Indian J Pe0iatr 1989; 56 : 385-391

Factors Influencing Prevalence of

Breastfeeding in a Resettlement
Colony of New Delhi
Sanjiv Kumar, L.M. Nath and V.P. Reddaiah

Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi

Influence of some family and maternal characteristics on prevalence of

breastfeeding was studied in a cross sectional study using WHO sug-
gested methodology. 547 mothers with children less than three years of
age were interviewed with the help of a schedule. Age and parity of the
mother, sex of the child, length of urban stay, mother's going for work did
not influence the prevalence of breasffeeding. Prevalence was higher
among illiterate mothers and mothers belonging to lower socio-economic
status. The mothers from higher socio-economic status initiated
breasffeeding eadier. More mothers from higher socio-economic statue
and those with better education thought that supplementation was needed
before the child was 4 months old and felt that breasffeeding was needed
for less than two years.

Key words : Breas([eedinb" Infant child nutrition.

Nutritional, immunological, psychologi- the mothers towards it in a resettlement

cal, economic and social advantages of
breastfeeding have been proved beyond
any doubt. These advantages are even
more marked in a poor environment and
may be the only chance of giving child a fair
chance of survival and leading a healthy
life. There has been a decline in
breastfeeding in urban areas in India. 1 The
present study was carried out to fred out
the influence of some social factors on
prevalence of breastfeeding and attitude of
Reprint re.quints : Dr. Sanjiv Kumar, Lr
IX'lau'tmr of Prtvcntivr and Social Medidne,
UnivetdtyCollegeof MedicalSciences,Ring Road,
NewDeUd110029.
colony of New Delhi.
MA~ ~'~ MrmoDs
The study was carried out at Sector I of
Ambedkar Nagar, a resettlement colony in
South Delhi. Each house was visited and
mothers with children less than three years
of age were interviewed with the help of a
pretested, coded, close ended schedule
adopted from WHO suggested methodo-
logy3 The sample size was decided using
the formula suggested in that methodology
i.e.
K(pq)Z
N=
d2

385
386 THE INDIAN JOURNAL OF PEDIATRICS Vol. 56, No. 3

Where Since there was no clustering in the

N = sample size
K = clustering factor (not applicable in
the present study)
p = proportion of mothers breastfeed-
ing
q = proportion of mothers not
breastfeeding
z -- level of confidence (95%)
d = degree of precision (10%)
present study, clustering factor (K) was ig-
nored. Sample size was calculated from the
prevalence of breastfeeding in different age
groups after completing "g)0 interviews.
This was needed as there is a lot of re-
gional variation in the prevalence of
breastfeeding.
The schedule included identification
data, maternal age, education, duration of
urban stay, occupation, socioeconomic

TABLE 1. Family Characteristics and Prevalence of Breastfeeding

Family characteristics % of children breastfed X2value and P value

I. Socioeconomic status
Upper middle (62) 70.9 X2 10.10
Lower middle (181) 70.2 < 0.01
Upper lower (301) 81.9
and Lower lower
II. Mother's education
Illiterate (379) 80.4 X 2 = 8.29
Primary or less (104) 69.5 < 0.05
More than primary (60) 683
III. Time of urban stay
Less than 10 years (165) 73.5 Xz = 1.62
More than 10 years (378) 78.5 NS
IV. Mother's age
< 25 years (235) 77.4 Xa = 0.62
25-35 (201) 75..8 NS
More than 35 years (47) 80.9
V. Type of family - Joint (155) 75.8 X 2 -- 0.17
- Nuclear (388) 77.4 NS
VI. Parity
1 (133) 71.6 X2 = 5.57
2 (134) 78.5 NS
3 (118) 73.9
4 or more (158) 82.4

Figures in parenthesis is the total number in the sub-group. NS - Not significant

