Operational Definitions of Key Terms

Exclusive breastfeeding: Breastfeeding while giving no other food or liquid, not even water,

with the exception of drops or syrups consisting of vitamins, mineral supplements or medicine.

‘Almost exclusive breastfeeding’: Infant may receive small amounts of culturally valued

supplements – water, water-based drinks, fruit juice or ritualistic fluids.

‘Full breastfeeding’: ‘Exclusive breastfeeding’ and ‘almost breastfeeding’.

‘Any breastfeeding’: The child has received breast milk (direct from the breast or expressed)

with or without other drinks, formula or other infant food.

Working status; Working status refers to the status of an economically active person with

respect to his or her employment, that is to say, the type of explicit or implicit contract of

employment with other persons or organizations that the person has in his/her job.

Mothers; A female person who is pregnant with or gives birth to a child or is a woman who has

raised a child, given birth to a child, and/or supplied the ovum that united with a sperm which

grew into a child

Workplace Facilities: They are facilities provided by the employer to help lactating working

mothers combine work with breastfeeding effectively and they include: Lactation breaks, flexible

work options and equipments.

i
 CHAPTER ONE

INTRODUCTION

1.0: Introduction

This is a study about the relationship between working status of mothers and exclusive breast

feeding among school teachers in public schools focusing on Gombe Secondary School, St.

Maria Goretti Sen. Sec. School, Katende, and Nsamizi Training Institute of Social Development

in Mpigi District as the case studies. Working Status of school teachers will be the independent

variable whereas exclusive breast feeding will be the dependent variable. Working status of

mothers in form of job position, maternity leave period ,working hours are examined in relation

to exclusive breast feeding as illustrated in the conceptual frame work. Therefore this chapter

presents the background to the study, problem statement, purpose of the study, research

objectives, research questions, scope of the study, justification of the study, significance of the

study, the conceptual frame work and finally the operational definitions of terms and concepts.

1.1. Background to the study

Ancient history has many examples of working status of mothers and exclusive breast feeding in

action. As far back as 1750 BC, increasing women’s participation in the labour force was

frequently blamed for the low rate of breastfeeding. Statistics from the Malaysian population and

housing census showed an increasing trend in women’s labour force participation from 30.8%

(1957) to 47.7% (2003) (AbuNayan, 2016). The prevalence of exclusive breastfeeding declined

from 92% (1950) to 78% (1974) but rose to 85% and 94.7% respectively in 1988 and 2006 [Al-

Shoshan, (2017)]. The rise was explained by the introduction of the Malaysian Code of Ethics for

Infant Formula Products in 1979. This code of ethics is to ensure the provision of safe and

adequate nutrition among infants and an adequate standard and proper use of infant formula

1
products. In addition, legal provisions were also included in the Food Regulations (2010) to

promote breastfeeding (Pedro, 2017). Malaysian women employed in the public sector are given

two months maternity leave while those working in the private sector are given a slightly longer

leave of three months.

In the 90s, the Second National Health and Morbidity Survey (NHMS II) conducted in 2010

showed the prevalence of employed women who had ever breastfed was 91.4%. However, only

25.4% of employed women practiced exclusive breastfeeding compared to 31.3% among

nonworking women. The mean duration of breastfeeding were 26 weeks among working women

compared to 30 weeks among those who were not working [Al-Shoshan, 2011]. Breastfeeding

may be less convenient for working women. Many factors determine the success of

breastfeeding: a supportive workplace and working environment are essential. In Pakistan, some

false beliefs and practices interfere with breastfeeding. A large number of babies are started on

bottle feeding as early as during the first month (Mustansar 2019). Breastfeeding rate is low, only

16% of mothers exclusively breastfeed their children up to four months (Dawn 2013). An

increasing number of women working are supplementing breast milk with formula and cease

breastfeeding earlier (Morisky, Kar, Chaudhry et al 2019).

In Nigeria, as well as in neighboring countries of West Africa, infant morbidity and mortality

have been on the increase despite the efforts of mothers to breast feed their young ones

(Anyanwu and Enweonu, 2014). A lot of efforts have been made by Enugu State government to

ensure that mothers have the support required for them to be able to breastfeed their infants

exclusively. Maternal and child health care centres are instituted at strategic places in the city,

2
functional mobile clinics that go into the remotest parts of the state to enlighten mothers on the

need for them to practice exclusive breastfeeding’ as well as aggressive health education

campaigns in the cities on the importance and benefits of exclusive breastfeeding’.

In many less developing countries like Uganda, labor force participation by women in the

childbearing years has increased rapidly. Social and economic changes present new challenges

for women attempting to combine their roles as workers and mothers. Employed mothers

perceive some contradictions messages on breastfeeding and most of them prefer to leave work

after birth to exclusively care for their babies and others wished to have more institutional

support (Barona-Vilar et al., 2015). In Egypt, mothers return to work from maternity leave when

their children are only three months. . Little is known about how these challenges affect infant

feeding. To date, various Ministries of Health across the world have adopted the WHO/UNICEF

Baby Friendly Hospital Initiative. This initiative aimed to increase breastfeeding among all

women in line with the WHO recommendation of at least six months of exclusive breastfeeding.

According to Wanjala (2018) in Ugandan education sector, the standard maternity leave for a

working mother is three months after their baby is born but the medically recommended

exclusive breastfeeding period is however supposed to last the first six months of the baby’s life.

How a mother continues to provide the precious gift of breast milk when she returns to work

remains among today’s biggest challenges for the working mother. For the greater section of

working mothers who want to continue exclusive breast feeding till the six month mark,

challenges abound. According to the International Breastfeeding journal, 99 per cent of women

in Uganda initiate breastfeeding but the rates of keeping it exclusive for six months remain low.

