p ISSN
2723-6927-e ISSN 2723-4339
Experience
of Breastfeeding And Exclusive Breastfeeding For Women With Physical
Disabilities: Scoping Review
Ririn1, Mufdlilah2, Endang Koni Suryaningsih3
1,2,3'Aisyiyah University,
Central Java, Indonesia
Email: ririnsaputri9797@gmail.com1, mufdlilah.stikes@gmail.com2, koni@unisayogya.ac.id3
ABSTRACT
The study aims to
investigate the scientific evidence concerning breastfeeding and exclusive
breastfeeding experiences among women with physical disabilities. Exclusive
breastfeeding entails providing only breast milk to infants from birth to 6
months old, excluding any other food or drinks except medications and vitamins.
However, breastfeeding is not halted after exclusive breastfeeding; it
continues until the child is two years old. Utilising the scoping review
method, the research employed the Population, Concept, and Context (PCC)
framework. Six articles meeting the inclusion criteria were identified from a
pool of 1,553 articles from PubMed, ScienceDirect, Wiley, and Research Rabbit
databases. These articles shed light on the challenges, experiences, barriers,
and support systems related to breastfeeding and childcare encountered by women
with physical disabilities.
The research on breastfeeding experiences among women with physical
disabilities reveals both facilitators and barriers. Facilitators include
adaptations, peer support, and necessary equipment, while barriers encompass
insufficient support, health considerations, and milk production and latching
challenges. These findings underscore the importance of tailored support and
access to information for women with physical disabilities who aim to
breastfeed effectively. Implementing such support mechanisms can contribute to
improving breastfeeding rates among this demographic, thus promoting the health
and well-being of both mothers and infants while addressing societal attitudes toward
disability issues.
Keywords: Breastfeeding,
Exclusive Breastfeeding, Women with Physical Disabilities
INTRODUCTION
Breast
milk (ASI) is a source with a balanced composition for the baby's growth and
development needs. Apart from that, breast milk is also the primary source of
life, so it is sought that babies only drink breast milk without any other
additions such as formula milk, tea water, honey, and water and without
complementary foods, often referred to as exclusive breastfeeding (Habibah, 2022). Exclusive breastfeeding involves providing
infants with only breast milk, excluding any other foods and drinks, except for
medications and vitamins from birth up to 6 months old. However, this does not
imply that breastfeeding ceases after the exclusive breastfeeding period; instead,
it continues to be given to infants until they reach two years of age (Roesli U, 2013).
According to the World Health
Organization (WHO), global exclusive breastfeeding rates for infants aged 0-6
months stood at approximately 44% from 2015 to 2020 (Vaz et al., 2021). This falls short of the global target of 50%
coverage for exclusive breastfeeding. In Indonesia, the indicator for infants
under six months receiving exclusive breastfeeding reached 67.96%, meeting the
national target 2022. Aceh had the lowest achievement among Indonesian
provinces, while DI Yogyakarta had the highest (Muliadi et al., 2023).
Disability has changed according to the
development of knowledge in society, especially Indonesia, ranging from people
with disabilities, people with disabilities, people with disabilities, someone
with disabilities, someone with disabilities, and extraordinary children to
become a term for special needs and disabilities. Disability stands for
Differently abled people or people with different abilities, which appeared in
1998 (Aziz & Safrudin, 2014). These different abilities can affect the
activities of people with disabilities due to the shortcomings of the
individual. Disability is the loss or limitation of individuals in
participating in daily activities in society, not only due to physical or
psychological disorders but also due to social obstacles that contribute.
People with physical disabilities experience
decreased mobility or endurance, which affects the muscular, respiratory, or
nervous systems and disturbances in activities. Physical disabilities can
consist of paraplegia, cerebral palsy (CP), and dwarfism. Paraplegia is the
loss of ability in the lower limbs, such as the legs and hips. This is usually
due to genetic factors and the spinal cord (OT & Das, n.d.). Cerebral palsy (CP), usually caused by brain
damage if it develops before or after birth, is a disorder that occurs in the
nerve networks and brain that control movement, learning speed, feelings, and
thinking abilities (Patel et al., 2020). Dwarfism is when a person experiences
abnormal bone growth caused by genetic or medical factors. People with
disabilities are also called people with
disabilities (UN Convention on the Rights of Persons with
Disabilities) (Pritchard, 2020).
People with disabilities constitute
the largest minority group in the world. More than one billion people, or equivalent to 15% of the world's
population, live with some form of disability, of which 190 million (3.8%) are
aged 15 years and over, and the prevalence of disability is higher in
developing countries (Organization,
2020). Data from the Central Statistics Agency (BPS) as of August 2021
recorded that the proportion of women with disabilities in Indonesia of working
age was more significant (9.32 million or 55%) than men of working age (7.62
million or 45%). Of this figure, only 7.04 million people with disabilities
work, and the rest are openly unemployed. There are fewer women with
disabilities entering the workforce, 3.1 million people or 42.7%, while men are
57.3% or around 4.29 million people.
