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Benefits and Perception of Exclusive Breastfeeding as Family
Planning Method among Nursing Mothers Attending Post-Natal
Clinic in Primary Healthcare Centres in South-South Nigeria
1Dr. Bodeno Ehis., 2Dr. Hendrith Esene, 2Dr. Zekeri Sule, 2Dr. Godwill Agbon-ojeme., 2Dr. Felix
Otuomagie
1Department of Community Medicine, Igbinedion University, Edo State, Nigeria
2Department of Obstetrics and Gynaecology, Igbinedion University, Edo State, Nigeria
DOI: https://doi.org/10.51244/IJRSI.2025.1210000029
Received: 23 Sep 2025; Accepted: 29 Sep 2025; Published: 30 October 2025
ABSTRACT
Background: Exclusive breastfeeding is an economically cheap, a yet crucial health practice which provides
optimal nutrition for infants and short-term contraception for the mothers. The aim of this study was to assess
the awareness and perception of exclusive breastfeeding as a method of family planning among nursing
mothers in Ovia, Edo State, Nigeria and to identify factors that influence its perception which is vital to
ensuring improved maternal and child health.
Methods: A cross-sectional study design was adopted involving 290 nursing mothers selected using a multi-
stage sampling technique. Data was collected through structured, self-administered questionnaire adapted from
previous studies. Data analyses applied descriptive and inferential statistics using SPSS version 25.0, with
logistic regression employed to identify significant predictors. A p value of less than 0.05 was considered
statistically significant.
Results: The majority (76.9%) of the respondents had knowlege of exclusive breastfeeding, about half (47.2%)
were familiar with exclusive breastfeeding as a form of family planning method but only 15.2% strongly
perceived exclusive breastfeeding as a good method of family planning. Age and occupation were significant
predictor, with an odds ratio (OR) of 0.291 (p=0.001, CI=0.156-0.542) and occupation (p=0,041, CI=0.026-
0.931) respectively.
Conclusion: The study revealed that although knowledge of exclusive breastfeeding as a method of family
planning was high among nursing mothers in Ovia, their perception was poor. The findings emphasize the
need to ensure healthcare providers are equipped with the necessary knowledge and tools to effectively educate
nursing mothers about exclusive breastfeeding as a method of family planning.
Keywords: Awareness, Contraception, Family planning, Nursing mothers,
BACKGROUND
Exclusive Breastfeeding (EBF) is viewed as being beneficial globally.1 Exclusive Breastfeeding for the first
six months of life followed by nutritionally adequate and safe complementary foods with continued
breastfeeding up to two years of age or beyond is the recommended practice by the World Health Organization
(WHO) and American Academy of Pediatrics (AAP).2 Because of its nutritious nature, EBF promotes growth
and development of infants and protects them from contracting infections.3 In addition to being beneficial to
the infant, breastfeeding is useful to the mother as it is associated with faster uterine involution and healing of
the uterus post-delivery. Its ability to alter the hormonal balance makes it appropriate and acceptable globally
for use as a contraceptive method.4-6 This is commonly known as the Lactational Amenorrhoea Method (LAM)
of contraception. Within the contraceptive imperatives, the use of EBF as a family planning method has been
relatively low globally.2,7 The Nigeria Demographic and Health Survey (NDHS) in 2018, reported only about
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5.0% LAM usage globally, in spite the widespread prevalence of the knowledge of EBF (97.0%).5,7 A few
women use the LAM, which is disheartening given that 97.0% of mothers exclusively breastfeed their infants
for sustenance. The fact that the rate of EBF decreased from 17.0% in 2003 to 13.0% in 2008 further
aggravates the problem. The main issue is why mothers do not use EBF as contraception despite its many
health benefits. The worldwide practice of exclusive breastfeeding is influenced by several factors including
the maternal knowledge, beliefs and perceptions such as insufficient breast milk and painful breastfeeding
associated with incorrect infant position and latch.
