Respondents’ Characteristics
Table 1 shows that all respondents were wet nurses who lived in Selangor. Variables of the study were age, marital status, several children are breastfed, residence, education level, occupation, and total income. The respondents in this study were 21 to 50 years old. The results showed that all respondents were married (100.0%). In terms of education, the respondents were examined from various educational backgrounds: Sijil Pelajaran Malaysia (SPM), Certificate, Diploma, Bachelor's Degree, Master's Degree, and the highest level of Doctor of Philosophy. The study showed that respondents with a bachelor’s degree outperformed respondents from other education levels of 48.0%. In terms of employment, 37.0% of the respondents were civil servants. While 32.0% of respondents worked in the private sector, and only 3.0% of respondents were students. Therefore, most of the respondents in this study consist of professionals who have monthly income that ranged from RM3001 to RM6000 (40.0%). Whereas 31.0% of respondents had RM1001 to RM3000 salary, and only 17.0% of respondents had below RM1000 salary.
Table 1 Socio-demography of respondents
Item
|
Respondent
|
|
Frequency
(n)
|
Percentage
(%)
|
|
|
Age (year)
|
|
|
|
21-30
|
30
|
30.0
|
|
31-40
|
64
|
64.0
|
|
41-50
|
6
|
6.0
|
|
|
|
|
|
Marriage status
|
|
|
|
Single
|
0
|
0
|
|
Married
|
100
|
100.0
|
|
Divorce
|
0
|
0
|
|
|
|
|
|
Residence (district)
|
|
|
|
Kuala Selangor
|
3
|
3.0
|
|
Kuala Langat
|
5
|
5.0
|
|
Sepang
|
8
|
8.0
|
|
Hulu Langat
|
26
|
26.0
|
|
Gombak
|
12
|
12.0
|
|
Petaling
|
28
|
28.0
|
|
Klang
|
18
|
18.0
|
|
Sabak Bernam
|
0
|
0
|
|
Hulu Selangor
|
0
|
0
|
|
|
|
|
|
Education level
|
|
|
|
SPM
|
7
|
7.0
|
|
Certificate
|
2
|
2.0
|
|
Diploma
|
20
|
20.0
|
|
Bachelor
|
48
|
48.0
|
|
Master
|
19
|
19.0
|
|
PhD
|
4
|
4.0
|
|
|
|
|
|
Occupation
|
|
|
|
Civil sector
|
37
|
37.0
|
|
Private sector
|
32
|
32.0
|
|
Self-employed
|
13
|
13.0
|
|
Housewife
|
15
|
15.0
|
|
Student
|
3
|
3.0
|
|
Income
|
|
|
|
Below RM1000
RM1000-RM3000
RM3001-RM6000
RM6001-RM9000
RM9001- above
|
17
31
40
10
2
|
17.0
31.0
40.0
10.0
2.0
|
|
Wet Nursing Practices
Influence factor to a wet nurse
Table 2 shows the frequency, percentage, and mean of each item or questions answered by the respondents. Analysis made based on the mean showed that the item with the highest mean value was the third item, “I breastfeed other milk children because I want to help mothers who do not have enough milk” by reaching mean = 3.36. Followed by the first item, “I breastfeed milk children because I have more milk” (mean = 3.18) and the fourth item, “I breastfeed milk children because their mothers are suffering from health problems preventing her from breastfeeding” (mean = 3.01). While the least favourite item was the second item, “I breastfeed other milk children as a source of income” (mean = 1.41). On average overall, although the number of respondents who agreed is higher than disagreed, it is observed that some respondents decided to make breastfeeding someone else's children as a source of income.
Table 2 Influence factors to wet nurse
No
|
Influence factors in breastfeeding others child
|
Strongly disagree
|
Disagree
|
Agree
|
Strongly agree
|
Mean±SD
|
n
|
n
|
n
|
n
|
%
|
%
|
%
|
%
|
1
|
I breastfeed another child because I have more milk
|
4
4.0
|
12
12.0
|
46
46.0
|
38
38.0
|
3.18±0.80
|
2
|
I breastfeed another child as a source of income
|
60
60.0
|
39
39.0
|
1
1.0
|
0
0.0
|
1.41±0.51
|
3
|
I breastfeed another child because I want to help mothers who do not have enough milk
|
2
2.0
|
6
6.0
|
46
46.0
|
46
46.0
|
3.36±0.69
|
4
|
I breastfeed another child because her/his mother is suffering from health problems preventing her from breastfeed (maternal debility)
|
5
5.0
|
22
22.0
|
40
40.0
|
33
33.0
|
3.01±0.87
|
Frequency of wet nursing
This study shows that a total of 42 respondents had breastfed at least one someone else’s child. While one of the respondents stated that she had nursed a total of 10 someone else's children. Table 3 also shows a total of 237 children have been breastfed by the respondents (N = 100). Of these, only 78.5% were breastfed five times, while 21.5% were breastfed less than five times. The findings show that there is still a wet nurse who did not achieve the conditions that can be categorized as a milk child that "the number of milk shall be five feedings" as determined by the National Muzakarah of Malaysia [21].
