Sociology Thesis

KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST FEEDING MOTHERS A case-study of Newar community of Madhyapur Thimi Municipality, Bhaktapur district, Nepal

Thesis Submitted to the Department of Sociology/Anthropology Tri-Chandra Multiple Campus for the Partial Fulfillment of the Requirements for the Master's Degree of Arts In Sociology/Anthropology

Submitted By Swasti kumari Shrestha Nepal April, 2008

LETTER OF RECOMMANDATION This is to certified that Ms. Swasti kumari Shrestha has completed the thesis on KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST FEEDING MOTHERS “A case-study of Newar community of Madhyapur Thimi Municipality, Bhaktapur district, Nepal” under my supervision. It is forwarded for evaluation.

Date:

Narayan Paudel Lecturer Department of Sociology/Anthropology Tri- Chandra multiple college Ghantaghar, Nepal

APPROVAL SHEET This is to certify that Miss. Swasti kumari Shrestha has prepared this dissertation entitled KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST FEEDING MOTHERS “A case-study of Newar community of Madhyapur Thimi Municipality, Bhaktapur district, Nepal”. It has beed accepted as the partial fulfillment for the degree of Masters of Art in Anthropology. Dissertation committee Chairman: External: Supervisor: Date:

ACKNOWLEDGEMENT I wish to express gratitude and thanks to Lecturar. Mr. Narayan Paudel my research guide and lecturer in department od sociology and anthropology, Tri-chandra multiple college, ghantaghar, Kathmandu nepal.

His guidance, tremendous support and

valuable inspirations made me to complete this work. I am extremely grateful to Mr Ravi Vitrakoti for his great help during the questionare preparation , data collection and during the statistical analysis of the data. And also for his kind cooperation and encouraging attitude. I would like to share my eternal respect to all the teachers and staffs of Department of sociology and anthropology, Tri-chandra Multiple College Ghantaghar, Kathmandu, Nepal, all of whom have been very generous and motivating. Also, I would like express my gratitude towards all the staff of the madhyapur thimi municipality for their tremendious supports during the secondary data collection and guidance for the materials collection for preparation of this thesis. Finally, I would like to express my profound gratitude to my parents for their unconditional support, motivation and blessings without whom this work would not have been possible.

…………………………….…. Date:

Swasti Kumari Shrestha

CHAPTER ONE 1. Introduction 1.1 Background of the Study Milk is unique food adapted to nutritional needs of offspring in mammals. Breast milk from mother is the ideal food for human infants. It meets the nutritional needs of the infants up to 5 months of age, provided the baby gets enough sunlight and has been born with adequate foetal store for minerals. That is why, there is a saying that “breast feeding is the best feeding” (Adhikari et al, 1997). Not all miracles stand up to scientific scrutiny but breast milk is one that does. It is without doubt one of the worlds greatest life savers. The most sophisticated science has taken long time to recognize and prove what mothers and midwives always know breast feeding is the best for the babied and there is no substitute of equal value. Breast milk is one that saves life of human beings. So breast milk is life, comprise of containing of all the nutrients vital for nourishment, as well as growth factors believed to help in tissue development and antibodies to fend of infections. It is always at the right temperature, requires no mixing sterilization or equipment and is safe regardless of the quality and aviability of water, its composition changes from feeding to feeding and even within feedings, and the amount are triggered by the mother’s hormonal response to the needs of the baby breast feeding encourages bonding between mothers and baby and discourage conception (UNICEF, 1996) Infant feeding practices affect the health of both the mother and her child. They are important determinants of children’s nutritional status and many studies have shown that breast feeding has beneficial effects on the nutritional status, morbidity and mortality of young children. Brest feeding is also associated with longer periods of post partum amenorrhea, which in turn leads to longer birth intervals and lowers fertility levels. A longer birth interval allows mothers to recover fully before the next pregnancy and averts maternal depletion, which may follow births that are too closely spaced.

