Somali Knowledge Attitude Practices Study (KAPS) - EthnoMed

The two key informants working with INGOs affirmed the reasons cited by the community
respondents. They also noted that a mother’s attitude towards breastfeeding may be the same or
may differ from that of her social network members. The belief that the breast has no milk is a
key factor in delayed initiation of breastfeeding. They attributed the origin of the belief and hence
the consequential practice to culture and lack of knowledge. The practice of delaying initiating
breastfeeding is sustained by continued belief that the breast has not milk, lack of appropriately
competent TBAs and also lack of health education.
Since the two differed in their view on whether the practice existed before the conflict with one
affirming that it did while the other claimed it did not, the conclusion is that it probably existed
but has become more widespread during the conflict era.
The two respondents were requested to suggest practical ways that can be effectively applied to
make mothers breastfeed immediately. They both proposed training and building capacities of
TBAs and caregivers and creation of awareness on breastfeeding to the community in general.
Although a mother decides on the appropriate age to introduce complementary feeding, other
caregivers influence the decision making process. The age of the child and knowledge are major
influencing factors on when to start while nutritional quality of foods, availability and
affordability of foods influence what is given as complementary.
Mothers stop breastfeeding when they become pregnant due to the belief that the milk of a
pregnant mother causes diarrhoea to the one being breastfed. The other reason is illness, when
such a mother becomes sick or feels weak (anaemic) it is attributed to breastfeeding while
pregnant.
The networks that mould breastfeeding include, fathers (husbands) who are seen as people who
assert pressure on mothers. This can be direst or indirect, e.g., when a mother is apprehensive of
breastfeeding for fear that the breast will sag and result in reduced or loss of her husband’s
interest in her. They can either encourage or discourage a mother. Other key persons are
grandparents of the child. The others, relatives and neighbours among others are less influential.
In response to the question whether there are specific community members who need to be
convinced first for change in child feeding practices to occur, the answer was in the affirmative
and both listed husbands/fathers of the children and service providers (TBAs, midwives and other
health workers) change agents.
Two nutritional strengths of Somali complementary diets are that it is considered to be nutritious
(in which availability of powder milk was accredited) and the practice of continued breastfeeding.
On the flip side, offering of water with sugar and tea and the general inappropriate
complementary feeding were cited as weaknesses. It was noted that some caregivers do not
observe hygienic practices and feeding of unboiled milk was cited as one example.
In expounding further the issue of inappropriate complementary feeding, food availability, lack of
knowledge on balanced diets and health and lack safe water for domestic use, including drinking
were cited as key factors that influence the quality of children’s diet between the age of four and
59 months. The key players in determining the quality are mothers and fathers and other
caregivers in general.
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