration of exclusive breast feeding [n=84, 90.3%], breast milk superiority over formula/cow’s milk [n=86, 92.5%] and promotion of emotional bonding by breastfeeding [n=70,75.2%] was adequate in most fathers.  However, the knowledge that breast feeding reduces postpartum depression in mother [n=27, 29%] and weight gain [n=15, 16.1%] Also, knowledge that after LSCS also, mothers can produce enough milk [n=31, 33.3%] was inadequate. Majority fathers [n=51] felt that breastfeeding should be continued for more than a year.

Fathers in the age group of 31-40, had more knowledge than those in the age group of 21-30 but the difference was not statistically significant. Attitude was neutral in the fathers of 21-30 age group, [n=18] and was positive in 31-40 age group, [n=26] but again the difference was not statistically significant.

Fathers educational and work status and the family type did not have any influence on knowledge or attitude of breast feeding practices.

Birth order of the child had a negative influence, with knowledge and attitude declining with increasing birth order. Fathers whose child had co morbidities in the neonatal period or hospitalization in the neonatal period had more knowledge and a positive attitude. When the child was delivered by Caesarean section, fathers had good knowledge and positive attitude [Table 4].

Table-4: Fathers knowledge score and attitude score in comparison with variables
    

Variable

Knowledge score in percent

Total

Significance

less than 30

30-70

>70

 

 

Age

21 to 30

22

12

3

37

 

 

.047

31-40

18

35

2

55

more than 40

0

1

0

1

Education

Profession

5

3

0

8

 

 

 

 

 

 

.157

Graduate

17

24

3

44

Post High School Diploma

6

3

0

9

High School

6

16

2

24

Middle School

5

0

0

5

Primary School

1

2

0

3

Working status

Profession

8

7

1

16

 

 

 

 

 

 

.019

Semi-profession

8

17

0

25

Clerical/shop owner / farmer

1

1

2

4

Skilled worker

13

12

2

27

Semi-skilled worker

7

8

0

15

Unskilled worker

3

3

0

6

Family type

Nuclear

20

21

3

44

.711

Joint

20

27

2

49

Birth order

1

23

34

5

62

 

 

 

.003

2

17

7

0

24

3

0

6

0

6

5

0

1

0

1

Co morbidities in baby

No

38

42

5

85

 

.525

 

Yes

2

6

0

8

mode of delivery

 

 

 

 

 

Vaginal

26

25

2

53

 

 

.115

Assisted

2

2

0

4

LSCS

12

21

3

36

Variable

Attitude score in percent

Total

Significance

less than 30

30-70

>70

 

 

Age

21 to 30

8

18

11

37

 

 

.348

31-40

7

22

26

55

more than 40

0

1

0

1

Education

Profession

2

3

3

8

 

 

 

 

 

 

.629

 

Graduate

6

21

17

44

Post High School Diploma

3

4

2

9

High School

2

10

12

24

Middle School

2

1

2

5

Primary School

2

1

2

5

Working status

Profession

3

8

5

16

.932

Semi-profession

2

12

11

25

Clerical/shop owner / farmer

1

2

1

4

Skilled worker

4

10

13

27

 

Semi-skilled worker

4

6

5

15

Unskilled worker

1

3

2

6

Family type

 

Nuclear

7

20

17

44

.968

Joint

8

21

20

49

birth order

 

1

9

28

25

62

 

 

 

.468

2

6

11

7

24

3

0

2

4

6

5

0

0

1

1

Co morbidities in baby

 

No

15

38

32

85

 

.107

 

Yes

0

3

5

8

Mode of delivery

 

Vaginal

9

24

20

53

 

 

.648

Assisted

0

3

1

4

LSCS

6

14

16

36

Father’s knowledge regarding breast feeding had no influence on the practice of giving prelacteal feeds or duration of exclusive breast feeding [Table 5].

Table-5: Father’s knowledge score and attitude score influencing duration of exclusive breastfeeding

Variable

Duration of exclusive breastfeeding

Total

Significance

less than 4months

4-6months

more than 6months

 

 

Knowledge score in percent

less than 30

6

31

3

40

 

 

.451

30-70

9

37

2

48

>70

2

2

1

5

Variable

Duration of exclusive breastfeeding

Total

Significance

less than 4months

4-6months

more than 6months

 

 

Attitude score  in percent

less than 30

1

13

1

15

 

 

.617

30-70

7

31

3

41

>70

9

26

2

37

Table-6: Knowledge affecting the attitude towards breast feeding

 

Knowledge percent score

Attitude percent score

less than 30

30-70

>70

Total

less than 30

14

0

1

15

30-70

16

23

2

41

>70

10

25

2

37

Total

40

48

5

93

Fathers with better knowledge had positive attitude towards breastfeeding and it was statistically significant [Table 6].

Discussion

Fathers in our study were keen to get information about breastfeeding, similar to fathers in other studies [7] but only half of them had adequate knowledge about breastfeeding before birth of baby. This may be because of limited involvement of fathers during antenatal checkup in our country.

As reported in earlier studies from India, after child birth, only a few fathers got information about breastfeeding from healthcare professional [8]. As a routine, fathers are not involved in infant feeding education decisions in our setting.

As reported earlier, most fathers knew that breast milk was superior to formula [9] and that it increased emotional bonding between mother and baby [10].

In contrast to other studies, fathers education status had no influence on knowledge or attitude towards breast feeding [11] probably due to the influence of the family structure in our country.

Neither nuclear nor joint family type had an influence on knowledge and attitude of the fathers in our study suggesting non involvement of fathers in infant feeding decisions in our setting.

As reported earlier, fathers in our study exhibited positive attitude towards breastfeeding, when they had a child delivered by Caesarean section or when the baby was hospitalized for comorbidities [12] probably due to exposure to health care professional and health education.

Even fathers with moderate knowledge and positive attitude, could not influence the duration of exclusive breast feeding and this finding is reported by Karande [13], while study done by Susin [14] reports otherwise. This difference may be attributed to family dynamics in our setting and dominant role played by females in decision making strategies of infant feeding.

Previous studies have shown that if fathers are educated and involved in infant feeding decisions making, the rates of exclusive breast feeding will definitely increase [15]. In our study fathers with good knowledge had a positive attitude towards breastfeeding even though they did not have antenatal classes or postnatal involvement in infant feeding

Conclusion

Father’s knowledge was positively affected by health care exposure and education. Fathers with good knowledge had a positive attitude towards breast feeding. If fathers are educated by health care professionals the rates of exclusive breastfeeding will improve.

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

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How to cite this article?

K. Abhinaya, T. S. Arunprasath, L. N. Padmasani. Father’s knowledge and attitude towards breast feeding. Int J Med Res Rev 2016;4(10):1778-1785.doi:10.17511/ijmrr. 2016.i10.12.