Table 3 Frequency of wet nursing
No.
|
Total of children
|
Total of respondents
|
Frequency of wet nursing
|
Total of children
|
Less than five times
|
Five times or more
|
n
|
%
|
n
|
%
|
1
|
1
|
42
|
10
|
23.8
|
32
|
76.2
|
42
|
2
|
2
|
17
|
7
|
20.6
|
27
|
79.4
|
34
|
3
|
3
|
22
|
19
|
30.6
|
43
|
69.4
|
62
|
4
|
4
|
10
|
9
|
22.5
|
31
|
77.5
|
40
|
5
|
5
|
2
|
3
|
30.0
|
7
|
70.0
|
10
|
6
|
6
|
4
|
0
|
0.0
|
24
|
100.0
|
24
|
7
|
7
|
1
|
0
|
0.0
|
7
|
100.0
|
7
|
8
|
8
|
1
|
2
|
25.0
|
6
|
75.0
|
8
|
9
|
10
|
1
|
1
|
10.0
|
9
|
90.0
|
10
|
|
TOTAL
|
100
|
51
|
21.5
|
186
|
78.5
|
237
|
Method of feeding
Table 4 shows the feeding method that has been used to feed someone else's child. Most respondents feed children using bottles (82.0%), followed by direct breastfeeding (58.0%). On the other hand, 11.0% of respondents used cups and 10.0% used syringes. Only 8.0% of respondents used tube (Supplemental Nursing System) to help them deliver milk to the children. This indicates that almost all respondents understand that the practice is permissible by legislation, and that there is the milk extraction condition, in which the sipped milk must reach the baby's stomach.
Table 4 Method of feeding
Method of feeding
|
Frequency (n)
|
Percentage (%)
|
Direct breastfeeding
|
58
|
58.0
|
Using a cup
|
11
|
11.0
|
Using a bottle
|
82
|
82.0
|
Using a syringe
|
10
|
10.0
|
Using a Supplemental Nursing System (SNS)
|
8
|
8.0
|
Others method
|
7
|
7.0
|
Providing breast milk with the combination of many other foods and beverages
Table 5 shows most of the respondents provided breast milk without any other additional food. However, this study also showed that 17.0% of the respondents mixed their breast milk with a variety of different foods, respectively, from the highest percentage to the lowest, includes porridge (17.0%), formula milk (14.0%), biscuits (14.0%), cereal (7.0%), fruit/vegetable puree (3.0%) and breast milk from another mother (1.0%).
Table 5 Breast milk combined with other foods and beverages
Food and other beverages
|
Frequency (n)
|
Percentage (%)
|
Breast milk only
|
57
|
57.0
|
Breast milk + another mother’s breast milk
|
1
|
1.0
|
Breast milk + formula milk
|
14
|
14.0
|
Breast milk + cereal
|
7
|
7.0
|
Breast milk + porridge
|
17
|
17.0
|
Breast milk + biscuit
|
14
|
14.0
|
Breast milk + fruit/ vegetable puree
|
3
|
3.0
|
Issues related to wet nursing
Payment received during wet nursing
Based on Table 6, the majority of respondents did not receive any payment or charged any fees for wet nursing (94.0%). However, some respondents received a payment of RM100 (4.0%), RM1 (1.0%) and RM50 (1.0%) for wet nursing. This clearly shows that almost all respondents voluntarily breastfed other children at no charge.
Table 6 Total payment received during wet nursing
No
|
Total payment (RM)
|
Frequency (n)
|
Percentage (%)
|
1
|
No charge
|
94
|
94.0
|
2
|
1
|
1
|
1.0
|
3
|
50
|
1
|
1.0
|
4
|
100
|
4
|
4.0
|
Affinity relationships between mother and milk child
Table 7 shows that the majority of respondents (93.0%) recognized their milk children. However, it also showed that the remaining 7.0% could not identify their milk children, which is somehow worrying. Meanwhile, 13.0% of respondents did not know the identity of their milk children. When asked about their relationships with the milk children, the majority of them were still in contact (95.0%) and knew where they live (91.0%). Some who had lost contact with their milk children did not have any information regarding the presence of their infants/milk children.
Table 7 Affinity relationships between wet nurse and milk child
No.
|
Affinity relationships
|
Yes
|
No
|
n
|
%
|
n
|
%
|
1
|
Do you recognize your milk child?
|
93
|
93.0
|
7
|
7.0
|
2
|
Do you and your family know the identity of the milk child?
|
87
|
87.0
|
13
|
13.0
|
3
|
Are you still in touch with your milk child?
|
95
|
95.0
|
5
|
5.0
|
4
|
Do you know where / residence milk children?
|
91
|
91.0
|
9
|
9.0
|
Note: ‘ƒ’: frequency of respondents; '%': Percentage of respondents
The practice of wet nursing documentation
Questionnaires were distributed to obtain information on the importance of keeping wet nursing data records. Table 8 shows that not all respondents recorded the information of their milk children. Only 72.0% of them documented data on their milk children's background. When they were asked about the importance of recording data on their milk children, there are still 15.0% of respondents who thought that the data were unnecessary to record. Although the majority of respondents felt that it should be recorded (85.0%).
Nevertheless, the awareness of keeping information on milk children should be raised among the breastfeeding mothers to prevent any undesireable situations following wet nursing activity; the woman and milk child might be settling elsewhere and no longer meet. They may even be living outside the state or perhaps residing abroad and so on. This situation can result in disconnected and inaccessible contact.
Table 8 The importance of recording breastfeeding information
No.
|
The importance of wet nursing documentation
|
Yes
|
No
|
n
|
%
|
n
|
%
|
1
|
Did you record your infant's milk child background data?
|
72
|
72.0
|
28
|
28.0
|
2
|
Do you feel the need to record your infant's milk child background data?
|
85
|
85.0
|
15
|
15.0
|
Note: ‘ƒ’: frequency of respondents; '%': Percentage of respondents