Universidad De Manila Antonio J. Villegas St.

, Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

CHAPTER I

INTRODUCTION

Realizing optimal maternal and child health nutrition is the ultimate concern of the Promotion of Breastfeeding Program. Thus, exclusive breastfeeding in the first four (4) to six (6) months after birth is encouraged as well as enforcement of legal mandates. The Mother and Baby Friendly Hospital Initiative (MBFHI) is the main strategy to transform all hospitals with maternity and newborn services into facilities which fully protect, promote and support breastfeeding and rooming-in practices. The legal mandate to this initiative are the RA 7600 (The Rooming-In and Breastfeeding Act of 1992) and the Executive Order 51 of 1986 (The Milk Code). National assistance in terms of financial support for this strategy ended in year 2000, thus LGUs were advocated to promote and sustain this initiative. To sustain this initiative, the field health personnel has to provide ante-natal assistance and breastfeeding counseling to pregnant and lactating mothers as well as to the breastfeeding support groups in the community; there should also be continuous orientation and re-orientation/ updates to newly hired and old personnel, respectively, in support of this initiative.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

PROBLEM AND ITS BACKGROUND OF THE STUDY

The MANILA EARNSHAW HEALTH CENTER (MEHC) is one among many of the LGUs institutions tasked to continuously implement the breastfeeding program to the community pursuant to DOHs directive. And like any local government health operating units saddled with operational and administrative deficiencies, such as lack of operational funds, manpower shortages, inadequate health facilities, etc., there is a need to take a closer look on how the MEHC cope and effectively implement the DOHs Breast Feeding Program to its intended beneficiaries. Many literatures in medical science have shown the imperatives of the program to the mother-child well-being as well as to the overall health development of the community and the nation as a whole. Thus, an assessment of the program even in the very limited scale of using MEHC as a model is in order. Other than the above, the continued disappearance of breastfeeding from the nutritional scene in many areas of the world, particularly in developing countries like the Philippines, is cause for great concern.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

STATEMENT OF THE PROBLEM The study is an assessment on the effectiveness of breastfeeding program in Manila Earnshaw Health Center (MEHC). Specifically the researchers try to find out the answers to the following: 1. What are the demographic profiles of the respondent in terms of: 1.1. Age 1.2. Civil Status 1.3. Educational Attainment 1.4. Estimated Monthly Income 1.5. Number of Siblings 2. What are the standard parameters and rating that will define the programs success in

terms of effectiveness from the perception of its administrator and targeted beneficiaries? And, 3. How do the administrators and targeted beneficiaries perceived the effectiveness of

breastfeeding program?

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

SIGNIFICANCE OF THE STUDY The imperatives of this study is that this review focus, for the most part, on breastfeeding and key indicators related to this practice and its success after it has been observed that the program has not lift off significantly after its implementation has been devolved to the local government health units. Furthermore, there were observable indications that the program has been downplayed due to the inherent inadequacies of its implementers and lobbying of multinational milk companies who stand to lose significant business due to the program. Viewed against this light, this study was made to serve as a wake-up call among mothers and health practitioners on the importance of the breast feeding program after it has been observed that the national consciousness has been declining in favor of the controversial Reproductive Health Bill.

Other than the above, the study is significant for the following reasons: a. The result of this study can give a supporting assessment of the implementation status of the breastfeeding program in different LGU health units through the information and identification of its strengths and weaknesses.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

b. This study will help to specifically identify areas which can be targets improvement of the breastfeeding policies of the government health units. And,

for

c. This study would also serve as a baseline data for other health centers which intend to evaluate their own breastfeeding policies.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

SCOPE AND DELIMITATIONS OF THE STUDY

The study is limited to the evaluation of the breastfeeding policy implementation at local government health units level when said programs continuing propagation was devolved upon the LGUs since year 2000. In particular, this study measures the effectiveness of LGU health centers as represented by the M. Earnshaw Health Center in promoting the program from the point of view of health administrators and targeted beneficiaries during the period of their interaction. This study did not include follow-ups on breastfeeding mothers after the cessation of their consultation with local health centers.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

DEFINITION OF TERMS The following were defined for better understanding of the study:

TERMINOLOGIES 1. Breastfeeding Policy

CONCEPTUAL DEFINITION

OPERATIONAL DEFINITION

Refers to a written documents It contains instructions to be formulated by the Manila followed by the health care Earnshaw Health Center. professionals in the health center for proper promotion and implementation of breastfeeding. Refers to any food being marketed or otherwise represented as partial or total replacement for breast milk, whether or not suitable for that purpose. In order to ensure that safe and adequate nutrition for infants is provided, there is a need to protect and promote breastfeeding and to inform the public about the proper use of breast milk substitutes and supplements and related products through adequate, consistent and objective information and appropriate regulation of the marketing and distribution of the said substitutes, supplements and related products It Engaged directly or indirectly, in health care for the mothers and infants admitted in Manila Earnshaw Health Center. An action that must follow the health care professionals in health center for proper promotion of breastfeeding policy.

