Tulane students' research provides insights on breastfeeding norms in Kinshasa, Democratic Republic of the Congo

Doctoral candidates Francine Wood and Dieudonné Bidashimwa

Francine Wood, a doctoral candidate in the Department of Global Community Health and Behavioral Sciences at the Tulane University School of Public Health and Tropical Medicine, has published findings on social norms in Kinshasa, Democratic Republic of Congo, that may be useful for further efforts to improve child health in the sub-Saharan country.

Wood was first author of the study published in the BMC Pregnancy & Childbirth. Her advisor, Dr. Anastasia Gage, a professor focused on adolescent health and maternal and reproductive health in sub-Saharan Africa and Haiti, and Dieudonné Bidashimwa, a doctoral candidate in the Department of Health Policy and Management, were co-authors. Their study is entitled "Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study."

For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first six months of life. However, according to the nationally representative 2013–2014 Demographic and Health Survey, less than 50% of babies in the Democratic Republic of Congo are exclusively breastfed.

Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breast milk during the first three days of life. Their analysis in the study aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa.

According to their study, participants were more likely to think that the number of first time moms using breastfeeding exclusively to feed their children was low, and this perception tended to influence whether or not first-time mothers practiced exclusive breastfeeding. They also found that injunctive norms against exclusive breastfeeding were strong. Most participants perceived that the mothers and friends of first-time mothers as disapproving of exclusive breastfeeding practices.

"Exclusive breastfeeding during the first six months of life has tremendous benefits for the child," said Wood. "Previous studies suggest that social support influences exclusive breastfeeding, but in Kinshasa, there is limited research on the effect of social support on breastfeeding as well as perceived social norms and how they affect breastfeeding. Social norms are informal rules that determine the acceptability and unacceptability of behavior.” The researchers used data from the MOMENTUM project to understand the factors that deter exclusive breastfeeding.

Addressing negative social attitudes has the potential to increase the prevalence and duration of exclusive breastfeeding. They concluded that efforts should focus not only on the first-time mother, but also on those who influence infant feeding decisions, such as first-time mothers’ mothers, mothers-in-law, male partners, and friends.

Dr. Anastasia Gage, a Tulane professor in the Global Community Health and Behavioral Sciences Department