RESEARCH ARTICLE

https://doi.org/10.5005/jp-journals-11003-0142
Journal of Medical Academics
Volume 7 | Issue 1 | Year 2024

Empowering Future Mothers: A School Intervention Approach to Promote Breastfeeding Awareness among Adolescent Girls in Rural Uttar Pradesh, India

Kritika Tiwari¹ https://orcid.org/0000-0003-0979-3003, Priya Arora²

^1,2Department of Community Medicine, Army College of Medical Sciences, New Delhi, India

Corresponding Author: Kritika Tiwari, Department of Community Medicine, Army College of Medical Sciences, New Delhi, India, Phone: +91 8630425932, e-mail: kritika.nik@gmail.com

Received on: 04 June 2024; Accepted on: 24 June 2024; Published on: 05 July 2024

ABSTRACT

Aims and background: Breastfeeding is vital for the health of both infants and mothers, yet breastfeeding rates remain low in rural areas of developing countries such as India. In rural Uttar Pradesh, sociocultural barriers and a lack of knowledge hinder optimal breastfeeding practices. This study aims to evaluate the effectiveness of a school-based educational intervention in promoting breastfeeding awareness among adolescent girls in this region.

Materials and methods: This pre–post intervention study was conducted among adolescent girls from 7th to 12th grade at a government girls’ school in rural Uttar Pradesh. Stratified random sampling was used to ensure representative participation across different classes. A pretested, self-structured questionnaire assessed baseline knowledge, attitudes, and perceptions regarding breastfeeding. An interactive teaching session served as the intervention. Changes in knowledge, attitudes, and perceptions were measured using a posttest with the same questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) (version 23), with paired t-tests to compare pre- and posttest scores.

Results: The mean pretest score was 6.05 [standard deviation (SD) = 2.01], which significantly increased to 11.26 (SD = 1.46) postintervention (p < 0.001). The effect size (Cohen’s d) was 2.1, indicating a very large impact. Positive attitudes toward breastfeeding increased from 87.1 to 98.4%, and future breastfeeding intentions rose from 79 to 96.8%. The majority of participants (68%) were initially unaware of breastfeeding week, and family was the most common source of breastfeeding knowledge.

Conclusion: The school-based educational intervention significantly improved breastfeeding knowledge and attitudes among adolescent girls in rural Uttar Pradesh. This suggests that such interventions can effectively address knowledge gaps and misconceptions, providing a supportive environment for future breastfeeding practices.

Clinical significance: Educational interventions in schools can play a crucial role in promoting breastfeeding awareness and positive attitudes among future mothers in rural areas. Implementing similar programs could enhance breastfeeding practices, thereby improving maternal and child health outcomes in resource-limited settings.

How to cite this article: Tiwari K, Arora P. Empowering Future Mothers: A School Intervention Approach to Promote Breastfeeding Awareness among Adolescent Girls in Rural Uttar Pradesh, India. J Med Acad 2024;7(1):8-12.

Source of support: Nil

Conflict of interest: None

Keywords: Adolescent, Breastfeeding, Child health, Health education, India, Maternal health, Rural population, School health services.

INTRODUCTION

Breastfeeding is recognized globally as a critical practice for ensuring the health and well-being of both infants and mothers. The World Health Organization (WHO) recommends exclusive breastfeeding for the initial 6 months of life, followed by complementary feeding along with continued breastfeeding for up to 2 years or beyond.¹ Breastfeeding has numerous benefits, including reduced risks of infections, improved child survival rates, and enhanced maternal health.²^,³ Despite its well-documented benefits, breastfeeding rates remain suboptimal in many regions, particularly in rural areas of developing countries such as India.⁴^,⁵

In rural Uttar Pradesh, sociocultural factors, lack of knowledge, and misconceptions significantly hinder breastfeeding practices.⁶ Adolescents, who are future mothers, often lack adequate information about breastfeeding, which perpetuates a cycle of poor breastfeeding practices.⁷ Studies have shown that early initiation of breastfeeding can significantly reduce neonatal mortality.²^,⁸ School-based interventions have been identified as effective strategies to enhance health knowledge among adolescents, owing to the structured environment and the receptive nature of this age-group.⁹^,¹⁰

Previous studies have highlighted the potential of educational interventions in improving breastfeeding awareness and attitudes among adolescents.¹¹ For instance, a study in rural Bangladesh demonstrated significant improvements in breastfeeding knowledge following school-based educational programs.¹² Similarly, interventions in rural parts of Africa have shown positive changes in breastfeeding perceptions and intentions among adolescent girls.¹³ However, limited research has been conducted in the context of rural India, particularly in Uttar Pradesh, which has unique cultural and socioeconomic dynamics influencing health behaviors.¹⁴^,¹⁵

This study aims to bridge this gap by implementing a school-based intervention to promote breastfeeding awareness among adolescent girls in rural Uttar Pradesh. The intervention focuses on educating young girls about the benefits of breastfeeding, addressing common misconceptions, and empowering them with knowledge that can influence future practices.

