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Prevalence of Exclusive Breastfeeding and Factors 
Influencing Infant Feeding Practices among Mothers of 
Central Nepal

Journal of College of Medical Sciences-Nepal, Vol-18, No 4, Oct-Dec 2022
ISSN: 2091-0657 (Print); 2091-0673 (Online) Open Access 

DOI: 10.3126/jcmsn.v18i4.49737

Srijana Panthi,1 Pallavi Koirala,1 Prerna Bansal,1 Meera Prasai,1 Kamal Khadka,1 Ranjeeta Phuyal,1 Ayasha Shrestha1

1Department of Community Medicine, College of Medical Sciences-Teaching Hospital, Chitwan, Nepal.

Original Research Article

Correspondence: Dr. Srijana Panthi, Department of Community Medicine, College of Medical Sciences, Bharatpur, 
Chitwan, Nepal. Email: srijanapanthi7@gmail.com. Phone: +977-9843028082.

ABSTRACT

Introduction

Infants should be exclusively breastfeed for the first six months of life to achieve optimal growth, 
development and health. Considered as an ideal food for infants, it also helps to fight disease like 
diarrhea and pneumonia. In Nepal only two third of the mother exclusively breastfeed their child 
in the past 24 hrs. The aim of this study is to find prevalence of exclusive breastfeeding and factors 
influencing infant feeding practices among mothers.  

Methods

A cross-sectional study was conducted in Bharatpur, Chitwan among 290 lactating mothers at 
the Immunization Center of Bharatpur Hospital Chitwan. Mothers were interviewed on details 
regarding feeding of their child. 

Results

The mean age of the study population was 25.6 ± 4.5 years. A majority of the respondents were <30 
years of age (234, 82.4%), primipara (175, 61.6%) and living in a joint family (199, 70.1%). Exclusive 
breast feeding (EBF) was practiced by 203 (71.5%) mothers on the current infant. Low production 
of milk was the commonest reason for not practicing EBF (66.6%). Over two-thirds (195, 68.7%) 
had started breastfeeding within 1 hour of delivery. Cesarean section was the most frequent cause 
(71, 88.6%) for late initiation of breastfeeding. 

Conclusions 

The study revealed that Prevalence of Exclusive Breast Feeding is 71.5% and 93.5% of respondents 
had heard of EBF. Low production of milk was the commonest reason for not practicing EBF 
(66.6%). Still 28.5% mothers did not practice EBF, 7.7 %mothers had not heard of EBF, indicating a 
need for EBF promotion which could be carried out within the existing healthcare system such as 
the antenatal and vaccination clinics.

Keywords: exclusive breastfeeding; infants; mother; practiced.



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INTRODUCTION

According to WHO, exclusive breastfeeding 
means the infant receives only 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.1   For the first six months of life, 
a baby should only be breastfed in order to 
obtain the best possible growth, development, 
and health.2   Considered an ideal food for 
infants, besides providing nutrients, it also 
contains antibodies and immunoglobulins 
that help to fight diseases like diarrhea and 
pneumonia.1Starting breastfeeding early 
stimulates prolactin secretion and increases 
milk production.3    Mothers should start 
breastfeeding within an hour of giving birth, 
continue it exclusively for six months, and then 
supplement with safe, nutritious foods until the 
child is at least two years old.4    In addition, 
breastfeeding decreases the baby's risk of 
obesity and overweight, even while decreasing 
the mother's risk of ovarian and breast cancer in 
the long term.5

 However, in Nepal, only two third of the mother 
exclusively breastfeed their child in the past 24 
hours (66%).6 Poor infant feeding practices have 
been associated to undernutrition, as seen by 
stunting and wasting, and mortality in Nepal 
and other countries in South Asia.4   According to 
the Nepal Demographic Health Survey (NDHS) 
of 2011 and 2016, there is a slight reduction from 
70% to 66% respectively.7