Brest feeding is almost universal; only 0.3% of children are said not to have been breast fed at all. For more than half (54%) of children breast feeding is started within the first two hours, but it is sometimes delayed for as long as 2-3 days. Nationally just over a third (36%) of children had the colustrum thrown away rather than fed to them. There is variation by geographic area and by ethnicity. In Tarai, it is more likely that colustrum will be thrown away and that starts of breast feeding will be delayed. children who had the colustrum thrown away at their birth are at increased risk of being malnourished, in particular they have nearly twice the risk of being wasted(Ibid) Breast feeding is generally prolonged, with nearly half of children aged 36 months still being breast fed however exclusive- breast feeding does not last long after birth and liquid or solid complements are often added within the first three months. By three months nearly, three quarters of children are receiving liquid or solid complements. The perceived benefits of breast feeding, especially for the children, far outweight the perceived disadvantages. The commonest reasons for stopping breast feeding are pregnancy (59% and birth of another child 12%) (Ibid) The Nepali child still benefits from the almost universal practice of breast- feeding. The 1995 NMIS reports that approximately 90%. Nepali women are still breast feeding at 18 months and at least half of the women in Nepal continue to breast fed to the child third years. The mean duration is about thirty months (UNICEF, 1996). The study shows that women with education in urban areas breast fed for an average of 29 months unlike women in rural areas with no education breast fed for an average of 31 months. Approximately 22% of the women who deliver at home started breast feeding with in one hour after giving birth compare to 14% of mothers who delivered at healthy facility. There appears to be no disparity between male and female children in the provision of breast milk during the first six months. Exclusive breast feeding is sufficient to meet the nutritional needs of infants up to six months. Howver exclusive breast feeding (without any added foods or fluids) is practiced by only 60% of the women in the first month of the child life. This goes down to 35% by the third months, far below the 100% exclusive breast feeding aspect. (Ibid) Early initiation of breast feeding is beneficial for both mothers and their children. Early sucking benefit mothers because it stimulates the release of hormones that helps

uterus to contract, the breast milk is important for babies because it contains colostrum which is rich in antibodies that protect the new born from diseases. In Nepal, although almost all babes are breast fed at some time, only 10% breast fed with in one hour of birth. 3out of 5 babies breast fed with in 24 hours of birth.(Ibid) A 1992 study on the situation of breast feeding in Nepal reported that the general factors that influence the initiation and maintenance of lactation were difficult during delivery and the mother’s feeling of inability to produce sufficient milk. In urban areas, babies were then given glucose water or formula milk, while buffalo and cow milk was a common substitute in rural areas. The study noted that breast feeding practices were also distributed because breast feeding time conflicted with the mother’s work. It is reported that the majority of the infants were only fed three to four times a day. Normally, a women breast feed whenever the baby cries, perhaps every two to three hours. Since, women, especially in rural areas, are often working away from home and children are often left in the care of others, it is likely that many women breast feed only two or three times a day ( UNICEF,1996). In the rural setting, the economic status of the family influences the continuation of breast feeding. In economically better off families, new mothers are usually not involved in farm activities for up to six months after delivery. If the family is poor and nuclear, the new mother resumes her regular work on the farm as two weeks after delivery. This is also reported that there are geographical and ethnic differences in exclusively breast feeding practices. Although the rate of exclusive breast feeding declines in both urban and rural areas as the child grows older, the decline is much more rapid in urban areas (Ibid). Prolonged breast feeding has been the only means of infants feeding until recently in poor socio-economic group of developing countries, and it is still the most prevalent infant feeding method in the world. Nevertheless, there is an obvious trend towards decreased breast feeding throughout the underdeveloped countries of the world, especially in the urban areas. Socio-economic development, rapid urbanization and

