‘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

Abstract

Background In South Africa almost 2 million women work informally. Informal work is characterised by poor job security, low earnings, and unsafe working conditions, with high rates of poverty and food insecurity. The peripartum period is a vulnerable time for many working women. This study explored how mothers navigate the tension between the need to work and the need to take care of a newborn baby, and how this affects their feeding plans and practices. Methods A mixed methods longitudinal cohort method was employed. Informal workers were recruited in the last trimester of pregnancy during an antenatal visit at two clinics in Durban, South Africa. Data were collected using in-depth interviews and quantitative questionnaires at three time points: pre-delivery, post-delivery and after returning to work. Framework analysis was used to analyse qualitative data in NVIVO v12.4. Quantitative analysis used SPSSv26. Results Twenty-four participants were enrolled and followed-up for a period of up to 1 year. Informal occupations included domestic work, home-based work, informal trading, and hairdressing, and most women earned <R3000 (US$175) per month. Participants had good knowledge of the importance of breastfeeding for child health. Most women planned to take time off work after the birth of their babies, supporting themselves during this time with the child support grant (CSG) received for older children, their savings, and support from the baby’s father and other family members. However, financial pressures forced many mothers to return to work earlier than planned, resulting in changes to infant feeding practices. Several mothers tried expressing breastmilk, but only one was able to sustain this while away from the baby. Most participants introduced formula, other foods and fluids to their babies when they returned to work or stopped breastfeeding entirely, but some were able to change their work or adapt their working hours to accommodate breastfeeding. Conclusions Interventions are needed within the social and work environment to support mothers with breastfeeding while they continue earning an income in the informal economy. The extension of the CSG to the antenatal period could assist mothers to stay at home longer post-delivery to breastfeed their babies.

‘I can no longer do my work like how I used to’: a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa

“…Responsibilities for child care and household work usually fall disproportionally on women, reducing their ability to work [ 22 ], and women with children consistently have lower earnings than their male counterparts [ 23 ]. Women in the informal economy are vulnerable to losing their jobs if they take leave, so they often return to work soon after childbirth [ 24 ]. The need to work has an impact on how mothers in informal work care for their children, particularly affecting where and by whom childcare is provided during working hours [ 25 ].…”

Does The Unconditional Cash Transfer Program in South Africa Provide Support for Women After Child Birth? Barriers To Accessing The Child Support Grant Among Women in Informal Work in Durban, South Africa

“…The effect of the delay in receiving the CSG for many of our participants was poverty, household food insecurity and an early return to work. Among informal workers in our study early return to work disrupted breastfeeding or led to mothers stopping breastfeeding altogether, with the need to buy formula adding to mothers' nancial pressures, as reported elsewhere [27]. In addition, early return to work reduced the time available to continue with the CSG application, which was therefore further delayed.…”

“…These are a vulnerable group with low paid, insecure jobs, no access to maternity protection, and high rates of food insecurity [26]. Studies among informally working women suggest that the CSG is an important additional source of income, with many informally working women relying on the CSG received for their older children for support immediately after childbirth [26][27][28]. As heads of households, women carry responsibilities for feeding and childcare, which has a negative impact on their ability to work and support their family.…”

Does the unconditional cash transfer program in South Africa provide support for women after child birth? Barriers to accessing the child support grant among women in informal work in Durban, South Africa

“…The data presented in this paper forms part of a larger longitudinal mixed methods cohort study that explored the relationship between childcare and informal work [ 27 , 30 ]. We followed-up pregnant informal workers until they returned to work or the child reached the age of one year.…”