The impact of urbanization and socioeconomic status on

infant feeding practices in Lagos, Nigeria

Rosemary C. Anyanwu and Cyril O. Enwonwu

INTRODUCTION MATERIALS AND METHODS

Breast-feeding is currently a subject of immense health The study sample comprised 558 randomly selected
and nutritional interest all over the world. As recently Nigerian women resident in Surulere. An interview
as 1983, the World Health Organization called attention was conducted at the Gbaja and Randle Health Centres
to what it described as an impressionistic view of located in the area, using a standard questionnaire to
world-wide decline in the prevalence and duration of obtain information on the following:
breast-feeding, and underscored the urgent need for -- ethnic origin of mother,
more definitive data on present-day infant-feeding
-- level of education,
practices and trends, as well as information on the key
factors influencing women’s decisions on how to feed -- mother’s occupation and age,
their babies (1). Breast-feeding for up to one year or -- total income of the family,
more has been the traditional infant-feeding practice -- number of children born alive to mother,
in the developing world, but recent extensive reports
-- type of infant feeding preferred by mother and
strongly suggest that this is rapidly giving way to the
factors influencing the decision,
“bottle culture,” especially among societies in transition
mainly in pert-urban areas and in the poverty pockets of -- age at which breast-feeding was supplemented with
urbanized population groups (2, 3). The dimensions of other foods,
this rapid, pervasive socio-cultural transformation, often -- specific types of supplementary foods preferred by
erroneously regarded as a symbol of modernity, as well as the mothers,
the forces underlying the disturbing negative change, are -- duration of breast-feeding,
not yet clearly defined. -- influence of hospitals/clinics and advertisers of baby
This report covers the first phase of an on-going national foods on choice of infant-feeding practice.
study designed to evaluate current maternal perceptions Yorubas, members of the predominant tribal group
of infant-feeding among different ethnic, religious, in Lagos State, constituted 55 per cent of the sample,
cultural, and socio-economic groups in Nigeria, with the followed by Ibos from the eastern states of the country
primary objective of assessing the extent of decline in (25 per cent). Women from the non-lbo-speaking
breast-feeding as well as the major factors responsible for minority groups of Bendel State constituted 10 per cent
the negative change, and how best to institute corrective of the sample, while the remaining mothers were mainly
educational measures. For this particular study, Surulere, Efiks and Ibibios from Cross River State.
a suburb of metropolitan Lagos that is heterogeneous in
its ethnic and socio-economic composition, was selected Most of the women interviewed (71 per cent) were 21-
as a pretest area for the widely assumed negative effects 30 years old, while those 16-20 years and 31-35 years
of urbanization and modernization on infant-feeding accounted for 11 and 12 per cent respectively of the
practices and the traditional African image of mothering. sample. Four mothers were under 16 years, and the
rest were over 36 years of age. Twenty-four per cent
of the women interviewed described themselves as
full-time housewives with no readily visible occupation
outside their homes, while 48 per cent were traders The
rest were teachers, civil servants, nurses, seamstresses,
hairdressers, and full-time students.
Rosemary C. Anyanwu and Cyril O. Enwonwu
National Institute for Medical Research, Yaba, Nigeria

Food and Nutrition Bulletin, vol. 7, no. 1 © 1985, The United Nations University. 1
2 The impact of urbanization and socioeconomic status

The women’s educational qualifications were assessed >12 67 12

by grouping them into the following major categories:
Does not know 64 11
no formal schooling of any type, completion of primary
school education lasting about six years, completion of TABLE 4. Actual Duration of Breast-feeding Practised by
the Mothers
secondary school or its equivalent, including modern
school, and graduates of university or post-secondary Number of
Duration (months) Percentage
professional programmes. Only 12 per cent of the women Mothers
belonged to the last group, while 15 per cent had had no Never breast-fed - -
formal schooling. The highest proportion of the sample <1 3 <1
(44 per cent) had completed primary school.
1 3 <1
TABLE 1. Family Income Status of Study Sample
2-3 22 4
Monthly Number of Mothers
Percentage 4-6 80 14
Income(Naira)* Responding
7-9 146 26
<200 160 29
10-12 137 25
200-399 154 28
>12 73 13
400-599 36 7
Not applicable* 94 17
600-799 17 3
*Women who were still breast-feeding at the time of the interview.
800-999 8 1
>=1,000 8 1
RESULTS
Does not know/did
157 31 Table 1 summarizes the income levels of the families
not state
studied. The estimated total monthly income per family
*Combined monthly income of father and mother.
was less than N 400 (1 naira = US$1.30) for about 56 per
TABLE 2. Number of Children Born Alive to Mother cent of the study sample. No fewer than 29 per cent of the
Number of families had monthly incomes below N 200, well below
Number of Children Percentage the subsistence level in a city rated among the most
Mothers
expensive in the world in terms of housing and general
1 170 31
cost of living.
2 134 24
The number of children born alive to most of the
3 108 19 women (74 per cent) varied from one to three, while
4 54 10 16 per cent of the women had five or more children born
5 41 7 alive (table 2).
6 32 6 In the opinion of most of the mothers, breast-feeding
7 6 1 should be practiced for as long as 7 to 12 months, while
a relatively small number (less than 12 per cent) believed
8-10 10 2
that breast-feeding should be restricted to only the first
>10 3 <1 six months of life (table 3). Contrary to the belief of the
mothers (38 per cent) that breast-feeding should continue
TABLE 3. Mother’s Expressed Opinion on Ideal Duration of
for up to one year of life, only about 24.6 per cent of the
Breast-feeding
mothers practiced breast-feeding for that long (table 4).
Number of While none of the 558 mothers interviewed was of the
Duration (months) Percentage
Mothers opinion that breast-feeding should stop before the first
No breast-feeding - - month, three mothers actually breast-fed their infants
<1 - - for less than this. As many as 64 women interviewed
(about 11 per cent) admitted that they did not know how
1 3 <1
long breast-feeding should last, while a comparatively
2-3 8 2 similar number (about 17 per cent) were still
4-6 50 9 breast-feeding their babies at the time of the study.
7-9 156 28 Table 5 summarizes the opinions of the women
10-12 210 38 regarding the appropriate age for introduction of
Rosemary C. Anyanwu et al. 3