8,9 Maternal characteristics such as age, income, education,
knowledge, and ethnicity have been associated with the initiation and continuation of EBF. The lack of
support, encouragement, and education from healthcare professionals, family and friends can become barriers
to exclusive breastfeeding.10,11 This study will help look into the maternal knowledge and perception of
exclusive breastfeeding as a family planning method, and its benefits at large.
MATERIAL AND METHODS
Study Area
The study was carried out in Ovia North East Local Government Area (LGA) of Edo State, Nigeria, which
encompasses several communities within its jurisdiction. The LGA is home to several PHC facilities that
provide 24-hour services, including antenatal care, immunization, HIV/AIDS services, family planning, health
education, as well as maternal and newborn care. With an estimated population of 436,036 as at 2024. Ovia
North East spans an area of 2,301 km². The region is diverse, with communities such as Okada, Uhen, Utese,
and others, inhabited by various ethnic groups including the Bini, Igbo, Yoruba, Urhobo, and more. The LGA
has a significant Christian population, with smaller groups practicing Islam and African Traditional Religion.
The region is also home to Igbinedion University and a variety of economic activities, including sawmilling,
which shapes the local economy.
Study Population:
The study focused on all nursing mothers aged 18 years and above who were attending post-natal clinics in
Ovia North East. This population was selected due to their potential awareness and perception of EBF as a
method family planning.
Sampling Technique
A cross-sectional study was carried out among 290 nursing mothers attending post-natal clinic in primary
healthcare centres in Ovia North East Local Government Area, Edo State, Nigeria. The study was conducted
over a period of nine month from February 2024 to November 2024. The respondents were selected by
multistage sampling method. In the first stage, four wards; Okada, Iguomo, Utese and Egbeta were randomly
selected using Simple random sampling by balloting from the list of ten wards in Ovia North East. In the
second stage, one Primary Healthcare Centre (PHC) was randomly selected using Simple random sampling by
computer generating numbers from each of the four wards and following PHCs were selected, Okada, Iguomo,
Utese and Egbeta. In the third, participants were selected. To ensure equal chance of selection, the participants
were selected using systematic sampling. The sample size 290 was calculated with an additional 5% non-
response rate factored into account for incomplete or missing responses using Cochrane formula for cross-
sectional surveys with n = Z2 PQ/d2 where n is sample size, Z = Standard normal deviation, set at 1.96 to
correspond to 95% confidence interval, P = The value for 'P' was taken from the perception of mothers
attending post-natal clinic in the literatures in previous study reported in this study which was 21.7%.6
Data Collection
Data for this study was collected using structured, interviewer-administered questionnaires, which were
designed to capture socio-demographic characteristics, awareness and perception of EBF as method of family
planning among nursing mothers. The questionnaire, adapted from existing instruments, was tailored to the
study context. The first section collected data on participants' socio-demographic characteristics such as age,
gender, marital status, education level, occupation, and religion. These variables were important for identifying
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potential factors that might influence EBF. The second section on awareness evaluated nursing mothers’
knowledge of EBF as method of family planning. It also explored sources of information such as community
health workers, media, or personal visits, aiming to assess factors influencing awareness.
The final section focused on the perception of EBF as method of family planning, exploring factors like
nutritional status, healthiness breast milk, protection from disease, encourage bonding, contraceptive
advantage, if EBF is easier than infant feeding formula and if it is a good way to decrease family expenses. A
pre-test was conducted in Okha PHC, Ovia South West LGA, with 29 participants. Feedback from the pre-test
led to adjustments in the questionnaire to ensure clarity and relevance for the main study. This approach
ensured the data collection tool was both reliable and valid for the research objectives.
Ethical Considerations
Ethical clearance for this study was granted by the Ethical and Research Committee of Igbinedion University
Teaching Hospital, Okada with ethical clearance certificate number: IUTH/R.24/VOL.1/34C. A written
informed consent was obtained from all participants which was read out to each of the participant and signed,
ensuring they were fully aware of the study's aims and that participation was voluntary. Confidentiality was
maintained throughout the study, with no personal identifiers included in the questionnaires. Participants were
informed of their right to withdraw from the study at any time without consequence. All data collected were
securely stored, with access restricted to the research team.
