This document outlines a proposed study on breastfeeding practices among adolescent mothers in Nepal. The study aims to describe breastfeeding rates at 6 weeks postpartum and compare breastfeeding self-efficacy among mothers with exclusive, partial, or no breastfeeding. The conceptual framework is based on self-efficacy theory. The methodology describes a descriptive comparative design using surveys of 110 adolescent mothers attending a well-baby clinic. Data will be analyzed to classify breastfeeding practices and compare self-efficacy scores. The results could inform policies to improve breastfeeding among adolescent mothers in Nepal.

2. Background & Significance
Background & Significance
Gap of Knowledge
Research Objectives & Questions
Research HypothesisResearch Hypothesis
Definition of Terms
Literature Review
Expected Benefits
Timeframe of the Study
Methodology
Conceptual Framework
Outline
References

3. Background and significance
Breastfeeding practice is divided by WHO (2002, 2009) into 3 types:
1) Exclusive breastfeeding refers to the practice of a mother in
providing infants only her breast milk. No other liquids or solids are
given – not even water – with the exception of oral rehydration
solution, or drops/syrups of vitamins, minerals or medicines or
breast milk; 2)
2) Partial breastfeeding refers to practice of a person giving a baby
some breastfeeds, and some artificial feeds, either milk or cereal, or
other food; 3)
3) No breastfeeding refers to a practice of a mother in providing her
infant formula or non maternal expressed milk. In this study,
maternal breastfeeding practice will be measured by breastfeeding
practice questionnaire using open ended and closed questions
(Yimyam, 2013).

4. Benefits of breastfeeding

5. Recommendation
☺World Health Organization (WHO) and the United
Nations International Children's Fund (UNICEF)
recommended the practice of breastfeeding and state
that “breastfeeding is an unequalled way of providing
ideal food for growing infants’’.
☺As a global health recommendation, infants should
be exclusively breastfed for the first six months of their
lives followed by continued breastfeeding for up to two
years to achieve optimal growth, development and
health of the infant (WHO, 2007; 2009; UNICEF, 2013).
Recommendation

6. Globalbreastfeedingsituation
 Worldwide, only 40% of newborns were
breastfed within the first hour of birth,
Nearly same proportion(38%) of infants
were breastfed until the age of six
months (WHO, 2002).
 In 2012, 85 million newborns failed to
receive breastfeeding at the first six
month of life,
 Half of them (40 million) were from
Asia.
 In South Asia, the percentage of
Infants who are breastfed within one
hour of birth was 78% & at six months
was 65% (UNICEF, 2013a; WHO, 2014b).

8. Duration Exclusive
Breastfeeding
Partial
Breastfeeding
At birth 74% 15%
At one month 78% 38%
At six month 53% 69-79%
(Nepal demographic health survey [NDHS], 2011;Ulak, Chandyo,
Mellander, & Shrestha, 2012).

The Breastfeeding rates in Nepal

9. What are Influencing factors?

10. Situation of adolescent mothersSituation of adolescent mothers
in Nepalin Nepal
According to the World Health Organization (WHO),
adolescence is a transition stage between childhood and
adulthood.
Age between 10 to 19 years is considered to be the critical
phase in this transition (WHO, 2014).
Nepalese girls often get married at an early age:
 41% to 52.3% girls in Nepal get married before or at the age
of 18 years (Maharjan, Karki, Shakya, & Aryal, 2012; Nepal demographic
health survey [NDHS], 2011) and
 17% of girls under the age of 20 years had already given
birth or were pregnant with their first child (NDHS, 2011).
According to the World Health Organization (WHO),
adolescence is a transition stage between childhood and
adulthood.
Age between 10 to 19 years is considered to be the critical
phase in this transition (WHO, 2014).
Nepalese girls often get married at an early age:
 41% to 52.3% girls in Nepal get married before or at the age
of 18 years (Maharjan, Karki, Shakya, & Aryal, 2012; Nepal demographic
health survey [NDHS], 2011) and
 17% of girls under the age of 20 years had already given
birth or were pregnant with their first child (NDHS, 2011).

11. However, maternal agematernal age (Ajibade, et.al., 2013; Nadler, 2007; Shetty &
Shetty, 2013; Atuyambe, et.al, 2008; Infant Feeding Surveillance System [IFSS], 2012)
andand breastfeeding self–efficacybreastfeeding self–efficacy (Dennis, 2002; Blythe, et.al., 2004;
Britton, et.al.,2007; Meedya, Fahy & Kable, 2010) have been identified as the
key factors for breastfeeding practicekey factors for breastfeeding practice among mothers
where adolescent mothers’ breastfeeding practice duration
were shorter compared to adult mothers (Blyth et al., 2002; Santo, 2007;
Mossman, et.al., 2008; Beattie–Fairchild & Dennis, 2013; Yimyam, 2013).