Malnutrition possess a serious threat to millions 
of children worldwide. It is estimated that if 
breastfeeding rates worldwide reached 90%, 13% 
of all infant deaths in low- and middle-income 
countries would be prevented.8  Nepal is one of 
the thirty-four countries that account for 90% of 
the world's child malnutrition incidences.9   36% 
of children are stunted, 10% are wasted, and 

27% are underweight, according to NDHS.10 
For our country Nepal to meet the Sustainable 
Development goal we have to overcome hindering 
factors associated with the high Infant Mortality 
Rate.This study aims to find the prevalence 
of breastfeeding among lactating mothers in 
Bharatpur. Also to evaluate the associated factors 
that hinder exclusive breastfeeding and to assess 
the complementary feeding practices in Bharatpur.

METHODS

A cross-sectional study was conducted among 
290 lactating mothers at the Immunization Center 
of Bharatpur Hospital Chitwan. Prior to the main 
study to check the reliability and validity of the 
questionnaire pilot study were done among 23 
(10% of the total sample size). Then using SPSS-
20 Cronbach’s alpha was calculated, and its value 
was 0.793. Also, consulting other research expert 
questionnaires was finalized. A predesigned 
questionnaire was used. Non-probability, 
convenient sampling technique was used. 
Prevalence of Exclusive breastfeeding (P) = 0.757, 
q=1 -0.757=0.243, z score value at 95% CI=1.96 error 
(e) =5%=0.05. The sample size was determined by 
using the formula (n) = z 2pq/e2 =1.962x0.757x0.243/
(0.05)2=283. The minimum sample size for this 
study was 283. Ethical approval was taken from 
the Institutional Review Committee of College 
of Medical Sciences (COMSTH-IRC/2021-67). 
Mothers of children <1 year of age who are 
breastfeeding were enrolled and infants suffering 
from any congenital abnormalities were excluded. 
Data were collected by interview. The interview 
schedule had socio-demographic information and 
questions on the practices of mothers regarding 
exclusive breastfeeding, and factors associated 
with exclusive breastfeeding. The respondents 
were informed about the purpose of the study, 
verbal consent was obtained from each mother 
before the interview, who was willing to participate 
in the study. Data analysis was done using SPSS 
18 software. Descriptive statistics including to 

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JCMS | Vol-18 | No 4 | Oct-Dec 2022350

Panthi et al. Prevalence of Exclusive Breastfeeding and Factors Influencing Infant Feeding Practices...

summarize mother’s socio-demographic and 
practice related information. Univariate analysis 
was carried out to identify any factors that were 
associated with Exclusive Breastfeeding.

RESULTS

Out of a total 290 mothers that were initially 
interviewed, data from only 284 respondents 
was used for further analysis, because 6 of them 
had incomplete data. The mean age of the study 
population was 25.6 ± 4.5 years (Range: 17 – 42 years). 

Table 1 shows the sociodemographic characteristics 
of the study participants.  A majority of the 
respondents were <30 years of age (234, 82.4%), 
primipara (175, 61.6%), and living in a joint family 
(199, 70.1%). More than one-third (112, 39.4%) of 
the mothers were from the Janajati ethnicity. A 
vast majority of the mothers (211. 74.3%) were 
homemakers, and only 15 (5.3%) were illiterates. 
The median age of the infant during the interview 
was 10 months (4 – 14 months).

Table 1. Sociodemographic characteristics of the 
study population (n = 284).

Variables Summary statistic

Age category, n (%)
<30 years
≥ 30 years

234 (82.4)
50 (17.6)

Parity, n (%)
Primi
Multi

175 (61.6)
109 (38.4)

Family type, n (%)
Nuclear
Joint

85 (29.9)
199 (70.1)

Ethnicity, n (%)
Brahmin
Chhetri
Janjati
Others

71 (25.0)
38 (13.4)
112 (39.4)
63 (22.2)

Religion, n (%)
Hindu
Buddhist
Muslim
Christian

223 (78.5)
42 (14.8)
9 (3.2)
10 (3.5)

Occupation, n (%)
Homemaker
Service
Business
Agriculture

211 (74.3)
35 (12.3)
21 (7.4)
17 (6.0)

Educational status, n (%)
Illiterate
Up to primary education
Up to higher secondary education
Up to graduation

15 (5.3)
51 (18.0)
190 (66.9)
28 (9.9)

Sex of the infant, n (%)
Male
Female

167 (58.8)
117 (41.2)

Age of the infant (months), 
median (IQR)

10 (4 – 14)

Table 2. Characteristics related to exclusive breast 
feeding (n = 284).