participation of women in work force have all been cited as possible causes for this trend (UNICEF, 1996). According to micronutrient survey, was undertaken in 1990, no significant number have been decreased to breast feed of child. It is reported that approximately 90% mothers breast feed to their child up to 23 months. Likewise, 60% mothers have breast feed to their children up to 35 months but the percentage of exclusive mothers who feed their children only milk is not so satisfactory (WHO, 2053 Bikram Era). 1.2 Statement of the problem The trend of breast feeding to the children is gradually decreasing. Many studies have shown the decline tendency in the exclusive breast feeding rate in urban as well as rural areas. So the falls is obviously sharper in the urban areas and among the educated and economically sound families. The changing pattern of the social and family structure is also responsible to cause for this declined trend. The mothers from urban areas spend more time outside their home and young child or the old people staying at home. The rest of the members of the family also go to their business or service. The offices where the mothers work have no facilities for baby caring and breast feeding (Adhikari, 1997). Malnutrition is the great problem concerned to public health in Nepal. It is a great issue of Nepalese people. Approximately 50% children are malnourished in Nepal. The nutritional status of women who is already mother and going to be mothers is also not satisfactory. The situation of malnourished child begins with the malnourished pregnant mothers, which affect child throughout the life. The best nutrient food of child is milk to grow up and getting healthy situation (WHO, 2058 Bikram Era). The world health organization and Unicef recommended that babies be fed breast milk only and nothing else, not even water for about the first six months of life. Worldwide reduction of formula feeding and improve breast feeding practices could save an estimated 1.5 million children a year.

The increasing trend of urbanization and the attractive package of readymade food have highly impressed which discourage the breast feeding to their children. The survey conducted by WHO says that there is little chance to be affected by disease of child one who is breast fed. It is also reduces child mortality rate significantly. Each one needs nutrient thing since the pregnancy period of mother when s/he is inside the stomach of mother. The first eating thing for baby is milk of mother after his/her birth. Nothing is needed except the milk of mother till six months for his/her well growth. The different substitute market of milk has reduced the practice of breast feeding. Although, many mothers who are not understood about the importance of breast feeding, it is best food for babies on the following aspects. •

Mother’s milk is nutrient comprised of all required elements for physical and mental growth of baby till five months.

•

Mother’s milk is readymade food which can be fed when baby gets hungry.

•

It can be fed anywhere as the requirement of the baby.

•

It has immunity power to protect from other diseases.

•

Mother’s milk is the first vaccine of the baby.

•

Milk reduces the chances of diarrhea if the breast is fed properly with neat and cleanness.

•

It develops the sentimental relationship between mothers and child.

•

It also saves the life of mothers. o It reduces the size of uterus after birth of baby o Also minimize breast cancer

•

Breast feeding help in birth spacing.

•

Breast feeding also reduce economic burden of the family.

In Nepal, as a result of many other working in nontraditional jobs in urban and semi urban areas and influence of the media, the use of bottle feeding is in rising trend although the situation may not be alarming now. This has implications on infants health as formula milk may be diluted to save money reducing the nutritional content and milk may be diluted unsterilized water increasing the incidence of diarrhea related and other diseases (Nepal family health service, 1991-92).

1.4 Significance of study In view of above, it is thus worth wide to micro study on different aspects of breast feeding as practiced by mothers in an ethnic Newar community of a country with middle income. It analyses the different factors which is responsible to determine the breast feeding. This study identifies the level of awareness among Newar community toward the breast feeding which also determine the practices of breast feeding. This study also helps health planners to assess whether they have adequate knowledge or not in order to breast feeding and it also access whether mothers of similar communities have adequate knowledge on breast feeding, leading them to designing effective training package for such a community. This study will also helpful to develop the breast feeding policy, planning and programs for concerned persons, organization to encourage mothers and their families for effective breast feeding. 1.5 Definition of key terms Higher education - who has passed secondary level. Secondary education - who has studied classes 8-10. Lower secondary education - who has studied classes 6-8. Primary education - who has studied classes 1-5. Literate - one who can read and write. Illiterate - who cannot read and write. Nuclear family - a family with husband, wife and their children only. Joint family - a family with grandfather/mother, husband, wife and their son and daughter. Ethnicity - typical case, Newar in this connection study. Colostrums - first production of milk after birth of baby. KAP – Knowledge, attitude and practice.

1.6 Organization of study The study altogether is divided into six chapters. The first chapter presents the background of the research, statement of the problem, objective of the research, significance of definition of variables and key definition of different forms. In second chapter a brief account of literature review is presented. Chapter three and four deal with methodology and general introduction of the study area. Chapter five presents data analysis and interpretation. Last chapter presents summary, conclusion and recommendation. At last, the additional matters, which provide more other informations are included.