12. In Nepal....
 Similarly, Nepalese adolescentadolescent mothers' breastfeeding
practice has been significantly lower thansignificantly lower than adult mothers (Aryal,
2007; Khanal, Adhikari, Sauer, & Zhao, 2013) due to lack of breastfeeding skill,
knowledge and confidence in breastfeeding (Khanal et.al, 2013).
 Studies support that there could be numerous other factors to
this, however, self–efficacy and maternal ageself–efficacy and maternal age play the most
significant role in breastfeeding practice and efficiency among
young mothers.

13. Gap of knowledge
 Most of the studies conducted to investigate maternal
breastfeeding self–efficacy and breastfeeding practice
among adolescent mothers (Blythe, 2002; Mossman, et.al, 2008; Beattie–
Fairchild & Dennis, 2013) have been carried out in different countries
with different cultural and socio–economic contexts to
Nepal. Thus, the studies could be territorial; both culturally
and geographically, and thus difficult to generalize.
 Equally, those studies that were conducted in Nepal were
conducted only among general population (Keller, 2010; Khanal et Al.,
2013; Shrivastava, Singh, & Shah, 2013; Paudel & Giri, 2014).

14. Cont..  The results from the study of general population may not give
true picture or explain the situation of Nepalese Adolescent
mothers’ breastfeeding practice and breastfeeding self–
efficacy.
 Therefore, this study aims to explore and compare
breastfeeding self efficacy among Nepalese adolescent
mothers who provide different types of infant feeding during the
first six weeks of postpartum life.
 The results can be used as a baseline information for
breastfeeding policy makers and related health centres in order
to develop proper strategies to improve breastfeeding practice
among Nepalese adolescent mothers.

15. Objectives of the Study
 To describe breastfeeding practice at six
weeks of postpartum among adolescent mothers
in Nepal
To compare the differences in breastfeeding
self-efficacy among adolescent mothers with
exclusive, partial and no breastfeeding practice
at six weeks in Nepal
Objectives of the study

16. Research QuestionsResearch questions
 How do adolescent mothers in Nepal breastfeed
their infants at six weeks of postpartum?
 Are there any differences in breastfeeding self-
efficacy among adolescent mothers with exclusive,
partial and no breastfeeding practice at six weeks?

17. Breast feeding self-
efficacy level is different
among adolescent mothers
practicing exclusive, partial
and no breastfeeding feeding.

18. Definition of Terms
Breastfeeding
Practice
Breastfeeding Self-
efficacy
Adolescent Mother
Definition of terms

19. Breastfeeding practice
Breastfeeding practice is the feeding activities of an infant with breast
milk at six weeks of postpartum period (UNICEF, 2013).
Breastfeeding practice is divided into 3 types defined by WHO (2002,
2009) as:
1) Exclusive breastfeeding1) Exclusive breastfeeding refers to the practice of a mother in
providing infants only her breast milk. No other liquids or solids are
given – not even water – with the exception of oral rehydration
solution, or drops/syrups of vitamins, minerals or medicines or
breast milk.
2) Partial breastfeeding2) Partial breastfeeding refers to practice of a person giving a
baby some breastfeeds, and some artificial feeds, either milk or
cereal, or other food. In this study, partial breastfeeding will be
refers as mother in providing her infant with her breast milk
together with non human milk or formula including additional solid or
semisolid any food or liquid.
3) No breastfeeding3) No breastfeeding refers to a practice of a mother in providing
her infant formula or non maternal expressed milk.
In this study, maternal breastfeeding practice will be measured by
breastfeeding practice questionnaire using open ended and closed
questions (Yimyam, 2013).

20. Breastfeeding self-efficacyBreastfeeding self-efficacy
refers to a mother’s confidence in her ability to breastfeed her
infant(Dennis, 1999). In this study, maternal breastfeeding self-efficacy
will be measured by Dennis breastfeeding self-efficacy short-form
scale (BSES-SF) (2003).
Adolescent MothersAdolescent Mothers
refers to first time Nepalese women who have given birth at the
age under of 20 years.