Variables Summary statistic

Heard about exclusive breast 
feeding (EBF), n (%)

262 (92.3)

Practiced EBF on the current infant, 
n (%)
Yes
No

203 (71.5)
81 (28.5)

Reasons for not practicing EBF, n (%) #

Low production of milk
Working mother
Painful breasts
Difficulty in sucking
NA

54 (66.6)
9 (11.1)
8 (9.9)
2 (2.5)
8 (9.9)

Time of starting breast feeding 
after delivery, n (%)
Less than 1 hour
More than 1 hour
NA

195 (68.7)
80 (28.2)
9 (3.1)

Reasons for late initiation of breast 
feeding, n (%)!

Cesarean section
Severe pain
Baby in NICU
NA

71 (88.6)
3 (3.8)
3 (3.8)
3 (3.8)

# Out of 81 mothers that did not practice EBF
! Out of 80 mothers that had the time of initiation of breast feeding >1 hour
NA: Information not available

Exclusive breast feeding (EBF) was practiced by 
203 (71.5%) mothers on the current infant. Low 



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production of milk was the commonest reason 
for not practicing EBF (66.6%). Working mothers, 
painful breasts, and difficulty in sucking were 
the other reasons. [Table 2] Over two-thirds (195, 
68.7%) had started breast feeding within 1 hour 
of delivery. Among the mothers that had late 
initiation of breast feeding, having undergone a 
cesarean section was the most frequent cause (71, 
88.6%).

Furthermore, univariate analysis was carried out 
to identify any factors that were associated with 
EBF. None of the maternal factors (age, parity, 
family type, ethnicity, religion, educational status, 
occupation, and prior information about EBF) 
was found to be significantly associated with EBF. 
[Table 3] Sex of the child was also not found to be 
associated with EBF. Multivariate regression was 
carried out as none of the factors were found to be 
associated with EBF in univariate analysis.

Panthi et al. Prevalence of Exclusive Breastfeeding and Factors Influencing Infant Feeding Practices...

Table 3. Factors associated with exclusive breast feeding.

Variables
Exclusive breast feeding

P-value#
Yes (n = 203) No (n = 81)

Age 
   <30 years
   ≥ 30 years

166 (81.3)
37 (18.2)

68 (84.0)
13 (16.0)

0.73

Parity
   Primi
   Multi

122 (60.1)
81 (39.9)

53 (65.4)
28 (34.6)

0.42

Family type
   Nuclear
   Joint

63 (31.0)
140 (69.0)

22 (27.2)
59 (72.8)

0.57

Ethnicity
   Brahmin
   Chhetri
   Janjati
   Others

45 (22.2)
28 (13.8)
85 (41.8)
45 (22.2)

26 (32.1)
10 (12.3)
27 (33.3)
18 (22.3)

0.34

Religion
   Hindu
   Buddhist
   Muslim
   Christian

164 (80.8)
28 (13.8)
5 (2.5)
6 (3.0)

59 (72.8)
14 (17.3)
4 (4.9)
4 (4.9)

0.37

Occupation
   Homemaker
   Service
   Business
   Agriculture

155 (76.4)
20 (9.9)
16 (7.9)
12 (5.9)

56 (69.1)
15 (18.5)
5 (6.2)
5 (6.2)

0.25

Educational status
   Illiterate
   Up to primary education
   Up to higher secondary education
   Up to graduation

12 (5.9)
35 (17.2)
140 (69.0)
16 (17.9)

3 (3.7)
16 (19.8)
50 (61.7)
12 (14.8)

0.27

Sex of the infant
   Male
   Female

116 (57.1)
87 (42.9)

51 (63.0)
30 (37.0)

0.42

Heard about EBF 187 (93.5) 75 (93.8) 1.0
# Fisher’s exact test



JCMS | Vol-18 | No 4 | Oct-Dec 2022352

DISCUSSION

This study aimed to identify the prevalence of 
exclusive breastfeeding and factors influencing 
infant feeding practices among Nepalese mothers.