Working mothers in education sector are in the group that falls off the wagon along the way.

3
The public schools have put in place areas where teachers have access to a suitable facility in

which they can breastfeed their infant or express their breast milk, providing breaks from work in

order to breastfeed or express milk, discuss their breastfeeding needs with their employers and

enabling breastfeeding women time off work in order to breastfeed. Despite the above policies

that have been put in place by public schools to improve the working status of breastfeeding

mothers, it is still evident that working mothers in these public schools have continued to resign

in order to have more time to exclusively breastfeed as evidenced in the table below.

Table 1. 1 : Working mother rate in 5 public schools between 2016-sept - 2019

Year Total number of Number of Number of working mothers Percentage of

working mothers new working at end of year. working mothers
at start of Year mothers in who resigned in the
the year year.

2005 160 100 250 3.8%

2006 250 30 260 7%
2017 260 10 160 40.7%
2018 160 20 130 27.7%
Sept 2019 130 60 145 23.6%
Source: Public schools Human Capital Management reports, 2016- 2019,

www.ubaintrnet/infopool/HCM/Staffcount

Thus this research proposal will be intended to examine the relationship between working status

of mothers and exclusive breast feeding among secondary school teachers focusing on Gombe

Secondary School, St. Maria Goretti Sen. Sec. School, Katende, and Nsamizi Training Institute

of Social Development in Mpigi District as the case studies.

1.2 Problem statement

The management of the 3 different public schools has put in place deliberate policies aimed at

creating effective conditions for exclusive breast feeding by their employees (mothers) such as;

4
creating working policies in support of breastfeeding like maternity leave of up to 60 working

days which is insufficient to allow mothers to exercise exclusive breastfeeding for six months,

one hour (flexible hour) to breastfeed their babies, allowing breast feeding mothers to spread out

their leave and return  to work before their leave ends , working half day, having refrigerators,

where breastfeeding mothers can store expressed milk. In the course of the day, they take time

off to express the milk and keep it in the fridge to take home for their babies which relieves

mothers of breast engorgement and leakage.

In spite of these exclusive breast feeding best practices, the 5 different public schools are still

faced with problems like many working mothers quitting jobs just to sit at home to nurse and

breastfeed their babies. Out of the 160 working mothers recruited in the different public schools,

less than 50 working mothers are still employed by the public schools- implying that they fill

resignation letters so that they stay home to breastfeed their babies thus rising to more than 50%.

The working status of mothers for 2017/18 was recorded at an industry minimum of 5%, but

moved to 40% for 2018/2019 suggesting that about 4 in every 10 working mothers resigned from

the Public schools during this period. Hence the Management of these public schools need to

check this trend and pay serious attention to the problem. It is against this background that the

study seeks to investigate the influence of mother’s working status and exclusive breastfeeding in

3 public schools.

1.3 Objectives

1.3.1 General objective

5
 The purpose of this study is to establish the relationship between working status of mothers and

exclusive breast feeding in 5 public schools in Mpigi district.

1.3.2 Specific Objectives

This study will be guided by the following research objectives:

i. To establish the extent to which length of maternity leave period influences exclusive breast

feeding amongst working mothers in public schools.

ii. To assess the relationship between working hours /time frame of work and exclusive breast

feeding amongst working mothers in public schools.

iii. To establish the effect of Job position/level on exclusive breast feeding amongst working

mothers in public schools.

iv. To examine other factors that affect exclusive breast feeding amongst working mothers in

public schools.

1.4 Research Questions

The study will aim at answering the following questions

i. To what extent does length of maternity leave period influence exclusive breastfeeding

amongst working mothers in public schools?

ii. What is the relationship between working hours /time frame of work and exclusive breast

feeding amongst working mothers in public schools?

iii. What is the effect of Job position/level on exclusive breast feeding amongst working mothers

in public schools?

iv. What are the other factors that affect exclusive breast feeding amongst working mothers in

public schools?

6
1.5 Hypotheses

The study will be guided by the following hypotheses:

H1: Length of maternity leave period affects exclusive breast feeding amongst working mothers

in 5 public schools in Mpigi district.

H2: Working hours /time frame of work affects exclusive breast feeding amongst working

mothers in public schools

H3: Job position/level affects exclusive breast feeding amongst working mothers in public

schools

H4: Existence of other factors affects exclusive breast feeding amongst working mothers in

public schools

1.6 Justification of the study

Despite an enormous literature on working status of mothers and exclusive breast feeding in

public schools (Prince, 2012) there is yet no universally accepted account of framework as to

why people choose not to exclusively breastfeed (Lee & Mithcel, 2011). What is clear from

existing research works available is that there were many reasons that affect exclusive breast

feeding in public schools. Much of the research revolves around models of exclusive

breastfeeding, which looks at working status of mothers and exclusive breast feeding. Nearly all

the researchers have suggested further areas of research to be carried out. This reinforces the

need for specific research in 5 different public schools within Mpigi. Bevan (2011) observed that

important differences exist within public schools and within groups of working mothers which

suggests that only organization – specific investigation can isolate the precise nature and factors

affecting or influencing exclusive breast feeding. Secondly the magnitude of the problem at hand

demands urgent attention when exclusive breast feeding is a major threat.

7
1.7 Scope of the Study

1.7.1 Geographical scope

This study will be conducted in in public schools focusing on Gombe Secondary School located

in Butambala, Kibibi, St. Maria Goretti Sen. Sec. School, (SMAGOK) as a Ugandan mixed

Catholic-founded school, located in Central Region, off Masaka-Kampala road on the Katende

Hill, about 200 meters from the Highway and Nsamizi Training Institute of Social Development

located on Konge Road within Mpigi Town Council 35 Km from Kampala on Masaka road as

the case studies within Mpigi district.

