Heather Thomas and Dr. Madanat Hala, Health and Human Performance
In the wake of the Iraq war, the Israel/ Lebanon conflict and the ongoing violence in Palestine, Jordan has become a country overburdened with refugees. The UNHCR estimates that over 3 million refugees are living in Jordan, with the majority being from Palestine, Iraq and Lebanon (UNRWA, 2005). Many of these refugees don’t have access to health services. Consequently, infant mortality rates are much higher among refugees than the surrounding population, and UNICEF indicates that these numbers could be reduced if more children were exclusively breastfed (UNICEF, 2003).The purpose of my research was to discover what the prevalence of exclusive breastfeeding was among Iraqi refugee women in Jordan and to identify what barriers, if any, there were to exclusive breastfeeding.
The survey was conducted during a BYU International Volunteers program to Amman, Jordan during the summer 2006. I worked in cooperation with Caritas, Jordan and the UNHCR to distribute and collect the survey. The distribution and collection of the survey was challenging for several reasons: first, the refugee population was widely distributed throughout the city of Amman; secondly, the population size was very small and specific, making difficult to locate and thirdly, the war with Lebanon and Israel broke out when we were there, which taxed the availability of Caritas and UNHCR resources. Yet, despite these challenges we obtained a very good sample size and had a response rate of 97%.
Our initial goal for the survey was to determine the percentage of women who exclusively breastfed their babies and to determine what barriers the women had to breastfeeding. Yet because of weaknesses in the survey we were unable to determine the breastfeeding rate or to identify the main barriers to breastfeeding. Still, the survey proved to be very beneficial in providing insight into Iraqi refugees’ knowledge and attitudes towards breastfeeding. We found that the population was fairly well educated about the importance of breastfeeding and for the most part had correct information about how to breastfeed.
On the other hand, we found that despite respondent’s knowledge of breastfeeding they were lacking in forms of pre-natal education, encouragement and support for breastfeeding. Twenty-eight percent of respondents said they didn’t receive any form of pre-natal education; 39.7% of respondents said that they received no help, support, or information for breastfeeding within 48 hours after delivery; 74.3 % indicated that they were not told were to get help with breastfeeding after they left the hospital and 63.3% said that once at home this didn’t receive any help, information or support for breastfeeding. Of those who did receive education and support came from doctors and health professionals.
These responses are interesting because they indicate that Iraqi refugee women’s main education source for pre-natal and breastfeeding information are doctors and medical personnel. Yet, 30.4% of respondents indicated that a relative or friend was the most influential factor in their decision on how to feed their baby. Health professionals on the other hand were only influential for 7.6% of the respondents.
Most of the refugee women have been separated from their families and their normal channels of support: mothers, aunts and sisters. Yet, the respondents indicated that their decision to breastfeed was still mostly influenced by relatives and friends rather than health professionals. As a result, we identified a potential for the use of a peer counseling programs for breastfeeding among the refugee population. Peer counseling program are designed to fill gaps in normal channels of support; providing encouragement, education and support for mothers who otherwise would not receive any. Not only do peer counseling program access “hard to reach” populations easier but they also ensure that women receive support and education from those women who can influence their behavior the most.
Thus we developed a peer counseling program among the refugee population where we conducted a two day “train- the- trainer” program for Iraqi women who were interested in becoming peer counselors in their communities. The training included basic information about breastfeeding, techniques for teaching breastfeeding and communication skills. We identified 11 women who attended the training for both days. At the end of the training the women committed to be advocates for breastfeeding among their peers and to also provide education and support for refugee mothers who needed it. The women who participated indicated that they thought peer counseling was a good way for women in their situation to have access to good health information and to empower mothers.
Due to time restraint we did not have the time to conduct and evaluation of our peer counseling training or to see if the women followed through with their commitments to advocate for breastfeeding in their communities. Still, Caritas, Jordan indicated that the training was a great help to their efforts to improve maternal and child health among refugee populations. They also indicated a willingness to pursue peer counseling programs in the future, not only in breastfeeding but for other health issues as well.
This mentoring project was a wonderful experience for me and was a very valuable learning opportunity. My mentor and I are hoping to publish the results in a professional journal before the end of the year. Not only will having a publication help me as I purse my graduate studies but I now feel that I am better qualified in my field and have gained skills that will give me an advantage in pursing a career in Public Health.