1.7 Statement of the Problem The trend of breast feeding to the children is gradually decreasing. Many studies have shown the declined tendency in exclusive breast feeding rate in urban as well as rural areas. So the rates are obviously sharper in the urban areas and among the educated and economically sound families. Changing social and family structure may be one of the contributory causes for this decline trend. Urban mothers have to spend a lot of time outside their home and the young infants are the responsibilities of older children or the old people staying at home. Many mothers are going out to work. Their may not be facilities in working places to allow mothers to take their babies and breast fed. In Nepal, as result of many mothers working in traditional jobs in urban and semiurban areas and the influence of the media, the use of bottles-feeding is in the rising trend, although the situation may not be alarming now. This has implications on infant’s health, as formula milk may be diluted to save money, reducing the nutritional content, and the milk may be diluted with un-sterilized water, increasing the incidence of diarrhea- related and other diseases. To sum up following research questions were raised. •

Have the mother’s adequate knowledge on breast feeding?

•

When do they leave the children for the work after birth of the baby?

•

How the breast feeding is being practiced among the mothers?

•

What are the factors affecting in the particular populations?

1.8 Objectives of the Study The general objective of the study is to examine the knowledge, attitude and practice of breast feeding among mothers in particular areas. The specific objective of this study is; •

To assess the knowledge of working mothers on importance and advantages of breast feeding

•

To identify the factors associated with practice or non practice of breast feeding among working mothers

•

To exanimate the existing perceptions and taboos on breast feeding.

1.9 Rationale of the study No more studies have been conducted in order to find out the knowledge, attitude and practice of breast feeding among the mothers. Mother’s milk has been tragically under valued by economist and national planners. Rarely does anyone but a mother see it, and she sees only drops at the time. It is not marketed, so no price ,only recently has the economic importance of breast feeding and it is unique contribution to the health of infants have been appreciated breast feeding on the other hand is cheaper than artificial feeding even when the extra food required by lactating mother is taken into account. This study identifies the level of awareness among the Newar community towards the breast feeding. This study also helps health planners to develop breast feeding policy, planning and programs for concern persons/organization to encourage mothers and their families for effective breast feeding.

CHAPTER TWO 2. Review of the Literatures The past documents and publication covering the study are reviewed. Basically, literature on factors affecting breast feeding, advantages of breast feeding, colustrum feeding has reviewed.

2.1

factors affecting Breast feeding Various studies have shown a number of factors affecting breast feeding. While socio-demographic factors like social class, education and residence play a significant role in a woman’s motivation to breast feed, the importance of health systems to spread bottle feeding in this regard can not be ruled out.

2.2

Advantage of breast feeding Breast feeding has several advantage which is categorized as, economic advantage, avoided the bad effect of unsuitable substitutes, prevents infection, and malnutrition, allergy protection ,reduce cost of illness due to bottle feeding, Breast feeding in population control, psychological advantage, paid work and the decline of breast feeding.

2.3

Colustrum feeding For the first few days after delivery, the breast secrets colustrum, colustrum is yellow and thicker than latter milk and it is secreted in only small amount. But it is enough for a normal baby and it is exactly what a baby needs for a first few days.

2.4

Some statistics on breast feeding Reports on the world fertility survey, population reference bureau, June 1981 Table; percentage of children born in the 3 years proceeding the survey who were breast fed, world fertility survey (WFS) Asian country.

Country Nepal

Percentage Breast Fed 98

Bangladesh Indonesia Kenya Sri-Lanka Pakistan Korea Rep. of Thailand Philippines Malaysia Source: B. ferry, 1981, Table 1

CHAPTER THREE 3. Research Methods

98 97 96 96 95 93 92 85 74

3.1 Rationale of the selection of the Study Area Study area selected for this study is Madhyapur Thimi, Bhaktapur district. Reason for the area selection is •

Research area is near and easy to reach there.

•

No more costly to conduct study and more familiar with the research area.