supplementary foods. Only 4 per cent of the mothers TABLE 6. Youngest Age at which Supplementary Feeding
believed that breast feeding should be supplemented for Was Actually Introduced
infants under one month of age. Forty-four per cent of Number of
the women suggested one to three months as the best Age (months) Percentage
Mothers
age for introducing supplementary feeding, while about
<1 241 43
28 per cent believed that breast-feeding should remain
unsupplemented for as long as six to nine months. In 1 91 16
marked contrast to their expressed beliefs, 43 per cent 2 85 15
of these mothers actually introduced supplementary 3 37 7
feeding to their infants before one month, and as many 4 15 3
as 81 per cent used supplementary foods for infants from
5 7 1
birth to three months (table 6). Only about 2 per cent
of the women waited until their infants were six months 6 3 <1
and older before initiating supplementary feeding, an >6 9 2
observation markedly different from their expressed Does not remember 70 13
opinions. In effect, these mothers did not practice their
beliefs about infant feeding. The commonest reasons TABLE 7. Supplementary Foods Commonly Used by
advanced by the women for early introduction of Study Sample
supplementary feeding included the following: Number of
Percentage
-- the nature of work outside the home militates against Mothers
prolonged breast-feeding; Milk and milk-based products
195 35
-- insufficient breast milk; (e.g. Cerelac, SMC)
-- supplementary feeding promotes faster growth of Cereals (akamu-corn starch,
156 28
the baby; mashed millet, etc.)

-- others do so. Animal proteins (minced meat,

148 27
eggs, fish)
The preferred supplementary foods used by the
Others (legumes-especially
mothers studied included imported powdered milk or 59 10
beans-fruits, potato, yam, etc.)
milk-based products, various locally available as well as
imported canned cereals, animal proteins, and mashed TABLE 8. Mothers’ Opinion Regarding Best Type of
beans and yams (table 7). Feeding for Infant Aged 3-6 Months

TABLE 5. Mothers’ Opinion as to Age at Which Number of

Percentage
Supplementary Feeding Should Be Introduced Mothers
Breast-feeding only 280 50
Number of
Age of Infant (months) Percentage Bottle-feeding only 63 11
Mothers
<1 24 4 Combination of breast- and
193 35
bottle-feeding
1 39 7
No opinion 22 4
2 101 18
3 105 19 The wide gap between the women’s expressed opinions
4 16 3 about infant feeding and what they actually practiced is
5 8 2 further underscored by the data in table 8. Contrary to
their actual practice as indicated in table 6, 50 per cent
6 54 10
of these mothers believed that infants aged three to
6-9 79 14 six months thrived best on breast-feeding alone, while
>9 80 14 about 35 per cent shared the view that a combination
No opinion 52 9 of breast-and bottle-feeding was the right answer
4 The impact of urbanization and socioeconomic status