1.7.2 Content scope

The study will focus on relationship between working status of mothers and exclusive breast

feeding in 3 Public schools in Mpigi district in terms of content scope.

1.7.3 Time scope

The study will be restricted to a period of 4 years 2015 to 2019. This period is selected because

many breastfeeding mothers have resigned despite the effective conditions/ policies put in place

to favour their working status.

1.8 Significance of the Study

This study will be considered beneficial in the following ways:

The information from this study might create awareness for policy makers in the 3 different

public schools to come out with sound policies for employers to ensure the provision of

workplace facilities for breast feeding working mothers such as flexible work options, provision

of private rooms for breastfeeding mothers etc.

To the academia, releasing the results of this proposal, will contribute to the already existing

literature in this field.

8
1.9 Conceptual Framework

Figure 1: Conceptual framework showing the relationship between working status of mothers

(independent variable) and exclusive breast feeding (dependent variable) and the intervening

variables

INDEPENDENT VARIABLE DEPENDENT VARIABLE

Working status of mothers Exclusive Breast Feeding

Maternity leave period FACTORS INFLUENCING EXCLUSIVE BREASTFEEDING

Working hours /time frame Husband’s Education
Job position/level Mother’s Work Status
Personal work pressure Husband’s Work Status
Place of Residence
Level of Wealth Index
Exposure to the Media
Mother’s Current Age
Factors Present at Child Birth
Size of the Child at Birth
Place of Delivery and Assistance at Delivery
EXTRANEOUS VARIABLES Total Children Ever Born
Attitudes of mothers towards exclusive breastfeeding
Management commitment to working mothers

Source (Modification of Lata S (2001). Breastfeeding practices among female health

functionaries. Indian Journal, 92:185–186)

From the conceptual framework in Figure 1.1 above; working status of mothers is considered as

the independent variable which is operationalized in terms of maternity leave period, working

9
hours /time frame, Job position/level and Personal work pressure. Exclusive breast feeding is

hypothesized as the dependent variable and operationalized in terms factors influencing

exclusive breastfeeding such as Husband’s Education, Mother’s Work Status, Husband’s Work

Status, Place of Residence, Level of Wealth Index, Exposure to the Media, Mother’s Current

Age, Factors Present at Child Birth, Size of the Child at Birth, Place of Delivery and Assistance

at Delivery and Total Children Ever Born. Attitudes of mothers towards exclusive breastfeeding,

Management commitment to working mothers are considered as moderating variables as adopted

by Taylor (2011).

10
 Chapter 2: Literature review

2.1 Introduction

This chapter will entail the introduction of the review of literature between working status of

mothers and exclusive breast feeding, the theoretical review, the actual thematic review based on

study objectives and summary of the literature.

2.2 Theoretical review

2.2.1 Commitment Affect theory

The study is based on the Affect theory by Locke (1976) and the Affective commitment theory

by Meyer and Allen (2012). The main premise of Locke’s theory is that job satisfaction is

determined by the discrepancy between what one wants in a job and what one has on the job. In

practice, lactating working mothers who want workplace facilities to be able to combine full time

work with exclusive breasting will be satisfied and committed to their jobs especially when they

have these facilities in their respective organizations. The second theory looked at organizational

commitment which in general terms can be defined as an employee's psychological attachment to

the organization. For the purpose of this study, Meyer & Allen's model of commitment was used.

According to Meyer and Allen's (2012), there are three-component model of commitment which

indicates that, there are three "mind sets" which can characterize an employee's commitment to

the organization and they are: Affective Commitment, Continuance Commitment and Normative

Commitment. For the purpose of this study, Affective commitment level of the lactating working

mothers’ was measured. Affective commitment is about an employee’s positive emotional

attachment to the organization. The main premise of this theory of commitment is that, lactating

working mothers who are affectively committed to their work because of the presence of

workplace facilities at the workplace to assist them combine exclusive breastfeeding with full
11
time work will strongly identify themselves with the goals of the organization and desires to

remain a part of the organization.

2.2.3 Theory of self-efficacy

The theory of self-efficacy, based on Albert Bandura’s Social Cognitive Learning Theory, was

used as the theoretical framework for this study. This theory asserts that much of human behavior

is self-regulated (Chung, 2007). The basic assumption underlying the theory is that individuals

regulate their behavior based on their self-efficacy beliefs. Humans avoid situations that they

believe they are unable to cope with successfully and they seek out situations that they believe

they can successfully overcome. Perceived self-efficacy plays a role in humans’ self-regulation

of behavior. Perceived self-efficacy refers to a person’s beliefs about what he or she is capable of

doing based on the expectations of the outcomes that will result when engaging in a certain task.

According to Bolton, Chow, Benton & Oslon (2008), Perceived self-efficacy stems from

numerous sources, such as performance accomplishments, vicarious experiences, verbal

persuasion, and affective or physiologic states. An individual cognitively processes the

information from these sources and will be influenced to make decisions and choices whether to

attempt the task, how much effort to expend, how much perseverance to have, and impact their

emotional reactions.

Therefore the above theories will guide this study in identifying the extent to which work status

of mothers in public schools influences exclusive breast feeding.

