1.1 Background Information

Breastfeeding is the feeding of an infant or young child with breast milk directly from human breast (Adelekan, 2003). It begins from the day the child is born and last for about two years of the infant life.                                                                                                                 Exclusive breastfeeding (EBF) -is defined as ‘’an infant’s consumption of human milk with no supplementation of any type (no water, no juice, no human milk, and no food) except for vitamins, minerals and medication until sixth moths. (Adelekan,2003)                                      EBF for six months is important for both infant and maternal health. Infants who are not exclusively breastfeeding are more likely to develop gastrointestinal infections, not only in developing but also in industrialized countries. The risk of mortality due to diarrhoea and other infections can increase many-fold in infants who are either partially breastfed or not breastfed at all. During the first two months of life, infants who are not breastfed are nearly six times more likely to die from infectious diseases such as gastroenteritis, pneumonia etc  than infants who are breastfed; between 2 and 3 months, non-breastfed infants are 4 times more likely to die compared to breastfed infants ( WHO, 2010).

Infant and young child feeding practices directly affect the nutritional status of children under two years of age and, ultimately, impact child survival. Worldwide, more than nine million children under five years of age die each year. www.who.int/nutrition/topics/exclusive_breastfeeding/en/

Sub-Saharan Africa has been the worst affected with the highest proportion of disease burden associated to suboptimal breastfeeding. The World Health Organization (WHO) recommends timely initiation of breastfeeding within the first hour of birth, exclusively breastfeeding up to the age of 6 months and continued breastfeeding through to 24 months together with appropriate complementary feeding.                                                                                                        To promote EBF, Ghana adopted the Baby-Friendly Hospital Initiative (BFHI) in 1991 and subsequently formed a BFHI authority to oversee its implementation, development of breastfeeding policy and training of health workers to promote and support the practice of breastfeeding. Furthermore, Ghana enacted and implemented the Ghana Breastfeeding Promotion Regulation 2000 otherwise known as Legislative Instrument [LI] 1667) to curb the aggressive marketing of breastmilk substitutes. (Tampah-Naah, Kumi-Kyereme 2013).      Similar to several countries in the sub-Saharan region, these have not yielded the desired impact as the practice of exclusive breastfeeding is still low ( Aryeetey,2013) .In 2008, the Ghana Demographic and Health Survey (GDHS) estimated Ghana’s EBF rate to be 63 % (GDHS 2008). Forty-six percent of Ghanaian children aged less than 6 months were exclusively breastfed in 2011(Ghana Statistical Service ,2011) obviously these estimates fall short of the WHO’s recommendation of 90 % coverage (Lancet, 2003). Mother’s knowledge and attitudes towards exclusive breastfeeding as well as family pressures, maternal level of education, socio-cultural practices, maternal age, marital status and family income/social class. Place of delivery, and time of initiation of first breastfeeding have been previously cited for the current situation. It is thus imperative to explore these mothers’ practice, knowledge and problems faced towards EBF . Evidence from this study may further increase understanding of the practice and associated factors of EBF among mothers. Understanding the knowledge and challenges of mothers towards the practice of EBF may be a necessary step to help improve infant feeding practices among lactating mothers as a means of reducing infant morbidity and mortality. Furthermore, findings from this study may be used as a basis for the design of future EBF promotion programs to improve the practice and knowledge of exclusive breastfeeding among mothers.