CHAPTER ONE
INTRODUCTION
Background to study
The 2008 Lancet Series on Maternal and Child Undernutrition indicated that suboptimum breastfeeding, especially not exclusively breastfeeding a child for the first six months of life, results in 1.4 million deaths and 10 % of the disease burden in children younger than five years in low-income and middle-income countries [1] . Other statistics indicate that one hundred and thirty-five million babies are delivered annually, but only 42 % (57 million) initiate breastfeeding within the first hour after birth, 39 % are breastfed exclusively during the first six months, and 58 % continue breastfeeding up to the age of two years [2] . Several studies have reported barriers accounting for this situation, including returning to work after delivery [3] . Others have stated factors that determine the success of exclusive breastfeeding even upon return to work, indicating that a supportive workplace and working environment are essential [4] . Yet, the Nigeria 2010 Population and Housing Census Report showed an increasing trend of women joining the labour force [5] . Guendelman et al. note that the challenge of balancing breastfeeding and paid work is an important reason for breastfeeding cessation in the first six months [6] . In Nigeria, the success of exclusive breastfeeding is subject to the nature of a women’s job and occupation, especially at places where women are engaged in industrial work away from home, and long working hours [7, 8] . Elsewhere, Magner, and Phillipi attribute cessation of breastfeeding within the first month to returning to work [9] . Aryeetey and Goh note that exclusive breastfeeding in Nigeria usually lasts for a median of about three months, which, incidentally coincides with the maternity leave period [10] . Cai et al. in their 2012 “global trends in exclusive breastfeeding” indicate that the early cessation of exclusive breastfeeding favours the use of commercial breast milk substitutes, often of poor nutritional quality [11] . Recently, Fosu-brefo and Arthur in their work titled “effect of timely initiation of breastfeeding on child health in Nigeria” acknowledged that interventions that improved child health and prevented childhood diseases included early breastfeeding initiation [12] . Also, the factors acknowledged locally in Nigeria, Ayton and colleagues have identified several others that are harmfully associated with effective breastfeeding, such as delays in and/or failure of early breastfeeding initiation [13] . Exploring the constraints to exclusive breastfeeding practice among working class Breastfeeding mothers in Southwest Nigeria, Agunbiade and Ogunleye note that early introduction of complementary feeding, based on false beliefs that it is only beneficial to infants less than six months, adversely affects breastfeeding initiation and sustainability [14] . In China and Western Kenya, several factors accounted for low EBF prevalence among working mothers. Early return to work, limited flexibility of work hours, lack of privacy [15] , as well as a feeling of being watched and judged, lack of support including networks, tiredness and emotional support at work [16] were cited as challenges facing working mothers. Mother’s work outside the home, father’s type of occupation (demanding occupations) which may limit their support for mothers to breastfeed and shorter maternity leave regulation also hindered EBF practice among professional working mothers in Vietnam [17] , who all intended to exclusively breastfeed. These studies report that although most working mothers leave the maternity ward breastfeeding exclusively, the practice is quickly abandoned, mostly due to work and employment related factors.