KUMAR El" AL : FACTORS INFLUENCING BREASTFEEDING
status of the family, child's age, sex, feeding
pattern and maternal views on duration of
exclusive breastfeeding, total duration of
breastfeeding and the place of preference
for breastfeeding.
Socioeconomic status of the family,
mothers' education, age, parity, occupation
and duration of urban stay were studied to
see any possible influence these factors had
on breastfeeding prevalence. The mother-
child pairs were divided into the following
age groups depending on the age of the
child in completed months : 0-2, 3-5, 6-8, 9-
11, 12-14, 15-18, 19-23, 24-35. However, for
analysis of various factors all the groups
were combined to have sufficient numbers.
RZsuLrs
The prevalence of breastfeeding in dif-
ferent groups was 0 to 2 - 100%, 3 to
5 - 91.1%, 6 to 8 - 95.5%, 9 to 11 - 83.0%,
12 to 14-82.8%, 15 to 17-80%, 18 to
23- 62.4% and of 24 to 35 months 43%.
The overall prevalence was 75.3%.
Prevalence of breastfeeding did not vary
significantly with parity (Table 1). Age of
the mother also did not influence
(Table 1).
Among male children 74.7% (222/297)
were being breastfed and among females
76% (190/250) were being breastfed at the
time of interview. The difference was not
statistically significant (X2 = 2.13, P >
0.05). The mothers were divided into two
groups with respect to their urban stay-less
than ten years and more than ten years.
The difference in these two groups was not
statistically significant.
Mothers from joint families, 75.8% of
them were breastfeeding their children
whereas among the nuclear family mothers
77.4% were doing so. This difference was
not statistically significant [(X 2 = 0.17
387
P > 0.05) Table 1].
Among illiterates 80.4% mothers and
among those educated upto primary 69.5%
and among those with more than primary
68.3% were breastfeeding at the time of in-
terview. This difference was significant [(X2
= 6.39, P < 0.05) Table 1].
Only 45 mothers were working. Among
them 75.6% were breast feeding at the
time of interview and among non working
76.3% were doing so. Most of these work-
ing were construction labourers who stayed
at home for 2 to 3 months after child birth
and then carried the child along to the
place of work where they fed the child fre-
quently.
The prevalence of breastfeeding was
higher among mothers from lower socio-
economic status than those from upper
(Table 1).
The children from higher socioeco-
nomic status got their first breastfeed ear-
lier than those from lower socioeconomic
status (X2 = 33.63, P < 0.001).
Prevalence of breastfeeding in relation
to the time of initiation of breasffeeding
was also studied. No difference was found
in the prevalence of breasffeeding among
those who initiated breastfeeding within 48
hours of child's b;rth and those who initi-
ated after it.
Maternal views on duration of exclusi,ve
breastfeeding and total duration of breast-
feeding revealed that with the rise in socio-
economic status and maternal literacy
more mothers preferred to supplement be-
fore the baby was 4 months old (Table 3)
and stop breastfeeding before the baby was
2 years old (Table 4). The duration of ur-
ban stay (Table 3) and the type of family
had no influence on it (Tables 3 and 4). It
was observed that more mothers from
higher socio-economic status and with
388 THE INDIAN JOURNAL OF PEDIATRICS Vol. 56, No. 3

TABLE 2. Mother's Preferring Privacy for Breastfeeding in Relation to Various Characteristics

Characteristic % of mothers preferring privacy X"~value and P value

I. Socio economic status
Upper middle (62) 58.1 X 2 = 64.75
Lower middle (180) 29.4 < 0.001
Upper lower (301)
and lower lower 12.6
II. Mother's education
Illiterate (379) 15.8 X 2 = 23.06
Primary or less (104) 40.4 < 0.001
More than primary (60) 46.7
III. Type of family
Joint (155) 26.4 X 2 = 1.14
Nuclear (388) 22.2 NS
IV. Urban stay
Less than i0 years (165) 18.8 X 2 -- 14.72
More than 10 years (378) 33.9 < 0.001
Figures in parenthesis is the total number in each sub-group. NS -- not significant