21. 8.1 Definition and benefits of breastfeeding
8.2 Global situation and trends
8.3 Influence on breastfeeding initiation
8.4 Breastfeeding practice among adolescent mothers
8.5 Breastfeeding Self-Efficacy
8.5.1 Definition and concept
8.5.2 Measurement of breastfeeding self-efficacy
8.5.3 Breastfeeding Self-Efficacy and breastfeeding
practice
8.6 Breastfeeding practice among adolescent mothers in
Nepal
8.6.1 Adolescent mothers in Nepal
8.6.2 Breastfeeding practice among Nepalese adolescent
mothers
8.6.3 Measurement of Breastfeeding practice

22. • The study conceptual framework is based on Bandura's
self-efficacy theory (1977), and other literature reviews.
According to Bandura, human behaviour is predicted by
overall self-efficacy of an individual. Dennis (2002)
concluded this theory with breastfeeding behaviour of
mothers. It states that mothers with higher self-efficacy
have higher rate of breastfeeding practice compared to
mothers with lower self-efficacy, and mothers who
perform different types of breastfeeding practice have
different level of self-efficacy.

23. Methodology

24. Design Descriptive Comparative StudyDescriptive Comparative Study
Population Nepalese adolescent mothersNepalese adolescent mothers attending the Baby Clinic in
Paropakar Maternity and Women's hospital with six week old
healthy babies.
Sample Size o Power analysisPower analysis; alpha level of α = 0.05 and power test (1– β) of
0.80 (Polit & Hungler, 1999). The population effect size of 0.3 is
estimated as medium size (Cohen, 1990). The calculated sample
size was 88, but in anticipation of possible 20% loss of subjects
22 more samples were added bringing the final sample
population to 110.
Sampling
Method
o Purposive sampling methodPurposive sampling method (January 2015 clinic record shows
that the total number of mothers visiting the clinic was 70 – 100
per day).
Inclusion
Criteria
 Mother with at least six weeks old healthy infants.
 No maternal and infant complications that interferes with
breastfeeding.
 Infant with normal birth weight of at least 2,200 – 4,000 grams.
 Mothers who are willing to participate, and are able to read and
write Nepali language.
Research
Settings
o Well Baby Clinic in Paropakar Maternity and Women's
hospital, Kathmandu, Nepal

25. Research
Instruments
Breastfeeding Self-efficacy
Short Form Scale
Breastfeeding
Practice
1
2
3

26. Personal Data Profile containing closed ended and open
ended questions on demographic data including maternal
age, maternal education, and maternal occupation, family
income, and characteristics of family, numbers of family
member as well as pregnancy and childbirth history
including parity, and gestational age, complications during
pregnancy, labour and postpartum
The Breastfeeding Self Efficacy– Short Form (2002)
- 14 self report questionnaire
- 5 point Likert type scale
-Score with a possible range from 14 – 70
-All items preceded by the phrase "I can always"

27. The Breastfeed Practice (2013)
The modified breastfeeding practice form is based on
Boundary points cut-offs and preposition breastfeeding
practices tool (Yimyam, 2014) consists of six open ended and closed
ended preceding with;
1. Have you ever breastfeeding your infant?
2. Are you still be breastfeeding?
3. When did you start and stop breastfeeding?
4. Are there other milk or any foods or water that you gave to your
infant?
5. What are those foods and supplements?
6. When did you start and stop to give those foods and supplents?
From mothers’ response, breastfeeding practice will be
classified into three groups:
a) exclusive breastfeeding
b) partial breastfeeding
c) no breastfeeding

29. Why Breastfeeding
Practice tool?
It is useful to measure
breastfeeding practice
at a particular age of
infant
It helps to distinguish
either postpartum mothers
are breastfeeding and not
breastfeeding their infants
It helps to classify the
types of breastfeeding
practice among
mothers

30. Psychometric propertiesPsychometric properties of questionnaireof questionnaire
Test of Validity

31. Test of
Reliability

32. Datacollectionprocedure
Research proposal will be submitted &
reviewed by ethical committees.
Letters from the dean of FON will be issued & related
documents will be submitted to the Paropakar maternity and
women's hospital in Nepal and Paropakar well baby unit of
the hospital.
Request for data collection and explanation about the study
will be submitted to hospital Directors and Nursing
Supervisors from selected units.
Samples will be approached based on medical records
& inclusion criteria.
Verbal information about the study will be given to the
samples if they meet the criteria and are willing to
participate in the study.
• Face to face interview will be carried out.
•Consent will be obtained and then questionnaires
distributed.
•Clarification on questions will be made on request.
•Responses will be collected.

33. Data analysis procedure

34. Expected benefits

35. Thank You