2. Breast milk Substitutes

3. Health Care Staff

Refers to nurses and midwives.

4. Implementation

Refers to the extent of enforcement of the breastfeeding policy

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

CHAPTER II REVIEW OF LITERATURE AND RELATED STUDIES The importance of this chapter was to determine the related studies undertaken by local and foreign authors. The researcher reviewed several studies made by them which served as significant of the study. The related information and details were in one way or another related in some aspect to the present attempt which added more relevance and depth of the research study. LEGAL BASES EXECUTIVE ORDER NO.51. MILK CODE. Adopting a national code of marketing of breast milk substitutes, Breast milk supplements and related products, penalizing violations serves as the legal foundation for the need of the implementation of the program. Whereas, in order to ensure that safe and adequate nutrition for infants is provided, there is a need to protect and promote breastfeeding and to inform the public about the proper use of breast milk substitutes and supplements and related products through adequate, consistent and objective information and appropriate regulation of the marketing and distribution of the said substitutes, supplements and related products; consistent with Article 11 of the International Code of Marketing of Breast milk Substitutes, the present government should adopt appropriate legislation to give effect to the principles and aim of the aforesaid International Code.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration REPUBLIC ACT NO. 7600. The Rooming-In and Breast-Feeding Act of 1992. The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It shall create an environment where the basic physical, emotional, and psychological needs of mothers and infants are fulfilled through the practice of rooming-in and breastfeeding. Breastfeeding has distinct advantages which benefit the infant and the mother including the hospital and the country that adopt its practice. It is the first preventive health measure that can be given to the child at birth. It also enhances mother-infant relationship. Furthermore, the practice of Breastfeeding could save the country valuable foreign exchange that may otherwise be used for milk importation. Breast milk is the best food since it contains essential completely suitable for the infants needs. It is also natures first immunization, enabling the infant to fight potential serious infection. It contains growth factors that enhance the maturation of an infants organ systems.

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FOREIGN LITERATURE

Strategies to Support Breastfeeding Prepared for Centre for Health Promotion, SA Breastfeeding Program, Children, Youth and Womens Health Service. The aim of this review is to inform the South Australian Breastfeeding Action Plan 2006-2011 by summarizing and interpreting the literature on strategies for enabling longer breastfeeding duration, with a particular focus on the early months after birth Interventions to increase duration of breastfeeding were investigated using randomized controlled trials with the majority of the programs evaluated having no effect on breastfeeding duration. This is a finding that has been noted in the past. Most of the interventions tested involved professional or peer support, but the support varied considerably in intensity and content. A Canadian peer support program and a small trial where women were first screened for need of support with breastfeeding prior to the intervention was effective in increasing early breastfeeding duration, which suggests that careful attention to attributes of peer support programs and evaluation by randomized controlled trial would be issues for assessment and for adoption of any similar program in Australia. This article recommended that any choice of intervention to increase breastfeeding duration should recognize that the success of such interventions in South Australia will be dependent on the ability to effect change in a population where there is already a high initiation rate, but a relatively quick subsequent cessation of breastfeeding. Interventions which rely on

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration increasing the apparent average duration of breastfeeding by increasing breastfeeding initiation are unlikely to be effective. Due to a lack of experimental research in the Australian and South Australian context, it is unclear what the most effective intervention to increase breastfeeding duration in South Australia might be. To achieve targets for breastfeeding duration, however, women experiencing difficulties with breastfeeding, and women who are from lower socio-economic backgrounds would be the recommended (large) target groups with which to work. This may involve re-orienting current services.

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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LOCAL LITERATURE An article from the Philippine Online Chronicles titled Breastfeeding is Best for Women dated March 12, 2010 by Mec Areavalo, The article promotes the use of breastfeeding among Filipinas by dispelling common Filipino misconceptions against the said practice like, breastfeeding limits mothers diet, causes saggy breasts, inability to breastfeed is hereditary, etc.; and emphasizing the numerous benefits to be gained by women in indulging in breast feeding practices such as: a. Breastfeeding benefits child spacing since it generally delays ovulation b. Breastfeeding helps post-partum weight loss, c. Breastfeeding decreases the chances of women developing osteoporosis by up to four times lower. d. Breastfeeding also reduces the risk of breast, uterine and ovarian cancers, (all leading causes of death in women in the country) which is partly attributed to the lower oestrogen levels during lactation. e. Lastly, the greatest benefit of all is the promotion of emotional health in the mother. Nursing mothers have been reported to show less postpartum anxiety and depression compared to non-breastfeeding ones. This is probably due to the