2.3 The extent to which length of maternity leave period influences exclusive breast

feeding amongst working mothers in public schools

Exclusive breastfeeding for six months (versus three to four months, with continued mixed

breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and

12
prevent pregnancy but has no long-term impact on allergic disease, growth, obesity, cognitive

ability, or behaviour. Recent statistics show that more than half of breastfeeding mothers are in

the labour market (Thompson & Bell, 2007). Nationwide statistics also revealed that women face

barriers in their attempt to combine full time work with the practice of exclusive breastfeeding

when they resume work (Blum, 2012; Thompson & Bell, 2012). According to Judith Galtry

(2012), three main workplace facilities are required for women to successfully combine work

with breastfeeding. First, lactation break: to enable the mother to either express breast milk or go

to feed her baby during working hours. The International Labour Organization (2012)

recommends one or more daily breaks or a daily reduction of hours of work which is counted as

working time and remunerated accordingly. The facility of adding these breaks to their lunch

break would allow the mothers to travel to breastfeed their babies.

Second, workplace facilities: A clean, hygienic and private area in which women could express

breast milk or breastfeed their babies if the baby was brought to the workplace and thirdly, a

flexible work options: Enable breastfeeding mothers to work at a more flexible hour in the early

weeks and months following childbirth. Two out of three mothers work outside the home

(Suarez, 2010). According to a Bureau of National Affairs Special Report, the fastest growing

segment of the labour market today is composed of mothers with infants and toddlers Cohen &

Mrtek (2010). They also reported that more than half of women with children under one year of

age are in the Labour market and this situation is not different in Ghana. This is further supported

by Lindberg (2010), who concluded in his study that at least 50% of women who are employed

when they become pregnant return to the Labour force by the time their children are three

13
months old. This is clear evidence that mothers who have children aged three months or less or

mothers who are lactating return to work after their short maternity leave in Ghana.

It is therefore very important to pay attention to such working mothers at the workplace since

their number keeps on increasing (Lindberg, 2010). Mothers facing workplace obstacles to

breastfeeding at the workplace are more likely to experience some psychological problems such

as tension and anxiety. When mothers encounter barriers to breastfeeding upon their return to

work, they may also feel guilty about being unable to successfully meet the demands of being a

mother and to play their employee roles. For many mothers, this is when breastfeeding ends for

most women. The stress associated with the role conflict may affect the quality of a woman’s

work (Gates & O’Neill, 2012). Mothers who are not able to breastfeed or reduce the duration of

breastfeeding their babies because of the absence of workplace facilities extend their stress to the

workplace which affect their employers and their work outcomes. According to Cohen et al,

(2012) there was higher rates of employee absenteeism and lost income was associated with

incidences of illnesses among infants who are not breastfed. In fact, they did a comparison study

of maternal absenteeism and infant illness rates; they found that of the 40 illnesses causing 1

day’s absence for employed mothers, only 25% occurred in breastfed babies while 75% occurred

in formula-fed babies.

2.4 The relationship between working hours /time frame of work and exclusive breast

feeding

Breastfeeding, especially when done exclusively for the first six months, helps babies develop

immunity against many diseases. Unfortunately, work prevents many mothers from exclusively

breastfeeding their babies (new vision, Aug 09, 2012). Although the work policy in support of

14
breastfeeding permits maternity leave of up to 60 working days, these are insufficient to allow

mothers to exercise exclusive breastfeeding for six months. There is need for organisations to be

more mother-friendly and consider the plight of working mothers. Below are initiatives different

organisations have put in place to support working mothers to breastfeed (Kyotalengerire, 2012).

According to the 2011 Uganda Demographic Health Survey report, 62% of children born in the

country are exclusively breastfed (for the first six months), the best way to ensure working

mothers breastfeed exclusively is by creating a baby-friendly environment at workplaces, for

example, breastfeeding corners or giving mothers flexible hours to enable them breastfeed.    In

recent years, the creation of supportive environments for encouraging mothers to breastfeed their

children has emerged as a key health issue for women and children. While the number of new

mothers in the workplace increases, an early return to work and inconvenient workplace

conditions discourage women from breastfeeding or cause them to discontinue breastfeeding

early. The World Health Organization (WHO) recommends exclusive breastfeeding for the first

six months of life [Galtry,2009]. The length of maternity leave is positively associated with the

duration of breastfeeding [Lindberg, 2011]. The International Labour Organization (ILO)

recommends a period of maternity leave of not less than 14 weeks [Kloeblen, 2012]. However,

the typical maternity leave in many Asian and Middle Eastern countries falls below these levels,

only offering less than 12 weeks paid leave [Brown, 2007].

2.5 The effect of Job position/level on exclusive breast feeding amongst working

mothers in public schools.

The practice of exclusive breastfeeding is still low despite the associated benefits. Improving the

uptake and appropriating the benefits will require an understanding of breastfeeding as an

15
embodied experience within a social context. In many developing countries, labor force

participation by women in the childbearing years has increased rapidly. Social and economic

changes present new challenges for women attempting to combine their roles as workers and

mothers. Employed mothers perceived some contradictions messages on breastfeeding and most

of them preferred to leave work depending on their Job position/level after birth to exclusively

care for their babies and others wished to have more institutional support (Barona-Vilar et al.,

2012).

As revealed in this study, and similar to findings by Oweis, Tayem and Froelicher [2012] and

Otoo, Lartey, and Pérez-Escamilla [2009], breastfeeding could be tiring, stressful or pleasurable

to some mothers. Breastfeeding was described as stressful, painful, or pleasurable based on

personal and prevailing circumstances around breastfeeding mothers. Some of the grandmothers

and breastfeeding mothers described exclusive breastfeeding as an investment in a child's life.

While a mother may intend to practice exclusive breastfeeding for the first six months and

continue with breastfeeding for up to a year, personal and socio-cultural factors could act as

constraints.

2.6 To examine other factors that affect exclusive breast feeding amongst working

mothers in public schools.