Based on the results of the study (Acheampong et al., 2020), In Ghana, mothers facing physical
limitations perceive breastfeeding as challenging and costly due to issues such
as sleep disorders, limb dysfunction, and the necessity for breastfeeding
mothers to maintain a balanced and nutritious diet. Participants expressed
experiencing prejudice and discrimination in various aspects of their daily
lives. The challenges encountered by mothers with physical disabilities
highlight the need for a shift in societal attitudes toward disability issues
in Ghana.
The study by Powell (Powell et al., 2018) on breastfeeding among women with physical
disabilities in the United States identified four key facilitators and five
common barriers to breastfeeding. Facilitators included adaptations and
necessary equipment, utilisation of breast pumps, receiving physical assistance
from others, and peer support. Conversely, barriers encompassed insufficient
support, health considerations related to disabilities, limited access to
information, challenges in milk production, and difficulties with latching.
These findings underscore the necessity for enhanced support and access to
information for women with physical disabilities who aspire to breastfeed
effectively.
According to the study by (Andrews et al., 2020) on breastfeeding experiences among disabled
women, four key themes emerged. These included challenges in communication with
lactation consultants, issues concerning milk supply and attachment,
significant pressure to breastfeed, and positive interactions with healthcare
providers. The research offers novel insights into the breastfeeding
experiences of women with disabilities. These results underscore the importance
of providing enhanced support for decision-making regarding breastfeeding among
women with disabilities, as well as improving access to clinical resources that
are supportive of disability-related needs.
Given the mentioned phenomenon, there
is a need to narrow down topics to focus specifically on the experiences of
breastfeeding and exclusive breastfeeding among women with physical
disabilities. This study aims to examine scientific evidence concerning the
experiences of exclusive breastfeeding and breastfeeding among women with
physical disabilities, incorporating relevant evidence from each identified
article.
RESEARCHED
METHODS
The
research method used in this review is Scoping Review, a systematic design used
to review the scope of the methodology, interpret evidence-based findings, and map
out the concepts and type of research underlying the research. The steps
undertaken in this review include several stages. First, researchers identified
research questions guided by questions about breastfeeding experiences and
exclusive breastfeeding in women with physical disabilities. Then, researchers
develop a review focus and search strategy using the Population, Concept, Context
(PCC) format, which leads to identifying key concepts and developing
appropriate search terms. The second stage involves identifying relevant
studies by determining the database, inclusion criteria, and keywords.
Researchers use a variety of databases and specific inclusion criteria to
identify relevant research articles.
The third
step involves article selection by checking duplication, filtering titles and
abstracts, and reading the research article in full. This study uses the Prisma
Flow Chart to provide an overview of scientific article search protocols and
conduct quality assessments to improve writing quality. After article
selection, the Data Charting stage is completed by compiling data in tables
that include information about the title, researchers, year, country, goals,
methods, participants, and results of each relevant research article. Lastly,
the study assessed the quality of articles using tools from the Joanna Briggs
Institute (JBI) for qualitative and quantitative research studies by
establishing value criteria for each question related to research methodology.
Researchers then categorise the total value of articles based on certain
limitations to determine the quality of the articles reviewed. Thus, this study
uses a systematic and comprehensive approach to answer the research questions.
RESULTS AND DISCUSSION
Breastfeeding Facilities
Breastfeeding adaptations and aids
Women with physical disabilities do not have
the physical strength to hold their babies long enough to breastfeed and cannot
find a suitable position. Women with physical disabilities choose to use breast
pumps that they can do independently or with physical assistance (Powell et al., 2018). Women with physical disabilities talk about
breastfeeding while lying down. Pillows are commonly used in breastfeeding
individuals to position the baby (Warkentin et al., 2021).
Physical Help From Others
Women with physical disabilities say it is essential
to receive physical assistance in breastfeeding from others, especially
partners and family members. Physical assistance includes positioning the
mother and baby; sometimes, the helpful individual has to hold the baby while
the mother is breastfeeding (Powell et al., 2018). Women with physical disabilities receive
help from others or their partners. Aids include physically positioning the
baby into the mother's arms, sometimes more general aids such as putting a
pillow on, and sometimes adding an extra pillow underneath the baby (Warkentin et al., 2021).
Peer Support
Women with physical disabilities find value in
receiving breastfeeding information from peers, particularly those who share
similar disabilities. They gather such information by participating in annual
conferences for individuals with disabilities. The significance lies in the
ability to directly communicate with others with similar disabilities, allowing
for the exchange of advice on adaptation and positioning during breastfeeding (Powell et al., 2018).