In this study, the prevalence of Exclusive Breast 
Feeding (EBF) was 71.5%, which is in alignment 
with the study by Bhandari et al conducted in 
Dhulikhel Municipality (75.7%).4 Studies from 
Africa such as the ones done in Nigeria and 
Ethiopia mentioned EBF prevalence to be 66.7%11 
and Ethiopia 82.2% 12 respectively. A study done 
in Ghana found that the prevalence of EBF was 
66.0%. 13 Also similar findings were observed in 
studies from Northwest Ethiopia (60.8%) Central 
Ethiopia (68.6%), and Hossana town (70.5%).14-16

The prevalence of EBF in this study was higher 
than in other studies conducted in Nepal. A study 
conducted by Mukta et al tertiary-level reported 
a prevalence of (45%)5,  whereas Dharel and 
Dhugana et al reported 23.2%, in a study done 
in mid-western and eastern regions of  Nepal.10 
Eastern Ethiopia (45.8%)17 Other study findings 
Bahirdar city (50.3%)18 and (49.1%)  and Muta 
town19, East Gojjam zone (50.1%).20

These findings show that there are significant 
cultural, geographical, and socioeconomic 
differences in exclusive breastfeeding habits both 
globally and within Nepal, as well as differences 
in the study population and study setting. A high 
proportion of mothers with a higher educational 
level would be the reason for the high prevalence 
of EBF in our study. Exclusive breastfeeding is 
very important for the growth of children.21 The 
new global EBF target is above 60% by 2030 and 
only a few countries have met the target.22

Colostrum (first milk), which is suitable during 
this early period for a baby because it contains 
a high concentration of protein and another 
nutrient the body needs, is also rich in anti-
infective factors that protect the baby against 
respiratory infections and diarrheal diseases, 

so early breastfeeding initiation is extremely 
important.23

The commonest reason for not practicing EBF 
in our study was less production and secretions 
of milk (66.6%). A study in Bangladesh by Joshi 
PC et al has similar findings with 64% of the 
mothers having inadequate secretion.8 Nutrition 
of the mother and position of breastfeeding to 
infant have a crucial role to enhance milk flow. 
So after the delivery mother has to take in extra 
calorie which contains lots of protein, vitamin, 
and minerals.

The majority of our research participants (68.7%) 
practiced early initiation of breastfeeding within 
1 hour of delivery. Nepal Demographic Health 
Survey (NDHS) has reported that 55% of children 
are breastfed within the first hour of life 24which 
is higher in our study. Health education and 
awareness programs in health institutions are 
going well, and therefore would have an effect on 
the higher rates of early initiation of breastfeeding. 
A similar rate (63.4%) was found in the study by 
Bernard et al13.  In a study done in the Rupandehi 
district in Nepal, Khanal and Scott reported a 
slightly lower rate (42.2%).  One reason may be 
that some mothers had traditional birth attendant 
assistance during delivery. 18

The Delay in early initiation of breastfeeding in 
this study was a cesarean section, severe pain, 
baby in NICU. This also affects the duration of 
exclusive breastfeeding practice could be that 
some mothers also had delivery assisted by a 
traditional birth attendant.25

In our study, 81.3% of mothers less than 30 
years of age practiced EBF  whereas Exclusive 
Breastfeeding practice mothers among age >35 
(66.7%) than mothers of other age group study done 
by Joshi et.26 As mentioned by Bernard Exclusive 
Breast Feeding were high when the mother’s age 
is over to 20 years13. Asemahagn presented that 
practice of the Exclusive breastfeeding was more 

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in mothers of age group 30 or more, the reason 
that mothers get to experience an increase in 
age.27 But it was not statistically significant.