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration fact that nursing mothers hold their child all the time which facilitates the bonding process between mother and child. A group of doctors also endorsed the advantages of breastfeeding. The Philippine Academy of Family Physician (PAFP) cites the beneficial effects of breastfeeding. For the baby, theme include better nutrition, and resistance to infection for the mother, possible delay in the onset of the menstruation had thus of conception and pregnancy; for the couple a healthy sex life; and for the family, a closer parent child relationships. (Logarta,1999). Likewise stresses the development of closer parent child relationships as one significant effects of breastfeeding. The act of breastfeeding by the mother establishes the initial contact between mother and child, and forged the long lasting emotional bond. (Logarta,1999)

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration FOREIGN RELATED STUDIES A Descriptive Study of Breastfeeding Practices and Policies in Missouri Hospitals was conducted by (Syler,1997). In this study, all Missouri hospitals that offer maternity services were assessed to measure their compliance with WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). Representatives from seventy six hospitals responded to a telephone survey relating to hospital breastfeeding practices and policies as defined by BFHI's Ten Steps to Successful Breastfeeding. The result showed that no hospital fully supported the Ten Steps and compliance with the WHO/UNICEF criteria varied greatly. The least support was for Step 1 wherein only 28% of hospitals had a written breastfeeding policy that was communicated to all staff. The greatest support was for Step3 wherein 93% of hospitals had staff who informed all pregnant women of breastfeeding benefits. It was stated that in order to increase breastfeeding rates and duration, administrators of hospitals that offer maternity services must increase their efforts to consistently implement the Ten Steps, to become more baby friendly, and to more fully establish a breastfeeding culture within their institutions. A considerable number of observational studies were also included in this review. In particular, many support programs for breastfeeding were only evaluated using observational methods, with the majority of the studies indicating no influence on duration of breastfeeding. Common methodological weaknesses included small numbers in the cohorts or groups of interest and missing comparison groups. Some programs had benefits for other aspects of breastfeeding,

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration for example initiation, which would make them less applicable to increasing duration in Australia where existing initiation rates are already quite high by international standards. A study was also conducted by (Aguayo, 2003) about Monitoring compliance with the International Code of Marketing of Breast milk Substitutes in West Africa: Multisites cross sectional survey in Togo and Burkina Faso. The participants were Staff at 43 health facilities and 66 sales outlets and distribution points, 186 health providers, and 105 mothers of infants aged less than or equal to 5 months in 16 cities. The result of the study revealed that six (14%) health facilities had received donations of breast milk substitutes. All donations were being given to mothers free of charge. Health providers in five health facilities had received free samples of breast milk substitutes for purposes other than professional research or evaluation. Health professionals in five health facilities had received promotional gifts from manufacturers. Promotional materials of commercial breast milk substitutes were found in seven health facilities. Special displays to market commercial breast milk substitutes were found in 29 sales and distribution points. Forty commercial breast milk substitutes violated the labeling standards of the code: 21 were manufactured by Danone, 11 by Nestle), and eight by other national and international manufacturers. Most health providers had never heard of the code, and 66 mothers had never received any counseling on breast feeding by their health providers. It was concluded that in West Africa, manufacturers are violating the code of marketing of breast milk substitutes. Comparable levels of code violations are observed in Burkina Faso, which has a regulating legislation, and in Togo, which has no regulating legislation. It stated that legislation must be

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration accompanied by effective information, training, and monitoring systems to ensure that healthcare providers and manufacturers comply with evidence based practice and the code. Another study was done in India by (Bhat,1993) about Who is Responsible for Artificial Feeding? In this research study, mothers of 320 infants who were artificially fed before 6 months of age and attended the child health clinic of the Department of Community Medicine, SKIMS Srinagar, between March and November, 1991, were surveyed. The sample of mothers included 59% who were illiterate, 52% were housewives and 44% had a middle socioeconomic status, while 31% had a low socioeconomic status. Fifty three percent of the artificially fed babies surveyed were born at a hospital, and 2.5% of which received intensive care. About 46% of babies were born at home. Three percent of them were completely artificially fed from birth; and at 3 months, 19% were exclusively artificially fed. Eleven percent of infants were fed with artificial milk and breastfed at birth and 26% by 3 months and 42% by 6 months. Fifty one percent of mothers were advised by pediatricians to use artificial feeding; 25% were advised by general practitioners and 10% by paramedical. Around 40% were advised at private clinics and 26% in hospital wards at the time of discharge. 18% were advised in outpatient departments and 16% at other health centers, such as immunization clinics, health clinics, or nutrition education centers. There were 66% mothers who received recommendations to use tinned milk (Lactogen/ Milk-care) and 30% for cows milk. Forty five percent of mothers received advice from pediatricians about tinned milk and 6% about cow's milk, whereas 6% of mothers received advice from general practitioners about tinned milk and 5% about cow's milk. Over 80% of mothers were given instructions on the amount of dilution and

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration frequency of feeding. About 61% of mothers received information on feeding equipment and 56% on sterilization of feeding equipment. Only 59% and 65% of them were able to understand instructions on equipment and sterilization, respectively. The reasons given by mothers for using artificial feeding were low milk output (50%), nonacceptance of breast milk by the baby (23%), working mothers (12%), and baby illness (8%). Mothers attributed infections, colic, and regurgitation to artificial feedings. This study showed that the professional community is not complying with the professional code promoted by the World Health Assembly and Indian legislation in 1986 on not recommending milk formulas.

