Infant feeding practices of Somali mothers residing in Norway : A qualitative study

ABSTRACT BACKGROUND Breastfeeding provides the optimal food for the healthy growth and development of infants. Norwegian recommendations for infant feeding consist of advice on exclusive breastfeeding for six months and timely introduction of complementary foods. Previous national surveys, have shown that the diet among Norwegian six months old infants, was generally in line with the recommendations for infant feeding. However, there is still limited knowledge about the diet and infant feeding practices among Norwegian-born infants with immigrant parents, since this group was not included in these national surveys. The group of Norwegian-born infants with immigrant parents have grown in the recent years. It is thereby important to increase knowledge on nutrition and infant feeding practices among this group. Earlier nutrition studies have shown that infant from certain immigrant groups, were more prone to various nutritional deficiencies compared to ethnic Norwegian children. Other studies reported that immigrant mothers rarely receive cultural sensitive advices from their health care providers. An increase of knowledge on the infant feeding practices among immigrant groups may be beneficial, and perhaps a step towards targeting and improving the potential nutrition problems that may exist. This might also improve the nutrition information provided to immigrant parents. METHOD The InnBaKost- project aims at generating valuable information on early feeding practices of Somali immigrant mothers, their perceptions to infant feeding and experiences to these practices, as well the way the mothers experience nutrition communication for their children at the health clinics. This thesis is based on the findings from the first part of the qualitative sub study of InnBaKost. In-depth interviews were conducted with 15 Somali mothers with young infants in Oslo and Akershus municipality. An interpreter assisted in some of the interviews. The inclusion criteria were mothers of Somali origin, with infants who were born in Norway, aged around 6 (±2) months. FINDINGS In the present study, none of the Somali mothers breastfed exclusively for six months. Most mothers intended to breastfeed for one year. But four mothers had stopped breastfeeding at the time of the interview. Despite having a positive attitude towards breastfeeding, difficulties with breastfeeding and not knowing how to overcome them, influenced mothers’ choice to introduce complementary foods from early on, or to stop breastfeeding completely. There seemed to be a limited support from the health clinics regarding how to overcome breastfeeding problems, this might have further influenced some mothers to stop breastfeeding or to introduce complementary foods. The mothers had diverse views on their health clinic, although most were pleased with the overall service provided, but stated that the information on infant feeding was lacking. Limited infant feeding advice and information given by health care providers, can in turn make a mother uncertain about how to feed her infant. The limited information given by the health clinic on exclusive breastfeeding and the timely introduction of complementary foods, may also have influenced the early introduction of others liquids foods. The choice of not breastfeeding in public, or not giving expressed breast milk when the infant was being taken care of by others, might have further influenced the mothers’ duration of exclusive breastfeeding. Insufficient breast milk production or that the infant refused to be breastfeed was the most common problems that were mentioned. An interesting finding was the common advice to feed the infants formula milk among Somalis. The encouragement for formula feeding from family/relatives may further have motivated to the early cessation of exclusive breastfeeding. Complementary foods, in form of formula milk and water, were usually introduced to the infant at the age of three months. Porridge, mashed vegetables and fruits were the most common solid foods that were introduced to the infant around four months of age. CONCLUSION Information about breastfeeding, exclusive breastfeeding and the timely introduction of complementary foods was not commonly informed between the health clinic and Somali mothers. Many of the mothers had experienced difficulties with breastfeeding, the findings seem to suggest that these mothers had not received the necessary support from the health clinic to overcome these challenges. It is important for the health clinic to follow up on mothers that are having difficulties with breastfeeding. Furthermore, it is also important for the health clinic to pay attention to mothers who are experiencing the pressure of formula feeding from their Somali network. Appropriate breastfeeding support and information about infant feeding, needs to be further communicated to mothers.