TABLE 3. Maternal Views on Duration of Exclusive Breastfecding

Characteristics % of mothers who considered X z and P value
< 4 month as optimum period
I. Socio-economic status
Upper and lower middle (242) 33.9 X z = 12.82
Upper and lower lower (301) 203 < 0.001
II. Literacy
Illiterate (379) 22.4 X z = 16.1
Primary or less (104) 28.9 < 0.001
More than primary (60) 46,7
III. Urban stay
< 10 year (165) 24.8 X z = 0.27
More than 10 years (378~ 27.0 NS
IV. Type of family
Joint (155) 25.8 X 2 = 0.03
Nuclear (388) 26.6 NS
Figures in parenthesis is the total number in each sub-group. NS = not significant
KUMAR ET AL : FACTORS INFLUENCING BREASTFEEDING 389

TABLE 4. Maternal Views on Optimum Total Duration of Breastfeeding

Characteristic % of mothers who considered X2 and P value
< 24 months as op~-numperiod
I. Socioeconomicstatus
Upper and lower middle (242) 67.7 X2 -- 16.65
Upper and lower lower (301) 13.6 < 0.001
II. Literacy
Illiterate (379) 12.7 X2 = 44.18
Primary or less (104) 30.8 <0.001
More than primary (60) 45.0
HI. Urban stay
< 10 years (165) 23.6 X2 = 0.829
More than 10 years 078) 18.3 NS
IV. Type of family
Joint (155) 23.9 X2 = 2.09
Nuclear (388) 183 NS
Figures in parenthesis is the total number in each sub-group. NS = not significant

