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Abstract
Breastfeeding is the process of feeding an infant with milk produced in a woman’s mammary glands.(1) Each year new evidence contributes to the knowledge of breastfeeding’s role in the survival, growth, and development of a child as well as the health and well-being of a mother.(2) These provide scientific and epidemiological evidence in support of the World Health Organization’s(WHO) and UNICEF’s Global Strategy for Infant and Young Child Feeding (2002) which stressed the importance of exclusive breast-feeding(EBF) for the first 6 months versus first 4 months.(3)The definition of the WHO for EBF stated that ”an infant is receiving only breast milk which includes expressed breast milk and milk from a wet nurse. The infant might also receive medications, vitamins or minerals, as required.(4) Research in developed and developing countries of the world provides strong evidence that human milk feeding decreases the incidence and/or severity of a wide range of infectious diseases including bacterial meningitis, bacterium, diarrhea, respiratory tract infection, necrotizing enter colitis, obits media, urinary tract infection and late-onset sepsis in preterm infants. In addition, post neonatal infant mortality rates are reduced by 21% in breastfed infants. (5) WHO and UNICEF (1989) have issued a joint statement on “Ten Steps to Successful Breast Feeding” to be implemented in every health facility providing maternity care and care for the newborn babies. This include: 1) to have a written breast-feeding policy that is communicated to all health staff, 2) to train all health care staff in skills necessary to implement this policy, 3) to inform all pregnant women about the benefits and management of breast feeding. 4) to help mothers initiate breast-feeding within 60 minutes of birth, 5) to show mothers how to breast-feed, and how to maintain lactation, 6) to give newborn infants no pre lacteal food other than breast-milk, unless medically indicated, 7) to practice rooming-in, which is allowing mother and infant to remain together, 24 hours a day, 8) to encourage breast-feeding on demand. 9) to give no artificial teats or pacifiers to breastfed infants, 10) and to foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic. (6) There is evidence for all of these 10 steps to enhance breastfeeding indicators globally.(7) The compliance of mothers to the items related to their practice (immediate breastfeeding initiation, rooming in, breastfeeding on demand, avoiding prelacteal feeding , avoiding use of pacifier and avoiding use of bottles) is of great importance to achieve better breastfeeding outcomes.(8) Nowadays baby friendly hospital initiative(BFHI) is considered the most important determinant of breast feeding, and the most evidence based program for promotion of breast feeding worldwide.(7) UNICEF support for integrated, community-based health care includes the promotion of exclusive breastfeeding. In Egypt the agency is working with the Ministry of Health and Population (MOHP) and relevant partners to revitalize the baby friendly initiative.(9) In the year 1993, training on BFHI had commenced in Egypt, and by the year 2002 the number of health facilities accredited as baby friendly reached 122.(10) Also Ministry of Health and Population (MOHP) since 1997 is implementing a continuous program of in-service training for both physicians and nurses to support and promote good practice in breast feeding.(11) Despite mentioned efforts, an increasing number of Egyptian babies are not given breast milk in the first crucial hour of life. Only 42.9% of babies began breastfeeding within one hour of birth in the year 2005, a marked reduction from the figure of the year 2000 which was 57%.(9) The rate of EBF in Egypt in the year 2005 was 52.4 percent among infants zero to three months old, which DROPped to 38.3 percent among infants zero to five months old. This leaves hundreds of thousands of children vulnerable to disease and death. Around 2.4 per cent of all babies in Egypt die in the first month. (9) Low compliance of mothers with breastfeeding recommendations in developing countries was reported.(12) Also several studies in Egypt reported poor performance of both mothers and health care providers on the successful steps to breast feeding.(13-15) The aim of this study is to highlight the influence of breastfeeding promotion and support efforts on mother’s compliance to the 6 items related to their practice, and the health providers’ attitudes toward the 10 points of successful breast feeding.