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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LOCAL RELATED STUDIES A study was also done by (Que,1999) on the Evaluation of the Breastfeeding Program of the Zamboanga City Medical Center. This study intended to evaluate the breastfeeding policy of the Zamboanga City Medical Center since its implementation in 1993 to determine which aspect of the policy would need further support and improvement.

The success of the policy was evaluated using multiple methodologies for the collection of data namely (a) survey of mothers who delivered in the hospital during the period covered by the study, (b) in-depth interviews of the three breastfeeding coordinators of Region IX, (c) focus group discussion among six breastfeeding-trained personnel of both Obstetric and Pediatric Departments, and (d) eight ocular inspections of the hospital premise using a checklist. A total of 1,265 subjects were recruited into the study, of which 465 were lost to follow-up. Almost all the mothers intended to breastfeed their babies but only 0.8% was exclusively breastfeeding at 6 months. Only 40% heard of the governments breastfeeding policy or were taught on the benefits of breastfeeding. Ninety percent have seen a poster on breastfeeding. Majority were not aware of the no bottle-feeding and rooming-in policy of the hospital. The most common problems, cited by the interviewees and during focus group discussion, which hinder the implementation of the governments breastfeeding policy include lack of man power, presence of artificial formula/bottle, inadequate milk banking, and lack of support groups. Eight

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration ocular inspections of the hospital premises made on different occasions revealed that the main problem focused on the presence of artificial milk/bottles.

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SYNTHESIS OF THE STUDY The foregoing studies provided a review of relevant documents detailing the beneficial effects of breastfeeding to national health and the conscientious efforts of the government and private sector in promoting the program. Likewise, these studies provide the mechanics and operational strategies adopted for its implementation. Also, these studies provide an initial assessment of the breast feeding program as implemented in the Philippines prion to year 2000.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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CHAPTER III RESEARCH METHODOLOGY

This chapter included the discussions on the methods of research, sources of data, sampling technique, research instrument to be used, data gathering procedure and statistical treatment. The researchers come up with the method where the data will be acquired thru the use of survey, questionnaire and interviews.

RESEARCH DESIGN

The descriptive method of research was used for this study. To define the descriptive type of research, this method of research is to gather information about the present existing condition. The aim of descriptive research is to obtain an accurate profile of the people, events or situations. With this research type, it is essential that the researcher already has a clear view or picture of the phenomena being investigated before the data collection procedure is carried out. Since the study is concern with the effectiveness of Department of Health breastfeeding program on Manila Earnshaw Health Center District IV of Manila, the researcher used the descriptive method in pursuing the objectives of the study as to the profile of the respondents and MEHC present status in implementing the breastfeeding program.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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RESEARCH INSTRUMENT A survey questionnaire was provided with pertinent data and information to be undertaken in the study. It was the main instrument used in gathering the data from the Manila Earnshaw Health Center. The questionnaires was prepared in such a way that the respondents will simply put a check mark in the question on the spaces provided to signify the answers chosen from a set of answers provided for each question. Unstructured interview was conducted by the researchers among the health administrators of the Manila Earnshaw Health Center. This interview consist mostly of open ended and probing questions with the intention of unravelling the pros and cons they experienced in implementing the program from their individual perspective and level of competencies. Also, Through this, the researchers will be able to clarify some of the portions of the survey questionnaires to the respondents and likewise, inapplicable questions will be corrected accordingly.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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RESPONDENTS OF THE STUDY

The respondents of study are the beneficiaries and implementors of the program. For purposes of this study, the beneficiaries are the mother and their infant who stand to gain in the program; and the health workers i.e., doctors, nurses and other health workers who have taken an active role in the propagation of the breast feeding program. The individual profile of the respondents are taken to describe their demographic characteristics; age, gender, number of siblings, estimated monthly income, educational attainment and employment based on the assumption that their response to the program will differ depending on the above variables.

RESEARCH LOCALE

The research locale of the study are the families and households being serviced by the Manila Earnshaw Health Center in the Sampaloc District of the City of Manila. For geographical convenience, the study locale will include Barangay 401 and its nearby barangay units. This area was targeted for the primary reason that it adequately represent the different barangays of the City of Manila in terms of demographics and health conditions. (NOTE: INCLUDE VICINITY MAP OF BARANGAY AS REQUIRED)

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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SAMPLE AND SAMPLING TECHNIQUES

