Determinants of breastfeeding promotion as perceived by health personnel

Demographic, physical, social and psychological factors make breastfeeding and its maintenance complex. Despite extensive breastfeeding promotion programs, no progress has been achieved. As breastfeeding is a phenomenon embedded in culture and folk perceptions, identification of its key determinants is essential when designing policies and implementing programs. In this qualitative study, data were collected from 35 health professionals through a 4-day group interview using a structured questionnaire (open-end questions). The participants were purposefully recruited from among the health professionals attending a 4-day breastfeeding promotion workshop. The determinants of breastfeeding were categorized into 2 main domains, namely, people's perception of breastfeeding phenomenon and approaches employed in its promotion. The former domain was described by beliefs, demographic characteristics, social variables, and indigenous theories, and the later by practice in the cultural and social context, policies, interactions and practical skills. From the participant's perspective, misperceptions of people can determine the degree of success or failure of a breastfeeding promotion program. Our findings confirm that people's perceptions are deeply influenced by their demographic characteristics, folk theories and social variables. As regards the breastfeeding promotion domain, the barriers are social-cultural factors rooted in the local beliefs and folk theories. The participants listed the breastfeeding promotion determinants as lactation policies and health provider's performance related to their skill in effective communication with mothers. Our findings also indicate that wrong beliefs, maternal and child diseases, caesarian section, and mother's employment were believed to be deterrents in promoting breastfeeding in the community and that pediatricians, obstetricians and other health professionals can play key roles in the field. Based on our findings, we can further conclude that the phenomenon of breastfeeding and its maintenance are deep-rooted in social structure and cultural diversity. When designing and implementing breastfeeding promotion programs, local variables and determinants should be taken into consideration.