Lower Prevalence of Exclusive Breastfeeding Among Employed Mothers: Results from a Cross-Sectional Survey in Naivasha, Kenya

Abstract

Abstract Objectives We compared the prevalence of exclusive (EBF) and continued breastfeeding (BF) among formally employed, informally/self-employed, and non-employed mothers in Naivasha, Kenya, where the commercial agriculture and hospitality industries employ many women. Methods We conducted a cross-sectional survey from Sept. 2018 to Oct. 2019. Mothers of infants presenting to 3 health facilities were asked about their BF status and reasons for EBF cessation at four postpartum points: prior to discharge (n = 296), 6-weeks (n = 298), 14-weeks (n = 295), and 36-weeks (n = 297). BF status at 24-weeks was estimated at the 36-week visit. We used separate multivariable logistic regression models to compare the prevalence of early initiation (within 1-hr of birth) and EBF, between groups at each time-point, controlling for maternal age, education, HIV status, delivery setting, delivery type, and infant morbidity. We collapsed the non-employed, informal and self-employed groups into one category due to a lack of differences between these groups across all analyses. Results 65.6% of those formally employed reported early initiation of BF, compared to 75.6% without formal employment, although differences were not significant in adjusted models [OR = 0.62, 95% CI = 0.35, 1.14]. Upon hospital discharge, >96% in both groups reported practicing EBF. At 6 weeks, EBF prevalence did not significantly differ between mothers with (94.0%) and without formal employment (86.6%), [OR = 2.00, 95% CI = 0.81, 4.95]. By 14-weeks, formally employed mothers had a lower EBF prevalence compared to mothers without formal employment, 47.2% versus 78.8%, [OR = 0.19, 95% CI = 0.11, 0.33]. The lower EBF prevalence among formally employed mothers was also observed at 24-weeks (15.8% versus 48.9% [OR = 0.72, 95% CI = 0.11, 0.33]. At 36-weeks, the prevalence of continued BF was ≥98% in both groups [OR = 0.72, 95% CI = 0.11, 4.89]. The primary reasons reported for early EBF cessation were return to work (46.5%), belief that it is appropriate to feed other foods based on the child's age (33.5%), and perceived milk insufficiency (13.7%). Conclusions Formally employed mothers in Kenya experience shorter durations of EBF compared to mothers who are not formally employed by 14-weeks postpartum. These mothers may benefit from additional supports to help prolong the period of EBF. Funding Sources NIH Fogarty International Center.