Data Analysis
The data was analyzed using IBM SPSS Statistics version 27. Descriptive statistics, including frequency and
percentage distributions, were used to summarize the data. Univariate and bivariate analyses were conducted to
explore associations between variables, using chi-square tests, Fisher's exact tests where applicable and
Logistic regression model for predictors of perception. A p-value of less than 0.05 was considered statistically
significant.
Limitations
No further diagnostic or confirmatory tools were used to confirm or refute the crude findings generated from
the used General Health Questionnaire and as such, the awareness and perception of EBF as a method of
family planning may be over or underreported.
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
RESULTS
Table 1: Socio-demographic characteristics of respondents
Variable Frequency (n=290) Percent (%)
Age (years)
21 – 25 170 58.6
26 – 30 56 19.3
31 – 35 45 15.5
≥ 36 19 6.6
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Marital status
Single 150 51.7
Married 116 40.1
Co-habiting 10 3.4
Separated 7 2.4
Widowed 4 1.4
Divorced 3 1.0
Educational level
No formal education 9 3.1
Primary 14 4.8
Secondary 91 31.4
Tertiary 176 60.7
Religion
Christianity 228 78.6
ATR 32 11.1
Islam 30 10.3
Occupation
Student 150 51.7
Trader 64 22.1
Civil servant 34 11.7
Lecturer 23 7.9
Farmer 19 6.6
A total of 290 respondents participated in the study, with the majority 170(58.6%) aged between 21 and 25
years. Over half 150(51.7%) of the respondents were single, 176(60.7%) had tertiary level of education, with a
significant portion 228(78.6%) identifying as Christian.
Table 2: Level of awareness of Exclusive Breastfeeding
Variable Frequency Percent (%)
Ever heard of EBF
Yes 223 76.9
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No 67 23.1
Source of information (n = 223)*
Health centre 83 37.2
Government hospital 44 19.7
Private hospital 40 17.9
Family planning clinic 35 15.7
NGO 21 9.5
Understanding of EBF
Only breast milk for 6 months 184 82.5
Breast milk and water 36 16.1
Breast milk and solid food 3 1.3
Advantages of EBF
Nutrition 169 75.8
Protect infant from illness 31 13.9
Child spacing 9 4.0
Economic reason 6 2.7
Prevent pregnancy 8 3.6
Awareness of EBF as a contraceptive
Yes 116 52.0
No 107 48.0
Woman practicing EBF can get pregnant
Yes 123 55.2
No 100 44.8
Majority 223(76.9%) of the respondents had heard of exclusive breastfeeding, and major 83(37.2%) source
was at the health centres. Most 184(82.5%) of the respondents had understanding of EBF as “only breast milk
for 6 months”, 169(75.8%) identified nutrition as the advantage of EBF, 116(52.0%) were aware of EBF as a
contraceptive and only 100(44.8%) of the respondents were aware practicing EBF can prevent pregnancy.