•

More interested to conduct research with the women of the Newar community.

•

No any study conducted under the field of breast feeding.

3.2 Research Design The designs of research will more community based as it will be conducted directly in the community developing different questionnaire based on discussion of community people with the people participation. The research will be more descriptive as it has described the present knowledge toward breast feeding of Newar mothers in association with their age, income, education etc. the research will be also analytical, analysis show relationship between breast feeding and other socio-economic factors.

3.3 Nature and sources of Data This study is a sociological study which is based on qualitative cum-quantitative data. Primary as well as secondary data are used in this study. The primary data are collected from field survey as an observation and interview whereas the secondary data are obtained from available published and unpublished literature. Basically these are books, journals, articles, dissertation and research report etc.

3.4 The Universe and Sampling The study will be conducted in Madhyapur Thimi municipality ward no 10 and11. Approximately 200 households are there. A list of all households with at least one child with breast feeding is prepared. And the proportional stratified random sampling method can be used for selection of households.

3.5 Data Collection Techniques 3.5.1

Interview schedule:-

The mother of the child (who is being breast fed) is interviewed through some structured questionnaire. 3.5.2

Observation :Some sampled households were observed while being breast fed the child.

3.6 Method of Data Analysis Collected data is analyzed mainly descriptively as well as statistically; demographic information is analyzed in simple tabulation by process of percentage and number.

3.7 Reliability and Validity of Data Data either primary or secondary should be checked whether they are reliable or not. The valid data only can represent the researcher’s work authentic and the reliability and validity of secondary data also depend on heir limitation and factors.

3.8 Limitation of the Study •

This study is conducted to only small area particularly Newar community.

•

The status of breast feeding exist in Newar community may not entirely represent to another community.

•

This study cannot represent the whole area of Nepal but can be applied to the cultural areas, which have the similar characteristics.

CHAPTER FOUR

PRACTICE, KNOWLEDGE AND ATTITUDE ON BREAST FEEDING The respondents were asked how they felt about breast-feeding. A number of questions were administered to them to assess the existing knowledge, attitude and practice of breast feeding. 4.1 Duration of breast feeding About 54% respondents had currently breast-fed who were less than two years of age while it was good aspect to see that 45% respondents had been breast –feeding their children from 2-4 years of age. All respondent had been given up breast- feeding to their grown up children by the end of 3 years. This may be because of birth of new baby who needed more care and had to feed breast than the older one. 4.2 Frequency of breast feeding The children were fed breast maximum 12 times and minimum 5 times during the 24 hours. All respondents fed breast their youngest children during the 24 hours at a time. All respondents were breast feeding to their youngest children. 4.3 Breast feeding practice It was observed that exclusive breast feeding was up to six months in majority of respondents but very few respondents had fed breast till 1 years. 62% mothers had started to give complimentary food to their children, when they reach 6 months. It was encouraging to see that no any mothers admitted discrimination between their sons and daughters while breast feeding. 89% mothers fed colustrum to their newly born children. But few percentage 11% mothers did not fed colustrum majority of mothers around 60% fed colustrum just because it was nutritious for children. Others to feed colustrum where as 10% mothers, getting relief from breast pain. As mentioned above only 11% mothers did not fed colustrum due to some reasons i.e not suggested to feed colustrum by others, traditionally not in practice, may child get sick etc. 98% mothers fed breast to their children only for food except other causes. But very few percentages i.e 2% mothers expressed that it also builds good maternal

relationship between mother and children while feeding breast. They also accept that it is also major food for the children. A larger number of mothers 78% preffered family food like rice, pulse etc. as complementary food for their children, where as, 15% mothers preferred lito( flour made food) as complementary food. 7% mothers provide other complimentary food like fruits and biscuits etc. Very little percentage of mothers fed bottle milk not being avoidance of breast feeding its all because of the busy work but very large percentage of mothers did not feed bottle milk as breast feeding was sufficient for the infants. 4.4 Breast care practice All the respondent mothers agree that the breast should take care. All mothers take care their breast by cleaning and washing with soap and water bt not regularly, they clean it when they take bath. 4.5 Knowledge on breast feeding Altogether 30 questions were asked to respondent mothers to identify and assess their level of existing knowledge, which they have on breast feeding. The ultimate answers which carry to response those questions, have been covered importance advantages and disadvantages of breast feeding. Each question was dealt carefully to ensure that the respondents can understood very properly. The study shows that all respondents were aware that breast milk is the most appropriate food for babies. While only 15% knew that colustrum feeding is like immunizing for the babies. Almost all 90% respondents agreed that breast milk is hygienic. It is quite interesting that 60% mothers believed that breast feeding increase love and harmony