Inhibitions in Breastfeeding
Lack of Support
Women with physical disabilities recognise the
absence of support as a barrier to breastfeeding, both in the immediate and
prolonged sense. They face challenges in collaborating with lactation
consultants or accessing their services. Women feel that lactation consultants
lack understanding of their needs and fail to propose strategies for adapting
breastfeeding techniques to accommodate their physical limitations (Powell et al., 2018). Additionally, blind women express
difficulties in learning to breastfeed. In such cases, blind women should be
guided by lactation consultants to teach them to communicate location and
direction effectively.
Disabled women expressed feeling extremely
anxious when they encountered difficulties in breastfeeding, fearing that this
might lead hospital staff to question their ability to care for their babies (Andrews et al., 2021). Additionally, women with disabilities
reported not exclusively breastfeeding due to various reasons such as financial
constraints to enhance their nutritional intake, previous cesarean sections,
pressure from some medical personnel, and ineffective communication strategies,
among others. The primary source of support for these women came from their
mothers and grandmothers (Buor et al., 2021)
Limited information
Breastfeeding women highlight the lack of
information regarding breastfeeding and disability as a significant obstacle.
One woman expressed frustration due to receiving information primarily tailored
for non-disabled women, which did not address her specific needs. Women with
disabilities expect others to have a better understanding of their requirements
and advocate for more accessible and relevant breastfeeding information explicitly
targeted toward women with disabilities (Powell et al., 2018)
Difficulties with milk supply
Women with physical disabilities discuss
difficulties associated with breastfeeding supply. They experience delays
initiating breastfeeding due to finding the appropriate breastfeeding
technique. This delay is believed to contribute to their inability to produce
adequate amounts of milk (Powell et al., 2018). Additionally, women with physical
disabilities express that the breast milk supply is insufficient to sustain
breastfeeding. Despite their desire to breastfeed, many women cannot continue
breastfeeding for an extended period (Andrews et al., 2021).
Difficulty in breastfeeding
Breastfeeding women have difficulty latching. However,
attachment is a challenge for many women. Women with physical disabilities
often feel irritated because of their limitations, namely problems in
positioning (Powell et al., 2018).
Breastfeeding Experience
The Decision To Breastfeed Or Vice Versa
Women with physical disabilities opt to
breastfeed influenced by various factors. Their mothers influence some, while
others are inspired by their admiration for breastfeeding women. Additionally,
some decide to breastfeed based on advice from nurses and their personal
beliefs regarding breastfeeding. Women express that their affection towards
their children, the natural properties of breast milk, and the belief that
breast milk is a divine creation influence their decision to breastfeed.
Breastfeeding elicits emotions, including joy, love, anger, and pain for some
women. It is viewed as a bond of love between mother and child (Acheampong et al., 2020)
Challenges Related To Childcare
Mobility
Women with physical disabilities employ
various methods of mobility in their daily lives. Some may crawl while carrying
their babies, others sit in wheelchairs with their babies on their laps, and
some use crutches and callipers to move around. When babies cry at night, some
women may need to crawl on the floor to reach their babies and breastfeed them (Acheampong et al., 2020).
Prejudice
Women with physical disabilities experience
feelings of judgment from the broader society, starting from the antenatal
period through becoming mothers. They perceive that many individuals believe
they are unfit for motherhood due to their physical limitations. There is a
prevailing notion that women with physical disabilities are unable to fulfil
the responsibilities of competent motherhood (Acheampong et al., 2020).
Discrimination
Women with physical disabilities recount
instances where they perceive discrimination, often stemming from the belief
among some individuals that physical disabilities are contagious. They report
feeling discriminated against in various encounters with different people, with
some experiencing emotional distress to the point of crying (Acheampong et al., 2020). However, there are limitations to this
study. Firstly, the search is restricted to English, potentially introducing
bias in each article. Additionally, the search is limited to the years
2018-2023, which may restrict the breadth of the search. Furthermore, including
various research methods in the scoping review yields diverse results, albeit
potentially less significant.
CONCLUSION
In summary, breastfeeding and infant care
offer a source of hope for women with physical disabilities despite
encountering numerous challenges in fulfilling their maternal roles. These
women experience a range of breastfeeding facilities, barriers, experiences,
and childcare-related challenges. Enhancing breastfeeding support for women
with physical disabilities necessitates a deeper understanding of their needs
and experiences. With healthcare providers gaining better insight into
breastfeeding among this demographic and increased access to lactation
consultations, physical assistance, and community support, more women with
physical disabilities can successfully breastfeed.
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Copyright Holder: Ririn1, Mufdlilah2,
Endang Koni Suryaningsih3 (2024) |
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First Publication Right: Journal of Health Science |
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