Facilitators and Barriers to Breastfeeding Practices of Internally Displaced Mothers Residing in Disaster Relief Camps in Pakistan: A Critical Ethnography

Abstract

Background and Aim Disaster relief camps are one of the most vulnerable settings where women are at risk of discontinuing their breastfeeding practices. Although challenges associated with continued breastfeeding during disasters and displacements are prevalent globally, they are particularly problematic in Pakistan. Pakistan is a low-middle income country where infant and child mortality rates are high. This country often faces disasters such as earthquakes and floods that exacerbate the discontinuation of breastfeeding. This study aims to explore the facilitators and barriers to breastfeeding practices of internally displaced mothers residing in the disaster relief camps in Pakistan. Methods Critical ethnography was employed as a study design to uncover the breastfeeding experiences of mothers in the disaster relief camps and to situate their experiences within the intersections of maternal, sociocultural, economic, and geopolitical factors. I used the theoretical perspective of critical realism to guide me to uncover reality in relation to human agency and social structures. Data were collected using multiple methods, including field observation, document analysis, and in-depth interviews with 18 displaced mothers who were residing in disaster relief camps in northern Pakistan and who had young children aged one day to 36 months. Mothers were eligible to participate in the study regardless of their breastfeeding practices. Findings Three main themes were derived from the data: “facilitators to breastfeeding”, “barriers to breastfeeding”, and “recommendations”. Findings revealed a wide range of maternal (micro level), socio-cultural (meso level), economic (exo level), and geopolitical (macro level) factors that are directly and indirectly affecting the breastfeeding practices of displaced mothers residing in the disaster relief camps. Recommendations shared by the participants reflected their perspectives on possible solutions to the encountered challenges surrounding the breastfeeding practices of displaced mothers in disaster relief camps in Pakistan. Conclusion Multilayered, context-specific, and interdisciplinary interventions at the micro, meso, exo, and macro levels are essential to promote, protect, and support the breastfeeding practices of displaced mothers in disaster relief camps. Breastfeeding-friendly initiatives led by displaced mothers, their family members, the community at large, and country-based and international organizations are instrumental to enhance maternal autonomy in breastfeeding during disaster, displacement, and settlement of displaced mothers in disaster relief camps. In the future, research should also test the feasibility and effectiveness of composite interventions in improving the breastfeeding practices of displaced mothers in disaster relief camps, as well as explore stakeholders’ perceptions about encountered challenges in the implementation of the breastfeeding-friendly services during disaster and displacement.