Table 3: Association between socio-demographics and awareness of exclusive breastfeeding as family planning
method
Variable Awareness of EBF n (%) Test Statistic p-value
Yes (n=223) No (n=67)
Age (years)
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21 – 25 138 (81.2) 32 (18.8) 7.665 0.050
26 – 30 44 (787.6) 12 (21.4)
31 – 35 29 (64.4) 16 (35.6)
≥ 36 12 (63.2) 7 (36.8)
Marital status
Single 131 (87.3) 19 (12.7) 19.051 0.001#
Married 92 (65.7) 48 (34.3)
Educational level
No formal education 0 (0.0) 9 (100)
Primary 4 (28.6) 10 (71.4) 57.292 0.001#
Secondary 63 (69.2) 28 (30.8)
Tertiary 156 (88.6) 20 (11.4)
Religion
Christianity 179 (78.5) 49 (21.5) 2.623† 0.283
Islam 23 (76.7) 7 (23.3)
ATR 21 (65.6) 11 (34.4)
Occupation
Student 132 (88.0) 18 (12.0) 0.001#
Trader 28 (43.8) 36 (56.3)
Civil servant 54 (94.7) 3 (5.3)
Farmer 9 (47.4) 10 (52.6)
Heard about EBF as contraceptive
Yes 48 (88.9) 6 (11.1) 5.372 0.030#
No 175 (74.2) 61 (25.8)
† = chi-square, * = Fisher’s exact, # = statistically significant
Majority of respondents aged 18 to 25 year 138(81.2%) were aware of EBF as a form of birth control but the
association was not statistically significant. (p=0.050), however, single 131(87.3%) and respondents with
tertiary education 156(88.6%) were aware of EBF as birth control and these associations were statistically
significant. (p=0.001)
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Table 4: Perception of Exclusive Breastfeeding as Family Planning Method
Variable Strongly
agree Freq
(%)
Agree
Freq (%)
Maybe
Freq (%)
Disagree
Freq (%)
Strongly
disagree
Freq (%)
Quality of breast milk
Nutritious 56(25.1) 95(42.6) 2(10.8) 45(20.2) 3(1.3)
Healthy 89(39.9) 126(56.5) 3(1.3) 4(1.8) 1(0.5)
Protection against disease 24(10.8) 137(61.4) 25(11.2) 21(9.4) 16(7.2)
EBF encourage bonding 69(30.9) 139(62.3) 1(0.5) 10(4.9) 4(1.8)
Mothers should BF even in public
places
74(33.2) 109(48.9) 25(11.2) 16(7.2) 3(1.3)
EBF is a good family planning
method
34(15.2) 80(35.9) 43(19.3) 50(22.4) 16(7.2)
EBF can lead to malnutrition 25(11.2) 93(41.7) 50(22.4) 51(22.9) 4(1.8)
Women can get pregnant while
practicing EBF
36(16.0) 95(42.6) 57(25.6) 31(13.9) 4(1.8)
Only EBF makes baby weak 3(1.3) 3(1.3) 24(10.8) 137(61.4) 56(25.1)
EBF is not good for women with
health challenges
42(18.8) 30(13.5) 63(28.3) 69(30.9) 19(8.5)
EBF is a healthier choice for all
women
22(9.9) 26(11.7) 101(45.3) 56(25.1) 18.8(8.1)
EBF is easier than infant formula
feeding
50(22.4) 137(61.4) 21(9.4) 10(4.5) 5(2.3)
EBF has no negative effect on
marital relationship
89(39.9) 74(33.2) 16(7.2) 25(11.2) 23(8.5)
EBF is a good way to decrease
family expenses
126(56.5) 50(22.4) 16(7.2) 21(9.4) 10(4.5)
Community encourages EBF over
feeding infant formula
24(10.8) 25(11.2) 10(4.9) 89(39.9) 75(33.2)
Health workers encourage EBF 137(61.4) 45(20.2) 4(1.8) 25(11.2) 12(5.4)
BF = Breast Feeding, EBF = Exclusive Breast Feeding
Majority 123(55.2%) of the respondents had approved of EBF as a method of family planning, 74(33.2%) had
never tried EBF as family planning method, 62(27.8%) reported that EBF was a good family planning method
while 42(18.8%) reported that EBF was not 100% effective and they do not think it is reliable method of
family planning method.