higher education preferred privacy to
breastfeed their babies. Mothers who had
stayed in the urban area for more than ten
years also showed preference for privacy
(Table 2). The type of family had no influ-
ence (Table 2).
DISCUSSION
The background of the family and the
mother is expected to influence prevalence
of breastfeeding. In the present study, age
and parity of the mother did not influence
prevalence of breastfceding. Other studies
in India also do not show any clear cut
trend. WHO study3 in Indian urban poor
and rural mothers did not show any asso-
ciation with parity and age of the mother.
A study observed that younger mothers
tended to give up breastfeeding earlie#
and two studies found prevalence higher
among primipara. 5.6
The prevalence was same among male
and female children. Ghosh et a/~ did not
fred any difference, one study found it
higher among males 7 and another 8 found it
higher among female children. In India
usually male children are preferred yet the
prevalence of breastfeeding did not show
male preference.
Though urbaniTation is expected to have
deleterious effect on prevalence of breast-
feeding the prevalence was unaffected with
the length of urban stay. Other studies3~
also did not fred any correlation between
duration of urban stay and prevalence of
breastfeeding.
It is expected that the amount of sup-
port available from other members in the
joint family is likely to have a positive influ-
ence on prevalence and duration of
breastfeeding. However, the present study
found no significant difference. The WHO
390 THE INDIAN JOURNAL OF PEDIATRICS
studya also did not fred any difference in all
the countries except in economically ad-
vantaged in Guatemala.
The prevalence was higher among illit-
erate mothers than literate mothers. As the
number of literate mothers became very
small on breaking them up into years of
education received, they were taken as one
group and no trend could be inferred. Sev-
eral other studies have also shown the
negative effect of education on breastfeed-
ing.S The fact that 11.3% of illiterate
women were working as against 1.2%
among literate was not significant as the
prevalence of breastfeeding was same
among working and nonworking women.
The reason for this could be that most of
the working women were labourers 0 2 /
45) who stayed at home for 3 to 4 months
after childbirth to look after the child and
later carried the child to their place of
work. Among the rest most (7/13) were
part-time workers and came back in 2 to 4
hours.
The prevalence was higher among the
mothers of lower socio-economic status as
compared to higher. The children from
higher socio-economie group received their
first breastfeed earlier than those from
lower. Studies from Delhi9,1~ and other
parts of India show a similar associa-
tion4,7.n,u whereas a study from Bombay
shows the oppositefl
Time of initiation of breastfeeding and
subsequent prevalence in different age
groups did not have any correlation. These
results are same as that of the WHO
study? This is contrary to the possibility
that the mothers who initiate breastfeeding
late are more likely to be unsuccessful in
breastfeeding.
Sodoeconomic status had a positive in-
fluence on the mothers preference for pri-
Vol. 56, No. 3
vacy for breastfeeding so also education.
This may decrease the frequency of suck-
ling and bring down the breast milk output.
Duration of urban stay had no influence on
prevalence of breastfeeding but it did influ-
ence mothers' need for privacy to
breastfeed their babies. The type of family
had no influence.
More literate mothers and those from
better socioeconomic status felt that exclu-
sive breastfeeding should be less than four
months contrary to the recommendation
that exclusive breastfeeding should be
given for at least four months.14,~ A higher
proportion of literate and socioeconomi-
cally better off mothers felt that total dura-
tion of breastfeeding should be less than
two years. These differences were also evi-
dent in the practice. The duration of urban
stay and type of family had no influence.
R~rgggNogs
L UNICEF, Breastfeeding practices and re-
lated research in India - an annotated bib-
liography. UNICEF/ROSEA, New Delhi
1982.
2. WHO. Methodology for determination of
breastfeeding patterns. Based on an infor-
mal meeting on the development of a
methodology for the surveillance of
breastfeeding. MCH/BF/SUR/81.1
MCH. WHO, Geneva 1981.
3. WHO. Contemporary patterns of
breastfeeding. Report of the WHO col-
laborative study on breastfeeding, WHO,
Geneva 1981.
4. Fernandez A, Munshi NN, Shan J.
Changing pattern in breastfeeding.
Pediatr Clin India, 1980, 15 : 7-13.
5. Ghosh S, Gidwani S, Mittal SK, Verma
R.K. Socio cultural factors affecting
breastfeeding and other infant feeding
practices in an urban community. Indian
Pediatr 1976; 13 : 827-&~2.
6. Suvama Devi P, Behera PL. A study of
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breastfeeding practices in South Africa.
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7. Kumar V, Sharma R, Vanaja K, Real M.
Breastfeeding pattern in urban infants in
Chandigarh. Indian J Pediatr 1984; 51
(408): 13-19.
8. Gopujkar PV, Chaudhury SM,
Ramaswamy M_A, Gore MS, Gopalan C.
Infant feeding practices with special refer-
ence to the use of commercial infant foods.
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9. Dattabanic ND. Some observations on
feeding programmes, nutrition and
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10. Anand D, Ramarao A. Feeding practices
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12. Walia BNS, Gambhir SK, Bhatia U.
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13. Crean JTG, Ling SC, Pearson DJ, Shaw
SN, Stewart RJ, Wilson JH. An investiga-
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in urban slums of Dharavi in Bombay. J
Trop Pediatr 1987; 33 Supp. 2, 1-30.
14. WHO/UNICEF. Infant and young
childfeeding current issues. World Health
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INSULIN PEN FOR DIABETIC CONTROL

Is insulin pen injector merely an expensive gimmick or a real advance ? It is simply a device
made of plastic or metal, shaped like a pen, and holding a cartridge which can deliver
metered amounts of insulin. By pressing a button, 2 units of insulin are indicated delivered
by a visual or audible scale.
The most physiological way of treating diabetes is to provide a background level of insulin
by means of a long-acting preparation (rag, ultralente) once daily, with injections of soluble
insulin before each meal. If this regimen is followed,'a pen is a great advantage. The device
can be carried in a pocket or handbag and there is no need to carry a bottle or syringe. One
cart draw up the insulin, or remove air bubbles; and injections can be given simply and
quickly. To many diabetics, use of a pen is more socially acceptable than injecting with a
syringe, and it removes real anxieties about accusation of being a drug addict. Some studies
have shown improved control and there has been no increase in episodes of hypoglycaemia.

The pen costs about Rs. 800/- abroad. In India both the pen and cartridges are not yet
available. Certainly their availability would improve the management of children in India.
Abstracted from :
Lancet 1989; i : 307-308.