The researchers used random sampling among the lactating mothers who visited the clinic. A random sampling was resorted to adequately generate a representative responses of the population from a manageable number which would otherwise be impracticable considering the huge number of lactating mothers to be observed. Responses from the sampled mothers will be used to generate observations and inferences which will serve as bases for the studys analysis and findings. This sampling method is conducted where each member of a population has an equal opportunity to become part of the sample. As all members of the population have an equal chance of becoming a research participant. Listed down all the members of the population and then selected members to make the sample. This method involves the selection of the sample at random from the sampling frame through the use of random number tables. Numbers were assigned for each respondent in the master list. These numbers were written on pieces of paper and drawn from a box; the process was repeated until the sample size was reached. Based on the information given by the health center, the total population of Barangay 401, Zone 41 M. Earnshaw, Sampaloc, Manila as of July 2011 is 2,070. A total of 87 mothers aged 1850 years old were randomly selected and surveyed which is 5% of the total population of the Barangay that breastfed their babies.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration The mothers are the respondents which will be used to provide answers on the prepared survey questionnaires on An Assessment on the Effectiveness of Breastfeeding Program of the Department of Health (DOH) in Manila Earnshaw Health Center (MEHC).

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DATA GATHERING PROCEDURE

The researchers asked permission from the Health Officer of Manila Earnshaw Health Center and the Officials on the Barangay 401, Zone 41 District IV Manila. After securing approval, the researchers will discuss the topic with the respondents to present a clear view of the topic under consideration. The finalized questionnaire was distributed by the researchers and will be retrieved an hour after. During the retrieval of the questionnaire, the researcher will conduct unstructured interview with respondents to clarify or verify their responses. This is done to ensure that the respondents have understood correctly the items in the questionnaire. The questionnaire will be provided with a letter introducing the researchers and indicating the purpose of the study. Instructions on how the respondents will fill up the questionnaire will also be provided. The preliminary data was gathered through libraries, internet and MEHC. The researchers must be able to compile enough secondary materials needed in formulating specific problems of the study, related literature and studies and the survey questionnaire.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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STATISTICAL TREATMENT OF DATA

The data collected using the survey questionnaire were collated and analyzed using frequency distribution and percentage. For tabulation and analysis of the data, the following statistical formula were utilized: Relative Frequency - Will be use to analyzed the profile of the respondents in terms of: age, civil status, educational attainment, employment, estimated monthly income and number of siblings. P= Where: P = Percentage F= frequency of the respondents N= total numbers of respondents 100 = percentage The researchers used this relative frequency formula to be able to analyze and interpret the data according to the result of the survey questionnaire.
F x 100 N

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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Weighted Mean The researcher will use this in order to determine a total number of the respondents for every questions in average.

WM = Where:

WF N

WM = weighted mean W = weight of response F N = frequency of response = total number of respondents

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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CHAPTER IV Conceptual Framework Research in both developed and developing countries has shown a number of medical and economic advantages of infant breastfeeding, as compared to the use of artificial (formula) feeding (cf. Population Reports, 1975; 1978; 1981).

Notwithstanding the many beneficial effects of breastfeeding, and the apparent increase in breastfeeding practices in the more developed countries, Third World Nations seem to have suffered from a trend towards increased reliance upon artificial feeding (cf. Baer, 1981; Knodel and Debavalya, 1980).

Such trends are not accidental, but are linked to factors such as: 1. Urbanization and industrialization. Increase in the extra-household employment of married women, increased rates of literacy and educational attainment, changes in the institution of the family, and the expansion of multinational companies' marketing activities. 2. Socio-demographic factors. Associations between residence, education, and socio-economic status suggest that as urbanization, education, and standard of living increase, the overall practice of breastfeeding will decline unless other changes counteract them (cf. Population Reports, 1981).

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration 3. Psychosocial factors. Mother's decision to breastfeed is a function of the opportunity to breastfeed - "ideological conditions that reflect her attitudes, beliefs, and knowledge of breastfeeding and its alternatives" (cf. Baer, 1981). 4. Physiological factors. Illness or discomfort particularly in the early weeks of post-partum which range from breast engorgement, sore and cracked nipples, leakage of breast milk, breast abscesses and mastitis.

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To overcome these factors which act as barriers to the practice of breastfeeding, both demand and supply interventions are proposed in the areas of medical training, public education, community mobilization, and national legislation. The encouragement of partial breastfeeding through media campaigns, education, and the health services could probably be the most beneficial method to increase breastfeeding among working mothers (cf. Huffman, 1984). With the aim of promoting breastfeeding among urban working mothers, the pilot project's educational campaign incorporates the foregoing findings and some theories in communication. Illustrated in diagram form, the constituents are related as follows.

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In the illustrated conceptual framework, the Information, Educations and Promotion (IEC) Package initially constitutes the source of the message on breastfeeding. The message on breastfeeding is transmitted by the motivators (in the person of midwives or nurses of the Ministry of Health) to the receiver or the client-working mother. However, the signals or messages, that is, the advantages and routines/techniques of breastfeeding may be distorted by noise consisting of the barriers (physiological, psychosocial, and socio-demographic) to breastfeeding practice.

