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Breastfeeding Knowledge Among Indigenous Temiar Women: a Qualitative Study

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Breastfeeding Knowledge Among Indigenous Temiar Women: a Qualitative Study Mal J Nutr 25(1): 117-128, 2019 Breastfeeding knowledge among indigenous Temiar women: a qualitative study Sharifah Zahhura Syed Abdullah1* & Rozieyati Mohamed Saleh2 1Centre for Research on Women and Gender (KANITA), Universiti Sains Malaysia, Pulau Pinang, Malaysia; 2Biomedical Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia ABSTRACT Introduction: The benefits of breastfeeding for both mothers and infants are widely recognised. Breastfeeding confirms a woman’s unique ability to care for her infant in the best way possible and promotes optimum infant and maternal health. Methods: A qualitative research method involving five focus group discussions (n=33) was chosen in this study to compare and contrast the breastfeeding practice in two different locations: the communities of Pos Pulat and the regroupment scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in Kelantan, Malaysia which represents different lifestyle experiences of indigenous Temiar population. Results: The benefits of breastfeeding to the infants reported by some Temiar women (42.4%) were for the infant’s health and growth. Responses from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%), delays in the return of regular ovulation (6.1%), thus lengthening birth intervals and bonding between maternal-baby (6.1%). In general, respondents from Pos Pulat seemed to have little knowledge regarding this issue, except for a woman who mentioned that maternal milk contains vitamins. Based on the narrative analysis, knowledge gap was observed between these two communities. Conclusion: Although all the women interviewed had the experience of breastfeeding their infants, most of them lacked the knowledge regarding the benefits of the breastfeeding either to the infants or to the mothers. The findings from this study are crucial for the preservation of breastfeeding culture among the Temiar women and can be used to improve promotion of breastfeeding to other Orang Asli groups in Malaysia. Keywords: Breastfeeding, knowledge, health, indigenous, qualitative INTRODUCTION (Habibah, Hamzah & Mushrifah 2010) because they exist on the fringes of The Malay term Orang Asli that highly developed areas. The Orang Asli translates as “original people” or “first is generally classified under three main people” is the term given to indigenous groups: Negrito, Senoi and Proto Malay, people (Masron, Masami & Ismail, with each group comprising six sub- 2013). Anthropologists, economists groups with ethno-linguistic differences. and planners describe the livelihoods The Temiar is one of the sub-ethnic of these indigenous peoples as “poor groups of the Senoi people that can be and marginalised minority groups” found in the highest interior mountains __________________________ *Corresponding author: Dr Sharifah Zahhura Syed Abdullah Centre for Research on Women and Gender (KANITA), Universiti Sains Malaysia, Pulau Pinang, Malaysia Tel: +6019-2322355; Fax: +604-6566379; E-mail: [email protected] doi: https://doi.org/10.31246/mjn-2018-0103 118 Sharifah Zahhura SA, Rozieyati MS and at the headwaters of various rivers to be dropping among the former while with limited access to civilisation remaining stable in rich mothers. (Domhoff, 2003). Nowadays, although The protection of breastfeeding in the most still live a traditional life, others world’s poorest populations is therefore have moved out of the forest to settle a major priority. They also emphasised in more accessible locales. Some live in the importance of breastfeeding for all villages while others have migrated to women and children, irrespective of their towns and cities. They live by various economic background. combinations of swidden farming (‘slash As most mothers are able to and burn’ agriculture and crop rotation), breastfeed, they should be provided hunting, gathering, fishing, and trading with accurate information and support forest products. More recently, some from their families, communities, men have started to undertake waged and healthcare providers. Currently, employment as day labourers. A few have only limited data is available on the successfully become lawyers, teachers, breastfeeding practices among the doctors or government employees. Orang Asli Senoi, and particularly for The World Health Organization the Temiar sub-group. An earlier study (WHO) recommends that all infants be conducted among 189 Semai women exclusively breastfed from birth until six (other sub-ethnics of Senoi) found that months of age and it be continued until the mean breastfeeding duration was up two years of age or longer along with to 23 months (Khor, 1985). A study done complementary