The primary aim of this study was to evaluate the effectiveness of a school-based intervention in promoting breastfeeding awareness among adolescent girls in rural Uttar Pradesh. The specific objectives were:

To assess the baseline knowledge, attitudes, and perceptions regarding breastfeeding among adolescent school girls.
To implement a structured educational intervention focusing on the benefits and practices of breastfeeding.
To measure the changes in knowledge, attitudes, and perceptions postintervention.

MATERIALS AND METHODS

Study Design

The present study was a pre–post intervention study.

Study Population

This study was conducted among adolescent school girls in a government girls’ school located in a rural area of Uttar Pradesh.

Sampling

The study sample was selected through stratified random sampling method. The population of adolescent school girls was divided into strata based on their class levels (7th–12th grade). This ensured that each class was adequately represented, providing a comprehensive understanding of the baseline knowledge and perceptions regarding breastfeeding across different age-groups and educational stages. Within each class, 10 girls were selected using simple random sampling. Two class monitors were also included to ensure their participation, given their influential roles within their peer groups.

Ethical Consideration

Ethical clearance for the study was obtained from the institutional ethics committee, and permission to conduct the study was granted by the school principal. Confidentiality was maintained.

Intervention

A pretest was conducted to assess the baseline knowledge, attitudes, and perceptions regarding breastfeeding. A pretested, self-structured questionnaire was used for this purpose. It covered various aspects of breastfeeding, including best practices, benefits, and common misconceptions.

An interactive teaching session was conducted as the intervention. The session included lectures, visual aids, discussions, and interactive activities designed to educate the participants about the benefits and practices of breastfeeding. The content of the session was designed to address common misconceptions and provide evidence-based information on breastfeeding. Interactive teaching sessions are most effective when the group size is manageable, allowing for active participation, personalized attention, and meaningful interaction. A smaller group size of 62 participants facilitated a conducive learning environment where each student could engage actively in discussions, ask questions, and participate in interactive activities. This setting is crucial for ensuring that the educational intervention is impactful and that the students can absorb and retain the information provided.

Following the intervention, a posttest was administered using the same questionnaire to assess any changes in the participants’ knowledge, attitudes, and perceptions regarding breastfeeding.

Statistical Analysis

The data collected from the pretest and posttest were entered into a spreadsheet and analyzed using the software Statistical Package for the Social Sciences (SPSS) (version 23). Descriptive statistics such as mean and standard deviation were used to summarize the data. Paired t-test was performed to compare the pre- and posttest scores to determine the effectiveness of the intervention. A p-value of <0.05 was considered statistically significant.

RESULTS

The study was conducted among 62 adolescent school girls, with 10 girls selected from each grade (7th–12th) and two class monitors included for their influential roles within their peer groups.

Baseline and Postintervention Knowledge Scores

The comparison of pre- and posttest scores revealed a significant improvement in knowledge about breastfeeding following the intervention. The mean pretest score was 6.05 [standard deviation (SD) = 2.01], while the mean posttest score increased to 11.26 (SD = 1.46). The paired samples t-test indicated that this improvement was statistically significant (p < 0.001). The effect size, measured by Cohen’s d, was calculated to be 2.1, indicating a very large effect of the intervention on breastfeeding knowledge (Table 1).

**Table 1:** Paired t-test results and effect size for pre- and postintervention breastfeeding knowledge scores
	Mean	SD	p-value (paired samples t-test)	Effect size (Cohen’s d)
Pretest	6.05	2.01	<0.001	2.1
Posttest	11.26	1.46	<0.001	2.1

Attitudes Toward Breastfeeding

Figures 1 and 2 illustrate the shifts in attitudes toward breastfeeding before and after the intervention. Initially, 87.1% of the participants agreed that every woman should breastfeed her child. This percentage increased to 98.4% postintervention. Additionally, the number of girls who expressed their intention to breastfeed their own children in the future rose from 79% preintervention to 96.8% postintervention.

Fig. 1: Changes in attitudes toward breastfeeding pre- and postintervention: “Should every woman breastfeed her child?”

Fig. 2: Changes in attitudes toward breastfeeding pre- and postintervention: “Would you breastfeed your child in the future?”

Awareness of Breastfeeding Week

Figure 3 shows that many adolescent girls (68%) were unaware of breastfeeding week before the intervention. The intervention aimed to increase awareness of such initiatives.

Fig. 3: Awareness of breastfeeding week among participants preintervention

Sources of Breastfeeding Knowledge

Figure 4 indicates that family was the most common source of breastfeeding knowledge among the participants. This underscores the influence of familial teachings on health practices in rural areas.