Thus, the decision to practice breastfeeding-STAGE 4 (or the output of the whole communication process) whose grounds have been prepared and directed in the knowledge stage (STAGE 1)

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration and the persuasion stage (STAGE 2) may still be subjected to a confirmation stage or feedback (STAGE 3). Therefore, the motivators (government midwives or nurses) will have to follow-up the messages introduced in the IEC Package (leaflet and brochure) with interpersonal communication - group discussions and face-to-face communication - to reinforce the message given in stages I and 2, and to check the output level or incidence and duration of breastfeeding.

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From the foregoing bases: (a) the use of an educational campaign to encourage breastfeeding; and (b) the communication process, it is theorized that, "the use of Mass Media and the reinforcement from interpersonal channels - motivators" (nurses and midwives of the Ministry of Health) will allow the receiver (working mothers) to overcome socio-demographic, physiological, cultural and psychosocial barriers of selective exposure, perception and retention of breastfeeding messages."

The IEC Package is used as an intervention to overcome the barriers to breastfeeding practice among urban working mothers. It will ultimately cause increased incidence and duration of breastfeeding with the support intervention of the health personnel.

In a paradigm, the conceptual framework evolved for the study shows the relation of the components and the interventions or inputs used to promote the practice of breastfeeding

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. Specifically, the components in the study are defined as: 1. IEC Package - leaftlet, brochure, group discussions and face-to-face motivation on breastfeeding used for client-mothers. 2. Exposure - refers to the respondent's use of IEC materials on breastfeeding and the communication or contact with motivators. 3. Physiological Barriers - physical discomfort or illness experienced during the early weeks of post-partum which ranges from breast engorgement, sore and cracked nipples, leakage of breast milk and breast abscesses. Each of these barriers will be overcome by an explanation of its nature and the means to treat or cope with such discomforts 4. Socio-demographic Barriers - characteristics of client-mothers which include age, parity or number of living children, type of occupation and education.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration 5. Cultural Barriers - attitude towards baring of breast and perceptions regarding prevailing fashions in infant feeding. 6. Psychosocial Barriers - knowledge, beliefs and attitudes towards breastfeeding which include desire to breastfeed, misconceptions about breastfeeding practice and lack of confidence (insufficient milk/poor quality of breast milk) to cope with breastfeeding. 7. Motivators - nurses or midwives of the Ministry of Health stationed in Barangay Health Centers who introduced breastfeeding among mother clients and who persuade them to use breastfeeding. 8. Working Mothers - mothers who are working or are employed in clerical, factory, and professional jobs, in industries, or public and private institutions (formal sector); or those engaged in agricultural or fishing activities, cottage industries, and small-scale marketing (informal sector). 9. Knowledge - pertains to the respondents' understanding of the benefits of breastfeeding and the techniques used to successfully breastfeed a child (i.e., position of breastfeeding, expressing and storing breast milk) which is measured through a 25-item objective test. 10. Attitude - refers to the respondents' favorable or unfavorable disposition toward breastfeeding which is measured through a 10-item Likert scale. 11. Practice - the actual use of breastfeeding, the type of breastfeeding (pure or any breastfeeding) and the duration of use. 12. Any breastfeeding type - refers to the use of pure or mixed breastfeeding or both.

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Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration CHAPTER IV PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA The result of this study is purely based on the information and data gathered from the M.Earnshaw Clinics health workers and the lactating mothers who frequented the clinic for consultation as obtained from the survey questionnaire distributed to the former and interviews with the clinics medical professionals.

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No effort was made to validate the data on the pre- year 2000 breastfeeding practices of the clinic as such is deemed impossible and not practicable due to the time gap. To compensate for this deficiency, the study relies on the feedbacks and

disclosures of M. Earnshaw clinic health workers who have been in the clinic during those periods. This matter is vital since such qualitative information will serve as the studys base point of comparison on the effectiveness of the health center in implementing the breast feeding program. Of the 89 sample respondents, hereunder are the results.
1. Socio Demographic Characteristics a. Age The age of the respondents ranges from 18 to 52 years old. Of this range, the highest numbers of respondents belong to the 28-32 bracket which account for 21%, followed by mothers in the 33-37 age category, 19%; and 17% is comprised by those in the 23-27 years category. It is significant to note that the survey

did not register lactating mothers below the 18 years old bracket. A reason for this as gathered from the health workers is that young mothers refrain from visiting the center for fear of being criticized and from social stigma.

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Table 1. Respondents Distribution by Age

Age 18-22 23-27 28-32 33-37 38-42 43-47 48-52 Total

No. of Respondents 9 15 19 17 13 14 2 89

% to Total 10% 17% 21% 19% 15% 16% 2% 100%

A chart of the respondents percentage distribution by age group is shown in Figure 1.

Fig. 1. Distribution by Age Groupings

48-52 2% 43-47 16% 38-42 15% 33-37 19% 18-22 10% 23-27 17%

28-32 21%

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration
The statistical mean of the survey respondents is 33 years old which indicate that the centres mothers population is mature as is common among urban communities in the Philippines. b. Civil Status Of those surveyed, bulk or 70% of the mother are married while the rest or 30% have given birth out of wedlock. Of these unmarried mothers, 17% are

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accounted by those separated, 13% are single parent, and 1% is widower.

