Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya

Abstract

Background In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF. Objectives We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non–formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women. Methods We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables. Results EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non–formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%). Conclusions As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.

Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers

“…The Kenya Ministry of Health developed guidance to facilitate the implementation of these policies (Kenya Ministry of Health, 2018). However, despite these policies and guidelines, formal employment in Naivasha is associated with a 36% lower prevalence of EBF at 14 weeks compared with informal or no employment (Ickes et al, 2021).…”

Effect of IMB Model Combined with Spousal Support Breastfeeding Intervention on PBSES Score and Breastfeeding Rate of Primipara with Chronic Hepatitis B Virus Infection

“…Breast milk is an essential food for infants in the first six months after birth. In addition to a variety of nutrients, breast milk also has a variety of bioactive substances, which have positive significance in enhancing immunity and promoting intellectual development of infants [ 1 , 2 ]. Breastfeeding reduces the risk of respiratory diseases and diarrhea in infants and reduces infant mortality.…”

Factors Associated with Adequate Breastfeeding: Evidence from the Peruvian Demographic and Health Survey, 2019

“…This could be attributed to the fact that mothers without a job (formal or informal) would have the autonomy of their schedules to ensure exclusive breastfeeding for more months, while employed women needed to return to work early and would have less time to feed their children directly. It is reported that a higher proportion (by more than double) of unemployed mothers give EBF, compared to those who were employed [ 34 , 35 ]. The time offered (98 days, starting approximately 49 days before the expected date of delivery) could be insufficient, even though a maternity subsidy is provided in Peru [ 36 ].…”