(table 8). There was some suggestive evidence from Results of the present study are consistent with
the studies that bottle-feeding was not very strongly or reports (4-7) of progressive decline in the prevalence and
extensively promoted by the hospital/clinic staff attending duration of breast-feeding among urban Nigerians. It is
these mothers, although quite a number of the women noteworthy, however, that urban mothers retain their
(22 per cent) claimed that they received free milk samples belief that “breast is best” and that despite the difficulties,
for an ill-defined period after delivery of their babies over 98 per cent of mothers still manage to breast-feed for
(tables 9 and 10). an average of two to three months. Most of these earlier
TABLE 9. Encouragement to Bottle-feed
reports attributed the negative change to attitudes and
influences imported from the developed world and the
Number of preference for bottle-feeding by the urbanized African.
Percentage
Mothers It is clear that such explanations are oversimplified
No 517 93 and apply to only a few and ignore the hard realities of
Yes 23 4 urban existence that may make prolonged breast-feeding
difficult. The crucial questions, as rightly pointed out by
Not stated 18 3
Harfouche (8), are why and how “women who migrate
Mothers were asked whether they were encouraged to from the traditional rural areas to the so-called modern
bottle-feed either by advice or by a gift of free feeding universe adjust to new situations, adopt new attitudes
bottles from the hospital or clinic. and patterns of behaviour.”
For most Nigerians, urban existence is synonymous
TABLE 10. Data on Gift of Free Milk Samples to Mothers
with extreme individual and community poverty.
after Delivery by the Hospitals
Implicit in this is a great pressure on mothers to spend
Number of
Percentage
more time trying to augment the family income at the
Mothers expense of caring adequately for their children. There
No 426 76.3 is good evidence from the present study that breast-
Yes 125 22.4 feeding has not lost its prestige among the economically
underprivileged labouring classes in metropolitan
Not stated 7 1.3
Lagos, but is accorded lower priority because of the
overwhelming competing factors of urban existence
DISCUSSION AND RECOMMENDATIONS resulting from poverty. The crucial issue is how to
Complex interactions between broad economic and promote breast-feeding in the presence of the extensive
socio-cultural factors influence infant-feeding practices poverty characteristic of urban life in many parts of
in the developing countries The present study of the developing world. This issue assumes very serious
infant-feeding practices and maternal attitudes involved dimensions in view of the relatively rapid urban growth
558 urban women, most of whom had little or no formal rate (5 to 10 per cent) in these developing countries as
education, drawn mainly from the low-income level of exemplified by the disturbing projection that 50 per cent
Lagos society. The major variables investigated were the of the African population will be living in cities by the
prevalence of breast-feeding and its duration, with or year 2000, a phenomenon that has rightly been described
without supplementary feeding. Our data demonstrated by United Nations demographers as “the greatest mass
quite convincingly that virtually all the mothers studied migration in human history” (9).
still entertained strong positive feelings about the Findings in the present study were consistent with
importance of breast-feeding, an observation consistent the view that childhood malnutrition is more a result
with the reported findings of Goyea and Johnson (4) in of objective conditions of people’s lives than ignorance
a smaller number of Nigerian women residing in the on the mother’s part (10). It is suggested that economic
ancient city of Benin, Bendel State. and social pressures under which the low-income group
Equally evident from the present study was the wide live in an urban area, rather than serious ignorance on
discrepancy between the actual infant-feeding practice the part of the women, were responsible for the critical
of the women and their expressed views on what the change in traditional infant feeding practices and the
practice ought to be (tables 5, 6, and 8). Quite often African image of mothering. Until this major structural
the actual practice fell short of the mother’s nutritional defect of urban life in the developing world is eliminated
awareness, thus contradicting the frequently repeated or controlled, any nutrition education programme that
statements that such illiterate, urbanized women are solely emphasizes and extols the virtues of breast-feeding,
victims of poor or improper counselling. facts already well accepted by the people, is bound to
achieve minimal results in terms of reversing the current
Rosemary C. Anyanwu et al. 5

trend towards increasing displacement of breast-feeding 5. O. Alakija and F. Ukoli, “An Evaluation of Feeding Habits
by bottle-feeding of Infants Seen at an Urban Health Centre in Benin City,
Nigeria,” Niger. Med., 19: 683 (1979).
Perhaps more lasting benefits will be achieved by
emphasizing the education of mothers on how to 6. J. Uyanga, “Rural-Urban Differences in Child Care and
Breast Feeding Behaviour in South Eastern Nigeria,”
prepare and use hygienically acceptable supplementary
Social Sci. Med., 14: 23 (1980).
foods from relatively inexpensive but nutritious locally
7. I. Owie, “Influence of Educational Attainment on
available staple foods. Too much educational effort has
Nigerian Mothers: Preference for Breast or Artificial
been spent on trying to teach impoverished, urbanized Feeding for Infants,” Pub. Hlth Rep., 95: 562 (19801.
women precisely when to introduce supplementary
8. J.K. Harfouche, “Psycho-social Aspects of Breast-feeding,
feeding, when it is often forgotten that even among Including Bonding,” Food Nutr. Bull., 2 (1): 2 (1980).
nutrition experts there is still lack of unanimity on this
9. K. Newland, “The City Limits: Emerging Constraints on
issue (11-14). Rather, concentration should be on how to
Urban Growth” (Worldwatch Institute, Washington, D.C.,
do this most effectively. In addition, government policies 19801.
in developing countries should address the severe
10. M. Segal and A. White, “Research on Primary Health Care:
poverty of urban immigrants that prevents them from A Multidisciplinary Project in Ghana,” Wrld. Hlth. Forum,
being able to feed their children properly. 2: 341 (19811.
11. R.G. Whitehead, “The Infant Food Industry,” Lancet, 1976
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