By Caroline Wangui Wainaina, Intern, APHRC
Breastfeeding practice has been attributed to the well being of newborns and infants with studies showing long term effects of breastfeeding on child’s health (Koletzko et.al eds.2000). Research has shown that breast milk has immune boosters that are important in protecting the child from diseases like respiratory infections, diarrhea, lifestyle diseases like diabetes and hypertension (Eidelman et.al 2012). A lot of research and interventions have been done in the low income populations with the aim of advocating for exclusive breastfeeding. Even with all the interventions available, the percentage of babies exclusively breastfeeding in Kenya remains wanting at 32% (KNBS 2008).
Challenges to EBF have included work place support which has been mentioned in various studies conducted in Kenya. This has been cited as a need by mothers to enable them achieve the six months recommended EBF. The need for facilities for expressing and storing breast milk, provision of breastfeeding breaks and flexible time have been shown to be instrumental to breastfeeding practice (Hawkins et.al 2007).
APHRC recently engaged middle income mothers in Nairobi, Kenya on the challenges they face with regards to breast feeding through participatory action research. This research involved focus group discussions and in-depth interviews with working and stay at home mothers. The main challenges to exclusive breastfeeding or breastfeeding in general mentioned by working mothers included the transition of going back to work after the end of maternity leave, including being forced to wake up early in the morning to express breast milk to leave behind for the baby, lack of space at work place to express breast milk during the day and having to do this in odd places including in store rooms, toilets, inside private offices and the parking lot. The issue of storage was indicated as another challenge with others leaving the milk in the car in bottle warmers. There are no designated refrigeration facilities at the work place and there is usually objection to using the fridge used for general storage by colleagues.
“there was a server room but I felt it will be weird, what is this person doing in the server room all that time, then also how to store it there is a fridge but I was wondering what if someone opens in and wonders what this is so I used to keep it in the car but I used to get worried what if it spoils in the car”.(IDI with Middle Income Working Mother, Nairobi)
“I was given three months and when I went back it was hectic since I wanted my child to go for six months, so I had the pump I would wake up at 3 am to pump since I had a lot of milk so I would wake up at 3 to make sure that I prepare everything for the baby so that I just leave the house gal just taking care of her”. (FGD Kilimani mums, online community)
The decrease in the frequency to breastfeed has been shown to lead to reduction in breast milk production (Kent, et.al 2012). This was also observed by most of the mothers who indicated that the frequency of breastfeeding and expressing of breast milk had reduced and this had affected milk production causing them to introduce infant formula supplementation. This infant formula has been shown to have adverse effects on the infants’ digestive system as well as the immune system (Duijts et.al 2010).
“Not exclusively, at some point I had to supplement with the formula especially when I came back to work and I had to pump, now what I was pumping it was not as much as before because it is stimulated by breastfeeding and now he was just breastfeeding in the morning and evening”. (IDI with Middle Income Working Mother, Nairobi)
The issue of maternity leave was also mentioned by all the working mothers interviewed, this ranged from the maternity leave being short to mothers being made to work while on maternity leave. The duration of the maternity leave has been referred to in various articles and it has been shown to be a factor for early cessation of EBF and whole breastfeeding practice (Ogbuanu 2011). The three months that are normally given for maternity leave to mothers in Kenya were shown not to be adequate for proper recovery especially for the mothers with preterm babies, those who had undergone caesarean section deliveries and those with other post partum complications.
“I had a pre-term baby and by the time I was coming back to work my baby was 3.5 kgs that is a new born because I had already taken maternity leave and I had already exhausted my annual leave, so I had no option but to come back”. (FGD, Middle Income Working Mothers, Nairobi)
The working mothers expressed effect of work related stress on their milk production. This was due to the hours at work, away from the baby as well as the transition back to work. Mothers underscored the need for work place support including flexi-time to allow more interaction with their babies.
“it’s how stressed I am or how much I have to focus on other things in particular work, the situations where I have to think about work and the child and breastfeeding should remain in the back I find that I don’t produce much milk and the more stressed I am the less milk I produce”. (FGD, Middle Income Working Mothers, Nairobi)
“But I just want to underscore the pros of flexi time at the workplace. It is not just to be able to breastfeed but it will reduce the stress of the mother that you are away from your baby the whole day” (FGD, Middle Income Working Mothers, Nairobi)
The results indicate the need for work place support to enable mothers’ breastfeed optimally. There is need for designated places to be put in place for mothers to be able to express and store their milk while at work. To enhance productivity and reduce work related stress, there is need for flexible hours to be implemented or added to the existing policies at the work place. Njogu (2014) indicates that the productivity of an individual is linked to the family’s well being and this means that the family plays an important role in the mother’s productivity and thus the need for employers to consider this and employ support structures that ensure the mothers are able to take care of their babies as well as being productive at the workplace.
“it’s how stressed I am or how much I have to focus on other things in particular work, the situations where I have to think about work and the child and breastfeeding should remain in the back I find that I don’t produce much milk and the more stress I am the less milk I produce…” (FGD, middle income working mothers, Nairobi).
Increasing the duration of maternity leave should be taken into consideration to enable exclusive breastfeeding for six months as recommended by the WHO (2003). This as some mothers suggested can be through employing people for short term employment/contracts to cover the maternity leave,
“I had a friend who was being pressured that she works long hours and she comes back to work after two months otherwise she will lose her job… I think it is more of policies on the fact that your job will not be in jeopardy when you go home in whichever way they will choose to do it whether by replacement or by waiting for you I think that is up to them”. (IDI with middle income mother, Nairobi)
“if it was six months they would even invest in having someone sit in for you, but now I feel like I am working and I am at home(indicates they send her work)…they never invested in a replacement for me and that is the case for many”.(IDI with middle income mother, Nairobi).
There is also the proposal on tax breaks from the Government to cover the employer in the case where position remains vacant during the maternity leave (Njogu 2014). The combination of longer maternity leave and flexible hours would definitely lead to mothers being with their infants longer.
As we edge into the targeted year for achieving the millennium development goals, all efforts to reduce the infant mortality by two thirds should be focused not only on improving the health seeking behavior but also on work support systems to enable mothers’ breastfeed optimally and thus increase their child’s survival rate as breastfeeding is critical for child development and survival (Cai et.al 2012).
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Duijts L., et.al (2010) Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. Vol 126 (1); pp 18-25.
Eidelman, A. I., et.al (2012) Breastfeeding and the use of human milk. Pediatrics, 129 (3), e827-e841.
Hawkins, S., et.al (2007) Maternal employment and breast-feeding initiation: findings from the Millennium Cohort Study
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Koletzko, B., et.al (Eds.) (2000) Short and long term effects of breast feeding on child health, Vol. 478. Springer Science & Business Media.
Njogu (2014) We must seek ways to pay the family its dues as a factor of economic production. [Available Online] http://www.nation.co.ke/oped/Opinion/We-must-seek-ways-to-pay-the-family/-/440808/2423148/-/u3h3eg/-/index.html.
Ogbuanu C., et.al (2011) The Effect of Maternity Leave Length and Time of return to Work on Breastfeeding PEDIATRICS Vol 127 (6); 1414-1427.
WHO (2003) Global strategy for infant and young child feeding. Geneva: WHO