title: Barriers to Early Initiation and Continuation of Breastfeeding in a Tertiary care Institute of Haryana: A Qualitative Study in Nursing Care Providers.
abstract: BACKGROUND
  Ever increasing institutional deliveries in India has shifted the responsibility of timely initiation and continuation of breastfeeding from peripheral health workers and families to the nursing care providers of health facilities where the births take place. While institutional deliveries have increased to 72.6%, only 44.6% of the newborns enjoy early breastfeeding in India.
  
  
  OBJECTIVE
  To study the barriers to early initiation of breastfeeding in institutional delivery.
  
  
  METHODS
  A total 34 nursing care providers were selected randomly and five Focus Group Discussions (FGDs) were carried out. This Qualitative Study was conducted through FGDs among the nursing care providers of a tertiary care institute in the Indian State of Haryana, India.
  
  
  METHODS
  The analyses continued throughout the group discussions as the newly emerged themes were tested in the subsequent discussion. FGDs transcripts were analysed to enhance the robustness of the emerged domain.
  
  
  RESULTS
  Major barriers to initiation of breast feeding identified included: lack of awareness regarding proper technique of breastfeeding and benefits of colostrum; breast abnormality like inverted/retracted nipples; obstetric/neonatal complications requiring specialised care; and cultural practices like giving pre-lacteals and gender discrimination. It was further reported that the manpower has not been rationalised with ever increasing number of institutional deliveries. The respondents though willing to promote early initiation and continuation of breastfeeding felt excessive workload as one of the major barriers due to multi-tasking nature of their job.
  
  
  CONCLUSIONS
  The new challenges to the early initiation and continuation of breastfeeding are emerging due to change in the place of delivery which needs to be addressed at the policy level.
authors: Professor and Head, Department of Community Medicine, BPS Government Medical College for Women , Khanpur Kalan, Sonepat, Haryana, India .
authors: Jai Pal
authors: JP
authors: Majra
authors: Assistant Professor, Department of Community Medicine, BPS Government Medical College for Women , Khanpur Kalan, Sonepat, Haryana, India .
authors: Vijay Kumar
authors: VK
authors: Silan
keywords: India; Institutional delivery; Rural