By Milka Njeri – Research Assistant, APHRC
Breastfeeding is a call of nature and the mother and the child need to respond to this call in the most appropriate way possible. The act of breastfeeding has exclusive benefits apart from just being a call of nature. It provides critical nutrients that a baby needs; it aids mental development; it reduces child mortality; and provide a bonding opportunity for the mother and child. It is recommended that a mother exclusively breastfeeds for six month with the act spreading beyond the six month to at least when the child is two years. This task can be so daunting for a mother and special for special attention. However, breastfeeding mothers who work face various challenges in responding to this call of nature.
Optimal Breastfeeding and its importance
Optimal breastfeeding defined as a) the immediate initiation of breastfeeding after birth; b) breastfeeding on demand; c) exclusively for six months and d) continued breastfeeding for two years or beyond is recommended. Optimal breastfeeding is associated with child’s health, growth and development. Mothers who exclusively breastfeed recover faster after delivery and are protected from risks of excessive bleeding as well as from breast and ovarian cancer in the long run. To the family, exclusive breastfeeding of the baby lessens the household expenditure on food for the baby for six months, and expenses on healthcare. Optimal breastfeeding can prevent up to 12% of all child deaths and 10% of all common illnesses among children aged below 5 years. Further, optimal breastfeeding is associated with better education attainment, productivity of the individual and with improved Gross Domestic Product (GDP) to the nation.
Despite the documented benefits of optimal breastfeeding, sub-optimal breastfeeding practices are highly documented in Kenya. Approximately 40 % of children aged less than six months are not exclusively breastfed and about half of the children are stopped from breastfeeding before their second birthday. Among the impediments to optimal breastfeeding is work/ employment.
Challenges faced by breastfeeding mothers in formal employment
In a qualitative study done by the African Population and Health Research Center (APHRC) in seven counties across the country, work emerged as a major challenge to optimal breastfeeding for mothers. Low income mothers are presented with unique challenges as most of them are petty traders or casual laborers. In most cases, they are not offered the three-month maternity leave or they do not qualify for the leave due to their casual engagement. To compound this, abject poverty is prevalent in these areas and most of the families where the mothers come from live from hand to mouth. If such mothers are to stay at home to exclusively breastfeed as is proposed these mothers would have no income. This would mean that they will be sleeping hungry same as their children. Further, missing work puts them at the risk of losing their jobs. Moreover, carrying children to work is not an option for most of them, as their employers or working conditions do not allow them to do so. As a result, some mothers forego exclusive or any breastfeeding to save their jobs as they have to fend for their families. In addition, the option of expressing breast milk is a challenge due to the prohibitive cost of breast milk expressing and storage equipment, lack of skill to do so and the hygiene and sanitation requirements of expressed breast milk.
The excerpts below are picked from conversations relating to this issue with community members.
‘..Babies are given (food) because maybe the mother wants to go and look for work, she has her own businesses to do, and she has not time to sit there and breastfeed the baby because she has no one else to fend for her. Even if she has someone to fend for her, he (spouse) is a drunkard and comes in the evening with one hundred shillings. You know one hundred shillings nowadays is not money, it is very little. She feels it is better she goes back to her job of washing cloths and teach the baby to eat early… (Key Informant Interview, Religious Leader, Viwandani-Nairobi)
She (BF mother) will leave at eight, and then go to sit in someone’s compound up to six in the evening until the boss comes back so you can imagine all those hours, the baby has not breastfed but has been given other foods as they wait for the mother to come in the evening…and most bosses don’t like you carrying your baby to work; she feels that when she comes with her baby she will concentrate on her baby more than the job at hand” (Focus Group Discussion, CHWS, Vihiga)
‘………mother does not breastfeed the child according to what the doctor says, they do (breastfeed) according to the time they have because at times the mother has gone out to look for casual jobs so the baby may miss the timings for breastfeeding, he will breastfeed when the mother is available….So the children are not breastfed accordingly since the mother has to go and do casual jobs and in such places they are not allowed to go with the children ( Focus Group Discussion, Older Mothers, Kwale)
Challenges facing mothers in informal employment
Even women in formal employment are unable to practice exclusive breastfeeding. These women, unlike those in informal employment are entitled to the three month maternity leave and majority of them can afford to purchase breast milk expressing and storage equipment. However, it becomes increasingly difficult for them to practice exclusive breastfeeding and continued breastfeeding for at least two years after they resume work from the maternity leave. One of the challenges they face is lack of support at work to continue breastfeeding. Some may be willing to express breast milk for their babies while at their work places, but their efforts are hampered by the lack of private spaces or facilities for this exercise. Some are therefore forced to express breast milk in unlikely places like the wash rooms or in their vehicles, and store the expressed milk in their handbags, and have to constantly worry about the risks of a mess that would happen if the milk spilled or got spoilt.