foods (WHO, 2001). In a decade later found that although 95% the first six months of life breast milk of Semai women had breastfed their should be an infant’s sole and optimal infants, the average duration was found source of nutrition as it is superior to to be reduced to 17.9 months (Osman & all supplementations. The International Zaleha, 1995). Similar study conducted Convention on the Rights of the Child on another Senoi sub-ethnic (the Mah 1990 endorsed by the United Nations, in Meri group) revealed that the mean Article 24, has recognised breastfeeding period of breastfeeding was calculated as one of the child’s right (United Nation, to be around 11 months, although all 1990). Breastfeeding within the first one the mothers in the study had started hour of life has been shown to reduce lactation within one hour of delivery neonatal mortality by almost 22% (Wan Norlida et al., 2007). (Edmond et al., 2006; Debes et al., 2013; Many studies have utilised NEOVITA Study Group, 2016). quantitative methods such as A systematic review by Victora et knowledge, attitude and perception al. (2016) indicates that there are no questionnaires to gain information on differences between rich and poor breastfeeding. However, in recent years, mothers in exclusive breastfeeding rates, the use of qualitative methods such as in low and middle-income countries. interviews and focus group discussions They suggested that this was because has gained recognition in providing a rich mothers are adopting exclusive better understanding of the feelings breastfeeding at a much faster rate of individuals, their perceptions and than are poor mothers, although only misconceptions regarding breastfeeding 20 years ago, the poorer mothers had information and issues (Tengku Alina substantially higher rates of exclusive et al., 2012). Furthermore, underlying breastfeeding. Continued breastfeeding beliefs are better captured through this is still more common in poor than in type of qualitative studies (Rashidian, wealthy mothers, but the rates seem Eccles & Russell, 2008). In view of Breastfeeding knowledge among indigenous Temiar women 119 this, this study aimed to investigate potential participants. Each contact the knowledge among Temiar mothers person was a local person who was active regarding the breastfeeding practices in within or had connections to the Temiar their cultural context. community in that location. They knew of the best means to approach the target MATERIALS AND METHODS population and of any possible obstacles that might occur. The inclusion criteria This was an exploratory investigation were women of any age group who had conducted in 2015, using qualitative breastfed a child in each location. Those methods via five focus group discussions. who willingly consented to the study The two different locations chosen for this were enrolled and the times for focus project represented the different lifestyle group discussions were arranged. experiences and practices of the Temiar. Focus group discussion was selected The communities of Pos Pulat in Kelantan as a suitable method for this project in (a state that is located in the north-east order to gain in-depth understanding on of Peninsular Malaysia) represent the a specific topic of interest (Nyumba et experiences of Temiar who live in the al., 2018). In this instance, focus group forest or close to it, approximately 2 km discussions helped to reveal the benefits away. On the contrary, the communities of breastfeeding through active and live in the Rancangan Pengumpulan Semula discussion between the participants and (RPS) regroupment settlement scheme, a trained facilitator. An “ice-breaker” located in Kuala Betis in Gua Musang, or introduction was conducted before Kelantan, represented those in transition commencing each discussion session to from forest to urban living. create a friendly environment. Firstly, The participants in the project the facilitator introduced herself and were women in the various households broadly outlined the aims of the research who were responsible for feeding the and the protocols. The participants then infants. An appropriate sample size for a introduced themselves and were asked qualitative study is one that adequately to respond to the first question from answers the research question. In the focus group schedule. According to practice, the number of required Peterson & Barron (2007), encouraging subjects usually becomes obvious as participants to become involved in an the study progresses, as new categories, interactive, open discussion is one of themes or explanations stop emerging the major challenges for the focus group from the data (i.e. having achieved data facilitator. saturation) (Marshall 1996). Focus group discussions in Pos Pulat In each location, participants were took place on a veranda of the home of
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