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Table 5: Association between socio-demographics and perception of exclusive breastfeeding as family
planning method
Variable Perception of EBF as a birth control method n (%) Test Statistic p-value
Supportive Unsupportive
Age (years)
21 – 25 44 (31.9) 94 (68.1) 15.810† 0.001#
26 – 30 9 (20.5) 35 (79.5)
31 – 35 16 (55.2) 13 (44.8)
≥ 36 0 (0.0) 12 (100)
Marital status
Single 40 (30.5) 103 (69.5) 0.025* 0.884
Married 2 (31.5) 63 (68.5)
Educational level
Primary 0 (0.0) 4 (100.0) 2.672† 0.268
Secondary 17 (27.0) 46 (73.0)
Tertiary 52 (33.3) 104 (66.7)
Religion
Christianity 109 (60.9) 70 (39.1) 29.714* 0.001#
Islam 16 (48.5) 17 (51.5)
ATR 15 (28.6) 6 (40.6)
Occupation
Student 34 (25.8) 98 (74.2) 16.310† 0.001#
Trader 4 (14.3) 24 (85.7)
Civil servant 25 (46.3) 29 (53.7)
Farmer 3 (33.3) 6 (66.7)
† = chi-square, * = Fisher’s exact, # = statistically significant, ATR: African Traditional Religion
Majority 16(55.2%) of respondents aged 31 to 35 years had positive perception of EBF as family planning
method and this was statistically significant. (p=0.001) and higher 2(31.5%) proportion of married respondents
had positive perception of EBF as family planning method however, this was not statistically significant.
(p=0.884). Respondents with tertiary level of education had the highest 52(33.3%) proportion who had positive
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perception of EBF as family planning method and this association also was not statistically significant.
(p=0.268).
Table 6: Logistic regression model for predictors of perception of exclusive breastfeeding as family planning
method
Factors
B (regression
co-efficient)
Odds ratio 95% CI for OR p-value
Lower Upper
Age (years) -1.234 0.291 0.156 0.542 0.000#
Marital status
Single -1.37 0.254 0.062 1.043 0.057
Married 1
Educational level
Primary/secondary 0.045 1.046 0.327 3.348 0.94
Tertiary 1
Religion
Christianity 0.199 1.221 0.205 7.28 0.827
Islam 0.702 2.019 0.6 6.79 0.256
ATR 1
Occupation
Student -1.632 0.196 0.065 0.59 0.004#
Trader -3.212 0.04 0.004 0.368 0.004#
Civil servant -1.852 0.157 0.026 0.931 0.041#
Farmer
Age and occupation were significant predictor, with an odds ratio (OR) of 0.291 (p=0.001, CI=0.156-0.542)
and occupation (p=0,041, CI=0.026-0.931) respectively. The respondents with primary/secondary level of
education were 1.046 times less likely to have positive EBF as a family planning method compared to those
with tertiary level of education however; this finding was not statistically significant. (p=0.94, CI=0.327-
3.348).
DISCUSSION
From the present study, over three quarters of the respondents were aware of exclusive breastfeeding (EBF) as
a family planning method, yet significant variations were noted in the level of awareness regarding specific
types of family control methods. For instance, about two-thirds of the respondents had a proper understanding
of EBF as “only breast milk for six months”. This finding was in contrast with a study carried in Calabar which
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showed that a lesser number of the respondents had a proper understanding of EBF.12 Majority of the
respondents identified nutrition as an advantage of EBF, while only a few noted that it prevents infant illness,
aid child spacing and as a means of preventing pregnancy. Similarly, in Nigerian studies conducted in south
west, Nigeria, majority of the respondents were aware of breastfeeding as a birth control method.13,14 These
findings are crucial from a public health perspective. Majority of the respondents were aware of EBF and
common source of information on awareness was from health facilities. This demonstrates a good level of
community awareness and the fact that most of the respondents had heard about EBF at health centres
emphasizes the significance of health facilities as a valuable source of information. This finding was similar to
a study conducted in Yobe State, Nigeria where health facilities were identified as the most common source of
information on EBF.15
Almost half of the respondents were aware of EBF as a contraceptive. A similar finding was obtained among
women in USA and where half of women were aware that breastfeeding delayed menstruation, and similarly, a
lower proportion identified EBF as a contraceptive method.15 The fact that a majority of women identified
nutrition as an advantage of EBF is a positive sign, as it reflects an appreciation for the health benefits it offers.