between mothers and her baby/ child very few percent of

respondent mothers 5% marked that breast- feeding reduces the chances of excessive bleeding during menstruation and occurance of breast cancer. Most of the mothers 70% were aware that in pregnancy, milk is produced more if breast is fed frequently. Only 13% respondent mothers knew that bottle feeding increases chances of getting diarrhea. Few mothers knew the importance of colustrum. The percentages of mothers is 20%, who believe that colustrum is nutritious food for newborns, while 20% knew that feeding colustrum prevents children from getting diarrhea, when asked how many times they should feed breast to their babies? Almost all of the respondents feed

breast breast more than five times a day. All they agrees that they should eat some additional nutritious food than other as usual diet including increased quantity of liquid i.e jwanoko jhol’ in lactating periods.

4.6 KNOWLEDGE ON BREAST FEEDING S.n

Knowledge on different issue/ concerns

percentage

1

Breast milk is the most appropriate food for infants

100

2

Feeding colustrum can be treated as like immunizing 15

3

child. Breast milk is more hygienic

65

4

Breast milk has contraceptic effect

5

6

Breast feeding increases love and harmony between 60

7

mothers and babies Breast feeding reduces breast cancer

10

8

Colustrum is nutritious food for new borns

20

9

Mothers need to feed additional nutritious food for during lactation

100

10

Mothers should have soup like jwanoko jhol and others more often during lactation periods

60

From above table shows about knowledge on breast feeding as breast milk is the most approaches food for infant and mother showed eat additional nutritious food for during lactation knows by all as 100% where as less knowledge about breast feeding. Breast feeding has contraceptive effect which was only known by 5%.

4.7 Attitude on breast- feeding:-

During the study the attitude of respondent mothers towards breast- feeding was assessed by asking some of the questions indirectly. The study shows that 58% of the respondents fed colustrum to their newborn babies as other advised them. Many mothers were in practice of breast- feeding because it is the cheapest while bottle milk feeding is espensive. Attitude on breast-feeding S.n

Attitude

Percentage

1

Feed breast as being advised by others

58

2

Breast feeding is good for health of babies/ children

93

3 4

Bottle milk is not fed as it is expensive Fed breast because it is not expensive

98 97

The table shows the different attitudes on the breast feedin of the respondent mothers. 58% respondent mothers feed breast as others advice then to do so and 93% respondent mothers think that breast feeding is good for health of babies. Likewise, 98% respondent mothers don’t feed bottle milk, as it is expensive. The percentage of respondent mothers are 97% who fed breast because it is not expensive. 4.8 Taboos perceived by respondents on breast feeding S.n 1

Taboos Breast feeding deteriorates mother’s looking

Percentage -

2

Colustrum is not hygienic

80

SUMMARY, CONCLUSION AND RECOMMANDATION Summary

This study is an attempt to analyze the knowledge, attitude and practice of breast feeding mothers

socially and economically, the conceptual framework is

education of mothers, age, type of family, existing knowledge of health and breast feeding, income are taken as the very important factors, which effects the breast feeding habits of the mothers. Research summary Mothers milk is nutrient comprised of all required elements for physical and mental growth of the baby till five months. Mothers milk is ready- made food, which can be fed when baby gets hungry.it can be fed anywhere as the requirements of the baby. It has immunity power to protect from other diseases and also believe as the first vaccine for the babies. The breast milk reduces chances of the diarrhea.