Civil status Single Married Separated Widow Total

No. of % to Total Respondents 12 13% 62 70% 14 16% 1 1% 89 100%

Figure 2 shows the relative frequency distribution of the respondents by civil status.

Figure 2. Percentage Distribution by Civil Status

Widow 1% Separated 16% Single 13%

Married 70%

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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c. Education

In terms of educational attainment, more than half of the respondents have reached high school level comprising about 53% of total. Mothers who reached college level account for 45% while a small fraction about 2% have reached only elementary level.

Table 3. Distribution by Educational Attainment

Educational Attainment Elementary High school College Total

No of Respondents 2 47 40 89

Total 2% 53% 45% 100%

Likewise, the pie chart of the distribution is presented in Figure 3 for visual effects.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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Fig. 3 Distribution by Education

Elem. level 2%

College level 45%

High school level 53%

d. Income

By income grouping, 45% of the respondents fall within the P5-P10T monthly income category. Only 21% belongs to the higher than P10T bracket which indicate that on the whole the community being serviced by the clinic belong to the lower middle to middle-middle income category.

Estimated Monthly Income Less than P1,000 P1,001-P5,000 P5,001-P10,000 P10,000 above

No of Respondents 5 25 40 19

Total 6% 28% 45% 21% 100%

A graphical presentation of the above data is presented below.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration Fig. 4. Distribution by Income Group
Less than P1,000 6% P10,000 above 21%

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P1,001-P5,000 28%

P5,001-P10,000 45%

e. Number of Siblings

As to number of children, 79% of the respondents have less than 6 children while 21% have 6 children and above. This figure means that all of the mothers surveyed have given birth and have experienced motherhood and childbearing.

Number of siblings 1-5 6-10 11-15 Total

No. of Respondents 70 19 89

Total 79% 21% 0

2. Breastfeeding Policies and

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration
Majority of the respondents learned about the breast feeding programs of the government thru the M. Earnshaw Health Center. Among those learned from the center are the Department of Healths breast feeding policies rationals itself and the proper breast feeding medical procedures.

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I. Extent and Awareness of the Breastfeeding Policy among Mothers. (Lawak at kaalaman ng mga ina sa tamang patakaran ng pagpapasuso) Based on the survey result, all of the mothers interviewed are satisfied with the manner that the breast feeding policy of the DOH is communicated, disseminated and transferred to them by the Health Center through their medical personnel. A gauge of how these learnings impacted on actual application and implementation of the breast feeding program is measured by the degree of satisfaction among the respondents. On this basis, all of the respondents showed that the learnings imparted to them by the MEHC has proved effective in their practice and application of the breast feeding program among their lactating babies. Tables __ and __, respectively show satisfaction indexes among the respondents. As can be gleaned from the data, there were no substantial differences in the perception in general.
Learning Satisfaction Frequency Valid Effective Moderately Effective Very Effective Total 26 52 11 89 Percent 29.2 58.4 12.4 100.0 Valid Percent 29.2 58.4 12.4 100.0 Cumulative Percent 29.2 87.6 100.0

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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MEHC Training Satisfaction Cumulative Frequency Valid Effective Moderately Effective Very Effective Total 31 42 16 89 Percent 34.8 47.2 18.0 100.0 Valid Percent 34.8 47.2 18.0 100.0 Percent 34.8 82.0 100.0

. II. Extent and awareness in the Mechanics of the breastfeeding among mothers. (Lawak at kaalaman ng mga ina sa pamamaraan ng pagpapasuso) Measuring the effectiveness on the mechanics learned from MEHC and the mothers application in their own breast feeding actual practices, majority of the mothers surveyed are in unison that the MEHC has been effective in this aspect of the program implementation. It is of note, however, that there was a presence of 1 representing 1.1% of the sample respondents who felt that the breast feeding mechanics at MEHC has not been effective in her particular case. This spike in the general consensus necessitate for a conduct of statistical test of its significance on this matter which will be covered in the succeeding analysis.

Mechanics Learned at MEHC Cumulative Frequency Valid Not Effective Effective Moderately Effective 1 29 45 Percent 1.1 32.6 50.6 Valid Percent 1.1 32.6 50.6 Percent 1.1 33.7 84.3

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration
Very Effective Total 14 89 15.7 100.0 15.7 100.0 100.0

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By the same breadth, majority of the respondents perceived that the training given by the MEHC staff on the mechanics of breast feeding proved effective in their respective practice of breast feeding their lactating child.
Staff Training Cumulative Frequency Valid Less Effective Effective Moderately Effective Very Effective Total 1 28 47 13 89 Percent 1.1 31.5 52.8 14.6 100.0 Valid Percent 1.1 31.5 52.8 14.6 100.0 Percent 1.1 32.6 85.4 100.0