Fig. 4: Sources of knowledge regarding breastfeeding among participants

Participant Feedback

Postsession feedback revealed high levels of satisfaction with the educational intervention. An overwhelming 91.9% of the girls reported being satisfied with the session, suggesting that the interactive teaching methods were well-received and effective in conveying important information about breastfeeding.

Overall, the results demonstrate the effectiveness of the school-based intervention in significantly enhancing the knowledge and positively influencing the attitudes of adolescent girls toward breastfeeding in rural Uttar Pradesh.

DISCUSSION

The findings of this study highlight the significant impact of a school-based educational intervention on improving breastfeeding knowledge and attitudes among adolescent girls in rural Uttar Pradesh. The pre- and posttest results demonstrated a substantial increase in knowledge about breastfeeding, underscoring the effectiveness of the intervention.

Knowledge Improvement

The increase in the mean scores from 6.05 to 11.26 (p < 0.001) indicates a significant enhancement in the participants’ understanding of breastfeeding benefits and practices. This aligns with previous studies that have shown the positive effects of educational interventions on health knowledge among adolescents.⁹^,¹¹ The very large effect size (Cohen’s d = 2.1) further confirms the robust impact of the intervention. Similar improvements were observed in studies conducted in rural Bangladesh and parts of Africa, where school-based programs significantly enhanced breastfeeding awareness.¹²^,¹³

Attitudinal Shifts

The shift in attitudes, with an increase from 87.1 to 98.4% in the belief that every woman should breastfeed and from 79 to 96.8% in the intention to breastfeed in the future, indicates a positive change in perceptions. This is crucial, as positive attitudes toward breastfeeding are associated with higher rates of breastfeeding initiation and continuation.⁶^,⁷ The findings are consistent with other research that highlights the importance of addressing sociocultural factors and misconceptions to promote breastfeeding.⁶^,¹¹ Studies in Pakistan and other regions have similarly found that educational interventions can shift attitudes significantly, providing a more supportive environment for breastfeeding.¹⁶ Community involvement has been shown to be crucial in reinforcing health messages and promoting sustained behavioral changes, as observed in Latin America.¹⁷

Awareness and Sources of Information

The intervention also aimed to raise awareness about initiatives such as breastfeeding week. While 68% of the participants were initially unaware of such initiatives, the educational session improved their awareness. Family being the most common source of breastfeeding knowledge underscores the need to engage community and family members in educational efforts to reinforce positive health behaviors.¹⁴^,¹⁵

Educational Interventions in Rural Contexts

The results of this study emphasize the potential of school-based interventions to bridge knowledge gaps and alter health behaviors among adolescents in rural settings. Previous studies have highlighted the effectiveness of structured educational programs in improving health outcomes in similar contexts.¹⁰^,¹³ In rural Uttar Pradesh, where sociocultural barriers and misconceptions about breastfeeding are prevalent, such interventions can play a crucial role in empowering future mothers and promoting better health practices.⁶^,⁷ Educational programs specifically designed for young mothers have been critically reviewed, showing that tailored educational efforts are highly beneficial.¹⁸ Peer education models have also proven effective in rural settings.¹⁹

Limitations and Future Research

While the study demonstrates significant positive outcomes, it is not without limitations. The sample size was relatively small, and the study was conducted in a single school, which may limit the generalizability of the findings. Future research should consider larger, multisite studies to validate these results. Additionally, long-term follow-up studies are needed to assess whether the improved knowledge and attitudes translate into actual breastfeeding practices when the participants become mothers.

CONCLUSION

This study provides evidence that school-based educational interventions can effectively improve breastfeeding knowledge and attitudes among adolescent girls in rural Uttar Pradesh. By addressing misconceptions and providing evidence-based information, such interventions can empower future mothers, contributing to better health outcomes for both mothers and infants. These findings support the implementation of similar programs in other rural areas to enhance breastfeeding practices and maternal and child health.

Clinical Significance

This study shows the profound impact that educational interventions can have on health knowledge and attitudes among adolescents in rural areas. By significantly improving breastfeeding knowledge and positively influencing attitudes toward breastfeeding, the intervention addresses critical gaps in health education. This is particularly important in rural Uttar Pradesh, where sociocultural barriers and misconceptions about breastfeeding are prevalent.

Empowering adolescent girls with accurate information about breastfeeding can lead to healthier practices when they become mothers, contributing to better maternal and child health outcomes. Improved breastfeeding practices can reduce neonatal and infant mortality rates, lower the risk of infections, and enhance overall child development. Encouraging positive attitudes toward breastfeeding can create a supportive community environment, further promoting and sustaining breastfeeding practices.

Implementing similar school-based health education programs in other rural areas can be an effective strategy to improve long-term health outcomes for mothers and children in resource-limited settings.

ORCID

Kritika Tiwari https://orcid.org/0000-0003-0979-3003

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