It's a Slippery Slope: Perceptions of Insufficient Breastmilk Give Way to Early Feeding in the First 6 months of Life in Egypt

Purpose: Discuss perceptions, cultural beliefs/practices regarding sufficiency of breastmilk during the first 6 months postpartum according to mothers and health providers Methods: Implementation research was conducted in Upper and Lower Egypt in February-April 2013 among women who were participating in the United States Agency for International Development (USAID)-funded Maternal and Child Health Integrated Program (MCHIP)/ Smart project that focuses on improving the nutritional status of children less than two years of age. A doubling in stunting prevalence in Lower Egypt between the 2005 and 2008 Demographic and Health Surveys in comparison to Upper Egypt, served as the impetus for a research study examining factors associated with stunting in SMART project areas in Lower and Upper Egypt. For part of the study, qualitative data collection consisted of in-depth interviews with 150 postpartum women, who had children 0-23 months of age. Mothers discussed perceptions and cultural norms surrounding breastfeeding practices, problems experienced during breastfeeding, as well as the timing, type and reasons for introduction of certain foods and liquids. Results and conclusions: In the first few days of life mothers provide herbal drinks to sooth children’s crying. Following these prelacteal feeds, mothers continue to provide herbal drinks and introduce some foods, such as yogurt, as early as 2 months of age, if they perceive their breastmilk to be lacking in quality and/or quantity.  Provider advice regarding how mothers can address insufficient breastmilk was inadequate - which can encourage mixed feeding.  Messages should dispel misperceptions regarding breastmilk insufficiency by mothers and health workers.