Conclusion Basically the study was developed in order to know the knowledge, attitude and practices of breast feeding mothers with association to their socio- economic

factors. A case study was carried out to assess those relationships between knowledge attitude and practice and socio-economic indicaters. The study shows in newar community of the madhyapur thimi. The breast feeding mothers have no negative attitude towards the knowledge, attitude and practice of breast feeding. Comparatively the income and level of education and other socio-economic factors play the little role on breast feeding behaviours. Some respondent mothers feed colustrum as it is their tradition and others advised. Although some fed it as they think it is very useful and important for newborn babies. Thus it can be concluded that health education is the only factors contributing to the breast feeding behaviours and practices amongs the mothers. In the newar community of the madhyapur thimi, breast feeding practices can be promoted with imparing health education with the knowledge of exclusive breast feeding up to six months.

Recommandations Recommandation

Based on finding and subsequent discussions following recommendations can be made on the study of the breast feeding knowledge attitude and practice among the Newar community of Madhyapur Thimi, 1. Knowledge, attitude and practices of the breast feeding should br increased among the young mothers. 2. It needs to imparts health education in community mothers specially on the breast feeding habit. 3. Periodic health program in breast feeding should be conduct in the village. 4. Family member should be provided nutritional education. 5. Day care centers are mostly needed.

REFERENCES 1. Adhikari R.K. and Krantz M. 1997 Maternal and Child Health, Leasing Material 2. UNICEF. 1996 Child and Woman of Nepal, A Situation Analysis

Survey of Breast feeding among mothers of Newar community in Madhyapur Thimi, Bhaktapur. Questionnaires: 1. Name of the responded 2. Ward no. 3. Age of the respondent:…………years 4. Type of family o Joint o Nuclear 5. Religion o Hindu o Buddist o Christian o Others 6. Level of education o Illiterate o Literate o Primary o Lower secondary o Secondary o SLC o Higher 7. Main occupation of the family o Farming o Trade o Service o Labor o Other

8. Sufficiency of food from the farm production

o 0-4 months o 5-8 months o 9-12 months 9. Monthly income o

Father:

o

Mother:

10. Hours spend by mothers in work per day ……………..hours 11. When do you leave the baby for your work…………….months 12. Age of baby…………………months. 13. Description of the baby No of living children S.N Sex Age

No of dead children S.N Sex Age

Reason for dead

Information on breast feeding 14. Age of lactating child………………months 15. duration that elder child was breast fed…………….months 16. Do you breast feed your child? (a) Yes

(b) No

(go to question no 20)

If yes, 17. How many times in the last 24 hours did you breast feed your child? 18. By what age of child did you exclusively breast fed to him/her……….year, If No 19. Why didn’t you breast feed? 20. Did you discriminate your son and daughter while breast feeding? Yes/No If yes why………………….. 21. Did you feed colustrum to your child? Yes/No (if no go to question no 23) 22. If yes why? (a) Nutritious (b) Traditionally practice (c) As advice of other (d) Not practiced

(e) Protect from disease (f) Other (specify) 23. If not why? (a) Dirty (b) Not practiced (c) Cause dysentery and diarrhea (d) As advice of other (e) Pain of nipple 24. Why do you breast feed? o Food for child o Chances of breast cancer reduces o Increase relationship between mother and child o Others (specify) 25. What other food stuff you give to your child other than breast milk? o Litto o Bottle/packed food stuff o Traditional food( rice, pulse, curry) o Fruits o others (specify) 26. What other kind of milk do you give to your child? o Cow/buffalo milk o Dairy milk o Powder milk o Other specify 27. Do you feed bottle milk to your child? (a)Yes (b) No (if no go to question no 27.2) 27.1 If yes, why? o Mother is not able to produce breast milk o Insufficiency of breast milk o No time to breast feeding while in work

o Other (specify) 27.2 If not why? o More breast feeding reduces chance of infection o Bottle feeding is expensive o Breast milk is sufficient o Child does not like bottle milk o Other (specify) 28. Do you believe that breast feeding reduces mother’s beauty? o Yes o No 29. Do you believe that breast feeding enrich mother’s relation with child? o Yes o No 30. Do you take care of your breast? o Yes o No