Influences of Exclusive Breastfeeding Among Low-wage, Working Mothers in Kenya: Perspectives from Managers, Healthcare Providers, Daycare Directors, Mothers, and Fathers (OR30-02-19)

Abstract

ObjectivesKenya has legislation and policies on maternity leave and workplace support for breastfeeding (BF), and breastmilk expression. The extent to which this framework influences the BF practices of low-wage mothers is unknown. The purpose of this study was to understand the influences of EBF for 6 mo among mothers employed in the commercial agriculture and tourism industries. MethodsWe conducted in-depth interviews with employed mothers (n = 25), husbands of employed mothers (n = 10), managers of commercial flower farms and hotels (n = 8), daycare directors (n = 22), and health care providers (n = 20) in Naivasha, Kenya. ResultsDespite a widespread recognition of the recommended 6 months duration for EBF, employed mothers describe early cessation of EBF in preparation for their return to work, following a mandated 3-mo maternity leave. Husbands of employed women support EBF and would like to see the duration of EBF extended, but note similar challenges. Managers support lactating mothers through flexible work schedules and duties, yet few farms or hotels have designated lactation areas, and most recognize that mothers prefer to arrive later or leave early rather than visit children to feed during the workday. Daycare directors describe lack of refrigeration for expressed milk, and low interest from mothers in leaving expressed milk to feed their children during the workday. Employers with on-site housing and/or daycare report a more favorable environment to support EBF. Health care providers perceive low-wage, maternal employment as a challenge to 6 months of EBF, yet see childcare and a strengthened continuum of education from antenatal care to immunization services and community outreach as opportunities to improve EBF promotion. ConclusionsBeliefs about optimal BF practices do not align with practice. Mothers employed in low-wage work receive some benefits from their employers to support child care responsibilities, but distance from daycare, a low efficacy for expressing and storing milk, and lack of support for milk expression currently make EBF unattainable for most mothers in these industries. Interventions to improve the desirability and feasibility of milk expression are needed to strengthen the opportunity for EBF for employed mothers. Funding SourcesFogarty International Center, National Institutes of Health.