Culture is central: A framework for incorporating cultural influences in promoting exclusive breastfeeding

Study Objective: Exclusive Breastfeeding (EBF) is one of the single most effective preventive interventions with the potential of saving 1.3 million lives worldwide each year. In the Northwest Region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women EBF for the recommended 6 months. This study, conducted between February-June 2011, sought to develop a framework to explain the influences on women's EBF practices in the Kumbo West Health District, Northwest Region, Cameroon, so as to develop an appropriate EBF promotion program. Data Collection: Semi-structured interviews (SSI) were conducted with 6 women and 6 men followed by focus group discussions (FGD) with 3 groups of women and 3 groups of men, for a total of 37 female and 41 male participants. Methods: Using qualitative grounded theory methodologies, all of the FGDs and SIs were transcribed verbatim and coded for emergent themes. Results: Three themes emerged that influence EBF practices: woman's readiness to EBF, cultural influences towards EBF, and perceived constraints to EBF. In particular, the cultural influences theme emerged central towards influencing EBF behaviors. Through a series of contextualized discussions between investigators and local health experts, the emergent themes were used to create a theoretical framework. Recommendations: The theoretical framework provides a guide for developing an EBF promotion program in non-Western settings that are less individualistic and more heavily influenced by peer and family norms and cultural beliefs.