Infancy is a short period of human life. But since many vital processes in the growth and

development of humans occur during this short period, infant feeding affects many aspects of life

(Popkin et.al, 2012). Breastfeeding, particularly exclusive breastfeeding is an essential part of

early infant feeding. Place of and assistance at delivery take important roles in influencing a

mother’s decision to breastfeed and the duration of breastfeeding (Pechevis, 2011 p. 10-13).

Some researchers have found that there are many health officials who negatively influence the

16
eagerness of the mother to breastfeed. The lactation process can be disturbing if the baby has

difficulty with its suckling reflex. This often happens in babies born with low birth weight,

premature birth or a harelip. Babies with low birth weight are those born weighing less than

2,500 grams. These babies often have difficulty in suckling, easily get tired and choke. However,

because breastfeeding is important, especially for babies born with low weight (Kadri, 2009), the

mother needs to be patient and keep trying to breastfeed the infant.

The anatomic structure of the mother’s breast influences the process of lactation. For example if

the nipple is hidden inside the breast, it will be difficult for the mother to breastfeed the baby.

Liquids or semi-solid food that are given to the baby instead of breast milk decrease the

willingness of the baby to suckle, and this influences in decreasing the volume of breast milk

(Tuchida, 2010, pp. 67-71). Psychological conditions like emotion, stress, confusion, worry also

influence the willingness of a mother to breastfeed which, according to Lawrence (2010, p. 28),

also result in reducing the mothers’ breast milk production. Mother’s age influences the quality

as well as the quantity of breastmilk. Hasil Survey Kesehatan Rumah Tangga (SKRT, 2011, cited

in Mardaya, 2011, p. 25) found that there is a correlation between mother’s age and the practice

of breastfeeding. Some studies commonly found that there is a decrease in breast milk volume

among older mothers compared to younger mothers (Mardaya, 2012, p. 25).

The more educated the husband and the wife, the more they have a better economic condition

and the more they tend to bottle feed their babies instead of breastfeed. On the other hand,

families with low income tend to breastfeed exclusively, since they cannot afford to buy formula

milk (Lukman et al., 2010, Li-Ying et al., 2010, William, 2010)

17
Husbands’ work status might also be associated with their wives’ exclusive breastfeeding

practice, since most fathers or husbands in Indonesia are acknowledged as the breadwinners of

the households while the mothers or wives have more responsibility in taking care of their

children (Bullbeck, 2005, pp. 14-31). Moreover, in the context of exclusive breast feeding

practice, the husbands, as the mothers’ partners, have an important supportive role to persuade

their wives to practice exclusive breastfeeding. Women with husbands engaged in agricultural

work are more likely to breast feed than those who work in non-agricultural occupations (Li-

ying, et al., 2010, pp. 209-217).

18
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter describes the methods that will be employed in conducting the study. The chapter

begins with research design, study population, sample size and selection, sampling techniques

and procedure, data collection methods and instruments and validity and reliability of research

instruments, data processing and analysis and concludes with measurement of variables.

3.1 Research Design

The study will use a cross sectional case study design. The cross sectional survey will be used

because it captures the state of the variable at a particular point in time in different areas of an

organization .i.e. utilizing both quantitative and qualitative approaches at the same time Mugenda

and Mugenda (2007). Quantitative approach will be used to gather information for proper

analysis and making appropriate inferences, generalizations and conclusions to the population

while Qualitative approach will be employed so as to capture the information on attitudes and

behavior hence supplementing information from quantitative sources (Arya & Yesh, 2001).

3.2 Study Population

The study population will comprise of 400 respondents who are employees (mothers that are

breast feeding and those that have under gone breast feeding) in the 3 public schools within

Mpigi.

3.3 Sample size and selection

A representative sample of 201 respondents will be selected from a population of 420. The

selection of the sample size will be based on the Krejcie and Morgan 1970 table (Amin, 2005)

for determining sample size for research activities.

19
Table 3. 1: Sample size and selection

Category Population Sample Size Technique

Head teachers / Heads of Department 25 24 Purposive sampling

Mothers that are breast feeding and 375 172 Simple random sampling

those that have under gone breast

feeding
Total 400 196
Source: Adopted from Krejcie, Robert V., Morgan, Daryle W. (1970,).

3.4: Sampling techniques and procedure

The researcher will employ simple random sampling for selecting the mothers that are breast

feeding and those that have under gone breast feeding. Purposive sampling will be used to select

Head teachers / Heads of Department who are more knowledgeable about working status of

mothers that are breast feeding and those that have under gone breast feeding and exclusive

breast feeding and these will participate as key informants.

3.5: Data Collection Methods

Primary data will be collected using questionnaire guided interviews and face to face interviews

while secondary data will be obtained through documentary reviews.

20
3.5.1: Questionnaire Survey

A structured questionnaire will be developed and administered to the respondents to extract

information. The reason for selecting the questionnaire will be because it is an appropriate

method for collecting data, it offers greater assurance of anonymity, can be filled at the

respondent’s convenience hence increasing chances of getting valid information and it is a cheap

way of collecting data from a wide geographical area (Amin 2005).

3.5.2: Interviews

In-depth interviews with key informants (KIs) will be conducted to generate findings that will be

directly used in the report. The researcher will gather data through interviews with key

informants and this will help the researcher to address the questions to one key informant at a

time.

3.5.3: Documentary review

It will involve obtaining information by studying written documents. These will include; research

reports, bank policy documents and surveys, journals and conference papers.

3.6 Data Collection Instruments

The researcher will use a set of data collection instruments namely questionnaires, interview

guide, documentary review checklist and an observation checklist.

