Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa

Abstract

Background: Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers. Methods: The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method. Results: Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.

I decided to go back to work so I can afford to buy her formula’: a longitudinal mixed-methods study to explore how women in informal work balance the competing demands of infant feeding and working to provide for their family.

“…Breastfeeding has substantial and lifelong positive health bene ts for both mother and baby, and is important for the baby's cognitive development [6,7]. High levels of poverty and food insecurity among informal workers [3], put their children at high risk of malnutrition and failure to reach their long-term developmental potential.…”

“…However, many informal workers work in unsafe, unhygienic, unsupportive, and vulnerable working conditions, which has an impact on their decision to breastfeed after returning to work [3]. In addition, for many women bringing their children to work with them, breastfeeding in public spaces is deemed as culturally unacceptable, making it di cult to continue with breastfeeding [6].…”

‘I decided to go back to work so I can afford to buy her formula’: a longitudinal qualitative study to explore how women in informal work balance the challenges of infant feeding and childcare while working to provide for their family

“…However, many informal workers work in unsafe, unhygienic, unsupportive, and vulnerable working conditions, which has an impact on their decisions to breastfeed after returning to work [3]. In addition, for many women bringing their children to work with them, breastfeeding in public spaces is deemed as culturally unacceptable making it di cult to continue with breastfeeding [6]. Interventions in the informal work environment should include private spaces for childcare and breastfeeding for mothers.…”

“…This is particularly true for informal women workers, who are low paid and vulnerable to losing their jobs if they take prolonged leave. As a result, many women in informal work return to work soon after childbirth [3,6]. Thus, the need to work and provide for their family has a major impact on how these women are able to care for and feed their children [5].…”

‘I decided to go back to work so I can afford to buy her formula’: a longitudinal mixed-methods study to explore how women in informal work balance the competing demands of infant feeding and working to provide for their family

“…This is particularly true for informal women workers, who are low paid and vulnerable to losing their jobs if they take prolonged leave. As a result, many women in informal work return to work soon after childbirth [ 3 , 6 ]. Thus, the need to work and provide for their family has a major impact on how these women care for and feed their children [ 5 ].…”