‘My mother said it is not good, so I poured that one away’: a mixed methods study on breast feeding knowledge, perceptions and practices in Ghana’s urban slums

Background: The World Health Organization recommended immediate and exclusive breastfeeding to give the newborn a healthy start. This paper examined breastfeeding knowledge, perceptions, and practices in two large urban slums in Accra, Ghana Methods: The data used for this paper comes from a concurrent mixed -methods cross - sectional study. The quantitative survey was conducted among 279 randomly sampled mothers aged 15 - 49 years with live neonates 0 - 28 days old. 14 focus group discussions and 13 in-depth interviews were conducted with women of reproductive age with live newborns aged 0-28 days, slum based traditional birth attendants, care givers, community leaders, and public health managers purposively sampled. Descriptive analyses was conducted to describe breastfeeding practices. Bivariate and multiple logistic regression analyses were used to assess factors associated with breastfeeding at a 95% confidence level. Qualitative interviews were tape-recorded, transcribed, coded, and analyzed thematically. Results: Overall, only 47.1% of mothers initiated breastfeeding within the first hour after delivery. Pre -lacteal feeding within the first three days and twenty-eight days was low at 16.8%. Mode of delivery was significantly associated with the type of pre-lacteals given to newborns in the first three days (p=0.002) and the first 28 days (p=0.001) after birth. About 94% of mothers surveyed demonstrated poor breastfeeding knowledge and skills in proper positioning and attachment. The desire to maintain a positive body image among younger mothers affected the duration of breastfeeding. Several myths and misconceptions affect mothers’ self-efficacy to successfully breastfeed. Mothers of newborns who initiated breastfeeding for the first time within an hour after birth and between 1-3 hours after birth (AOR: 3.16, 95% CI: 1.08-9.27, p=0.036) were less likely to report illness in their newborns compared to those that initiated breastfeeding 4 hours or more (AOR: 5.02, 95% CI: 1.49-16.87, p=0.009) after delivery. Conclusion: Breastfeeding in Ghana’s urban slums is suboptimal. A combination of demographic, socio-cultural, and behavioural factors (i.e., age, marital status, education) affect breastfeeding practice in the slums. Improving timely initiation and exclusive breastfeeding among mothers in Ghana’s urban slums requires addressing these modifiable socio- behavioural variables and strengthening ANC services.