3.6.1: Questionnaire

The researcher will use two sets of questionnaires namely self-administered and researcher

administered questionnaires as data collection instruments to respondents. A self-administered

questionnaire designed on a likert scale will be used to collect data from respondents who can

write and read well.

21
3.6.2: Interview guide

An interview guide with pre-determined set of questions will be followed and used during the

interview to enable cover the variables under study. The instrument will be followed by the

researcher to ask questions prompting responses from KIs.

3.6.3: Documentary review guide

To support the interview and observation methods, a documentary review checklist and interview

will be used to gather and collect secondary data.

3.7 Validity and Reliability of the Research Instruments

3.7.1: Validity

In order to test and improve the validity of data collection instruments, the researcher will avail

the instruments to the respondents, who will look at the items and check on language clarity,

relevancy, and comprehensiveness of content and length of the questionnaire.

3.7.2: Reliability

Reliability is the degree to which the instrument consistently measures whatever it is measuring

Amin (2005). To ensure this, the researcher will measure the internal consistency using the

Cronbach alpha (Cronbach, 1951) basing on the five point likert scale items.

3.8: Procedure for Data Collection

Data collection procedures to be used in the study will include self and researcher administered

questionnaires, face to face interviews, taking notes from documentary review and visual

occurrences under observation. In all data collection procedures, protocol will be observed by

22
obtaining and presenting permission letters to collect data both from UMI and the 5 public

schools in Mpigi to enable access to study elements and to convince them to give the data.

3.9: Data Analysis

Data collected from the field will be sorted, coded by assigning themes to the study variables and

later entered into a computer using statistical software (SPSS) to enable analysis. The data will

be able to answer the research questions and hypothesis.

3.9.1: Quantitative data analysis:

The analysis of quantitative data encompasses calculations such as averages, totals as compared

to totals of responses expected. It will be done on a daily basis after the interviews and at times

on spot. After fieldwork, central editing will also be done to review and edit when all

questionnaires are completed and returned to the researcher. Corrections for wrong entries and

omissions will then be done. After central editing, questionnaires will then be brought back to

where computer data entry will be done into a statistical package for social scientist (SPSS)

software.

3.10 Measurement of Variables

To measure variables in a quantitative approach is to transform attributes of the conceptual

framework of variables studied into numerical quantities. According to Amin (2005, pg 261),

measurement is the process of transforming abstractly conceived concepts or variables into

numerical quantities. It involves quantifying observations about a quality or attribute. In

measuring variables, there are different scales used. Attitude scales determine what an individual

believes, perceives or feels about self, others, activities, institutions or situations. In this study, a

23
likert scale will be used. Data on key variables in the self and researcher administered

questionnaires will be measured on the likert scale (5, 4, 3, 2, 1) for strongly agree, agree,

uncertain, disagree and strongly disagree respectively.

3.11 Ethical considerations

 The research proposal will be submitted to the UCU School of Research and Post

graduate Studies for review and ethical approval before I conduct the study. I will also get

an introductory letter from UCU School of Research and Post Graduate studies to enable

me seek administrative clearance from the public schools where I will conduct the study.

 I will ensure that the research assistants maintain privacy and confidentiality of the

patients’ information during the process of data extraction by working in a private space

and ensure people who are not part of the research team do not access participant’s

information.

 The data collection tools will be coded to ensure that the data collected cannot easily be

linked to the individual patients and the final reports will also ensure that the information

entailed does not disclose information that will link to a particular individual.

 The data collected will be kept under lock and key with restricted access to members

conducting the research, supervisors and the examiners in order to maintain and

confidentiality.

 This research does not have any major risks that will directly affect the participants but

privacy and confidentiality of patients’ information will be maintained

 The objectives of the study will be clearly explained to the potential study participants

and they will also be given an opportunity to ask questions for clarification. Those who

24
 are willing to participate in the study will then be asked to read and sign the consent

document before they participate in the study.

 There are no direct benefits for the participants that will be involved in this study but

refreshments will be provided while participating in the study.

 The research assistants will be taken through the objectives of the research and the

activities that are involved. They will be informed about the need for maintaining privacy

and confidentiality of patient information. They will be asked to sign commitment forms

to ensure they maintain privacy and confidentiality of the patient’s information. The team

will be taken through the data collection tools so that they clearly understand the

information they need to collects and also given opportunity to ask questions for

clarification or make suggestions to improve the tools as well as give feedback on any

challenges faced while collecting the information.

3.13 Methodological constraints/ Limitations

 The study only will consider Mothers that are breast feeding and those that have under

gone breast feeding therefore will not be able give a general picture of those who are not

Mothers and that they have never done breast feeding and those that have not under gone

breast feeding.

 The findings of the study cannot be used for generalization to other populations as the

sampling of the geographical location is purposive.

25
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exclusive breastfeeding of infants younger than 6 months in Mozambique. J Hum Lact;
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Saudi Arabia: mothers attitudes and practices. East Mediterranean Health Journal; 12 (1-
2): 6-13.
Al-Shoshan, AA (2011): Factors affecting mother's choices and decisions related to breastfeeding
practices and weaning habits. Pakistan Journal of Nutrition; 6 (4): 318-322.
Amin, E.M. (2009). Social sciences research, concepts, methodology and analysis. Kampala,
Uganda: Makerere University.
Anyanwu and Enweonu, (2012): Breastfeeding and food policy in a hungry world. Academic
Press, New York.
Arya & Yesh. (2001). AIDS in Africa: Its present and future impact. London: Belhaven Press.
Barona-Vilar, C; Escribá-Agüir,V and Ferrero-Gandía, R (2009): A qualitative approach to social
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Bolton, T., Chow, T., Benton, P., & Oslon, B. (2008). Characteristics associated with longer
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Chung, M., Raman, G., Chew, P., Magula, M., DeVine, D., Trikalinos, T. & Lau, J. (2007).
Breastfeeding and maternal and infant health outcomes in developed countries. Tufts-
New England Medical Center Evidence-Based Practice Center. Agency for Healthcare
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http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf.