However, in the other hand, the relatively low awareness of exclusive breastfeeding as a contraceptive method
signifies an area that requires attention in public health education. Higher proportions of the respondents who
were single, those with tertiary level of education and civil servants were aware of EBF as a birth control
method and were found to be statistically significant although, age and religion were not significant despite the
high awareness among younger age groups and those practicing Christianity. This shows the importance of
strengthening the aspect of knowledge through education and how this could contribute to better family
planning and reproductive health outcomes in the community.
Regarding perception of EBF as a method of contraceptive, a third of the respondents had supportive
perception towards EBF, while a majority was unsupportive. However, Half of the women reported that they
approve it as a method of contraception and most of the women had never tried it. Some of the women do not
think EBF is a reliable contraceptive method, while only a few believed that it only works if the woman is
unemployed. This finding is in contrast to other studies where only a lower proportion of women intended to
use EBF.15,17
The perception of EBF as a method of family planning has significant public health relevance and
implications. In a UK NHS survey, women reported that EBF would make their breasts sag.18,19 Therefore, the
finding that a majority of women approve EBF as a method of contraception is noteworthy, as it highlights a
potential opportunity for promoting family planning and maternal health. Lactational amenorrhea provides a
natural contraception, however, it depends on adherence to EBF practices. A Nigerian study conducted in south
west, Nigeria showed that over two thirds of women did not agree that EBF was a contraceptive method.13 The
fact that a larger proportion of women had unsupportive perception towards EBF as a contraceptive method
suggests a need for further education and promotion of this approach. There is need to emphasize the
importance of addressing misconceptions and providing accurate information about the effectiveness of EBF
for birth spacing. Women aged 31 to 35 years, Islamic religion and those who were farmers had the highest
proportion of those with supportive perception towards EBF as a birth control method and were found to be
statistically significant. These findings highlight an important need to address gap in the perception of women
and presents the need to dispel myths and misconceptions surrounding EBF and contraception. From a public
health perspective, these findings emphasize the importance of targeted interventions to educate women and
communities about the contraceptive benefits of EBF. This could involve implementing comprehensive
maternal and child health programs that not only promote breastfeeding for its nutritional benefits but also
emphasize its role in preventing unintended pregnancies. The implications of these findings also extend to
healthcare providers and policymakers, highlighting the need for integrated reproductive health and family
planning services that consider and promote EBF as a viable short time family planning method. There is also
a need for culturally sensitive and evidence-based approach to promote informed decision-making regarding
contraception and breastfeeding.
On factors which determine perception of EBF as a family planning method, nature of work was identified by
most women as a factor regarding occupation. Other factors include underage mothers, ANC and post-natal
visits, marriage status and educational levels of mothers. These findings showed that housewives, married
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mothers, mothers who attended ANC/post-natal and educated mothers were more likely to have positive
perception of EBF as contraceptive method however, only age, religion and occupation were found to be
statistical significance in determining positive perception of EBF as a family planning method while age and
occupation were found to be significant predictors of positive perception of EBF as contraceptive method.
These findings were similar to the findings of studies conducted in Calabar, Nigeria and in Southern India on
perceptions and practices regarding EBF among post-natal women which showed that age of mothers, post-
natal visits, marriage status, educational levels and occupation of mothers were factors affecting perception of
EBF as a family planning method however, mothers’ educational level was inclusive as significant predictors
of positive perception of EBF as family planning method.6,12
CONCLUSION
This study shows the high level of awareness of exclusive breastfeeding among nursing mothers attending
postnatal clinic at the primary healthcare centres in Ovia North East Local Government Area, Edo State, while
revealing significant disparities in specific aspects of perception on EBF as a family planning method. Age and
occupation were significant predictors of positive perception of EBF as contraceptive method. The results
show the need to tailor training programs to address gaps in perception with a focus the community and
healthcare providers to be equipped with the necessary knowledge and tools to effectively educate nursing
mothers about EBF as a method of family planning. The community should create awareness through local
women's groups, religious institutions and outreach programs to encourage pregnant women to actively engage
in ANC services and participate in opportunities to learn about EBF as a method of natural family planning.
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