Why has breastfeeding become challenging in the Kingdom of Saudi Arabia? An interpretative phenomenological study based on mothers’ lived experiences

Abstract

Background: The duration of breastfeeding has declined in the Kingdom of Saudi Arabia (KSA) in recent decades, although accurate national data are lacking. Thirty years ago, a survey conducted in most Saudi regions found that any breastfeeding rate at two years of age was 62%. The most recent national survey, 2004-2005, found that the breastfeeding rate at 12 months was only 1.8%. In all reports the rate of exclusive breastfeeding by age is unknown.

Two literature reviews were undertaken to find evidence on the factors affecting breastfeeding practices in this millennium. The first revealed that breastfeeding initiation among mothers in the KSA was very high (≥90%) and a positive attitude towards breastfeeding was dominant; however, introducing formula and herbal fluids before the age of six months was common. Breastfeeding information and encouragement that affected the mothers’ decision to breastfeed came from families and healthcare professionals, and religion. The second identified that mothers’ religion worldwide was a vital factor for encouraging breastfeeding but not for practising successful breastfeeding. Furthermore, breastfeeding practices were highly affected by the context in which the mothers lived and the availability of organisational support.

Aim: To understand the factors affecting mothers’ decisions and experiences in relation to breastfeeding, to inform the development of appropriate considerations for improving breastfeeding practices in KSA.

Methods: A qualitative phenomenological study investigated mothers’ experiences of breastfeeding. Non-probability convenience sampling and snowballing strategies were designed to select the participants. Semi-structured interviews were conducted with sixteen mothers, from five healthcare settings, who had breastfed in the past two years, regardless of the frequency and duration. Interpretative phenomenological analysis (IPA) was adopted for the analysis framework.

Findings: The findings identified three themes: 1) ‘Up against the system’: policies, staff and systems were the main barriers to the first breastfeed and of exclusive breastfeeding; 2) ‘Social support and negativity’: family support in the first 40 days after birth protected breastfeeding continuation and was highly appreciated, but negative comments limited breastfeeding practices; and 3) ‘Managing tensions’: the challenge of managing tensions influenced mothers to stop breastfeeding.

Conclusion: This qualitative research revealed that the decision by mothers to breastfeed was straightforward. Mothers still believed in the importance of breastfeeding for two years, but policies and staff actions in hospital hampered successful exclusive breastfeeding. The decision to continue breastfeeding or not after a few months of giving birth was shaped by the surrounding social support and other people’s negativity, rather than by the mothers’ own views. Stopping breastfeeding earlier than the mothers had wished was a complicated and difficult decision for most mothers. Indeed, the mothers said that they intended to breastfeed their next baby successfully. The study also highlighted the importance of health promotion to improve breastfeeding experiences. Education and training policies for healthcare professional (maternity and primary healthcare staff, paediatricians and pharmacists) are needed to effectively help mothers to breastfeed exclusively for longer. A supportive environment maintains breastfeeding but stronger professional and peer support are needed. Enhancing mothers’ skills to manage tensions will contribute to them to achieve their two years of breastfeeding goal.

Date of Award	2020
Original language	English
Awarding Institution	University of Dundee
Sponsors	Saudi Arabian Cultural Bureau
Supervisor	Mary Renfrew (Supervisor), Andrew Symon (Supervisor) & Heather Whitford (Supervisor)