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Galtry,2009: Knowledge, attitude and practice of breastfeeding among postnatal mothers Curr
Pediatr Res 14 (2): 119-124.
Kombo & Tromp. (2006). Law, ethics, human rights and AIDS training manual for community
awareness. Uganda: Network on Law, Ethics and HIV/AIDS.
Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP,
Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E,
Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E
(2001): Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the
Republic of Belarus. JAMA; 285 (4): 413-420.
Krejcie, R.V., Morgan, D.W., (1970). Determining sample size for research activities.
Educational and Psychological Measurement.
Kruger, R and Gericke, G (2001): Breastfeeding practices of mothers with children (aged 0-36
months) in a rural area of South Africa. A qualitative approach. Journal of Family
Ecology and Consumer Sciences; 29: 60-71.
Kruger, R and Gericke, G (2004): A qualitative approach for exploration of feeding practices,
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Verbruikerswetenskappe; 32. ISSN 0378-5254.
Lata S (2001). Breastfeeding practices among female health functionaries. Indian Journal,
92:185–186
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International Medical Journal; 8 (1): 17-22.
Li, R Zhao, Z; Mokdad, A; Barker, L and GrummerStrawn, L (2003): Prevalence of
breastfeeding in the United States: the 2001 National Immunization Survey. Pediatrics,
111(5 part 2):1198-1201.
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Physician, 61: 2093-2109.

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Moussa Abba, A; De Koninck, M and Hamelin, A (2010): A qualitative study of the promotion of
exclusive breastfeeding by health professionals in Niamey, Niger International
Breastfeeding Journal; 8: 5-8.
Mugenda & Mugenda. (2010). Research methods – quantitative and qualitative approaches.
Nairobi, Kenya ACTS press.
Pant, I and Chothia, K (2012): Maternal knowledge regarding breastfeeding and weaning
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Breastfeeding and weaning practices among Hong Kong mothers: A prospective study.
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28
 Appendices

i) Consent form

Consent to participate in a Research study

School of Medicine, Uganda Christian University

Name of Investigator: .............................. Department: Masters of Public Health Leadership-

Save the Mothers Contact: .....................................................

Introduction

 You are being asked to be in a research study “the relationship between working status of

mothers and exclusive breast feeding among secondary school teachers in public schools

in Mpigi District, Uganda”.

 You were selected as a possible participant because you are a school teacher and a mother

who has undergone exclusive breast feeding in one of the selected in public schools in

Mpigi District, Uganda.

 I ask that you read this form and ask any questions that you may have before agreeing to

be in the study.

Purpose of Study

 The purpose of the study is to know the the relationship between working status of

mothers and exclusive breast feeding.

 Ultimately, this research may be presented as a report to the UCU School of Research and

Postgraduate studies, an abstract at conferences or published in a journal.

Description of the Study Procedures

If you agree to be in this study, you will be asked to answer some questions and reference may be

made to your medical records in relation to the study.

29
Risks/Discomforts of Being in this Study

There are no reasonable foreseeable (or expected) risks. There may be unknown risks.

Benefits of Being in the Study

There are no direct benefits of being involved in this study but the information got from this

study will contribute to the information in relation to the area of study.

Confidentiality

The records of this study will be kept strictly confidential. Research records will be kept in a

locked cupboard and all electronic information will be coded and secured using a password

protected file. I will not include any information in any report we may publish that would make it

possible to identify you.

Payments

You will not receive any payments for participation in this study but will be given a refreshment

while participating in the study.

Right to Refuse or Withdraw

The decision to participate in this study is entirely up to you. You may refuse to take part in the

study at any time without affecting your relationship with the investigator of this study. Your

decision will not result in any loss or benefits to which you are otherwise entitled. You have the

right not to answer any single question, as well as to withdraw completely from the interview at

any point during the process; additionally, you have the right to request that the interviewer not

use any of your interview material.

Right to Ask Questions and Report Concerns

• You have the right to ask questions about this research study and to have those questions

answered by me before, during or after the research. If you have any further questions about the

30
study, at any time feel free to contact me, (............................ by telephone

at .....................................). If you like, a summary of the results of the study will be sent to you.

If you have any other concerns about your rights as a research participant that has not been

answered by the investigator, you may contact my supervisor Dr Justus Kafunjo Barageine by

telephone on 0702454869.

• If you have any problems or concerns that occur as a result of your participation, you can

report them to Dr Justus Barageine at the number above.

Consent

Your signature below indicates that you have decided to volunteer as a research participant for

this study, and that you have read and understood the information provided above. You will be

given a signed and dated copy of this form to keep.

Participant’s Name (print):

Participant’s Signature: Date:

Investigator’s Signature: Date:

31
 QUESTIONNAIRE FOR EMPLOYEES OF PUBLIC SCHOOLS

Dear Respondent

The researcher is a student of Uganda Christian University pursuing a Masters of Public Health

Leadership. She is conducting an academic research study on the topic: “Working status of

mothers and exclusive breast feeding in 3 public schools in Mpigi district: a Case Study of 3

Public schools. You have been scientifically selected to be one of the respondents to this study.

You are kindly requested to take part in this study by filling in this questionnaire. The

information you will provide shall be purely for academic purposes and will be treated

confidentially. We do not require you to indicate your name. We request you kindly to provide

objective responses.