Cesarean section was the reason for late initiation 
of breast milk was found in 88.6% of mothers 
in our study. Different studies also stated that 
cesarean delivery is one of the main causes to 
delay initiation of Breast Feeding. 28 29. The study 
of Chandrashekhar in western Nepal stipulated 
27.5% of mothers had problems breastfeeding 
like pain in the nipple.30

In contrast to his study, only 9.9% of mothers had 
experienced problem feeding in the study. Now 
more women are aware. Health education during 
antenatal visits and advice on breast care help to 
minimize the problem of feeding, which is being 
run in Maternal and Child Health Care nowadays 
properly. Most of the deliveries are conducted at 
home with the help of family members. Pregnant 
women rarely attend medical facilities for 
antenatal treatment and guidance.31

This study does not find differences with caste 
to practice Exclusive Breast Feeding, whereas 
Khanal V found a delay in initiating breastfed 
within one hour in the middle caste and Dalit 
caste groups.25There need to have more studies 
regarding caste and socio-culture difference 
start breastfeeding within one hour. Mothers’ 
occupation is also found one of the influential 
factors in the early initiation of exclusive breast 
feeding. In the study majority of mothers are 
homemakers 74.3% and practiced Exclusive 
breastfeeding. Our studies have shown that a large 
number of Male infants are exclusively breastfed 
(57.1%) than female infants (42.9%). Chakravarty 
has also reported that there is a gender bias in 
breastfeeding in Egypt.32 Whereas it is found by 
the study of Joshi et al, female infants were more 
likely to be exclusively breastfeeding than male 
infants. Although this finding was found to be 
statistically not significant.26

In this study, primiparous mother practice 
exclusive breastfeeding (60.1%) compare to 
Multiparous mothers (39.9%) which is in contrast 
to the study done by Timilsina. 26 In the current 
study, Homemaker mothers were more likely 
to practice EBF (76.4%) than job-holder mothers 
which are similar to the study done in Ethiopia 
79.6%.20 This result is similar to studies from 
Malaysia,33 the Netherlands 34 Utah State35, 
Cameroon36, Ghana 37,  and Debre Markos, 
Ethiopia 38 it is due to homemakers staying with 
their kids and they have time for breastfeeding. 
Though the finding was similar, it was not 
statistically significant.

In addition to the above factors, mothers who 
delivered normally were two times more likely to 
exclusively breastfeed than those who delivered 
by a cesarean section which was similar to a study 
done by Dachew Assefa Berihun. Though it was 
not statistically significant in our study.

This study aimed to identify the prevalence of 
exclusive breastfeeding and factors influencing 
infant feeding practices among Nepalese mothers. 

CONCLUSIONS

The study revealed that the Prevalence of 
Exclusive Breast Feeding is 71.5%. 93.5% of 
respondents had heard of EBF. Low production of 
milk was the commonest reason for not practicing 
EBF (66.6%), working mothers, painful breasts, 
and difficulty in sucking were the other reasons. 
We have to encourage women to have a healthy 
diet and initiation of breastfeeding should be 
supported by hospital staff.

ACKNOWLEDGMENTS

We would like to express our sincere gratitude to 
all the respondents of our study for giving their 
valuable time, also we want to thank Bharatpur 
Hospital for permitting us for data collection.

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JCMS | Vol-18 | No 4 | Oct-Dec 2022354

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Citation: Panthi S, Koirala P, Bansal P, Prasai M, Khadka K, Phyual R, Shrestha A. Prevalence of Exclusive Breastfeeding 
and Factors Influencing Infant Feeding Practices among Mothers of Central Nepal. JCMS Nepal. 2022; 18(4); 348-57.

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