Determinants of Infant Young Child Feeding Among Mothers of Malnourished Children in South Punjab, Pakistan: A Qualitative Study

Inadequate feeding is one of the most critical underlying determinants of child malnutrition. In this study, we explore infant young child feeding (IYCF) and deconstruct breastfeeding barriers in mothers of severely malnourished children in one of the most marginalized districts of Punjab province of Pakistan. Using purposive sampling, 20 lactating mothers are recruited for open-ended semi-structured interviews. Results reveal that barriers to immediate and exclusive breastfeeding include the introduction of pre-lacteal, butter, and cow or formula milk by mothers and grandmothers. Birthing difficulties and ritualizing prelacteal to transfer religion and culture cause the delay of early initiation of breastmilk. The colostrum is also discarded based on its weird physical look. Moreover, household circumstances, limited diet, extra workload, and mental stress associated with marital relationships are other significant barriers. Mothers perceive their breastmilk as thin, impotent, and of bad quality and often complain against breastmilk insufficiency due to general weakness. Furthermore, poor mothers reduce breastfeeding when the fertility burden is high, especially if a female baby is in their womb. Alternatively, outer milk is recommended but washing bottles with detergents often becomes frequent. In conclusion, immediacy, exclusivity, frequency, and duration of breastfeeding are circumscribed owing to multiple social, cultural, and economic causes. Therefore, a holistic approach combining cultural and structural causes might be more relevant for successful IYCF practices in marginalized communities of Pakistan.

Automated summary

Inadequate feeding is a critical factor contributing to child malnutrition. This study explores the barriers to infant and young child feeding (IYCF), particularly breastfeeding, in mothers of severely malnourished children in a marginalized district of Punjab province, Pakistan. The findings reveal various obstacles to immediate and exclusive breastfeeding, including the introduction of pre-lacteal feeds and other foods, difficulties during childbirth, and cultural practices. Household circumstances, limited diet, extra workload, and marital stress are also significant barriers. Mothers perceive their breastmilk as thin, impotent, and of poor quality, and often complain of insufficient milk supply. Poor mothers tend to reduce breastfeeding when the fertility burden is high. Overall, a holistic approach addressing cultural and structural factors is crucial for improving IYCF practices in marginalized communities in Pakistan.