SECTION A: PERSONAL INFORMATION

Personal Particulars
1 Age
18- 25 36 - 40
26- 30 40 - 45
30- 35 46 - 50
50+
2 Sex
Male Female

3 Education level
Secondary Degree
Certificate Masters
Diploma Others

4. Working experience
0-2 years
32
 2-5 years
More than 5 years

b) Objective 1: the extent to which length of maternity leave period influences exclusive
breast feeding amongst working mothers in public schools.
Please read the following statements carefully and rate on a scale of 1-5 for each of the
categories. Circle the appropriate box against each statement to indicate your rating, where;
5=Strongly Agree, 4=Agree, 3=Not sure, 2= Disagree, 1=Strongly Disagree
5 lactation break offered by the public schools influences 5 4 3 2 1
exclusive breast feeding amongst working mothers
6 Short length of 3 months maternity leave period influences 5 4 3 2 1
exclusive breast feeding
7 length of maternity leave period does not influence 5 4 3 2 1
exclusive breast feeding amongst working mothers
8 There is a positive relationship between length of maternity 5 4 3 2 1
leave period and exclusive breast feeding amongst working
mothers in public schools
9 The length of maternity leave is positively associated with 5 4 3 2 1
the duration of breastfeeding

c) Objective 2: The relationship between working hours /time frame of work and exclusive
breast feeding amongst working mothers in public schools.
Please read the following statements carefully and rate on a scale of 1-5 for each of the
categories. Circle the appropriate box against each statement to indicate your rating, where;
5=Strongly Agree, 4=Agree, 3=Not sure, 2= Disagree, 1=Strongly Disagree
10 There is a relationship between working hours /time frame 5 4 3 2 1
of work and exclusive breast feeding amongst working
mothers in public schools.
11 The absence of flexible hours prevents many mothers from 5 4 3 2 1
exclusively breastfeeding their babies.
12 Stressful or pleasurable time frame of work prevents many 5 4 3 2 1
mothers from exclusively breastfeeding their babies.

33
d) Objective 3: The effect of Job position/level on exclusive breast feeding amongst working
mothers in public schools.
Please read the following statements carefully and rate on a scale of 1-5 for each of the
categories. Circle the appropriate box against each statement to indicate your rating, where;
5=Strongly Agree, 4=Agree, 3=Not sure, 2= Disagree, 1=Strongly Disagree
13 Appropriating the benefits of the job level or position 5 4 3 2 1
influencing a mother’s decision to breastfeed and the
duration of breastfeeding
14 There is a positive relationship between Job position/level 5 4 3 2 1
and exclusive breast feeding amongst working mothers in
public schools.
15 Job position/level affects exclusive breast feeding 5 4 3 2 1
negatively amongst working mothers in public schools

e) Objective 4: Other factors that affect exclusive breast feeding amongst working mothers
in public schools.
Please read the following statements carefully and rate on a scale of 1-5 for each of the
categories. Circle the appropriate box against each statement to indicate your rating, where;
5=Strongly Agree, 4=Agree, 3=Not sure, 2= Disagree, 1=Strongly Disagree
18 Place of and assistance at delivery take important roles in 5 4 3 2 1
influencing a mother’s decision to breastfeed and the
duration of breastfeeding
19 The lactation process can be disturbing if the baby has 5 4 3 2 1
difficulty with its suckling reflex.
20 The anatomic structure of the mother’s breast influences 5 4 3 2 1
the process of lactation.
21 Mother’s age influences the quality as well as the quantity 5 4 3 2 1
of breast milk.
22 Husbands’ work status is associated with their wives’ 5 4 3 2 1
exclusive breastfeeding practice
23 The education status of husband and the wife is associated
with their wives’ exclusive breastfeeding practice

‘‘Thanks for your co-operation’’

34
 INTERVIEW GUIDE FOR THE KEY INFORMANTS

The researcher is a student of Uganda Christian University pursuing a Masters of Public Health

Leadership. She is conducting an academic research study on the topic: “Working status of

mothers and exclusive breast feeding in 3 public schools in Mpigi district: a Case Study of 3

Public schools. You have been scientifically selected to be one of the respondents to this study.

You are kindly requested to take part in this study by filling in this questionnaire. The

information you will provide shall be purely for academic purposes and will be treated

confidentially. We do not require you to indicate your name. We request you kindly to provide

objective responses.

SECTION A: Respondent’s Bio data

 How long have you worked with the public school?

 What is your designation?

 What is the extent to which length of maternal age/ leave period influences exclusive breast

feeding amongst working mothers in public schools?

 What is the relationship between working hours /time frame of working mothers and

exclusive breast feeding amongst working mothers in public schools?

 What is the effect of Job position/level on exclusive breast feeding amongst working mothers

in public schools?

 What are the other factors that affect exclusive breast feeding amongst working mothers in

public schools?

THANK YOU

35
 ii) Commitment form for the research assistants

I…………………………………………………….. A research assistant for the research study

“Working status of mothers and exclusive breast feeding in 3 public schools in Mpigi district”,

I commit to ensure that;

- I maintain privacy while interacting with the participants.

- I maintain respect for the school teachers and their responses.

- I will document a true record of participants responses and not forge any information

- I maintain confidentiality of participants information collected

- I keep participant information safely out of reach from individuals not participating in the

research study.

Signature: ………………………………………………. Date:

………………………………….

Witness: ……………………………………………. Signature: ………………… Date:

………..

36
 Budget
Item Amount

Stationary 55,000

Binding proposal 24,000

Printing and photocopying 100,000

Transport 480,000

Meals 70,000

Airtime 140,000

Binding the dissertation 80,000

Miscellaneous 94,900

Total 949,000

37