III. Extent and manner of awareness in No Bottle-Feeding Policy (Lawak at paraan ng kaalaman sa tamang patakaran na nagbabawal magpasuso sa bote) This questionnaire portion attempts to determine specifically if MEHC is complies with the basic and specific requirement of the DOH Breast feeding program such as the No Bottle Feeding and non-use of milk substitutes other than those of the biological mother. From table __, 98.99% of the respondents felt that MEHC has been effective in the implementation of the no bottle feeding policy, with a greater bulk of them comprising 51.7% perceived that the MEHC is moderately effective in this regard.
No Bottle Feeding

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration
Cumulative Frequency Valid Less Effective Effective Moderately Effective Very Effective Total 1 24 46 18 89 Percent 1.1 27.0 51.7 20.2 100.0 Valid Percent 1.1 27.0 51.7 20.2 100.0 Percent 1.1 28.1 79.8 100.0

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IV. The promotion of Breast Milk substitutes in the MEHC. (Ang pagtataguyod ng MEHC na ang gatas ng ina ay pamalit/panghalili) Similar to the above findings, the respondents felt that MEHC also has been effective in the implementation of this policy.

Breast Feeding Substitutes Samples Cumulative Frequency Valid Less Effective Effective Moderately Effective Very Effective Total 2 41 30 16 89 Percent 2.2 46.1 33.7 18.0 100.0 Valid Percent 2.2 46.1 33.7 18.0 100.0 Percent 2.2 48.3 82.0 100.0

Bulk of the respondents felt that in the promotion of the No Milk Substitute Policy, the display of posters to the effect and the advantages of using natural milk have been very instrumental in discouraging mothers from using formulated milk.

Table __ shows the perception index of respondents on the use of these posters.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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Presence Of Posters on Substitutes Cumulative Frequency Valid Effective Moderately Effective Very Effective Total 38 33 18 89 Percent 42.7 37.1 20.2 100.0 Valid Percent 42.7 37.1 20.2 100.0 Percent 42.7 79.8 100.0

V. Awareness and Proper Implementation of the Breastfeeding Policy among Health Care Professionals in the MEHC(Kaalaman at tamang pagpapatupad sa patakaran ng pagpapasuso ng mga propesyonal na nangangalaga ng kalusugan sa MEHC) All of the respondents felt that the health care specialists manning the MEHC are technically qualified and competent to promote the breast feeding program of the government. Other than this, they viewed that these professionals possesses the dedication and personal initiative to effectively implement the program among their patients.
Policy and Implementation Awareness Encouragement Cumulative Frequency Valid Effective Moderately Effective Very Effective Total 27 46 16 89 Percent 30.3 51.7 18.0 100.0 Valid Percent 30.3 51.7 18.0 100.0 Percent 30.3 82.0 100.0

Among the programs that the respondents viewed the MEHC professional showed favorable competence are in advising them in the prevention of using teats or pacifiers to their child as a substitute to the childs feeding schedules and habits.

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration

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No Teats Advisory Cumulative Frequency Valid Less Effective Effective Moderately Effective Very Effective Total 1 43 35 10 89 Percent 1.1 48.3 39.3 11.2 100.0 Valid Percent 1.1 48.3 39.3 11.2 100.0 Percent 1.1 49.4 88.8 100.0

Similarly, mothers felt that these professionals are also effective in promoting rooming in between the mother and child during the initial period of child rearing.
Promoting Rooming in Cumulative Frequency Valid Effective Moderately Effective Very Effective Total 27 49 13 89 Percent 30.3 55.1 14.6 100.0 Valid Percent 30.3 55.1 14.6 100.0 Percent 30.3 85.4 100.0

By the same token, the MEHC professionals are instrumental in discouraging mothers from offering pre-lacteal feedings to their children which would disrupt the natural feeding habits and schedules of nursing child.
Prohibition of pre-lacteal feedings Cumulative Frequency Effective 38 Percent 42.7 Valid Percent 42.7 Percent 43.8

Universidad De Manila Antonio J. Villegas St., Mehan Gardens Manila College of Accountancy and Public Administration Department of Public Administration
Moderately Effective Very Effective Total 42 8 89 47.2 9.0 100.0 47.2 9.0 100.0 91.0 100.0

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On the whole, MEHC obtained an effective overall satisfaction rating from respondents. This indicates that by all standard measures of perception, MEHC has proven effective in the implementation of the Breast Feeding Program of the government despite the inherent financial inadequacies and operational shortcomings it may have in undertaking the program. Based on the study, these shortcomings were effectively remedied through improvisations, community support and creativities of its professionals in making do with the available resources at their disposal.
Over All Satisfaction in Breast Feeding Promotion Cumulative Frequency Valid Effective Moderately Effective Very Effective Total 36 34 19 89 Percent 40.4 38.2 21.3 100.0 Valid Percent 40.4 38.2 21.3 100.0 Percent 40.4 78.7 100.0