Midwives' perceptions of barriers to exclusive breastfeeding in Bhutan: A qualitative study

Problem: In Bhutan, exclusive breastfeeding is not routinely practised according to the World Health Organisation recommendation, thereby placing infants and women at increased risk of morbidity and mortality.

Background: Research indicates that support from midwives is positively associated with longer breastfeeding duration. Previously, no studies had been conducted in Bhutan to explore midwives' perceptions of the barriers to the promotion of exclusive breastfeeding.

Aim: To explore midwives' perceptions of the barriers to promoting exclusive breastfeeding among Bhutanese women.

Methods: A qualitative exploratory descriptive study design was used, involving individual semi-structured audio-recorded interviews. The Framework approach was utilised for data analysis.

Findings: Five themes emerged from a total of 26 interviews. The themes were: 'cultural and traditional practices', 'women's return to work', 'midwives' advice in response to breastfeeding problems', 'shortage of staff in a busy maternity service' and 'lack of professional development about breastfeeding'.

Discussion: Midwives reported that upholding Bhutanese cultural and traditional practices by women and their families was a powerful barrier to the promotion of exclusive breastfeeding. Midwives experienced difficulty in promoting exclusive breastfeeding among women in the immediate postnatal period during women's short hospital stay. A shortage of midwives, coupled with a lack of professional development about breastfeeding promotion and support, were additional barriers to the promotion of exclusive breastfeeding.

Conclusion: The study findings highlight the need for continuing professional development of midwives in relation to exclusive breastfeeding. Additionally, a review of the midwifery workforce model is recommended, to ensure midwives have time to provide women with breastfeeding support.