‘The people are very busy they have to go back to work after two months so the baby is introduced to NAN and cow’s milk, since she is not allowed to come back at home to breastfeed so the baby is left with the maid and it is given water. I can say that those who do exclusive breastfeeding here are like 50 percent’ (Focus Group Discussion, with cCommunity Hhealth wWorkers, Kiambu)
“We do not have a breastfeeding room, I have seen my colleague express in the toilet, so over time it is not very comfortable … you end up giving up” ( Focus gGroup dDiscussion, Employed, Working Mothers with Middle income mothers – Nairobi)
“When you are working it’s also not possible to breastfeed the child like that (exclusively for six months). So we started with breast milk and water then we give the child some fruits…..my wife was working so he had to be introduced to the foods but she would breastfeed at lunch time, but the foods had to be introduced so that the baby does not suffer for the long hours that the mother goes to work’ (Community Dialogue – Machakos)
“I felt it will be weird (expressing breast milk in the server room) , , then also how to store, I used to keep it in the car but I used to get worried what if it spoils in the car ( In-depth interview, with a Working Mother, middle income mother – Nairobi)
Challenges facing breastfeeding mothers in Rural Areas
Mothers in rural areas on the other hand are also not without challenges as they have to work for long hours in the farms or handle other domestic chores, denying them adequate time to breastfeed their babies. Harsh weather conditions and safety issues in the fields also hinder most of them in carrying their children to work. Expressing breast milk for mothers is also not common in most rural communities due to rampant cultural beliefs against expressing breast milk. These foregoing challenges have made it difficult for breastfeeding mothers in rural areas to practice optimal breastfeeding, with the obtaining situation of early introduction other foods thus affecting exclusive breastfeeding for six months. Others are forced to stop breastfeeding their children earlier than two years.
‘The challenge is that there are some who live very far from the shops and the water point so they may go for water one day and the other day they go to the shops so in those two days the baby does not breastfeed well…they start giving foods early so that they can be seen like they are healthy, so that is the main challenge, they don’t breastfeed exclusively for six months’ (Community Dialogue – Kajiado)
“A mothers starts working very early in the morning, even if it means going to the farm…..When she goes there, she will stay there most of the time and you find that the hours for breastfeeding the baby are few in a day…so you find that the baby is not doing well and we are forced to look for cow’s milk to supplement (Community Dialogue – Vihiga)
‘We have been told that it is good for the mother to express the milk then when she is away she can put the milk in the fridge and the house girl can give the baby. But in this community we have not adopted that….In our village our women do not express the milk…. ‘(Focus Group Discussion with fathers – Kwale)
What needs to be done?
To promote optimal breastfeeding and good child health and nutrition, the work related challenges for breastfeeding mothers must be addressed. Studies have associated greater workplace support with fewer absenteeism rates in breastfeeding mothers, leading to improved productivity. If organizations could provide breastfeeding rooms in their offices, evidence has shown it can facilitate mothers to successfully express milk, and that adoption of breastfeeding supporting laws in a country saves lives and reduces countries’ expenditure on health.
With realization of the potential challenges in breastfeeding for working mothers, global measures have been set up to promote, protect and support breastfeeding through the Innocenti declaration and the international Labour organization ( ILO), which recommend at least a 14 weeks maternity leave for mothers after delivery. In Kenya, according to the Kenyan Labour law, working mothers are entitled to three months (90 calendar days) maternity leave after delivery, with an assurance of resuming their job thereafter. Nonetheless, mothers from all social structures in urban and rural areas in Kenya continue to face work related hurdles in breastfeeding.
Workplace support for breastfeeding mothers by employers and colleagues is crucial and recommended. Support can include but is not limited to a) allowing mothers the three months maternity leave; b) provision of breastfeeding rooms (with adequate water and breast milk storage equipment); c) allowing for breastfeeding breaks and any other emotional or physical support required. Employers should adopt and operationalize laws that provide for the women in casual employment to be accorded three months maternity leave. Women working in farms can be supported by being provided with baby shades in the farms and breastfeeding breaks to facilitate optimal breastfeeding. Community and family support for breastfeeding mothers include breastfeeding/ baby shades in the farms and breastfeeding breaks for mothers working in the farms are also imperative to facilitate optimal breastfeeding for mothers in rural areas.